24 results on '"Clough, Rachel E."'
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2. Clinical Cases Referring to Diagnosis and Management of Patients With Thoracic Aortic Pathologies Involving the Aortic Arch: A Companion Document of the 2018 European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) Expert Consensus Document Addressing Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch
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Thierry Carrel, Carlos A. Mestres, Thomas R. Wyss, Martin Czerny, Jürg Schmidli, Luca Bertoglio, Rachel E. Clough, Konstantinos Tsagakis, Fabian A. Kari, Bartosz Rylski, Roberto Chiesa, Florian Schönhoff, Martin Grabenwöger, University of Zurich, Czerny, Martin, Schmidli, Jürg, Bertoglio, Luca, Carrel, Thierry, Chiesa, Roberto, Clough, Rachel E., Grabenwöger, Martin, Kari, Fabian A., Mestres, Carlos A., Rylski, Bartosz, Schönhoff, Florian, Tsagakis, Konstantino, and Wyss, Thomas R.
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Aortic arch ,Coronary angiography ,Male ,Computed Tomography Angiography ,Health Status ,Medizin ,Diagnostic Techniques, Cardiovascular ,Aorta, Thoracic ,Coronary Angiography ,Care plan ,610 Medicine & health ,Societies, Medical ,medicine.diagnostic_test ,Open repair ,Endovascular Procedures ,Disease Management ,Thoracic Surgery ,General Medicine ,Middle Aged ,2746 Surgery ,Europe ,Treatment Outcome ,Echocardiography ,Cardiothoracic surgery ,Practice Guidelines as Topic ,Female ,Cardiology and Cardiovascular Medicine ,Vascular Surgical Procedures ,Cerebral angiography ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Consensus ,Clinical Decision-Making ,Aortic Diseases ,Case descriptions ,Aortography ,2705 Cardiology and Cardiovascular Medicine ,Blood Vessel Prosthesis Implantation ,Predictive Value of Tests ,Endovascular repair ,medicine.artery ,Case description ,Aortic arch Case descriptions Endovascular repair Open repair ,medicine ,Humans ,Aged ,Aorta ,business.industry ,General surgery ,Surgery ,Expert consensus ,Vascular surgery ,10020 Clinic for Cardiac Surgery ,Cerebral Angiography ,2740 Pulmonary and Respiratory Medicine ,business - Published
- 2019
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3. ACR Appropriateness Criteria® Thoracoabdominal Aortic Aneurysm or Dissection: Treatment Planning and Follow-Up.
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Contrella BN, Khaja MS, Majdalany BS, Kim CY, Kalva SP, Beck AW, Browne WF, Clough RE, Ferencik M, Fleischman F, Gunn AJ, Hickey SM, Kandathil A, Kim KM, Monroe EJ, Ochoa Chaar CI, Scheidt MJ, Smolock AR, Steenburg SD, Waite K, Pinchot JW, and Steigner ML
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- Humans, United States, Follow-Up Studies, Societies, Medical, Evidence-Based Medicine, Angiography, Aortic Aneurysm, Thoracoabdominal
- Abstract
As the incidence of thoracoabdominal aortic pathology (aneurysm and dissection) rises and the complexity of endovascular and surgical treatment options increases, imaging follow-up of patients remains crucial. Patients with thoracoabdominal aortic pathology without intervention should be monitored carefully for changes in aortic size or morphology that could portend rupture or other complication. Patients who are post endovascular or open surgical aortic repair should undergo follow-up imaging to evaluate for complications, endoleak, or recurrent pathology. Considering the quality of diagnostic data, CT angiography and MR angiography are the preferred imaging modalities for follow-up of thoracoabdominal aortic pathology for most patients. The extent of thoracoabdominal aortic pathology and its potential complications involve multiple regions of the body requiring imaging of the chest, abdomen, and pelvis in most patients. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation., (Copyright © 2023 American College of Radiology. Published by Elsevier Inc. All rights reserved.)
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- 2023
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4. ACR Appropriateness Criteria® Lower Extremity Arterial Claudication-Imaging Assessment for Revascularization: 2022 Update.
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Azene EM, Steigner ML, Aghayev A, Ahmad S, Clough RE, Ferencik M, Hedgire SS, Hicks CW, Kirsch DS, Lee YJ, Myers LA, Nagpal P, Osborne N, Pillai AK, Ripley B, Singh N, Thomas R, and Kalva SP
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- Humans, Evidence-Based Medicine, Intermittent Claudication diagnostic imaging, Angiography, Lower Extremity diagnostic imaging, Lower Extremity blood supply, Societies, Medical, Peripheral Arterial Disease diagnostic imaging
- Abstract
Arterial claudication is a common manifestation of peripheral artery disease. This document focuses on necessary imaging before revascularization for claudication. Appropriate use of ultrasound, invasive arteriography, MR angiography, and CT angiography are discussed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation., (Copyright © 2022 American College of Radiology. Published by Elsevier Inc. All rights reserved.)
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- 2022
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5. Automated Image Fusion Guidance during Endovascular Aorto-Iliac Procedures: A Randomized Controlled Pilot Study.
