Skip to main content
Erschienen in: Current Cardiology Reports 9/2021

01.09.2021 | Cardiac PET, CT, and MRI (P Cremer, Section Editors)

Computed Tomography Imaging of Aortic Dissections with Endovascular Treatment Considerations

verfasst von: Patrick R. Vargo, Heidi Reich, Eric E. Roselli

Erschienen in: Current Cardiology Reports | Ausgabe 9/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

In the present review, we discuss the role of CT imaging in the management of aortic dissection, with a particular emphasis on endovascular treatment considerations.

Recent Findings

Computed tomography imaging is a fundamental tool in the diagnosis and management of acute and chronic aortic dissection. Its diagnostic accuracy and high resolution contribute to and guide operative strategy.

Summary

Persistent high mortality for patients who develop aortic dissections suggests a need for innovative diagnostic and treatment strategies. In the recent era, considerable advances have been made in computed tomography (CT) image acquisition, processing, and analysis as well as endovascular technologies with expanded roles in the treatment of aortic diseases.
Literatur
1.
Zurück zum Zitat DeMartino RR, Sen I, Huang Y, Bower TC, Oderich GS, Pochettino A, et al. Population-based assessment of the incidence of aortic dissection, intramural hematoma, and penetrating ulcer, and its associated mortality from 1995 to 2015. Circ Cardiovasc Qual Outcomes. 2018;11(8):e004689.CrossRef DeMartino RR, Sen I, Huang Y, Bower TC, Oderich GS, Pochettino A, et al. Population-based assessment of the incidence of aortic dissection, intramural hematoma, and penetrating ulcer, and its associated mortality from 1995 to 2015. Circ Cardiovasc Qual Outcomes. 2018;11(8):e004689.CrossRef
2.
Zurück zum Zitat Evangelista A, Isselbacher EM, Bossone E, Gleason TG, Eusanio MD, Sechtem U, et al. Eagle KA; IRAD Investigators. Insights from the International Registry of Acute Aortic Dissection: a 20-year experience of Collaborative Clinical Research. Circulation. 2018;137(17):1846–60.CrossRef Evangelista A, Isselbacher EM, Bossone E, Gleason TG, Eusanio MD, Sechtem U, et al. Eagle KA; IRAD Investigators. Insights from the International Registry of Acute Aortic Dissection: a 20-year experience of Collaborative Clinical Research. Circulation. 2018;137(17):1846–60.CrossRef
3.
Zurück zum Zitat Andersen ND, Benrashid E, Ross AK, Pickett LC, Smith PK, Daneshmand MA, et al. The utility of the aortic dissection team: outcomes and insights after a decade of experience. Ann Cardiothorac Surg. 2016 May;5(3):194–201.CrossRef Andersen ND, Benrashid E, Ross AK, Pickett LC, Smith PK, Daneshmand MA, et al. The utility of the aortic dissection team: outcomes and insights after a decade of experience. Ann Cardiothorac Surg. 2016 May;5(3):194–201.CrossRef
4.
Zurück zum Zitat Mariscalco G, Maselli D, Zanobini M, Ahmed A, Bruno VD, Benedetto U, et al. Aortic centres should represent the standard of care for acute aortic syndrome. Eur J Prev Cardiol. 2018;25(1_suppl):3–14.CrossRef Mariscalco G, Maselli D, Zanobini M, Ahmed A, Bruno VD, Benedetto U, et al. Aortic centres should represent the standard of care for acute aortic syndrome. Eur J Prev Cardiol. 2018;25(1_suppl):3–14.CrossRef
5.
Zurück zum Zitat Carroll BJ, Schermerhorn ML, Manning WJ. Imaging for acute aortic syndromes. Heart. 2020;106(3):182–9.CrossRef Carroll BJ, Schermerhorn ML, Manning WJ. Imaging for acute aortic syndromes. Heart. 2020;106(3):182–9.CrossRef
6.
