Lifelong aortic risk in Turner syndrome: Unexpected aortic events in asymptomatic patients.

Individuals with Turner syndrome (TS) face a high relative risk of acute aortic dissection compared with the general population. Dissection risk is greatest in those who have congenital heart disease, thoracic aortic aneurysms, or hypertension. This case report features two adult patients with TS who presented with asymptomatic thoracic aortic pathologies that were identified on routine surveillance imaging.

Predicting Late Adverse Events in Uncomplicated Stanford Type B Aortic Dissection: Results From the ROADMAP Validation Study.

Background: Risk stratification is highly desirable in patients with uncomplicated Stanford type B aortic dissection but inadequately supported by evidence. We sought to validate externally a published prediction model for late adverse events (LAEs), consisting of 1 clinical (connective tissue disease) and 4 imaging variables: maximum aortic diameter, false lumen circumferential angle, false lumen outflow, and number of identifiable intercostal arteries.

Methods: We assembled a retrospective multicenter cohort (ROADMAP [Registry of Aortic Diseases to Model Adverse Events and Progression]) of 401 patients with uncomplicated Stanford type B aortic dissection presenting to 1 of 8 aortic centers between 2001 and 2013, followed until 2020.

Cardiomegaly Status After Open Repair of an Arch Aneurysm.

This report describes a patient with a thoracic aortic aneurysm who presented with chest pain and dyspnea. Preoperative studies revealed a massive cardiomediastinal silhouette. Within hours after the operation, a profound reduction in cardiomegaly was observed.

Outcomes after open repair of aortic aneurysms and dissections in cannabis consumers.

Objective: To investigate the influence of cannabis consumption on the mid- and long-term surgical outcomes of patients with aortic aneurysms or dissections.

Methods: All individuals aged 18 years and older with more than 6 months of cannabis use at the time of surgical repair for cardiovascular disease (aortic aneurysms or aortic dissection) between 2007 and 2023 were eligible. Patients were stratified into 2 groups based on their preoperative history of cannabis use: cannabis users and noncannabis users.

Case studies in heritable vascular disease: Proceedings of the UTHealth Houston Multidisciplinary Aortic Conference.

Heritable thoracic aortic disease is caused by dominantly inherited mutations in more than a dozen genes, including mutations that cause Loeys-Dietz syndrome. McGovern Medical School at UTHealth Houston convenes a regular conference that includes cardiothoracic and vascular surgeons, cardiologists, geneticists, radiologists, and pathologists to formulate multidisciplinary approaches for the management of complex heritable thoracic aortic disease cases. In this report, we highlight the unique management of individuals with distinct presentations of Loeys-Dietz syndrome owing to mutations.

Routine intercostal artery reattachment strategy reduces delayed and permanent spinal cord injury after open descending thoracic and thoracoabdominal aortic aneurysm repair.

Objective: During open descending thoracic and thoracoabdominal aortic aneurysm (DTAA/TAAA) repair, we used a routine T8-T12 intercostal artery (ICA) reattachment strategy from July 2004 to June 2009 and after 2017, we used a selective ICA reattachment strategy (reattaching T8-T12 ICAs only when neuromonitor signals were lost) from July 2009 to 2016. This study reviewed our nearly 2-decade experience to assess the impact of 2 ICA reattachment strategies on spinal cord injury (SCI).

Methods: All open DTAA/TAAA repairs performed from July 2004 to June 2022 were included, except for cases without intraoperative cerebral spinal fluid drainage.

Navigating clinical appropriateness: A review of management strategies for type B aortic dissection.

Aortic dissection is a catastrophic, life-threatening event. Its management depends on the anatomic location of the intimal tear (type A v B) and the clinical presentation in type B aortic dissection. In this article, the current evidence supporting clinical practice, gaps in knowledge, and the need for more rigorous research and higher-quality studies are reviewed.

Vascular Surgeon Involvement in Pulmonary Embolism Response Teams: Barriers, Challenges, Concerns and the Imperative for Integration.

Background: The effective management of pulmonary embolism (PE) necessitates coordinated care among physicians from diverse specialties within a time-sensitive framework. Pulmonary Embolism Response Teams (PERTs) have been developed as a strategic approach to optimize and expedite treatment by integrating and coordinating different specialties. The current survey audit aimed to understand the level of interest among vascular surgeons and the logistical considerations surrounding their participation within the PERT.

Open repair with latissimus muscle flap coverage for treatment of infected thoracic endovascular aneurysm repair.

A male patient, 70 years of age, was evaluated for an infected thoracic endovascular aneurysm repair (TEVAR). After presenting with persistent fever, a positron emission tomography scan found an infected aortic stent graft. The patient underwent open repair with explantation of the infected TEVAR, extensive periaortic debridement, graft replacement with a Dacron graft, and complete coverage with a latissimus dorsi muscle flap.

Insights From the Histopathologic Analysis of Acquired and Genetic Thoracic Aortic Aneurysms and Dissections.

Objective: The purpose of this study was to apply contemporary consensus criteria developed by the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology to the evaluation of aortic pathology, with the expectation that the additional pathologic information may enhance the understanding and management of aortic diseases.

Methods: A scoring system was applied to ascending aortic specimens from 42 patients with heritable thoracic aortic disease and known genetic variations and from 86 patients from a single year, including patients with known genetic variations (n = 12) and patients with sporadic disease (n = 74).

Results: The various types of lesions of medial degeneration and the overall severity of medial degeneration overlapped considerably between those patients with heritable disease and those with sporadic disease; however, patients with heritable thoracic aortic disease had significantly more overall medial degeneration (P = .

