BACKGROUND: Surgery for Stanford type A aortic dissection (TAAD) is associated with an increased risk of late aortic reoperations due to degeneration of the dissected aorta. METHODS: The subjects of this analysis were 990 TAAD patients who survived surgery for acute TAAD and had complete data on the diameter and dissection status of all aortic segments. RESULTS: After a mean follow-up of 4.2 ± 3.6 years, 60 patients underwent 85 distal aortic reoperations. Ten-year cumulative incidence of distal aortic reoperation was 9.6%. Multivariable competing risk analysis showed that the maximum preoperative diameter of the abdominal aorta (SHR 1.041, 95%CI 1.008-1.075), abdominal aorta dissection (SHR 2.133, 95%CI 1.156-3.937) and genetic syndromes (SHR 2.840, 95%CI 1.001-8.060) were independent predictors of distal aortic reoperation. Patients with a maximum diameter of the abdominal aorta >30 mm and/or abdominal aortic dissection had a cumulative incidence of 10-year distal aortic reoperation of 12.0% compared to 5.7% in those without these risk factors (adjusted SHR 2.076, 95%CI 1.062-4.060). CONCLUSION: TAAD patients with genetic syndromes, and increased size and dissection of the abdominal aorta have an increased the risk of distal aortic reoperations. A policy of extensive surgical or hybrid primary aortic repair, completion endovascular procedures for aortic remodeling and tight surveillance may be justified in these patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04831073.

• Klíčová slova
• Aortic dissection, Diameter, Genetic syndrome, Loeys-Dietz syndrome, Marfan syndrome, Reoperation, Size, Type A aortic dissection, Vascular Ehlers-Danlos syndrome,
• MeSH
• aneurysma hrudní aorty * chirurgie   MeSH
• aorta abdominalis diagnostické zobrazování   chirurgie   MeSH
• aortální aneurysma * chirurgie   MeSH
• azidy * MeSH
• cévy - implantace protéz * škodlivé účinky   MeSH
• deoxyglukosa analogy a deriváty   MeSH
• disekce aorty * diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• 1,3,4,6-tetra-O-acetyl-2-azido-2-deoxyglucopyranose MeSH Prohlížeč
• azidy * MeSH
• deoxyglukosa MeSH

INTRODUCTION: Thoracic aorta false aneurysms (TAFA) are unexplored complications after cardiac surgery associated with significant morbidity and mortality. Therefore, the purpose of this study was to examine the clinical profiles, surgical techniques, and operative outcomes, of patients treated for TAFA at a single institution. METHODS: From 1996 to 2022, 112 patients were treated for aortic pseudoaneurysm (mean age 55 ± 14 years, 78 patients were male). In the majority of the patients (90%) TAFA developed after previous cardiovascular surgery, the most common diagnosis and surgical procedure preceding the TAFA development was an aortic dissection (52%) and Bentall procedure (47%). In the rest of the cohort, the leading cause was trauma. RESULTS: Sixty-one percent of patients were indicated for reintervention (surgical reoperation, endoluminal graft implantation, septal occluder implantation, coil embolization, or a combination of procedures). Overall, 52 patients had undergone cardiac reoperation. TAFA was resected and the aorta was repaired in 55% or replaced in 45%. Operative mortality was 5.7%. In postoperative follow-up, a hypoechogenic lesion encircling aortic prosthesis was present in 94%, therefore it was determined as a negative prognostic factor. The mean follow-up was 13.2 ± 19.4 years. CONCLUSION: Although there is no specific approach how to prevent TAFA development, maintaining normal blood pressure and regular follow-up should be applied. More frequent follow-ups should be performed in patients with a hypoechogenic lesion encircling and aortic prosthesis. Early detection during long-term postoperative follow-up, an individually tailored approach of a multidisciplinary team is necessary for favorable treatment outcomes.

