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Aspects on Imaging and Endovascular Treatment of Aortic Dissection and Aneurysm
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aortic aneurysm and dissections are potentially life threatening conditions. The advent of endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) has reduced perioperative mortality and morbidity and are now established therapy methods for treatment of aortic disease. Adequate pre- and intraoperative imaging is important for optimal results in endovascular procedures. However, the standard use of CT and angiography may not always be sufficient to provide necessary information required for treatment, and complementary techniques are warranted in selected cases.

TEVAR in acute complicated type B aortic dissections is proven effective in several reports, but long-term clinical outcome and aortic remodelling are still not fully evaluated.

Intravascular phased array imaging (IPAI) was used in patients undergoing EVAR and TEVAR for aortic aneurysm and dissection. The combined information from IPAI and fluoroscopy allowed exact positioning of the stent graft. The colour Doppler function facilitated detection of blood-flow in relevant arteries during and after the procedures, and it also facilitated control of ceased flow in excluded false lumens or aneurysms.

Clinical early and long-term results after TEVAR for acute complicated type B aortic dissection were investigated in all patients treated between 1999 and 2009 at UppsalaUniversityHospital. Results were favourable regarding survival and permanent neurological complications. Long-term follow-up of aortic morphological changes in the same patient group showed overall significant reduction of aortic and false lumen diameters, and an increase of true lumen diameter. Total thrombosis of the false lumen occured more often in patients with DeBakey IIIa aortic dissection, than in IIIb.

In conclusion, IPAI may be a complementary tool to traditional imaging modalities in EVAR and TEVAR in selected cases. Long-term clinical outcome is excellent with favourable aortic remodeling after TEVAR in patients with acute complicated type B aortic dissection.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. , 49 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 850
Keyword [en]
Aneurysms, aorta, stents, ultrasound, colour Doppler, vascular, interventional, aortic dissection, complicated, TEVAR, EVAR, re-intervention, survival, thrombosis, false lumen, aortic remodelling
National Category
Medical and Health Sciences
Research subject
Radiology
Identifiers
URN: urn:nbn:se:uu:diva-187464ISBN: 978-91-554-8559-7 (print)OAI: oai:DiVA.org:uu-187464DiVA: diva2:574836
Public defence
2013-02-01, Hedstrandsalen, Akademiska Sjukhuset, Ing 70, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2013-01-10 Created: 2012-12-06 Last updated: 2013-02-11Bibliographically approved
List of papers
1. Intravascular Ultrasound with a Vector Phased-Array Probe (AcuNav) Is Feasible in Endovascular Abdominal Aortic Aneurysm Repair
Open this publication in new window or tab >>Intravascular Ultrasound with a Vector Phased-Array Probe (AcuNav) Is Feasible in Endovascular Abdominal Aortic Aneurysm Repair
2009 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 50, no 8, 870-875 p.Article in journal (Refereed) Published
Abstract [en]

Background: The ideal imaging method for endovascular aneurysm repair (EVAR) should provide all data regarding diagnosis, measurements, and guiding of stent-graft deployment. Contrast-enhanced computed tomography (CT) is used for preoperative EVAR planning, together with intraoperative angiography. However, the administered contrast volume might result in contrast-induced nephropathy (CIN). Purpose: To develop a technique for aortic measurements, vessel wall evaluation, and stent-graft positioning by using a vector phased-array intravascular ultrasound probe with color Doppler function (AcuNav) in elective EVAR. Material and Methods: Thirteen elective EVAR patients were included. AcuNav was compared to pre- and postoperative CT examinations, perioperative angiography, and postoperative duplex. Results: Measurements for stent-graft sizing were easily obtained and facilitated by the color Doppler function and corresponded well with CT and angiography. The combined information from AcuNav and fluoroscopy provided exact positioning of the stent graft. An aortic placement of the probe provided superior imaging results compared to an inferior vena cava approach. Detection of endoleak was found to be difficult. No complications were registered. Conclusion: The use of AcuNav combined with fluoroscopy in EVAR was found to be safe, effective, and feasible in planning and guiding EVAR procedures. Best results were seen with the probe placed in the artery. AcuNav might be used to replace contrast-enhanced CT and angiography, hence reducing the risk of CIN, especially in high-risk patients.