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De Beaufort LM, Nasr B, Corvec TL, Brisard L, Guyomarc'h B, Fellah I, Postaire B, Chaillou P, Clough RE, and Maurel B
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- Aged, Aortic Diseases diagnostic imaging, Aortic Diseases physiopathology, Arterial Occlusive Diseases diagnostic imaging, Arterial Occlusive Diseases physiopathology, Automation, Female, France, Humans, Iliac Artery physiopathology, Male, Middle Aged, Pilot Projects, Prospective Studies, Radiographic Image Interpretation, Computer-Assisted, Time Factors, Treatment Outcome, Aortic Diseases therapy, Aortography, Arterial Occlusive Diseases therapy, Computed Tomography Angiography, Endovascular Procedures adverse effects, Iliac Artery diagnostic imaging, Radiography, Interventional
- Abstract
Background: The benefits of imaging guidance using a new fully automated fusion process (CYDAR) have been demonstrated during endovascular aortic aneurysm repair, but little is known about its use during aorto-iliac occlusive disease endovascular revascularization. The aim of this study was to evaluate the influence of CYDAR image fusion guidance during endovascular treatment of symptomatic aorto-iliac occlusive lesions, compared with control patients treated using standard 2D fluoroscopy alone., Methods: This is a single-center randomized controlled pilot study that recruited patients undergoing aorto-iliac endovascular revascularization., Results: Between January 2019 and February 2020, 37 patients with symptomatic aorto-iliac lesions were enrolled: 18 were assigned to the fusion group and 19 to the control group. Patients and lesions characteristics were well balanced between both study groups. The technical success of the procedure was 100% in the Fusion group and 94% in the control group. All radiation-related parameters were lower in the fusion compared to the control group, including: median DAP 18.5 Gy.cm2 vs. 21.8 Gy.cm2; Air Kerma 0.10 Gy vs. 0.12 Gy; fluoroscopy dose 4.2 Gy.cm
2 vs. 5.1 Gy.cm2 ; and number of DSA 7.5 vs. 8. The volume of iodinated contrast used was higher in the fusion group: 41 mL vs. 30 mL. The total procedure time was the same in both groups:60 min vs. 60 min., Conclusions: The results of this pilot study suggest the use of fusion imaging in endovascular treatment of aorto-iliac disease results in reduction in radiation-related measured parameters with no change in procedure time and higher doses of iodinated contrast used. These results need to be further investigated in a larger, adequately powered study., (Copyright © 2021. Published by Elsevier Inc.)- Published
- 2021
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6. Erratum to 'Long-term Survival and Risk Analysis in 136 Consecutive Patients With Type B Aortic Dissection Presenting to a Single Centre Over an 11-year Period' [European Journal of Vascular & Endovascular Surgery 57/5 (2019) 633-8].
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Clough RE, Barillà D, Delsart P, Ledieu G, Spear R, Crichton S, Vehier CM, Peacock J, Sobocinski J, and Haulon S
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- 2019
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7. Editor's Choice - Long-term Survival and Risk Analysis in 136 Consecutive Patients With Type B Aortic Dissection Presenting to a Single Centre Over an 11 Year Period.
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Clough RE, Barillà D, Delsart P, Ledieu G, Spear R, Crichton S, Mounier Vehier C, Peacock J, Sobocinski J, and Haulon S
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- Aged, Aortic Dissection diagnostic imaging, Aortic Dissection drug therapy, Aortic Dissection pathology, Antihypertensive Agents therapeutic use, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic drug therapy, Aortic Aneurysm, Thoracic pathology, Computed Tomography Angiography, Endovascular Procedures adverse effects, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Postoperative Complications, Progression-Free Survival, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery
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Objectives: To evaluate, in patients with acute type B aortic dissection, the results of medical and endovascular treatment in a large single centre experience and to investigate the clinical and imaging features on presentation that relate to poor outcome., Methods: This was a retrospective analysis of prospectively collected clinical and CT imaging data. Consecutive patients (136) with acute type B aortic dissection were included in the study over an 11 year period. The characteristics of patients receiving endovascular (complicated) or medical treatment (uncomplicated) were compared. Kaplan-Meier estimators were used to estimate cumulative overall survival and survival free of aortic events. Factors associated with overall and aortic event free survival were also explored using Cox proportional hazards models., Results: The mean follow up was 51 months (1-132), during which time 33 deaths and 48 aortic events occurred. At one and five years, overall survival was 94.0% and 74.8%, respectively, and freedom from aortic events was 75.6% and 58.7%. There was no difference in all cause survival and aortic event free survival at one and five years between the patients treated endovascularly and those receiving medical treatment alone. Risk analysis for aortic events demonstrated the maximum size of the proximal entry tear, the maximum thoracic aortic diameter, and the thoracic aortic false lumen maximum diameter to have a significant effect on the incidence of aortic events., Conclusions: Active management of patients with type B aortic dissection results in good long-term survival even in the presence of features traditionally associated with adverse outcomes. All patients require close lifetime surveillance as aortic events continue to occur during follow up even after endografting., (Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)
- Published
- 2019
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8. Clinical Cases Referring to Diagnosis and Management of Patients With Thoracic Aortic Pathologies Involving the Aortic Arch: A Companion Document of the 2018 European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) Expert Consensus Document Addressing Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch.
- Author
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Czerny M, Schmidli J, Bertoglio L, Carrel T, Chiesa R, Clough RE, Grabenwöger M, Kari FA, Mestres CA, Rylski B, Schönhoff F, Tsagakis K, and Wyss TR
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- Aged, Aortography standards, Cerebral Angiography, Clinical Decision-Making, Consensus, Coronary Angiography, Echocardiography, Female, Health Status, Humans, Male, Middle Aged, Practice Guidelines as Topic, Predictive Value of Tests, Treatment Outcome, Aorta, Thoracic diagnostic imaging, Aorta, Thoracic surgery, Aortic Diseases diagnostic imaging, Aortic Diseases surgery, Aortography methods, Blood Vessel Prosthesis Implantation standards, Computed Tomography Angiography standards, Endovascular Procedures standards
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- 2019
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9. Editor's Choice - Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS).
