Preemptive treatment in the acute and early subacute phase of uncomplicated type B aortic dissections with poor prognosis factors

ObjectiveDue to its favorable outcome regarding late morbidity and mortality, thoracic endovascular repair (TEVAR) is becoming more popular for uncomplicated type B aortic dissection (TBAD). This study aimed to compare preemptive endovascular treatment and optimal medical treatment (OMT) and OMT alone in patients presenting uncomplicated TBAD with predictors of aortic progression.DesignRetrospective multicenter studyMethodsWe analyzed patients with uncomplicated TBAD and risk factors of progression in two French academic centers. Aortic events [defined as aortic-related (re)intervention or aortic-related death after initial hospitalization], postoperative complications, non-aortic events, and radiologic aortic progression and remodeling were recorded and analyzed. Analysis was performed on an intention-to-treat basis.ResultsBetween 2011 and 2021, preemptive endovascular procedures at the acute and early subacute phase (<30 days) were performed on 24 patients (group 1) and OMT alone on 26 patients (group 2). With a mean follow-up of 38.08 ± 24.53 months, aortic events occurred in 20.83% of patients from group 1 and 61.54% of patients from group 2 (p < .001). No patient presented aortic-related death during follow-up. There were no differences in postoperative events (p = 1.00) and non-aortic events (p = 1.00). OMT patients had significantly more aneurysmal progression of the thoracic aorta (p < .001) and maximal aortic diameter (p < .001). Aortic remodeling was found in 91.67% of patients in group 1 and 42.31% of patients in group 2 (p < .001). A subgroup analysis of patients in group 1 showed that patients treated with preemptive TEVAR and STABILISE had reduced maximum aortic diameters at the 1-year (p = .010) and last follow-up (p = .030) compared to those in patients treated with preemptive TEVAR alone.ConclusionPreemptive treatment of uncomplicated TBAD with risk factors of progression reduces the risk of long-term aortic events. Over 60% of medically treated patients will require intervention during follow-up, with no benefit in terms of postoperative events. Even after surgical treatment, patients in the OMT group had significantly more aneurysmal progression, along with poorer aortic remodeling

Nouvelles données sur l’agglomération antique d’<i>Epomanduodurum</i> (Mandeure et Mathay, Doubs)

International audienceDem antiken Mandeure-Mathay (Epomanduodurum), dem aufgrund seiner Größe und seiner bedeutenden Monumentalbauten im Sequanerland der zweite Platz nach dem Civitas-Hauptort Besançon zukommt, ist seit 2001 ein pluridisziplinäres Forschungsprojekt gewidmet. Im Anschluß an einen im Jahrgang 2007 dieser Zeitschrift vorgelegten Beitrag berichtet das vorliegende Dossier über die Forschungen der Jahre 2005 bis 2011. Parallel zur Weiterführung und Vertiefung der im Bereich der Kult- und Monumentalbauten begonnenen Arbeiten, trieb das Forschungsteam während dieses zweiten Projektabschnittes verschiedene Studien zur gesamten antiken Stadtanlage und der sie umgebenden Mikroregion voran. Diese Untersuchungen liefern neue Einsichten zur Entstehung, Entwicklung und zum Niedergang von Epomanduodurum und tragen zu einem vertieften Verständnis der Gestalt dieser Stadt und ihrer religiösen, ökonomischen und sozialen Organisation im Zeitraum vom Ende der Eisenzeit bis zum Frühmittelalter bei.A collective research program is studying since 2001 the ancient agglomeration of Mandeure-Mathay (Epomanduodurum), considered as second one after the chief town Besançon, in the Sequani territory, by its size and its impressive monumental buildings. This article, following a previous paper published in Gallia in 2007, draws up a report of the researches completed between 2005 and 2011. In this second stage, alongside the ongoing in-depth investigations on cult and monumental area, the PCR (Collective Program Research) team intensified its different studies and researches on the ancient agglomeration and its microregional environment. These studies lead to a better understanding of the appearance, development and decline of Epomanduodurum ; a better knowledge of its morphology, and its religious, economic and social organization between the end of the Iron Age and the Early Middle Ages.L’agglomération antique de Mandeure-Mathay (Epomanduodurum), considérée comme la seconde du pays séquane par ses dimensions et l’ampleur de sa parure monumentale, derrière la capitale de cité, Besançon, fait l’objet d’un programme collectif de recherche (PCR), pluridisciplinaire, depuis 2001. Le présent dossier, qui fait suite à un précédent article paru dans Gallia en 2007, dresse un bilan des recherches réalisées entre 2005 et 2011. Dans cette seconde étape, parallèlement à la poursuite et à l’approfondissement des actions engagées sur le secteur cultuel et monumental, l’équipe du PCR a accentué les études et investigations de diverses natures portant sur l’ensemble de l’agglomération antique et sur l’espace microrégional dans lequel celle-ci s’insère. Ces recherches aboutissent à une meilleure compréhension des modalités d’émergence, de développement et de déclin de la ville d’Epomanduodurum, et à une connaissance plus approfondie de sa morphologie et de son organisation religieuse, économique et sociale, entre la fin de l’âge du Fer et le haut Moyen Âge

