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Dominik Fleischmann - One of the best experts on this subject based on the ideXlab platform.
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A pictorial review of Acute Aortic Syndrome: discriminating and overlapping features as revealed by ECG-gated multidetector-row CT angiography
Insights into Imaging, 2012Co-Authors: Takuya Ueda, Anne Chin, Ivan Petrovitch, Dominik FleischmannAbstract:Background The term "Acute Aortic Syndrome" (AAS) encompasses a spectrum of life-threatening conditions characterized by Acute Aortic pain. AAS traditionally embraces three abnormalities including classic Aortic dissection, intramural haematoma, and penetrating atherosclerotic ulcer. Although the underlying etiologies and conditions predisposing to AAS are diverse, the clinical features are indistinguishable. Methods Multidetector-row computed tomography (CT) with electrocardiographic gating (ECG-gated MDCT) has greatly improved imaging of Acute thoracic Aortic diseases by virtually eliminating pulsation artifacts transmitted from cardiac motion and reveals subtle Aortic abnormalities, which have been difficult to recognize by conventional non-gated CT. Results While these advances in imaging technology provide additional discriminating features of Acute Aortic diseases, they also reveal a range of overlapping features of these life-threatening conditions that not uncommonly are dynamic and evolving. These overlapping and transitional features may be a major source of misunderstanding, confusion, and controversy for diseases that cause AAS. Conclusion In this pictorial review, we describe the discriminating and typical imaging features as revealed by modern ECG-gated MDCT angiography. In addition to the discriminating features, recognition of the overlapping and transitional features in AAS will allow a more comprehensive understanding of their underlying pathophysiologic conditions and their natural history, and may improve therapeutic management. Main Messages • The superior visualization of ECG-gated CTA improves the diagnostic accuracy of Acute Aortic Syndrome. • ECG-gated CTA provides discriminating features of underlying pathophysiologic conditions of AAS. • Also, recognition of the overlapping features in AAS will allow a more comprehensive understanding.
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a pictorial review of Acute Aortic Syndrome discriminating and overlapping features as revealed by ecg gated multidetector row ct angiography
Insights Into Imaging, 2012Co-Authors: Takuya Ueda, Anne Chin, Ivan Petrovitch, Dominik FleischmannAbstract:Background The term "Acute Aortic Syndrome" (AAS) encompasses a spectrum of life-threatening conditions characterized by Acute Aortic pain. AAS traditionally embraces three abnormalities including classic Aortic dissection, intramural haematoma, and penetrating atherosclerotic ulcer. Although the underlying etiologies and conditions predisposing to AAS are diverse, the clinical features are indistinguishable.
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State-of-the-art computed tomography angiography of Acute Aortic Syndrome.
Seminars in ultrasound CT and MR, 2012Co-Authors: Anne S. Chin, Dominik FleischmannAbstract:Acute Aortic Syndrome refers to a spectrum of Acute life-threatening Aortic abnormalities requiring prompt recognition and treatment. Although underlying pathologies are diverse, presenting signs and symptoms are often indistinguishable clinically, underscoring the role of imaging to make the correct diagnosis. Computed tomography (CT) angiography, a safe and accessible imaging modality, is paramount in accurately confirming or excluding critical Aortic lesions, defining location and extent, and describing associated complications. Electrocardiographic gating further improves diagnostic precision of CT, providing motion-free 3- and 4-dimensional imaging of the entire aorta. This article reviews the imaging spectrum and state-of-the-art CT for patients presenting with Acute Aortic Syndrome.
Ferco H Berger - One of the best experts on this subject based on the ideXlab platform.