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Czerny M, Schmidli J, Adler S, van den Berg JC, Bertoglio L, Carrel T, Chiesa R, Clough RE, Eberle B, Etz C, Grabenwöger M, Haulon S, Jakob H, Kari FA, Mestres CA, Pacini D, Resch T, Rylski B, Schoenhoff F, Shrestha M, von Tengg-Kobligk H, Tsagakis K, Wyss TR, Document Reviewers, Chakfe N, Debus S, de Borst GJ, Di Bartolomeo R, Lindholt JS, Ma WG, Suwalski P, Vermassen F, Wahba A, and Wyler von Ballmoos MC
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- Aortic Dissection diagnostic imaging, Aorta, Thoracic surgery, Aortic Aneurysm, Thoracic diagnostic imaging, Computed Tomography Angiography, Humans, Magnetic Resonance Imaging, Vascular Surgical Procedures methods, Aortic Dissection surgery, Aorta, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic surgery
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- 2019
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10. The potential role of IDEAL MRI for identification of lipids and hemorrhage in carotid artery plaques.
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Khosa F, Clough RE, Wang X, Madhuranthakam AJ, and Greenman RL
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- Aged, Carotid Arteries diagnostic imaging, Carotid Arteries metabolism, Carotid Stenosis complications, Female, Hemorrhage complications, Humans, Least-Squares Analysis, Male, Middle Aged, Plaque, Atherosclerotic complications, Plaque, Atherosclerotic metabolism, Carotid Stenosis diagnostic imaging, Carotid Stenosis metabolism, Hemorrhage diagnostic imaging, Lipids analysis, Magnetic Resonance Imaging methods, Plaque, Atherosclerotic diagnostic imaging
- Abstract
Hemorrhage and lipid deposits contribute to instability in atherosclerotic plaques. Unstable carotid artery plaques can lead to cerebral ischemic events. While MRI studies have shown the ability to identify plaque components, the identification of hemorrhage and lipids has proven to be problematic. The purpose of this study was to quantitatively evaluate the potential of the MRI fat/water separation method known as iterative decomposition of water and fat with echo asymmetry and least squares estimation (IDEAL) to complement and improve existing methods for the identification of hemorrhage and lipids in carotid artery plaques. Fifteen asymptomatic subjects with 50-79% stenosis of at least one carotid artery were enrolled. Hemorrhage and lipid components within carotid plaques were identified using previously published criteria based on the multiple contrast-weighted (MCW) method (3D Time-of-Flight (3D-TOF), T1-Weighted (T1W) and T2-Weighted (T2W)). The hemorrhage:muscle, lipid:muscle and intra-plaque lipid:hemorrhage signal intensity ratios (SIR) and contrast to noise ratios (CNR) were measured on MCW and compared to IDEAL black-blood images. No differences were found between any of the MCW methods for any of the SIRs measured. The IDEAL Fat images had higher lipid:muscle and lipid/hemorrhage SIRs (p<0.001) compared to IDEAL Water and all MCW image sequence types. The mean values of IDEAL Fat hemorrhage:muscle SIR and CNR were nearly unity (1.1±0.6) and nearly zero (0.1±1.1), respectively. The IDEAL Water imaging was not significantly different than any of the MCW methods for any of the SIRs or for the hemorrhage:muscle CNR of 3D-TOF, while its CNRs were significantly higher than IDEAL Fat lipid:muscle (p<0.05) and lipid:hemorrhage (p<0.001) and all MCW methods (p<0.001). The addition of IDEAL Water and Fat imaging to the MCW method shows potential to improve the identification of hemorrhage and lipid structures in carotid artery plaques., (Copyright © 2017 Elsevier Inc. All rights reserved.)
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- 2018
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11. Multimodality Imaging of Thoracic Aortic Diseases in Adults.
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Bhave NM, Nienaber CA, Clough RE, and Eagle KA
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- Aorta, Thoracic physiopathology, Aortic Diseases physiopathology, Aortic Diseases therapy, Hemodynamics, Humans, Predictive Value of Tests, Prognosis, Regional Blood Flow, Aorta, Thoracic diagnostic imaging, Aortic Diseases diagnostic imaging, Multimodal Imaging
- Abstract
In diagnosing and following patients with acute aortic syndromes and thoracic aortic aneurysms, high-quality imaging of the thoracic aorta is indispensable. Mainstay modalities for thoracic aortic imaging are echocardiography, computed tomographic angiography, and magnetic resonance angiography. For any given clinical scenario, the imaging modality and protocol chosen will have a significant impact on sensitivity and specificity for the aortic diagnosis of concern. Imaging can also provide important ancillary information regarding myocardial performance, aortic valve morphology and function, and end-organ perfusion. Surveillance of patients following thoracic aortic surgery with serial imaging studies can identify complications that may require reintervention, and imaging has played an integral role in development of new surgical and interventional methods. Emerging techniques in thoracic aortic imaging include positron emission tomography, which addresses vessel wall inflammation, and 4-dimensional magnetic resonance angiography, which illustrates flow dynamics., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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12. Endovascular Repair of Thoracoabdominal and Arch Aneurysms in Patients with Connective Tissue Disease Using Branched and Fenestrated Devices.