Zurück zum Zitat Schoenhagen P, Roselli EE, Harris CM, Eagleton M, Menon V. Online network of subspecialty aortic disease experts: Impact of “cloud” technology on management of acute aortic emergencies. J Thorac Cardiovasc Surg. 2016;152(1):39–42.CrossRef Schoenhagen P, Roselli EE, Harris CM, Eagleton M, Menon V. Online network of subspecialty aortic disease experts: Impact of “cloud” technology on management of acute aortic emergencies. J Thorac Cardiovasc Surg. 2016;152(1):39–42.CrossRef
7.
Zurück zum Zitat Bhave NM, Nienaber CA, Clough RE, Eagle KA. Multimodality imaging of thoracic aortic diseases in adults. JACC Cardiovasc Imaging. 2018;11(6):902–19.CrossRef Bhave NM, Nienaber CA, Clough RE, Eagle KA. Multimodality imaging of thoracic aortic diseases in adults. JACC Cardiovasc Imaging. 2018;11(6):902–19.CrossRef
8.
Zurück zum Zitat • Lombardi JV, Hughes GC, Appoo JJ, Bavaria JE, Beck AW, Cambria RP, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. Ann Thorac Surg. 2020;109(3):959–81 This society statement document discusses important classification and nomenclature for type B dissections. These reporting standards will facilitate more granular analyses that may shape how to manage different variants of type B aortic pathology.CrossRef • Lombardi JV, Hughes GC, Appoo JJ, Bavaria JE, Beck AW, Cambria RP, et al. Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. Ann Thorac Surg. 2020;109(3):959–81 This society statement document discusses important classification and nomenclature for type B dissections. These reporting standards will facilitate more granular analyses that may shape how to manage different variants of type B aortic pathology.CrossRef
9.
Zurück zum Zitat Kreibich M, Siepe M, Beyersdorf F. Aortic dissection reconsidered: type, entry site, malperfusion classification adding clarity and enabling outcome prediction. Interact Cardiovasc Thorac Surg. 2020;30(3):451–7.CrossRef Kreibich M, Siepe M, Beyersdorf F. Aortic dissection reconsidered: type, entry site, malperfusion classification adding clarity and enabling outcome prediction. Interact Cardiovasc Thorac Surg. 2020;30(3):451–7.CrossRef
10.
Zurück zum Zitat Moon MC, Greenberg RK, Morales JP, Martin Z, Lu Q, Dowdall JF, et al. Computed tomography-based anatomic characterization of proximal aortic dissection with consideration for endovascular candidacy. J Vasc Surg. 2011;53(4):942–9.CrossRef Moon MC, Greenberg RK, Morales JP, Martin Z, Lu Q, Dowdall JF, et al. Computed tomography-based anatomic characterization of proximal aortic dissection with consideration for endovascular candidacy. J Vasc Surg. 2011;53(4):942–9.CrossRef
11.
Zurück zum Zitat Sobocinski J, O'Brien N, Maurel B, Bartoli M, Goueffic Y, Sassard T, et al. Endovascular approaches to acute aortic type A dissection: a CT-based feasibility study. Eur J Vasc Endovasc Surg. 2011;42(4):442–7.CrossRef Sobocinski J, O'Brien N, Maurel B, Bartoli M, Goueffic Y, Sassard T, et al. Endovascular approaches to acute aortic type A dissection: a CT-based feasibility study. Eur J Vasc Endovasc Surg. 2011;42(4):442–7.CrossRef
12.
Zurück zum Zitat Roselli EE, Hasan SM, Idrees JJ, Aftab M, Eagleton MJ, Menon V, et al. Inoperable patients with acute type A dissection: are they candidates for endovascular repair? Interact Cardiovasc Thorac Surg. 2017;25(4):582–8.CrossRef Roselli EE, Hasan SM, Idrees JJ, Aftab M, Eagleton MJ, Menon V, et al. Inoperable patients with acute type A dissection: are they candidates for endovascular repair? Interact Cardiovasc Thorac Surg. 2017;25(4):582–8.CrossRef
13.