Keyword
aneurysms, aorta, stents, ultrasound, vascular
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-110130 (URN)10.1080/02841850902912010 (DOI)000270459200006 ()19452296 (PubMedID)
Available from: 2009-11-04 Created: 2009-11-04 Last updated: 2017-12-12Bibliographically approved
2. The value of intravascular phased-array imaging in endovascular treatment of thoracic aortic pathology
Open this publication in new window or tab >>The value of intravascular phased-array imaging in endovascular treatment of thoracic aortic pathology
2011 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 52, no 3, 285-290 p.Article in journal (Refereed) Published
Abstract [en]

Background Careful pre-, intra- and postoperative diagnostics in endovascular treatment of thoracic aortic pathology is crucial for a favourable outcome. Computer tomography (CT) and digitally subtracted angiography (DSA) do not always provide sufficient diagnostic information. Purpose To report our primary experiences of using intraluminal phased-array imaging (IPAI) as an additive tool for diagnostics and endovascular treatment of thoracic aortic pathology. Material and Methods Eleven patients, nine men and two women (mean age 60, range 45) were examined intraoperatively with IPAI in stentgraft procedures of thoracic aortic pathology. Results IPAI could detect and visualize the entries and re-entries in the intima. Aortic branch vessels could be visualized for patency both during and immediately after stentgraft deployment. It was also possible to detect ceased blood flow in the false lumen or aneurysmal sac after stentgraft deployment. Conclusion IPAI is a helpful tool for diagnostics and for guiding stentgraft placing in the treatment of thoracic aortic pathology.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-152741 (URN)10.1258/ar.2010.100040 (DOI)21498364 (PubMedID)
Available from: 2011-04-29 Created: 2011-04-29 Last updated: 2017-12-11Bibliographically approved
3. Early and Long-term Outcome after Thoracic Endovascular Aortic Repair (TEVAR) for Acute Complicated Type B Aortic Dissection
Open this publication in new window or tab >>Early and Long-term Outcome after Thoracic Endovascular Aortic Repair (TEVAR) for Acute Complicated Type B Aortic Dissection
Show others...
2011 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 41, no 3, 318-323 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The study aimed to investigate early and long-term outcome of thoracic endovascular aortic repair (TEVAR) for acute complicated type B dissection. DESIGN: This was a retrospective, single-centre, consecutive case series. MATERIALS AND METHODS: During the period 1999-2009, TEVAR was carried out in 50 patients with non-traumatic acute complicated type B dissection, and in another 10 patients with acute complications, including rupture, end-organ ischaemia and acute dilatation during the primary hospitalisation, but >14 days after onset of symptoms. Thus, in total, 60 patients were included; 22 with a DeBakey type IIIa dissection and 38 with a type IIIb; median age was 67 years. Early (30-day) and long-term (5-year) survival, re-intervention rate and complications were recorded until 1 July 2010. RESULTS: Within 30 days, two (3%) deaths, one (2%) paraplegia and three (5%) strokes were observed. Five-year survival was 87% and freedom from re-intervention at 5 years was 65%. CONCLUSIONS: In patients with acute complicated type B aortic dissection, TEVAR can be performed with excellent early and long-term survival, whereas morbidity and long-term durability must be further elucidated.

Keyword
Aortic dissection-acute, Aortic dissection-complicated, Endovascular repair, Re-intervention, Survival, TEVAR
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-140800 (URN)10.1016/j.ejvs.2010.11.024 (DOI)000288728400004 ()21194985 (PubMedID)
Available from: 2011-01-10 Created: 2011-01-10 Last updated: 2017-12-11Bibliographically approved
4. Morphological outcome after endovascular treatment of complicated type B aortic dissection
Open this publication in new window or tab >>Morphological outcome after endovascular treatment of complicated type B aortic dissection
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-187463 (URN)
Available from: 2012-12-06 Created: 2012-12-06 Last updated: 2013-08-14

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