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Clough RE, Martin-Gonzalez T, Van Calster K, Hertault A, Spear R, Azzaoui R, Sobocinski J, and Haulon S
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- Adult, Aged, Aortic Aneurysm, Thoracic complications, Aortic Aneurysm, Thoracic diagnostic imaging, Aortography methods, Blood Vessel Prosthesis Implantation adverse effects, Computed Tomography Angiography, Connective Tissue Diseases diagnosis, Databases, Factual, Endovascular Procedures adverse effects, Female, France, Hospitals, High-Volume, Humans, Male, Middle Aged, Postoperative Complications therapy, Prosthesis Design, Retreatment, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Connective Tissue Diseases complications, Endovascular Procedures instrumentation, Stents
- Abstract
Background: Prophylactic open surgery is the standard practice in patients with connective tissue and thoracoabdominal aortic aneurysm (TAAA) and aortic arch disease. Branched and fenestrated devices offer a less invasive alternative but there are concerns regarding the durability of the repair and the effect of the stent graft on the fragile aortic wall. The aim of this study is to evaluate mid-term outcomes of fenestrated and/or branched endografting in patients with connective tissue disease., Methods: All patients with connective tissue disease who underwent TAAA or arch aneurysm repair using a fenestrated and/or branched endograft in a single, high-volume center between 2004 and 2015 were included. Ruptured aneurysms and acute aortic dissections were excluded from this study, but not chronic aortic dissections., Results: In total, 427 (403 pararenal and TAAAs, and 24 arch aneurysms) endovascular interventions were performed during the study period. Of these, 17 patients (4%) (16 TAAAs, 1 arch) had connective tissue disease. All patients were classified as unfit for open repair. The mean age was 51 ± 8 years. Thirteen patients with TAAA were treated with a fenestrated, 1 with a branched, and 2 with a combined fenestrated/branch device. A double inner branch device was used to treat the arch aneurysm. The technical success rate was 100% with no incidence of early mortality, spinal cord ischemia, stroke, or further dissection. Postoperative deterioration in renal function was seen in 3 patients (18.8%) and no hemodialysis was required. The mean follow-up was 3.4 years (0.3-7.4). Aneurysm sac shrinkage was seen in 35% of patients (6/17) and the sac diameter remained stable in 65% of patients (11/17). No sac or sealing zone enlargement was observed in any of the patients and there were no conversions to open repair. Reintervention was required in 1 patient at 2 years for bilateral renal artery occlusion (successful fibrinolysis). One type II endoleak (lumbar) is under surveillance and 1 type III (left renal stent) sealed spontaneously. One patient died at 2 years after the procedure from nonaortic causes (endocarditis)., Conclusions: The favorable mid-term outcomes in this series that demonstrate fenestrated and/or branched endografting should be considered in patients with connective tissue and TAAA and aortic arch disease, which are considered unfit for open surgery. All patients require close lifetime surveillance at a center specializing in aortic surgery, with sufficient experience in both open and endovascular aortic surgery, so that if endovascular treatment failure occurs it can be recognized early and further treatment offered., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
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13. Total Endovascular Aortic Repair in a Patient with Marfan Syndrome.
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Amako M, Spear R, Clough RE, Hertault A, Azzaoui R, Martin-Gonzalez T, Sobocinski J, and Haulon S
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- Adult, Aortic Dissection diagnostic imaging, Aortic Dissection etiology, Aortic Dissection physiopathology, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic etiology, Aortic Aneurysm, Thoracic physiopathology, Aortography methods, Blood Vessel Prosthesis, Computed Tomography Angiography, Humans, Male, Marfan Syndrome diagnosis, Prosthesis Design, Treatment Outcome, Vascular Patency, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation instrumentation, Endovascular Procedures instrumentation, Marfan Syndrome complications
- Abstract
Background: The aim of this study is to describe a total endovascular aortic repair with branched and fenestrated endografts in a young patient with Marfan syndrome and a chronic aortic dissection. Open surgery is the gold standard to treat aortic dissections in patients with aortic disease and Marfan syndrome., Methods: In 2000, a 38-year-old man with Marfan syndrome underwent open ascending aorta repair for an acute type A aortic dissection. One year later, a redo sternotomy was performed for aortic valve replacement. In 2013, the patient presented with endocarditis and pulmonary infection, which necessitated tracheostomy and temporary dialysis. In 2014, the first stage of the endovascular repair was performed using an inner branched endograft to exclude a 77-mm distal arch and descending thoracic aortic aneurysm. In 2015, a 63-mm thoracoabdominal aortic aneurysm was excluded by implantation of a 4-fenestrated endograft. Follow-up after both endovascular repairs was uneventful., Results: Total aortic endovascular repair was successfully performed to treat a patient with arch and thoraco-abdominal aortic aneurysm associated with chronic aortic dissection and Marfan syndrome. The postoperative images confirmed patency of the endograft and its branches, and complete exclusion of the aortic false lumen., Conclusions: Endovascular repair is a treatment option in patients with connective tissue disease who are not candidates for open surgery. Long-term follow-up is required to confirm these favorable early outcomes., (Copyright © 2016 Elsevier Inc. All rights reserved.)
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- 2017
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14. Results of celiac trunk stenting during fenestrated or branched aortic endografting.
