TL;DR: The natural history of aortic dissection and prognosis and follow-up in Marfan patients, and results of interventional therapy and complications of inter conventional therapy are described.
TL;DR: Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach.
Abstract: Background: Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in recent years. Methods: This study was a prospectively conducted multicenter trial involving 50 trauma centers in North America under the direction of the Multi-institutional Trial Committee of the American Association for the Surgery of Trauma. Results: There were 274 blunt aortic injury cases studied over 2.5 years, of which 81% were caused by automobile crashes. Chest computed tomography and transesophageal echocardiography were applied in 88 and 30 cases, respectively, and were 75 and 80% diagnostic, respectively. Two hundred seven stable patients underwent planned thoracotomy and repair. Clamp and sew technique was used in 73 (35%) and bypass techniques in 134 (65%). Overall mortality was 31%, with 63% of deaths being attributable to aortic rupture; mortality was not affected by method of repair. Paraplegia occurred postoperatively in 8.7%. Logistic regression analysis demonstrated clamp and sew (p = 0.002) and aortic cross clamp time of 30 minutes (p = 0.01) to be associated with development of postoperative paraplegia. Conclusions: Rupture after hospital admission remains a major problem. Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard. Aortic cross clamp time beyond 30 minutes was associated with paraplegia; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach.
TL;DR: This paper addresses clinical controversies and uncertainties regarding thoracic aortic aneurysm and its treatment, and identifies promising biomarkers, especially metalloproteinases, that can predict the onset of adverse events.
TL;DR: Breath holding statistically significantly improves three-dimensional gadolinium-enhanced MR angiography of the renal, celiac, and superior mesenteric arteries.
Abstract: PURPOSE: To develop and evaluate a sequence for breath-hold three-dimensional gadolinium-enhanced magnetic resonance (MR) angiography of the abdominal aorta. MATERIALS AND METHODS: In 63 patients, the abdominal aorta and its branches were imaged for 29, 43, or 58 seconds with breath holding. A fast spoiled gradient-echo sequence was used at 1.5 T during infusion of 42 mL of a gadolinium chelate. Correlation with conventional angiography was performed in 19 patients. MR image quality (signal-to-"total" noise ratio [S/N*]) with breath holding was compared with that with free breathing (104 patients). RESULTS: With breath-hold gadolinium-enhanced MR angiography, renal, celiac, and superior mesenteric artery occlusive disease was graded appropriately in 15 of 19 patients, and 10 of 11 accessory renal arteries were depicted correctly. Renal artery branches were visualized in 86 of 95 kidneys on breath-hold images compared with only 84 of 236 kidneys with free breathing (P < .001). Distal renal artery S/N* was ...
TL;DR: In Japanese patients, vascular lesions tend to occur primarily in the ascending aorta, aortic arch and/or its branches and extend into the abdominal aortA, while in Indian patients, the tendency is mainly in the abdominalAorta including renal arteries and extending into the thoracic aORTa.