• Klíčová slova
• Aortic dissection, Aortic pseudoaneurysm, Bentall surgery, Endoluminal graft implantation, Septal occluder implantation,
• MeSH
• aneurysma hrudní aorty * chirurgie   MeSH
• aorta thoracica chirurgie   diagnostické zobrazování   MeSH
• časové faktory MeSH
• cévy - implantace protéz škodlivé účinky   MeSH
• dospělí MeSH
• endovaskulární výkony škodlivé účinky   MeSH
• kombinovaná terapie MeSH
• lidé středního věku MeSH
• lidé MeSH
• nepravé aneurysma * chirurgie   etiologie   diagnostické zobrazování   terapie   MeSH
• pooperační komplikace etiologie   chirurgie   MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

We report a case of a 44-year-old woman surgically treated for tetralogy of Fallot who experienced an acute and extensive Stanford A type aortic dissection despite the meticulous follow-up. While aortic dilatation is prevalent in individuals with repaired tetralogy of Fallot, aortic dissection represents a rare consequence, that when it appears, is progressive and usually detected during the check-up visits. In the case reported, the dissection was unexpected and severe, and the patient's clinical state worsened suddenly, leading to death after a few days. Constant awareness for aortic aneurysms is essential in the Fallot tetralogy population, nevertheless, several causes may contribute to the acute worsening of the clinical condition until the patient's death.

• Klíčová slova
• Aortic dissection, CT, Echocardiography, Emergency, TOF, Tetralogy of Fallot,
• MeSH
• aneurysma hrudní aorty etiologie   chirurgie   diagnóza   MeSH
• disekce aorty * etiologie   chirurgie   diagnóza   MeSH
• dospělí MeSH
• Fallotova tetralogie * chirurgie   komplikace   diagnóza   MeSH
• fatální výsledek MeSH
• lidé MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Surgery for type A aortic dissection (TAAD) is frequently complicated by neurologic complications. The prognostic impact of neurologic complications of different nature has been investigated in this study. The subjects of this analysis were 3,902 patients who underwent surgery for acute TAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD). During the index hospitalization, 722 patients (18.5%) experienced stroke/global brain ischemia. Ischemic stroke was detected in 539 patients (13.8%), hemorrhagic stroke in 76 patients (1.9%) and global brain ischemia in 177 patients (4.5%), with a few patients having had findings of more than 1 of these conditions. In-hospital mortality was increased significantly in patients with postoperative ischemic stroke (25.6%, adjusted odds ratio [OR] 2.422, 95% confidence interval [CI] 1.825 to 3.216), hemorrhagic stroke (48.7%, adjusted OR 4.641, 95% CI 2.524 to 8.533), and global brain ischemia (74.0%, adjusted OR 22.275, 95% CI 14.537 to 35.524) compared with patients without neurologic complications (13.5%). Similarly, patients who experienced ischemic stroke (46.3%, adjusted hazard ratio [HR] 1.719, 95% CI 1.434 to 2.059), hemorrhagic stroke (62.8%, adjusted HR 3.236, 95% CI 2.314 to 4.525), and global brain ischemia (83.9%, adjusted HR 12.777, 95% CI 10.325 to 15.810) had significantly higher 5-year mortality than patients without postoperative neurologic complications (27.5%). The negative prognostic effect of neurologic complications on survival vanished about 1 year after surgery. In conclusion, postoperative ischemic stroke, hemorrhagic stroke, and global cerebral ischemia increased early and midterm mortality after surgery for acute TAAD. The magnitude of risk of mortality increased with the severity of the neurologic complications, with postoperative hemorrhagic stroke and global brain ischemia being highly lethal complications.