Zurück zum Zitat • Roselli EE, Idrees JJ, Johnston DR, Eagleton MJ, Desai MY, Svensson LG. Zone zero thoracic endovascular aortic repair: a proposed modification to the classification of landing zones. J Thorac Cardiovasc Surg. 2018;155(4):1381–9 Findings from this study discuss the complex anatomical considerations of the ascending aorta and endovascular repair of this zone.CrossRef • Roselli EE, Idrees JJ, Johnston DR, Eagleton MJ, Desai MY, Svensson LG. Zone zero thoracic endovascular aortic repair: a proposed modification to the classification of landing zones. J Thorac Cardiovasc Surg. 2018;155(4):1381–9 Findings from this study discuss the complex anatomical considerations of the ascending aorta and endovascular repair of this zone.CrossRef
14.
Zurück zum Zitat Vallabhajosyula P, Szeto WY, Pulsipher A, Desai N, Menon R, Moeller P, et al. Antegrade thoracic stent grafting during repair of acute DeBakey type I dissection promotes distal aortic remodeling and reduces late open distal reoperation rate. J Thorac Cardiovasc Surg. 2014;147(3):942–8.CrossRef Vallabhajosyula P, Szeto WY, Pulsipher A, Desai N, Menon R, Moeller P, et al. Antegrade thoracic stent grafting during repair of acute DeBakey type I dissection promotes distal aortic remodeling and reduces late open distal reoperation rate. J Thorac Cardiovasc Surg. 2014;147(3):942–8.CrossRef
15.
Zurück zum Zitat Roselli EE, Idrees JJ, Bakaeen FG, Tong MZ, Soltesz EG, Mick S, et al. Evolution of simplified frozen elephant trunk repair for acute DeBakey type I dissection: midterm outcomes. Ann Thorac Surg. 2018;105(3):749–55.CrossRef Roselli EE, Idrees JJ, Bakaeen FG, Tong MZ, Soltesz EG, Mick S, et al. Evolution of simplified frozen elephant trunk repair for acute DeBakey type I dissection: midterm outcomes. Ann Thorac Surg. 2018;105(3):749–55.CrossRef
16.
Zurück zum Zitat Leshnower BG, Keeling WB, Duwayri YM, Jordan WD Jr, Chen EP. The “thoracic endovascular aortic repair-first” strategy for acute type A dissection with mesenteric malperfusion: initial results compared with conventional algorithms. J Thorac Cardiovasc Surg. 2019;158(6):1516–24.CrossRef Leshnower BG, Keeling WB, Duwayri YM, Jordan WD Jr, Chen EP. The “thoracic endovascular aortic repair-first” strategy for acute type A dissection with mesenteric malperfusion: initial results compared with conventional algorithms. J Thorac Cardiovasc Surg. 2019;158(6):1516–24.CrossRef
17.
Zurück zum Zitat Yang B, Norton EL, Rosati CM, Wu X, Kim KM, Khaja MS, et al. Managing patients with acute type A aortic dissection and mesenteric malperfusion syndrome: a 20-year experience. J Thorac Cardiovasc Surg. 2019;158(3):675–687.e4.CrossRef Yang B, Norton EL, Rosati CM, Wu X, Kim KM, Khaja MS, et al. Managing patients with acute type A aortic dissection and mesenteric malperfusion syndrome: a 20-year experience. J Thorac Cardiovasc Surg. 2019;158(3):675–687.e4.CrossRef
18.
Zurück zum Zitat Lombardi JV, Gleason TG, Panneton JM, Starnes BW, Dake MD, Haulon S, et al. STABLE II clinical trial on endovascular treatment of acute, complicated type B aortic dissection with a composite device design. J Vasc Surg. 2020;71(4):1077–1087.e2.CrossRef Lombardi JV, Gleason TG, Panneton JM, Starnes BW, Dake MD, Haulon S, et al. STABLE II clinical trial on endovascular treatment of acute, complicated type B aortic dissection with a composite device design. J Vasc Surg. 2020;71(4):1077–1087.e2.CrossRef
19.
Zurück zum Zitat Woo EY, Carpenter JP, Jackson BM, Pochettino A, Bavaria JE, Szeto WY, et al. Left subclavian artery coverage during thoracic endovascular aortic repair: a single-center experience. J Vasc Surg. 2008;48(3):555–60.CrossRef Woo EY, Carpenter JP, Jackson BM, Pochettino A, Bavaria JE, Szeto WY, et al. Left subclavian artery coverage during thoracic endovascular aortic repair: a single-center experience. J Vasc Surg. 2008;48(3):555–60.CrossRef
20.
Zurück zum Zitat Canaud L, Ozdemir BA, Patterson BO, Holt PJE, Loftus IM, Thompson MM. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg. 2014;260(2):389–95.CrossRef Canaud L, Ozdemir BA, Patterson BO, Holt PJE, Loftus IM, Thompson MM. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg. 2014;260(2):389–95.CrossRef