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Acute Aortic Syndrome and blunt traumatic Aortic injury pictorial review of mdct imaging
European Journal of Radiology, 2010Co-Authors: Ferco H Berger, Krijn P Van Lienden, Robin Smithuis, Savvas Nicolaou, Otto M Van DeldenAbstract:Thoracic Aortic emergencies have high mortality and morbidity and should be diagnosed accurately and treated promptly. Advances in treatment options have increased survival and management choices heavily depend on imaging findings. Speed, accuracy and availability have made Multi Detector Computer Tomography (MDCT) the first line modality in evaluating thoracic Aortic emergencies and radiologists should be familiar with findings in these conditions. In this paper a pictorial review of the Acute Aortic Syndrome and Blunt Traumatic Aortic Injury will be given.
Christoph A. Nienaber - One of the best experts on this subject based on the ideXlab platform.
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impact of a streamlined rotational system for the management of Acute Aortic Syndrome sharing is caring
European Journal of Cardio-Thoracic Surgery, 2019Co-Authors: Ricky Vaja, Christoph A. Nienaber, Shagorika Talukder, Mindaugas Norkunas, Ross Hoffman, John Pepper, Ulrich Rosendahl, George Asimakopoulos, Cesare QuartoAbstract:Objectives Acute type A Aortic dissection is an emergency associated with up to 30% of hospital mortality. It has been established that outcomes are improved with specialist Aortic team care in high-volume centres. Most centres are limited to a small number of Aortic specialists, thus making it logistically impractical to have a dedicated 24/7 single-centre service. In 2011, a rotational 24/7 service between 3 centres covering a geographical location was introduced including 24/7 access to a dissection 'Hotline'. Methods We analysed data since 2003 from a prospectively collected database. A total of 227 patients underwent surgery for Acute Aortic Syndrome between 2003 and 2017. The results on outcomes were compared before and after the initiation of the dissection hotline and 24/7 dedicated service. Results We identified 128 patients from the pre-rotational group and 99 patients from the post-rotational group. Both groups were well matched in terms of demographics and comorbidities. In the post-rotational group, there was an increase in arch surgery (11.8% vs 20.2%, P: 0.07). The introduction of the rotational service reduced 30-day mortality (20% vs 8%, P: 0.010). The introduction of the service improved the overall long-term survival [P: 0.04, hazard ratio 1.86; confidence interval (1.03-3.38)] in the multivariable analysis. There was no difference between the groups in postoperative complications. There was an increase in the median length of hospital stay in the post-rotational group (13 days vs 20 days, P: 0.014). Conclusions A streamlined Aortic dissection service allows for centralized care. This provides the referring centres with 24/7 access to an experienced Aortic team and may improve patient outcomes.
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Endovascular “neobranching” to manage Acute Aortic Syndrome
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 2016Co-Authors: Isabelle L. Vandormael, Mohammad Yousuf Salmasi, James S‐m Yeh, Christoph A. NienaberAbstract:Acute Aortic Syndrome was coined in 2001 to describe a spectrum of Acute Aortic wall pathologies. The Syndrome represents a cluster of Aortic conditions such as Aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer. Acute Aortic dissection is more common than the latter two pathologies with an incidence of up to 6 cases per 100,000 per year. The following report focuses on an unusual case presentation emphasizing the newest management techniques including "neobranching" whilst dealing with challenging patient anatomy and refractory hypertension. We believe this case report eventually broadens our understanding of Acute Aortic Syndrome whilst addressing an entry tear outside the aorta by placing "neobranches". © 2016 Wiley Periodicals, Inc.
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Acute Aortic Syndrome
Deutsche medizinische Wochenschrift (1946), 2016Co-Authors: Christoph A. NienaberAbstract:Acute Aortic Syndrome is the common denominator for Acute events to the Aortic wall and encompasses dissection of the aorta, intramural hematoma, formation of Aortic ulcers and trauma to the aorta with an annual incidence of up to 35 cases/100.000 between 65 and 75 years of age. Both, inflammation and/or microtrauma at the level of the Aortic media layer, and a genetic disposition are promoting elements of AAS, while the extent and anatomic involvement of the ascending aorta call for either surgical resection/repair in the proximal part of the aorta, or an endovascular solution for pathologies in the distal aorta; in all cases of dissection (regardless of location) reconstruction/realignment has been proven to portend better long-term outcomes (in addition to medical management of blood pressure).