• Klíčová slova
• aortic dissection, global cerebral ischemia, stroke, type A aortic dissection,
• MeSH
• aneurysma hrudní aorty * chirurgie   mortalita   MeSH
• disekce aorty * chirurgie   mortalita   MeSH
• hemoragická cévní mozková příhoda epidemiologie   MeSH
• ischemická cévní mozková příhoda * epidemiologie   MeSH
• ischemie mozku etiologie   epidemiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• míra přežití trendy   MeSH
• mortalita v nemocnicích * trendy   MeSH
• pooperační komplikace * epidemiologie   MeSH
• prognóza MeSH
• registrace * MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH

BACKGROUND: Extended aortic repair is considered a key issue for the long-term durability of surgery for DeBakey type 1 aortic dissection. The risk of aortic degeneration may be higher in young patients due to their long life expectancy. The early outcome and durability of aortic surgery in these patients were investigated in the present study. METHODS: The subjects of the present analysis were patients under 60 years old who underwent surgical repair for acute DeBakey type 1 aortic dissection at 18 cardiac surgery centres across Europe between 2005 and 2021. Patients underwent ascending aortic repair or total aortic arch repair using the conventional technique or the frozen elephant trunk technique. The primary outcome was 5-year cumulative incidence of reoperation on the distal aorta. RESULTS: Overall, 915 patients underwent surgical ascending aortic repair and 284 patients underwent surgical total aortic arch repair. The frozen elephant trunk procedure was performed in 128 patients. Among 245 propensity score-matched pairs, total aortic arch repair did not decrease the rate of distal aortic reoperation compared to ascending aortic repair (5-year cumulative incidence, 6.7% versus 6.7%, subdistributional hazard ratio 1.127, 95% c.i. 0.523 to 2.427). Total aortic arch repair increased the incidence of postoperative stroke/global brain ischaemia (25.7% versus 18.4%, P = 0.050) and dialysis (19.6% versus 12.7%, P = 0.003). Five-year mortality was comparable after ascending aortic repair and total aortic arch repair (22.8% versus 27.3%, P = 0.172). CONCLUSIONS: In patients under 60 years old with DeBakey type 1 aortic dissection, total aortic arch replacement compared with ascending aortic repair did not reduce the incidence of distal aortic operations at 5 years. When feasible, ascending aortic repair for DeBakey type 1 aortic dissection is associated with satisfactory early and mid-term outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04831073.

• MeSH
• aneurysma hrudní aorty chirurgie   mortalita   MeSH
• aorta thoracica * chirurgie   MeSH
• cévy - implantace protéz * metody   škodlivé účinky   mortalita   MeSH
• disekce aorty * chirurgie   mortalita   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace * epidemiologie   MeSH
• reoperace * statistika a číselné údaje   MeSH
• retrospektivní studie MeSH
• tendenční skóre MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Evropa epidemiologie   MeSH

Surgery for type A aortic dissection (TAAD) is associated with a high risk of early mortality. The prognostic impact of a new classification of the urgency of the procedure was evaluated in this multicenter cohort study. Data on consecutive patients who underwent surgery for acute TAAD were retrospectively collected in the multicenter, retrospective European Registry of TAAD (ERTAAD). The rates of in-hospital mortality of 3,902 consecutive patients increased along with the ERTAAD procedure urgency grades: urgent procedure 10.0%, emergency procedure grade 1 13.3%, emergency procedure grade 2 22.1%, salvage procedure grade 1 45.6%, and salvage procedure grade 2 57.1% (p <0.0001). Preoperative arterial lactate correlated with the urgency grades. Inclusion of the ERTAAD procedure urgency classification significantly improved the area under the receiver operating characteristics curves of the regression model and the integrated discrimination indexes and the net reclassification indexes. The risk of postoperative stroke/global brain ischemia, mesenteric ischemia, lower limb ischemia, dialysis, and acute heart failure increased along with the urgency grades. In conclusion, the urgency of surgical repair of acute TAAD, which seems to have a significant impact on the risk of in-hospital mortality, may be useful to improve the stratification of the operative risk of these critically ill patients. This study showed that salvage surgery for TAAD is justified because half of the patients may survive to discharge.