21.
Zurück zum Zitat Pantaleo A, Jafrancesco G, Buia F, Leone A, Lovato L, Russo V, et al. Distal stent graft-induced new entry: an emerging complication of endovascular treatment in aortic dissection. Ann Thorac Surg. 2016;102:527–32.CrossRef Pantaleo A, Jafrancesco G, Buia F, Leone A, Lovato L, Russo V, et al. Distal stent graft-induced new entry: an emerging complication of endovascular treatment in aortic dissection. Ann Thorac Surg. 2016;102:527–32.CrossRef
22.
Zurück zum Zitat Nienaber CA, Kische S, Rousseau H, Eggebrecht H, Rehders TC, Kundt G, et al. Ince H; INSTEAD-XL trial. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013;6(4):407–16.CrossRef Nienaber CA, Kische S, Rousseau H, Eggebrecht H, Rehders TC, Kundt G, et al. Ince H; INSTEAD-XL trial. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013;6(4):407–16.CrossRef
23.
Zurück zum Zitat Ryoi O, Lin CH, Chen JM, Hsieh YK, Wang SS, Wu IH. Endovascular repair for retrograde type A intramural haematoma with intimal tear in the descending thoracic aorta. Eur J Vasc Endovasc Surg. 2020;60(3):386–93.CrossRef Ryoi O, Lin CH, Chen JM, Hsieh YK, Wang SS, Wu IH. Endovascular repair for retrograde type A intramural haematoma with intimal tear in the descending thoracic aorta. Eur J Vasc Endovasc Surg. 2020;60(3):386–93.CrossRef
24.
Zurück zum Zitat Levack MM, Kindzelski BA, Miletic KG, Vargo PR, Bakaeen FG, Johnston DR, et al. Adjunctive endovascular balloon fracture fenestration for chronic aortic dissection. J Thorac Cardiovasc Surg. 2020;7:S0022-5223(20)32711–2. Levack MM, Kindzelski BA, Miletic KG, Vargo PR, Bakaeen FG, Johnston DR, et al. Adjunctive endovascular balloon fracture fenestration for chronic aortic dissection. J Thorac Cardiovasc Surg. 2020;7:S0022-5223(20)32711–2.
25.
Zurück zum Zitat Miletic KG, Kindzelski BA, Hodges KE, Beach J, Tong MZ, Bakaeen F, et al. Impact of endovascular false lumen embolization on thoracic aortic remodeling in chronic dissection. Ann Thorac Surg. 2021;111(2):495–501. Miletic KG, Kindzelski BA, Hodges KE, Beach J, Tong MZ, Bakaeen F, et al. Impact of endovascular false lumen embolization on thoracic aortic remodeling in chronic dissection. Ann Thorac Surg. 2021;111(2):495–501.
26.
Zurück zum Zitat Upchurch GR Jr, Escobar GA, Azizzadeh A, Beck AW, Conrad MF, Matsumura JS, et al. Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J Vasc Surg. 2021;73(1S):55S–83S. Upchurch GR Jr, Escobar GA, Azizzadeh A, Beck AW, Conrad MF, Matsumura JS, et al. Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J Vasc Surg. 2021;73(1S):55S–83S.
Metadaten
Titel
Computed Tomography Imaging of Aortic Dissections with Endovascular Treatment Considerations
verfasst von
Patrick R. Vargo
Heidi Reich
Eric E. Roselli
Publikationsdatum
01.09.2021
Verlag
Springer US
Erschienen in
Current Cardiology Reports / Ausgabe 9/2021
Print ISSN: 1523-3782
Elektronische ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-021-01541-z

Weitere Artikel der Ausgabe 9/2021

Current Cardiology Reports 9/2021 Zur Ausgabe

Structural Heart Disease (RJ Siegel and NC Wunderlich, Section Editors)

Update in Paravalvular Leak Closure

Public Health Policy (SS Virani and D Mahtta, Section Editors)

Promise and Perils of Telehealth in the Current Era

Invasive Electrophysiology and Pacing (E. Kevin Heist, Section Editor)

Renal Denervation for Patients With Atrial Fibrillation

Pericardial Disease (L Klein and CL Jellis, Section Editors

Colchicine in the Management of Acute and Chronic Coronary Artery Disease

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.