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Management of Acute Aortic Syndrome.
Nature reviews. Cardiology, 2014Co-Authors: Rachel E. Clough, Christoph A. NienaberAbstract:Acute Aortic Syndrome (AAS) encompasses Acute Aortic dissection, intramural haematoma, and penetrating Aortic ulcer, a group of conditions that carry a risk of imminent Aortic rupture. The development of these disorders has been linked to a number of pathologies, including untreated hypertension and connective tissue disorders. In this Review, Clough and Nienaber discuss the epidemiology, diagnostic strategies, and treatment options for each condition.
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The role of imaging in Acute Aortic Syndromes
European heart journal cardiovascular Imaging, 2012Co-Authors: Christoph A. NienaberAbstract:The classic entity of life-threatening Aortic dissection represents one pathology of a spectrum of Acute conditions coined the Acute Aortic Syndrome comprising dissection, intramural haematoma, penetrating atherosclerotic ulcer, and contained Aortic rupture of any cause. The common denominator is disruption of the Aortic media layers associated with severe pain and a variety of other symptoms. Any clinical suspicion of Acute Aortic Syndrome should prompt immediate action and confirmatory non-invasive imaging; with respect to sensitivity and specificity for Acute Aortic pathology modern contrast-enhanced CT technology, MR imaging and ultrasound techniques have similar diagnostic accuracy near 100%. Since the prognosis of most patients with Acute Aortic dissection is related to undelayed diagnosis and (often surgical) treatment swift diagnostic imaging should be the primary goal in the work-up of any patient with suspected Acute Aortic Syndrome; transfer and in-hospital logistics and local expertise for the differential use of various imaging modalities should be constantly improved.
Otto M Van Delden - One of the best experts on this subject based on the ideXlab platform.
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Acute Aortic Syndrome and blunt traumatic Aortic injury pictorial review of mdct imaging
European Journal of Radiology, 2010Co-Authors: Ferco H Berger, Krijn P Van Lienden, Robin Smithuis, Savvas Nicolaou, Otto M Van DeldenAbstract:Thoracic Aortic emergencies have high mortality and morbidity and should be diagnosed accurately and treated promptly. Advances in treatment options have increased survival and management choices heavily depend on imaging findings. Speed, accuracy and availability have made Multi Detector Computer Tomography (MDCT) the first line modality in evaluating thoracic Aortic emergencies and radiologists should be familiar with findings in these conditions. In this paper a pictorial review of the Acute Aortic Syndrome and Blunt Traumatic Aortic Injury will be given.
Venu Menon - One of the best experts on this subject based on the ideXlab platform.
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transfer metrics in patients with suspected Acute Aortic Syndrome
Circulation-cardiovascular Quality and Outcomes, 2014Co-Authors: Bhuvnesh Aggarwal, Chad Raymond, Jessen Jacob, Damon Kralovic, Kristopher Kormos, David Holloway, Mandeep Singh Randhawa, Eric E Roselli, Matthew J Eagleton, Venu MenonAbstract:National guidelines by the American College of Cardiology, American Heart Association, and European Society of Cardiology have established benchmarks for patient transfer times (door-in-door-out time and door-to-balloon time) that serve as clinical performance measures for ST-segment–elevation myocardial infarction (STEMI) networks. Campaigns, such as D2B Alliance and Mission Lifeline, were also launched in an effort to reduce system delays in transfer and improve outcomes for subjects presenting with STEMI.1 This scrutiny on pre- and interhospital care has led to marked reductions in door-to-balloon times across the United States.2 Unlike STEMI, Acute Aortic Syndrome (AAS) defined as Acute Aortic dissection, intramural hematoma, or penetrating Aortic ulcer is a less frequent clinical event that lacks an effective diagnostic biomarker and requires definitive imaging for confirmation. The time-sensitive nature of AAS, complexity of surgery, and endovascular intervention and the relative paucity of institutions that deliver 24/7 state-of-the-art care strongly advocates for regional systems of care