Disección aórtica Stanford tipo B no complicada tratada con reparación aórtica endovascular / Stanford Type B Uncomplicated Aortic Dissection Treated with Endovascular Aortic Repair

Resumen La disección aórtica aguda es una urgencia médica asociada a una alta mortalidad, por lo que es fundamental el diagnóstico precoz a partir de una historia clínica detallada, hallazgos a la exploración física y estudios de imagenología, pilares fundamentales para su diagnóstico. El tratamiento depende de su localización, con recomendación de abordaje quirúrgico urgente para las disecciones agudas de tipo A y principalmente el tratamiento farmacológico en la disección aórtica tipo B no complicada. Presentamos el caso de un paciente del sexo masculino, de origen mexicano, que desarrolló disección aórtica tipo B no complicada, a quien se decidió abordar con tratamiento farmacológico y reparación aórtica endovascular, y presentó una adecuada evolución del cuadro clínico, sin complicaciones al egreso ni durante su seguimiento.

Abstract Acute aortic dissection is a medical emergency associated with high mortality, so an early diagnosis based on a detailed clinical history, physical examination findings, and imaging studies is essential for its diagnosis. The treatment depends on its location, with the recommendation of an urgent surgical approach for acute type A dissections and mainly pharmacological treatment in uncomplicated type B aortic dissection. We present the case of a Mexican male patient who developed uncomplicated type B aortic dissection, that was treated with pharmacological treatment and endovascular aortic repair, and presented an adequate clinical evolution without complications at discharge or during follow-up.

Implantación endovascular urgente de stent en disección aórtica aguda tipo III de DeBakey / Emergency endovascular stent graft implantation for acute traumatic DeBakey type III aortic dissection

RESUMEN El tratamiento de las enfermedades de la aorta torácica con la implantación percutánea de stent se viene realizando desde su aplicación, por primera vez, a principios del siglo XX. Se presenta un paciente de 79 años de edad que fue llevado a urgencias con intenso dolor de espalda posterior a un accidente automovilístico, a quien se le realizó tomografía computarizada y se le diagnosticó una disección aórtica tipo III de DeBakey. Se le implantó un stent endovascular autoexpandible de nitinol (Talent Stent Graft, Medtronic) en la aorta descendente, donde comenzaba el segmento disecado. Este procedimiento es un método eficaz para prevenir la isquemia de órganos y la ruptura vascular en las enfermedades traumáticas de la aorta. Es menos invasivo, tiene menos complicaciones que el tratamiento quirúrgico, y es efectivo para restituir el flujo sanguíneo de forma rápida y segura.

ABSTRACT The applications of thoracic aorta pathologies with a stent graft percutaneously have been performed for the first time since the beginning of the 20th century. Computed tomography was performed on a 79-year-old patient who was brought to the emergency room due to an in-vehicle traffic accident with severe back pain, and DeBakey type III aortic dissection was determined. An endovascular self-expanding nitinol stent (Talent Stent Graft, Medtronic) was implanted in the descending aorta where the dissected segment begins. Stent graft implantation is an effective method in preventing organ ischemia and rupture in traumatic aortic pathologies. This procedure is less invasive and has less complication than surgical approach. It is effective in providing blood flow quickly and safely.

Outcomes after Surgical Repair of Thoracoabdominal Aortic Aneurysm with Distal Aortic Dissection:DeBakey Type Ⅰ versus Type Ⅲ / 中国医学科学院学报

To evaluate the early and mid-term results after surgical repair of thoracoabdominal aortic aneurysm(TAAA)in patients with DeBakey typeⅠor Ⅲ aortic dissection. The clinical data of 130 patients who underwent TAAA repair for chronic DeBakey typeⅠ(groupⅠ, =47)or type Ⅲ(group Ⅲ, =83)aortic dissections in our center between January 2009 and December 2017 were retrospectively analyzed.Early postoperative results,midterm survival,and re-interventions were compared between these two groups. The 30-day mortality rate was 6.9%(=9)in the overall cohort,with no statistic difference between groupⅠand group Ⅲ(10.6% 4.8%;=0.803, =0.370).The incidence of major adverse events(38.3% 51.8%;=2.199, =0.138),5-year actuarial survival rate [(81.7±5.9)% (87.2±4.2)%;=0.483, =0.487],and 5-year actuarial freedom from all reinterventions [(84.5±6.7)% (85.5±4.8)%;=0.010, =0.920] showed no significant differences between these two groups. The early and mid-term outcomes after surgical repair of TAAA are similar for DeBakey typeⅠ and type Ⅲ patients.However,studies with larger sample sizes are still required.

Perioperative management of Debakey Ⅰ aortic dissection by new type of three branches aortic arch covered stent graft implantation / 中国综合临床

Objective To investgate the proper perioperative management of Debakey Ⅰ aortic dissection by new type of three branches aortic arch covered stent graft implantation. Methods A total of 56cases with Debakey Ⅰ aortic dissection were enrolled into the study and operated by new type of three branches aortic arch covered stent graft implantation from July 2009 to August 2010. Results The cardiopulmonary bypass time during the operation was 90. 0 -248.0 min( median time 180. 6 ains) ,aortic cross clamp time was 69. 0 - 180. 0 min(median time 108. 2 mins) ,circulation arrest time was 17.0 -37.0 min ( median time 22. 6mins) ,the time using reathing apparatus was 16.0 -260.0 hours (median time 42. 8 hours),ICU residence time was 3.0 -23. 0 days( median time 6. 6 days). Fifty-four patients got well and were discharged. One patient died of multi-organ failure postoperatively and another died of large area of acute myocardial infarction. After the operation, six cases had acute renal failure, five cases had tracheotomy, three cases had reoperation for hemorrhage,one case had retardant pericardial tamponade, one case suffered from spinal cord injury, one had cerebral hemorrhage, and five cases had refractory arrhythmias. Conclusion The new type of three branches aortic arch covered stent graft simplified the procedures of aortic arch operation and lowered the operative risk in treatment of Debakey Ⅰ aortic dissection. Properly control of blood pressure and pain before surgery, shorten circulatory arrest time, maintain good organ perfusion seem to be the key points to improve the prognosis in patients with aortic dissection.