Angio Cone-Beam CT (Angio-CBCT) and 3D Road-Mapping for the Detection of Spinal Cord Vascularization in Patients Requiring Treatment for a Thoracic Aortic Lesion: A Feasibility Study

Background: Spinal cord ischemia is a major complication of treatment for descending thoracic aorta (DTA) disease. Our objectives were (1) to describe the value of angiographic cone-beam CT (angio-CBCT) and 3D road-mapping to visualize the Adamkiewicz artery (AA) and its feeding artery and (2) to evaluate the impact of AA localization on the patient surgical strategy. Methods: Between 2018 and 2020, all patients referred to our institution for a surgical DTA disorder underwent a dedicated AA evaluation by angio-CBCT. If the AA feeding artery was not depicted on angio-CBCT, selective artery catheterization was performed, guided by 3D road-mapping. Intervention modifications, based on AA location and one month of neurologic follow-up after surgery, were recorded. Results: Twenty-one patients were enrolled. AA was assessable in 100% of patients and in 15 (71%) with angio-CBCT alone. Among them, 10 patients needed 3D road-mapping-guided DSA angiography to visualize the AA feeding artery. The amount of contrast media, irradiation dose, and intervention length were not significantly different whether the AA was assessable or not by angio-CBCT. AA feeding artery localization led to surgical sketch modification for 11 patients. Conclusions: Angio-CBCT is an efficient method for AA localization in the surgical planning of DTA disorders

Type B Aortic Dissection Treated With a Branched Aortic Arch Stent Graft and the STABILISE Technique

We report the case of a 57-year-old woman diagnosed with an asymptomatic chronic type B aortic dissection. The maximum aortic diameter was 70 mm in the proximal descending thoracic aorta. The entry tear was located at the aortic isthmus, and the proximal neck included all of the supra-aortic trunks. The targeted proximal neck was ≥q 25 mm. The dissection extended to the infrarenal aorta. The patient was treated with a custom branched aortic graft with two branches, one for the innominate trunk and one for the left common carotid artery, combined with the stent-assisted balloon-induced intimal disruption and relamination technique. This combined technique seemed to provide a proximal seal zone in the arch and allow remodeling of the distal aorta in this patient with aneurysmal type B aortic dissection

Feasibility of Non-Invasive Coronary Artery Disease Screening with Coronary CT Angiography before Transcatheter Aortic Valve Implantation

International audienceCoronary artery disease (CAD) screening is usually performed before transcatheter aortic valve implantation (TAVI) by invasive coronary angiography (ICA). Computed coronary tomography angiography (CCTA) has shown good diagnostic performance for CAD screening in patients with a low probability of CAD and is systematically performed before TAVI. CCTA could be an efficient alternative to ICA for CAD screening before TAVI. We sought to investigate the diagnostic performance of CCTA in a population of unselected patients without known CAD who were candidates for TAVI. All consecutive patients referred to our center for TAVI without known CAD were enrolled. All patients underwent CCTA and ICA, which were considered the gold standard. A statistical analysis of the diagnostic performance per patient and per artery was performed. 307 consecutive patients were enrolled. CCTA was non-analyzable in 25 patients (8.9%). In the per-patient analysis, CCTA had a sensitivity of 89.6%, a specificity of 90.2%, a positive predictive value of 65.15%, and a negative predictive value of 97.7%. Only five patients were classified as false negatives on the CCTA. Despite some limitations of the study, CCTA seems reliable for CAD screening in patients without known CAD who are candidates for TAVI. By using CCTA, ICA could be avoided in patients with a CAD-RADS score ≤ 2, which represents 74.8% of patients