across the United States. Successful transfer of patients with AAS has previously been described through such efficient regional care models.3,4 Our aim was to evaluate safety and timeliness of transfer provided by our regional Aortic network. The transfer metrics served by this analysis will help us improve as a network and more importantly serve as a benchmark to be replicated and improved on by others. Our AAS network shares a common hotline with our STEMI and stroke networks. On activation, a transfer team is dispatched immediately to the referring center. The transfer system is operated by critical care trained nurse practitioners and paramedics, who are equipped in handling all cardiovascular emergencies under direct consultation with cardiac intensive care unit (CCU) physicians. The transfer team’s goal is to expedite safe …
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prevalence and factors associated with false positive suspicion of Acute Aortic Syndrome experience in a patient population transferred to a specialized Aortic treatment center
Cardiovascular diagnosis and therapy, 2013Co-Authors: Chad Raymond, Paul Schoenhagen, Bhuvnesh Aggarwal, Damon Kralovic, Kristopher Kormos, David Holloway, Venu MenonAbstract:Study objective: Acute Aortic Syndrome (AAS) is a medical emergency that requires prompt diagnosis and treatment at specialized centers. We sought to determine the frequency and etiology of false positive activation of a regional AAS network in a patient population emergently transferred for suspected AAS. Methods: We evaluated 150 consecutive patients transferred from community emergency departments directly to our Cardiac Intensive Care Unit (CICU) with a diagnosis of suspected AAS between March, 2010 and August, 2011. A final diagnosis of confirmed Acute Type A, Acute Type B dissection, and false positive suspicion of dissection was made in 63 (42%), 70 (46.7%) and 17 (11.3%) patients respectively. Results: Of the 17 false positive transfers, ten (58.8%) were suspected Type A dissection and seven (41.2%) were suspected Type B dissection. The initial hospital diagnosis in 15 (88.2%) patients was made by a computed tomography (CT) scan and 10 (66.6%) of these patients required repeat imaging with an ECG-synchronized CT to definitively rule out AAS. Five (29.4%) patients had prior history of open or endovascular Aortic repair. Overall in-hospital mortality was 9.3%. Conclusions: The diagnosis of AAS is confirmed in most patients emergently transferred for suspected AAS. False positive activation in this setting is driven primarily by uncertainty secondary to motion-artifact of the ascending aorta and the presence of complex anatomy following prior Aortic intervention. Network-wide standardization of imaging strategies, and improved sharing of imaging may further improve triage of this complex patient population.
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transfer of patients with suspected Acute Aortic Syndrome
American Journal of Cardiology, 2013Co-Authors: Bhuvnesh Aggarwal, Chad Raymond, Jessen Jacob, Damon Kralovic, Kristopher Kormos, David Holloway, Venu MenonAbstract:Patients with Acute Aortic Syndrome (AAS) often require emergent transfer for definitive therapy. The aim of this study was to evaluate the safety of transfer and the ability to optimize hemodynamics in subjects with AAS transported by an Aortic network. A total of 263 consecutive patients with suspected AAS transferred to a coronary care unit from March 2010 to June 2012 were included. Transfers were accomplished by the institutional critical care transfer system using ground ambulance (n = 47), helicopter (n = 196), or fixed-wing jet (n = 20) from referring centers directly to the coronary care unit, bypassing the emergency department. The transfer mortality rate was 0%, and the in-hospital mortality rate was 9% (n = 23). Initial systolic blood pressure and heart rate at the time of arrival of the transfer team to the referring hospital were compared with those on arrival to the coronary care unit. The median transfer distance was 66 km (interquartile range 24 to 119), and the median transfer time was 87 minutes (interquartile range 67 to 114). The transfer team achieved significant reductions in systolic blood pressure (from 142 ± 29 to 132 ± 23 mm Hg) (mean difference in systolic blood pressure 10 mm Hg, 95% confidence interval 7 to 14, p