Outcomes of cardiothoracic surgery in women with Turner syndrome.

Background: To describe short- and mid-term surgical outcomes of patients with Turner syndrome (TS) after cardiovascular interventions.

Methods: All individuals >12 years of age at the time of surgical repair for cardiovascular disease (valve or coarctation repairs, aortic disease, aortic dissection) from 2002 to 2022 were eligible. The primary endpoint was complications or death within 30 days of intervention.

Presentation and outcomes of thoracic and thoracoabdominal aortic aneurysms in females, existing gaps, and future directions: A descriptive review.

Thoracic and thoracoabdominal aortic aneurysms are more common in men. Yet, females often have worse outcomes, fewer interventions, and lower treatment rates. Females have also benefited less from the research and treatment of those diseases than men.

Hybrid management of type B aortic dissection in a patient with right-sided aortic arch and aberrant left subclavian artery.

This report describes a patient with a right-sided aortic arch, aberrant left subclavian artery and Kommerell diverticulum, who presented with aneurysmal degeneration of the aortic root to the descending aorta, in addition to an acute type B aortic dissection. He underwent hybrid treatment with a valve-sparing aortic root replacement, transverse arch replacement with reattachment of the right subclavian artery, bilateral common carotid arteries, and thoracic endovascular aneurysm repair with left subclavian artery embolization and a left common carotid to subclavian artery bypass.

International Multi-Institutional Experience with Presentation and Management of Aortic Arch Laterality in Aberrant Subclavian Artery and Kommerell's Diverticulum.

Background: Aberrant subclavian artery (ASA) with or without Kommerell's diverticulum (KD) is a rare anatomic aortic arch anomaly that can cause dysphagia and/or life-threatening rupture. The objective of this study is to compare outcomes of ASA/KD repair in patients with a left versus right aortic arch.

Methods: Using the Vascular Low Frequency Disease Consortium methodology, a retrospective review was performed of patients ≥18 years old with surgical treatment of ASA/KD from 2000 to 2020 at 20 institutions.

Contemporary outcomes after treatment of aberrant subclavian artery and Kommerell's diverticulum.

Objective: Aberrant subclavian artery (ASA) and Kommerell's diverticulum (KD) are rare vascular anomalies that may be associated with lifestyle-limiting and life-threatening complications. The aim of this study is to report contemporary outcomes after invasive treatment of ASA/KD using a large international dataset.

Methods: Patients who underwent treatment for ASA/KD (2000-2020) were identified through the Vascular Low Frequency Disease Consortium, a multi-institutional collaboration to investigate uncommon vascular disorders.

Registry of Aortic Diseases to Model Adverse Events and Progression (ROADMAP) in Uncomplicated Type B Aortic Dissection: Study Design and Rationale.

Purpose: To describe the design and methodological approach of a multicenter, retrospective study to externally validate a clinical and imaging-based model for predicting the risk of late adverse events in patients with initially uncomplicated type B aortic dissection (uTBAD).

Materials And Methods: The Registry of Aortic Diseases to Model Adverse Events and Progression (ROADMAP) is a collaboration between 10 academic aortic centers in North America and Europe. Two centers have previously developed and internally validated a recently developed risk prediction model.

Inter-observer variability of expert-derived morphologic risk predictors in aortic dissection.

Objectives: Establishing the reproducibility of expert-derived measurements on CTA exams of aortic dissection is clinically important and paramount for ground-truth determination for machine learning.

Methods: Four independent observers retrospectively evaluated CTA exams of 72 patients with uncomplicated Stanford type B aortic dissection and assessed the reproducibility of a recently proposed combination of four morphologic risk predictors (maximum aortic diameter, false lumen circumferential angle, false lumen outflow, and intercostal arteries). For the first inter-observer variability assessment, 47 CTA scans from one aortic center were evaluated by expert-observer 1 in an unconstrained clinical assessment without a standardized workflow and compared to a composite of three expert-observers (observers 2-4) using a standardized workflow.

Imaging and Surveillance of Chronic Aortic Dissection: A Scientific Statement From the American Heart Association.

All patients surviving an acute aortic dissection require continued lifelong surveillance of their diseased aorta. Late complications, driven predominantly by chronic false lumen degeneration and aneurysm formation, often require surgical, endovascular, or hybrid interventions to treat or prevent aortic rupture. Imaging plays a central role in the medical decision-making of patients with chronic aortic dissection.

Assessment of histological characteristics, imaging markers, and rt-PA susceptibility of ex vivo venous thrombi.

Venous thromboembolism is a significant source of morbidity and mortality worldwide. Catheter-directed thrombolytics is the primary treatment used to relieve critical obstructions, though its efficacy varies based on the thrombus composition. Non-responsive portions of the specimen often remain in situ, which prohibits mechanistic investigation of lytic resistance or the development of diagnostic indicators for treatment outcomes.

Glossary of terms and concepts relating to diversity, equity, and inclusion to reflect on, debate, and raise awareness of: A report from the Society for Vascular Surgery Diversity, Equity, and Inclusion Committee.

The presented glossary highlights the concepts and terminology related to diversity, equity, and inclusion. Although this list should not be considered all-inclusive, it will provide our vascular surgical community with a common vocabulary to help propel change toward improved diversity, equity, and inclusion policies, practices, and culture. As these concepts and terminology find their place in our everyday lives, the Society for Vascular Surgery and its leadership believe that expanding the diversity, equity, and inclusion of vascular surgical professionals is a mission-critical step.