Analysis of neurological complication after type DeBakey Ⅰ aortic dissection / 中国医师进修杂志

ObjectiveTo evaluate the risk factors and of neurological complications after type DeBakey Ⅰ aortic dissection. MethodsSeventy patients underwent operations of the aortic dissection with deep hypothermic circulatory arrest (DHCA) in combination with antegrade selective cerebral perfusion (ASCP). Perioperative factors were evaluated by means of univariate and multivariate logistic analysis to identify relative risk factors of neurological complications. ResultsOne case was exduded. The extracorporeal circulation time was (158.39 ±47.16) min,the aortic crossclamp time was (99.12 ±46.27) min,the brain stop circulation time was (29.83 ± 6.85 ) min. Neurological complications occurred in 19 patients (27.5％),including 10 patients with temporary cerebral dysfunction, 3 patients with permanent cerebral dysfunction, 2patients with paraplegia,4 patients with hoarseness. Renal and hepatic dysfunction, hypertension disease,aortic crossclamp time ＞ 120 min,circulatory arrest time ＞40 min, blood transfusion volume ＞4000 ml,arterial blood pressure instability ＞ 80 mm Hg ( 1 mm Hg = 0.133 kPa) and postoperative low cardiac output were the risk factors for cerebral complication (P ＜ 0.05 or ＜ 0.01 ). ConclusionsNo single risk factor explains the onset of neurological complications. Cerebral perfusion duration within the limits of safe time and the methods of cerebral perfusion does not influence the neurological complications. Protection of all the endorgans would be helpful to the cerebral protection.

A nova pinça aerostática: descrição e análise dos nossos resultados / A new clamp called: aerostatic, description and analysis of our resolt

Introdução: A nova Pinça Aerostática foi projetada tomando por base os modelos Satinsky e DeBakey. A Pinça Aerostática possui em sua extremidade duas barras paralelas, seus ramos são conectados através de articulação do tipo "joint-box". Objetivos do estudo: 1) Descrever a nova Pinça Aerostática; 2) Analisar as vantagens do uso da Pinça. Casuística e métodos: A Pinça Aerostática foi utilizada em 57 cirurgias, realizadas nos hospitais Universitários (HU-UFJF) e Monte Sinai de Juiz de Fora (MG), no período de dezembro de 1998 a setembro de 2001. Foram avaliados: sexo e idade dos pacientes, tipo de cirurgia, duração do ato cirúrgico, tamanho da incisão, tempo de permanência do dreno e o custo do material cirúrgico utilizado. Resultados: Foram realizadas 57 cirurgias em 54 pacientes, com idade média de 56,25 anos (6-79). Trinta e três pacientes pertenciam ao sexo masculino (61%). A Pinça foi utilizada nas seguintes cirurgias: BP=50,877%; CRVP=22,807%; RN=12,281%; BU=8,772% e CI=5,263% dos casos. O tempo médio de cirurgia foi: 73,19 min para as BP; 83 min para as RN; 114,25 min para as CRPV; 155,8 min para BU; 193,3 min para as CI. O tempo médio de drenagem intercostal foi de: 1,7 dias para as BP; 2,16 dias para as RN; 1,66 dias nas CI; 4 dias nas BU e 7,33 dias nas CRVP. Conclusão: A Pinça Aerostática permitiu: diminuição do tempo operatório, redução nos gastos operatórios, rápida retirada do dreno torácico, resultando em maior conforto para os nossos pacientes.

Introduction: The development of a clamp called Aerostatic, which was made based on the Satinsky and Debakey standars, is demonstrated. Differing from the previously-mentioned styles, the new model has two parallel bars at its extremity. Objectives of the study: The purpose of this study is: 1) to describe the new Aerostatic Pincers, comparing their characteristics to the Satinsky and DeBakey standarda; 2) to report our experience in using the Aerostatic Pincers, stating the advantages of their application in some surgeries such as lung biopses, atypical segmentectomies for the resection of lung nodules, lung reduction surgeries for the treatment of emphysema, bulectomies and, mainly, the cases in which an incomplete lung fissure was found. The importance of using the Pincers together with bovine pericardium, which could enhance suture line protection, is stressed. Material and methods: A retrospective overview of all cases of surgeries carried out with the new Pincers, between December 1998 and September 2001, was made. There were a total of 54 patients from the Monte Sinai and HU-UFJF hospitals. Results: The patients consisted of thirty three men (61%) and twenty one women (39%). Their ages ranged from 6 to 79 years (average: 56,25). The Pincers were used in lung biopsies (50,877%), atypical segmentectomies for the resection of lung nodules (12,281%), lung reduction surgeries for the treatment of emphysema (22,807%), bulectomies (8,772%) and, mainly, the cases in which an incomplete lung fissure (there cases) was found. Conclusions: The new Aerostatic Pincers could significantly reduce surgical costs. Their use could also provide aerostatic improvements to Thoracic Surgery, which maym in turn, lead to more comfort for our patients and reduce the time they need to stay in hospital.