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Wattez H, Martin-Gonzalez T, Lopez B, Spear R, Clough RE, Hertault A, Sobocinski J, and Haulon S
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- Aged, Aortic Aneurysm complications, Aortic Aneurysm diagnostic imaging, Aortic Aneurysm physiopathology, Aortography methods, Blood Vessel Prosthesis Implantation adverse effects, Celiac Artery diagnostic imaging, Celiac Artery physiopathology, Computed Tomography Angiography, Constriction, Pathologic complications, Constriction, Pathologic diagnostic imaging, Constriction, Pathologic physiopathology, Endovascular Procedures adverse effects, Female, Graft Occlusion, Vascular etiology, Graft Occlusion, Vascular physiopathology, Humans, Imaging, Three-Dimensional, Male, Median Arcuate Ligament Syndrome, Middle Aged, Predictive Value of Tests, Prosthesis Failure, Radiographic Image Interpretation, Computer-Assisted, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Ultrasonography, Doppler, Duplex, Vascular Patency, Aortic Aneurysm surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Celiac Artery abnormalities, Celiac Artery surgery, Constriction, Pathologic surgery, Endovascular Procedures instrumentation, Stents
- Abstract
Background: Endovascular repair of aortic aneurysms involving the visceral segment of the aorta often requires placement of a covered bridging stent in the celiac axis (CA). The median arcuate ligament (MAL) is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus. The ligament may compress and distort the celiac artery and result in difficult cannulation, or stenosis and occlusion of the vessel. This study evaluated the influence of the MAL compression on the technical success and the patency of the celiac artery after branched and fenestrated endovascular aortic repair., Methods: We retrospectively analyzed a cohort of consecutive patients treated electively for complex aneurysms with branched and fenestrated endovascular aortic repair between January 2007 and April 2014. All data were collected prospectively. Analysis of preoperative computed tomography angiography on a three-dimensional workstation determined the presence of MAL compression. Patency of the CA bridging stent was assessed during follow-up by computed tomography angiography and duplex ultrasound evaluation. Statistical analysis was performed to compare the outcomes of patients with MAL (MAL+) and without MAL (MAL-) compression., Results: Of 315 patients treated for aortic disease involving the visceral segment during the study period, 113 had endografts designed with a branch (n = 57) or fenestration (n = 56) for the CA. In 45 patients (39.8%), asymptomatic compression of the CA by the MAL was depicted (MAL+). Complex endovascular techniques were required in this group to access the CA in 16 (14.2%) patients (vs none in the MAL- group; P = .003), which lead to a failed bridging stent implantation in seven patients (6.2%). Increased operative time and dose area product were observed in the MAL+ group, but this did not reach statistical significance. In the MAL+ group, no thrombosis of the CA bridging stents were observed during follow-up; an external compression of the CA bridging stent was depicted in six patients but without hemodynamic effect on duplex ultrasound imaging. In the MAL- group, one CA bridging stent occlusion occurred owing to an embolus from a cardiac source., Conclusions: MAL compression is associated with good celiac trunk bridging stent patency during follow-up, but with a higher rate of technical difficulties and failed bridging stent implantation during the procedure., (Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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15. Inner-Branched Endografts for the Treatment of Aortic Arch Aneurysms After Open Ascending Aortic Replacement for Type A Dissection.
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Milne CP, Amako M, Spear R, Clough RE, Hertault A, Sobocinski J, Brown W, and Haulon S
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- Adult, Aged, Aged, 80 and over, Aortic Dissection diagnosis, Aortic Aneurysm, Thoracic diagnosis, Feasibility Studies, Female, France, Humans, Male, Middle Aged, Patient Selection, Prosthesis Design, Reoperation, Tomography, X-Ray Computed, Treatment Outcome, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation, Endovascular Procedures, Stents
- Abstract
Background: The development of a postdissection aortic arch aneurysm after open ascending aortic replacement for type A dissection places the patient at increased risk for an open operation due to the need for redo sternotomy and total arch replacement. We conducted a computed tomography-based feasibility study to assess what proportion of these patients would be anatomically suitable for branched endograft repair of an arch aneurysm. We also aimed to identify ways to tailor the index operation to increase suitability for future endovascular repair., Methods: Our study was conducted at the Aortic Centre, Lille University Hospital, Lille, France. Postoperative images were assessed for patients after open replacement of the ascending aorta for acute type A dissection in this center between 2009 and 2015 to determine suitability for use of an aortic arch inner-branched device., Results: The assessment found 52 of 73 patients (71.2%) were anatomically suitable for treatment with the aortic arch inner-branched device. The only cause for absolute exclusion from suitability was the absence of a proximal landing zone in the ascending aorta. Reasons for this were the ascending aortic graft being too short (71.4%), the presence of a major kink in the graft (23.8%), and the graft diameter being too large (4.8%)., Conclusions: Approximately 70% of patients with arch aneurysm formation after open ascending aortic replacement for type A dissection are anatomically suitable for treatment with the aortic arch inner-branched device. In the future, surgeons will be able to fashion the prosthetic graft at the time of the index operation to ensure it fulfills criteria for an adequate proximal landing zone., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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16. Prognostic Significance of Sleep Apnea Syndrome on False Lumen Aortic Expansion in Post-Acute Aortic Syndrome.
