9-((2-phosphonylmethoxy)ethyl)guanine and Aortic-Dissection

Complicated acute nonA-nonB dissection with malperfusion is associated with a high in-hospital mortality up to 67%. Therefore, rapid identification and treatment are critical for clinical outcomes. We report the urgent treatment of a complicated subacute aortic dissection treated with a physician-modified-endograft (PMEG) fenestrated-TEVAR (f-TEVAR) for the left common carotid artery (LCCA). A 49-year-old male patient with acute non-A non-B aortic dissection with complete true lumen collapse and associated mesenteric and renal ischemia, was referred to another vascular center for abdominal pain and received exclusively medical treatment. After 15 days of persistent pain, the patient self-referred to our center and was treated with endovascular repair. The proximal entry tear was located at the level of the left subclavian artery: a PMEG f-TEVAR was performed with fenestration for LCCA in conjunction with carotid-subclavian bypass. In addition, spot stenting of the left renal artery was performed to resolve renal malperfusion. The final angiography showed satisfactory result. The patient soon reported significant pain relief. Follow-up at 30-days was satisfactory, with no need for further intervention. A physician-modified fenestrated-TEVAR can be used in emergency setting to treat acute non-A-non-B aortic dissection in conjunction with multiorgan malperfusion, with satisfactory results even after initial delayed treatment.

Topics: Aortic Aneurysm, Thoracic; Aortic Dissection; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Aneurysm Repair; Endovascular Procedures; Humans; Male; Middle Aged; Pain; Retrospective Studies; Stents; Treatment Outcome

The aim of this study is to perform patient-specific hemodynamic simulations of the patients with complicated aortic dissection underwent Physician-modified endograft (PMEG) and evaluate the treatment outcome.. 12 patient-specific models were reconstructed from computed tomography angiography (CTA) data of 6 patients with complicated aortic dissection before and after the PMEG. Hemodynamic simulations were conducted with the same time-varying volumetric flow rate extracted from the literature and 3-element Windkessel model (3 EWM) boundary conditions were applied at the aortic outlet. Hemodynamic indicators such as time-averaged wall shear stress (TAWSS), relative residence time (RRT) and endothelial cell activation potential (ECAP) were obtained to evaluate the postoperative effect of PMEG.. This study shows that PMEG, as a new technique for the treatment of complicated aortic dissection involving the distal tears in the visceral region, can effectively restore the abnormal blood supply of the visceral arteries, reduce the risk of aortic rupture, the formation of aortic dissection aneurysm (ADA), and thrombosis. This corresponds well with clinical retrospective studies and 1-year follow-up outcomes. The findings of this study are of great significance for the development of PMEG.

Topics: Aorta; Aortic Aneurysm, Thoracic; Aortic Dissection; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Hemodynamics; Humans; Prosthesis Design; Retrospective Studies; Stents; Treatment Outcome