Emergency Embolization of a Ruptured Aneurysm of the Internal Iliac Artery by Direct Ultrasound-Guided Puncture: Report of a Case

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Thoracic Aortic Aneurysms and Erdheim-Chester Disease

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Preoperative Inferior Mesenteric Artery Embolization is a Cost-effective Technique that May Reduce the Rate of Aneurysm Sac Diameter Enlargement and Reintervention After EVAR

International audienceBACKGROUND:Type II endoleaks are the most common complications after endovascular repair of abdominal aortic aneurysms (EVARs). Some studies have shown the benefit of preventive inferior mesenteric artery (IMA) embolization, but its efficacy and cost-effectiveness continue to be controversial. The aim of this study was to evaluate the efficacy of this procedure on the increase in aneurysmal sac diameter during follow-up.MATERIALS AND METHODS:All consecutive patients who underwent the embolization of the IMA before EVAR in our center, between January 2014 and July 2016, were included. We retrospectively compared the diameter of the aortic aneurysm sac, the rate of endoleak and reinterventions, and the theoretical cost of management between these patients (group 2) and a historical cohort of patients treated for EVAR before January 2014 who did not undergo prior IMA embolization (group 1).RESULTS:Two hundred twenty-four patients were retrospectively analyzed. After exclusion, we compared a group of 37 embolized patients with a control group of 46 patients. The rate of enlargement in the aneurysmal sac diameter was significantly higher in the control group at 2 years (27.9% vs. 4.3%, P = 0.025). The type II endoleak rate at 2 years was significantly higher in the control group (53.1% vs. 18.2%, P = 0.012), as was the aneurysm-related reintervention rate (31.1% vs. 8.1%, P = 0.013). Multivariate analysis confirmed these results. At 2 years of follow-up, there was no difference in the overall cost of patient management between the 2 groups.CONCLUSIONS:Preventive IMA embolization is an effective, reliable, and cost-effective technique that seems to reduce the rate of the aneurysmal sac diameter enlargement, type II endoleak, and reinterventions after EVAR

A dynamic study of the anterior cruciate ligament of the knee using an open MRI.

Place: GermanyRecent anatomical and radiological studies of the anterior cruciate ligament (ACL) suggest the ACL length and orientation change during knee flexion, and an open MRI sequencing during knee flexion enables a dynamic ACL analysis. This study's goal is to describe a normal ACL using a 1T open MRI and, in particular, variations in length and insertion angles at different degrees of flexion. Twenty-one volunteers with clinically healthy knees received a dynamic MRI with their knees in hyperextension, neutral position, and flexed at 45° and 90° angles. For each position, two radiologists measured the ACL lengths and angles of the proximal insertion between the ACL's anterior edge and the roof of the inter-condylar notch. Additionally, we measured the ACL's and the tibial plateau's distal angle insertion between their anterior edges and then compared these with the nonparametric Wilcoxon test. The ACL had a significant extension between the 90° flexion and all other positions (hyperextension: 31.75 ± 2.5 mm, neutral position: 32.5 ± 2.6 mm, 45°: 35.6 ± 1.6 mm, 90°: 35.6 ± 1.6 mm). There was also a significant increase of the angle insertion between the proximal 90° flexion and all other positions, as well as between hyperextension and bending to 45° (hyperextension: 2.45° ± 3.7°, neutral: 13.4° ± 9.7°, 45°: 33 25 ± 9.3, 90: 51.85° ± 9.3°). Additionally, there is a significant increase in the distal angle insertion for all positions (hyperextension: 133.2° ± 5.4°, neutral position: 134.95° ± 4.4°, 45°: 138.35° ± 5.9°, 90°: 149.15° ± 8.6°). Our study is the first to exhibit that a dynamic MRI has a significant ACL extension in vivo during bending. This concept opens the way for further studies to improve the diagnosis of traumatic ACL injuries using a dynamic MRI