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Delsart P, Juthier F, Clough RE, Sobocinski J, Azzaoui R, Ramstein J, Devos P, Rousse N, Jegou B, Fayad G, Modine T, Mallart A, Vincentelli A, Mounier-Vehier C, and Haulon S
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- Adult, Aged, Aortic Dissection diagnostic imaging, Aortic Dissection physiopathology, Aortic Dissection surgery, Aortic Aneurysm diagnostic imaging, Aortic Aneurysm physiopathology, Aortic Aneurysm surgery, Computed Tomography Angiography, Disease Progression, Female, Humans, Male, Mass Screening, Middle Aged, Oxygen blood, Prevalence, Prognosis, Recurrence, Risk Factors, Severity of Illness Index, Sleep Apnea, Obstructive blood, Sleep Apnea, Obstructive diagnosis, Sleep Apnea, Obstructive epidemiology, Stents, Syndrome, Aortic Dissection etiology, Aorta, Thoracic pathology, Aortic Aneurysm etiology, Hypertension complications, Sleep Apnea, Obstructive complications
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Background: Obstructive sleep apnea syndrome (OSAS) is a risk factor for resistant arterial hypertension and aortic dilatation. We assessed the value of systematic screening for OSAS in patients soon after the onset of acute aortic syndrome (AAS)., Methods: Between January 2010 and June 2014, patients were prospectively screened for post AAS OSAS. The severity of OSAS was defined by the Apnea-Hypopnea Index (AHI) and the Oxygen Desaturation Index (ODI). Blood pressure control was assessed with 24-h ambulatory monitoring., Results: The study population comprised 71 patients (males: 64.7%; median age [interquartile range]: 57 [49 to 64] years; type A AAS: 49.3%; type B AAS: 50.7%). According to the AHI, 58 patients (81.7%) had OSAS and 31 (43.6%) had severe OSAS. A prognostic analysis revealed that the descending thoracic false lumen dilatation rate rose significantly with the severity of OSAS (p = 0.0008 for the AHI and p = 0.0284 for the ODI). The median rate of increase was 7.5 (5 to 10) mm/year in the AHI greater than 30 events/h group and 5.0 (0 to 8) mm/year in the ODI greater than 30 events/h group. With regard to blood pressure control, the diastolic blood pressure varied as function of the ODI category (p = 0.0074)., Conclusions: Our results suggest that systematic screening for post-ASS OSAS is of value. The false lumen dilatation rate appears to be related to the severity of OSAS. It remains to be seen whether treatment of OSAS would modify the false lumen dilatation rate., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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17. Management of acute aortic dissection.
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Nienaber CA and Clough RE
- Subjects
- Acute Disease, Aortic Dissection diagnosis, Aortic Dissection etiology, Aortic Aneurysm, Abdominal diagnosis, Aortic Aneurysm, Abdominal etiology, Aortic Aneurysm, Thoracic diagnosis, Aortic Aneurysm, Thoracic etiology, Biomarkers blood, Diagnostic Imaging methods, Early Diagnosis, Emergency Service, Hospital, Endovascular Procedures methods, Hemodynamics physiology, Humans, Long-Term Care, Risk Factors, Treatment Outcome, Aortic Dissection surgery, Aortic Aneurysm, Abdominal surgery, Aortic Aneurysm, Thoracic surgery
- Abstract
A new appraisal of the management of acute aortic dissection is timely because of recent developments in diagnostic strategies (including biomarkers and imaging), endograft design, and surgical treatment, which have led to a better understanding of the epidemiology, risk factors, and molecular nature of aortic dissection. Although open surgery is the main treatment for proximal aortic repair, use of endovascular management is now established for complicated distal dissection and distal arch repair, and has recently been discussed as a pre-emptive measure to avoid late complications by inducing aortic remodelling., (Copyright © 2015 Elsevier Ltd. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
18. Regarding "patient outcomes and thoracic aortic volume and morphologic changes following thoracic endovascular aortic repair in patients with complicated chronic type B aortic dissection".
- Author
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Mani K, Clough RE, and Taylor PR
- Subjects
- Female, Humans, Male, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Aortography methods, Blood Vessel Prosthesis Implantation, Endovascular Procedures, Tomography, Spiral Computed
- Published
- 2013
- Full Text
- View/download PDF
19. A new imaging method for assessment of aortic dissection using four-dimensional phase contrast magnetic resonance imaging.
