Aortic dissection is a surgical emergency which poses a challenge to numerous clinicians across different specialties due to its high rate of associated morbidity and mortalities. Acute type A aortic dissection, which involves the ascending aorta and beyond, is a lethal condition. It is therefore vital to understand the pathophysiology that underlies this condition and the tools that aid its early detection. Haemodynamics factors including lumen wall shear stress and pressure, geometrical factors as entry tear location and size, and the composition of the aortic wall are well known to affect the disease progression. The studies on these factors are well established in Type B aortic dissection but not clearly emphasised in the setting of acute type A aortic dissection. The aim of this paper is to provide a comprehensive review of available literature on the relationship between tear size, location and the pressure of false lumen in acute type A aortic dissection.
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http://dx.doi.org/10.1016/j.hlc.2019.06.715 | DOI Listing |
Ann Vasc Surg
January 2025
Institute of Cardiac and Aortic Disorders, SRM Institutes for Medical Science (SIMS Hospitals), Chennai, India.
Background: Nonocclusive mesenteric ischemia (NOMI), a subtype of acute mesenteric ischemia, is primarily caused by mesenteric arterial vasoconstriction and decreased vascular resistance, leading to impaired intestinal perfusion.Commonly observed after cardiac surgery, NOMI affects older patients with cardiovascular or systemic diseases, accounting for 20-30% of acute mesenteric ischemia cases with a mortality rate of ∼50%. This review explores NOMI's pathophysiology, clinical implications in aortic dissection, and the unmet needs in diagnosis and management, emphasizing its prognostic significance.
View Article and Find Full Text PDFSci Rep
January 2025
University of Ulsan, 93 Daehak-ro, Nam-gu, Ulsan, 680-749, Republic of Korea.
This study employed large eddy simulation (LES) with the wall-adapting local eddy-viscosity (WALE) model to investigate transitional flow characteristics in an idealized model of a healthy thoracic aorta. The OpenFOAM solver pimpleFoam was used to simulate blood flow as an incompressible Newtonian fluid, with the aortic walls treated as rigid boundaries. Simulations were conducted for 30 cardiac cycles and ensemble averaging was employed to ensure statistically reliable results.
View Article and Find Full Text PDFEur J Cardiothorac Surg
January 2025
Department of Cardiothoracic Surgery, Maastricht University Medical Centre (MUMC+), Netherlands.
Objectives: Previous analyses of the volume-outcome relationship have focused on short-term outcomes such as early mortality. The current study aims to update a novel statistical methodology, facilitating the evaluation of the relation between procedural volume and time-to-event outcomes such as long-term survival, using surgery for acute type A aortic dissection as an illustrative example.
Methods: This study employed an existing dataset of type A dissection outcomes, retrieved from literature.
Gen Thorac Cardiovasc Surg
January 2025
Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, 1-5-2, Hikarigaoka, Nerima-ku, Tokyo, Japan.
Objective: Branched prostheses are used to treat aortic arch with dissection. However, changes in the neck vessel geometry and diameter after dissection are not well known. We aimed to evaluate neck vessels geometry and changes in diameter with dissection.
View Article and Find Full Text PDFCancers (Basel)
January 2025
Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
Approximately 36% of patients with cervical cancer present with regional nodal metastasis at diagnosis, which is associated with adverse survival outcomes after definitive treatment. In the modern era of chemoradiotherapy (CRT) and image-guided adaptive brachytherapy (IGABT), where excellent local control is achieved for patients with locally advanced cervical cancer (LACC), nodal failure remains a major challenge to cure. To optimize treatment outcomes for node-positive LACC and reduce the incidence of nodal failure, various treatment approaches have been explored, including methods of surgical nodal staging or dissection, RT dose escalation strategies, such as intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) to involved nodes, and elective treatment of subclinical para-aortic (PAO) disease.
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