- Author
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Clough RE, Waltham M, Giese D, Taylor PR, and Schaeffter T
- Subjects
- Aged, Aged, 80 and over, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Cohort Studies, Contrast Media, Female, Four-Dimensional Computed Tomography methods, Humans, Magnetic Resonance Angiography methods, Male, Middle Aged, Prospective Studies, Sensitivity and Specificity, Severity of Illness Index, Aortic Dissection diagnosis, Aortic Aneurysm, Thoracic diagnosis, Magnetic Resonance Imaging methods, Radiographic Image Enhancement
- Abstract
Introduction: Medical management of type B aortic dissection can result in progressive dilation of the false lumen and poor long-term outcome. Recent studies using models of aortic dissection have suggested flow characteristics, such as stroke volume, velocity, and helicity, are related to aortic expansion. The aim of this study was to assess whether four-dimensional phase-contrast magnetic resonance imaging (4D PC-MRI) can accurately visualize and quantify flow characteristics in patients with aortic dissection and whether these features are related to the rate of aortic expansion., Methods: Twelve consecutive patients with medically treated type B thoracic aortic dissection underwent a three-dimensional (3D) MRI anatomy scan using a blood pool contrast agent. Two-dimensional phase contrast MRI data (2D PC-MRI) were acquired in the ascending and descending aorta and 4D PC-MRI data were acquired in the entire thoracic aorta. The 2D PC-MRI measurements were used to assess the quality of the 4D PC-MRI velocity data. Stroke volume, velocity, and the direction of flow were calculated using 4D PC-MRI and related to the rate of aortic expansion measured on contrast-enhanced computed tomography., Results: Comparison of 2D PC-MRI and 4D PC-MRI measurements showed good correlation (Pearson R(2) = 0.98; 95% confidence interval [CI], 0.9818-0.9953; P < .0001) and no proportional bias (bias = 1.0 mL; standard deviation, 4.6). The median aortic growth rate was 6.1 mm/y (interquartile range [IQR], 1.1-15.1 mm/y), and this correlated well with the growth rate of the false lumen (Spearman ρ = 0.62; 95% CI, 0.06-0.89; P = .0347). False lumen thrombosis (FLT) was seen in 7 of 12 patients and was not associated with reduced aortic expansion rate (FLT present: 11.4 mm/y; IQR, 3.6-21.4) vs FLT absent: 9.9 mm/y; IQR, 3.4-24.2; Mann-Whitney P = .8763). False lumen stroke volume and velocity were associated with more rapid aortic expansion (ρ = 0.80 [95% CI, 0.39-0.94; P = .0029] and ρ = 0.59 [95% CI, 0.09-0.87; P = .0480] respectively). The position of the dominant entry tear was associated with rapid expansion, which tended to be higher with distal vs proximal entry tears (distal, 21.4 mm/y [IQR, 11.4-48.9] vs proximal, 5.5 mm/y [IQR, 3.4-16.6]; Mann-Whitney P = .096). Helical flow was seen in the false lumen in 8 of 12 patients and was related to the rate of aortic expansion (ρ = 0.83, P = .0154)., Conclusions: 4D PC-MRI can be accurately applied to visualize and quantify flow characteristics in patients with aortic dissection. Stroke volume, velocity, distal dominant entry tears, and helical flow are related to the rate of aortic expansion. This study demonstrates the potential of this new imaging method. A larger prospective study is now required to measure flow characteristics and determine their predictive value for risk stratification of patients with aortic dissection., (Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
20. Endovascular repair of the aorta and aortic arch arteries damaged during mediastinoscopy.
- Author
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Smith SJ, Lyons OT, Patel AS, Clough RE, Salter R, Bell RE, and Taylor PR
- Subjects
- Adult, Aged, Aneurysm, False etiology, Aorta, Thoracic diagnostic imaging, Female, Follow-Up Studies, Hodgkin Disease diagnosis, Hodgkin Disease surgery, Humans, Lung Neoplasms diagnosis, Lung Neoplasms surgery, Male, Mediastinal Neoplasms surgery, Mediastinoscopy methods, Multivariate Analysis, Risk Assessment, Sampling Studies, Stents, Tomography, X-Ray Computed methods, Treatment Outcome, Aneurysm, False therapy, Angioplasty methods, Aorta, Thoracic injuries, Mediastinal Neoplasms diagnosis, Mediastinoscopy adverse effects
- Abstract
Despite advances in imaging techniques, mediastinoscopy remains an important tool for the staging of the mediastinum in non-small cell lung cancer and diagnosing lymphoma with mediastinal adenopathy. Injury to the arterial system during mediastinoscopy is infrequent but a potentially fatal complication. We report three cases of injury to the aorta and supra-aortic arteries sustained during mediastinoscopy. These were effectively managed by endovascular techniques. Patient recovery was uncomplicated and median length of stay was 3 days. This technique avoids major open surgery in a high-risk group of patients and may offer a mortality benefit and more rapid resumption of oncological treatment., (Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)
- Published
- 2012
- Full Text
- View/download PDF
21. Endovascular treatment of acute aortic syndrome.
- Author
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Clough RE, Mani K, Lyons OT, Bell RE, Zayed HA, Waltham M, Carrell TW, and Taylor PR
- Subjects
- Aged, Aortic Diseases complications, Aortic Diseases mortality, Cohort Studies, Female, Humans, Logistic Models, Male, Middle Aged, Risk Factors, Survival Rate, Syndrome, Treatment Outcome, Aorta, Thoracic, Aortic Diseases surgery, Endovascular Procedures
- Abstract
Background: The term acute aortic syndrome (AAS) encompasses a range of conditions that have a risk of imminent aortic rupture and where delays in treatment result in increased mortality. Endovascular treatment offers an attractive alternative to open surgery but little is known about the durability of the repair and the factors that predict mortality., Methods: Prospective data were collected for a cohort of 110 consecutive patients with endovascular treatment for AAS. Patient and procedural characteristics were related to short- and midterm outcome using multivariate logistic regression analysis., Results: There were 75 men and 35 women with a median age of 68 (range 57-76) years. The pathologies treated were acute dissection (35), symptomatic aneurysm (32), infected aneurysm (18), transection (12), chronic dissection (9), penetrating ulcer (3), and intramural hematoma (1). Thirty-day mortality was 12.7% and this was associated with hypotension (odds ratio [OR], 5.25), use of general anesthetic (OR, 5.23), long procedure duration (OR, 2.03), and increasing age (OR, 1.07). The causes of death were aortic rupture (4), myocardial infarction (4), stroke (3), and multisystem organ failure (3). The stroke and paraplegia rates were 7.3% and 6.4%, respectively. The 1-year survival was 81% and the 5-year survival 63%. Secondary procedures were required in 13 (11.8%) patients. Factors associated with death at 1 year were presence of an aortic fistula (OR, 9.78), perioperative stroke (OR, 5.87), and use of general anesthetic (OR, 3.76); and at 5 years were aortic fistula (OR, 12.31) and increasing age (OR, 1.06)., Conclusions: Acute aortic syndrome carries significant early and late mortality. Emergency endovascular repair offers a minimally invasive treatment option associated with acceptable short and midterm results. Continued surveillance is important as secondary procedures and aortic-related deaths continue to occur throughout the follow-up period., (Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
22. A new method for quantification of false lumen thrombosis in aortic dissection using magnetic resonance imaging and a blood pool contrast agent.
- Author
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Clough RE, Hussain T, Uribe S, Greil GF, Razavi R, Taylor PR, Schaeffter T, and Waltham M
- Subjects
- Adult, Aged, Aged, 80 and over, Aortic Dissection diagnostic imaging, Aortic Aneurysm diagnostic imaging, Aortography methods, Chronic Disease, Female, Humans, Iohexol, Linear Models, London, Male, Middle Aged, Observer Variation, Predictive Value of Tests, Prognosis, Reproducibility of Results, Thrombosis diagnostic imaging, Tomography, X-Ray Computed, Aortic Dissection diagnosis, Aortic Aneurysm diagnosis, Contrast Media, Gadolinium, Magnetic Resonance Angiography methods, Organometallic Compounds, Thrombosis diagnosis
- Abstract
Background: False lumen thrombosis after aortic dissection is a major predictor of prognosis. First pass computed tomography (CT) and magnetic resonance (MR) imaging are used routinely, where the image acquisition is timed to the arrival of contrast in the proximal unaffected aorta. Delayed phase imaging is difficult to refine because flow rates in the false lumen are often very slow and highly variable between patients. Blood pool contrast agents bind to albumin and become homogenously distributed in the intravascular circulation, allowing accurate imaging of areas where flow is low. We compared first pass MR and CT with a delayed phase MR acquisition using a blood pool agent to assess whether this more accurately quantified false lumen thrombosis., Methods: Patients with medically treated chronic type B aortic dissection and evidence of false lumen thrombosis on previous CT imaging underwent first pass CT, first pass MR, and delayed phase MR with blood pool agent. Absence of false lumen contrast enhancement was quantified to assess the apparent differences in thrombosis. Phase-contrast MR data were also obtained to assess the affect of flow velocity on false lumen contrast enhancement, and direct thrombus MR images were used to confirm the presence of thrombus., Results: Twelve patients were recruited. No difference was seen in apparent thrombus volume between first pass CT and first pass MR imaging (146.9 cm(3) [SD, 88.6] vs 187.6 cm(3) [SD, 136.1], P = .1119; R(2) = .67 [95% confidence interval (CI), r = .46-.95], P = .0012). In all patients, the volume of thrombus derived from first pass acquisitions was greater than the volume derived from delayed phase MR imaging with blood pool agent: first pass CT (paired t test, P = .0007; mean difference = 83.4 cm(3) [95% CI, 44.1-122.6]) and first pass MR (paired t test, P = .0009; mean difference = 124.0 cm(3) [95% CI, 63.2-184.9]). The difference in thrombus volume between first pass and delayed phase MR imaging with blood pool agent correlated significantly with the mean velocity of flow in the false lumen, with lower flow related to a greater difference (R(2) = .61, P = .0028 [95% CI, r = -.94--.37]). Direct thrombus MR images were able to correctly discriminate between thrombus and blood and matched the area of contrast absence on delayed phase MR with blood pool agent images., Conclusion: First pass techniques to assess false lumen thrombosis in aortic dissection consistently overestimate the apparent thrombus volume by five to six times. This has implications for interpretation of cohort studies and clinical trials that use false lumen thrombosis as an outcome measure. We recommend delayed phase MR imaging with a blood pool agent when accurate assessment of false lumen thrombosis is required., (Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)
- Published
- 2011
- Full Text
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23. Endovascular repair of a tuberculous mycotic thoracic aortic aneurysm with a custom-made device.
- Author
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Clough RE, Topple JA, Zayed HA, Lyons OT, Carrell TW, and Taylor PR
- Subjects
- Angiography methods, Angioplasty methods, Antitubercular Agents therapeutic use, Combined Modality Therapy, Contrast Media, Female, Follow-Up Studies, Humans, Middle Aged, Mycobacterium tuberculosis isolation & purification, Preoperative Care, Prosthesis Design, Risk Assessment, Tomography, X-Ray Computed, Treatment Outcome, Tuberculosis diagnosis, Aneurysm, Infected diagnosis, Aneurysm, Infected surgery, Angioplasty instrumentation, Stents, Tuberculosis drug therapy
- Abstract
Mycotic aortic aneurysms are rare and it is unlikely that any center will obtain extensive experience in their management. The aim of treatment is to repair the aorta and eradicate the infection with minimal operative and postoperative risk. We describe a case in which a custom-made endovascular stent graft provided the optimal treatment strategy and remained durable at 4 years of follow-up., (Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)
- Published
- 2010
- Full Text
- View/download PDF
24. Levitronix ventricular assist device as a bridge-to-recovery for post-cardiotomy cardiogenic shock.
- Author
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Clough RE, Vallely MP, Henein MY, and Pepper JR
- Subjects
- Aged, Female, Humans, Middle Aged, Shock, Cardiogenic rehabilitation, Heart-Assist Devices, Recovery of Function physiology, Shock, Cardiogenic physiopathology, Shock, Cardiogenic surgery
- Published
- 2009
- Full Text
- View/download PDF
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