• Klíčová slova
• aortic dissection, cardiopulmonary resuscitation, emergency, salvage, type A aortic dissection, urgency,
• MeSH
• azidy * MeSH
• deoxyglukosa analogy a deriváty   MeSH
• disekce aorty * chirurgie   MeSH
• kohortové studie MeSH
• lidé MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Názvy látek
• 1,3,4,6-tetra-O-acetyl-2-azido-2-deoxyglucopyranose MeSH Prohlížeč
• azidy * MeSH
• deoxyglukosa MeSH

BACKGROUND: Brain strokes comprise the third leading cause of death worldwide. Microsurgical clipping is recognized as being one of the most effective approaches to the treatment of brain aneurysms. The incomplete closure of the distal-side aneurysm neck is the most common cause of the persistent filling of the dome. Since the diameter of the neck increases when the neck of the aneurysm is squeezed closed by the blades of the clip, the blades should be correspondingly longer. This study provided an assessment of whether the presurgical selection of clips using a 3D planning system is feasible in terms of selecting the most suitable clip for aneurysm occlusion. METHODS: The computational model was created based on computer tomography data obtained from nine brain aneurysms. The closing of the aneurysm was provided in two steps. The first the length of the blades used for closing corresponded to the length of the aneurysm neck as confirmed by the radiological measurements. The second the length of the blades was adjusted according to stage one, so as to determine the minimum required for the closure of all the gaps in the interior space of the aneurysm neck. RESULTS: No differences were detected between the radiological measurement of the aneurysm neck size and the measurements obtained from the reconstructed stereolithographic 3D models. It was observed that the size of the aneurysm neck increased following clipping by 40% to 60% of its original size. The larger the aneurysm neck, the greater the deformation of the aneurysm. CONCLUSION: Firstly, the 3D reconstruction of CT/MRI data did not result in any loss of accuracy and the measurement of the neck of the aneurysm was the same for both of the methods employed. The second, and more important, outcome was that the deformation of the neck of the cerebral aneurysm is at least 1.4x greater than its original size. This information is essential in terms of the pre-selection of the size of the clip.

• Klíčová slova
• Bladelength, Brain aneurysm, Clipping, Finite element method, Neck size,
• MeSH
• arteriae cerebrales MeSH
• chirurgické nástroje MeSH
• intrakraniální aneurysma * diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• neurochirurgické výkony metody   MeSH
• výkony cévní chirurgie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: Evidence is lacking to guide the management of infective native aortic aneurysm (INAA). The aim of this study was to establish expert consensus on surgical and antimicrobial treatment and follow up, and to define when an INAA is considered cured. METHODS: Delphi methodology was used. The principal investigators invited 47 international experts (specialists in infectious diseases, radiology, nuclear medicine, and vascular and cardiothoracic surgery) via email. Four Delphi rounds were performed, three weeks each, using an online questionnaire with initially 28 statements. The panellists rated the statements on a five point Likert scale. Comments on statements were analysed, statements were revised and added or deleted, and the results were presented in the iterative rounds. Consensus was defined as ≥ 75% of the panel rating a statement as strongly agree or agree on the Likert scale, and consensus on the final assessment was defined as Cronbach's alpha > 0.80. RESULTS: All 49 panellists completed all four rounds, resulting in 100% participation. One statement was added based on the results and comments of the panel, resulting in 29 final statements: three on need for consensus, 20 on treatment, five on follow up, and one on definition of cure. All 29 statements reached agreement of ≥ 86%. Cronbach's alpha increased for each consecutive round; round 1, 0.85; round 2, 0.90; round 3, 0.91; and round 4, 0.94. Thus, consensus was reached for all statements. CONCLUSION: INAAs are rare, and high level evidence to guide optimal management is lacking. This consensus document was established with the aim of helping clinicians manage these challenging patients, as a supplement to current guidelines. The presented consensus will need future amendments in accordance with newly acquired knowledge.

• Klíčová slova
• Aorta, Delphi study, Infected aneurysm, Infective native aortic aneurysm, Therapy,
• MeSH
• aortální aneurysma * MeSH
• delfská metoda MeSH
• konsensus MeSH
• lidé MeSH
• následné studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Endovascular treatment is widely applied as the first-line treatment for intracranial aneurysms and includes simple coiling (SC), stent-assisted coiling (SAC), flow diversion stent, and flow disruption stent. The present study is a retrospective cohort study performed in Imam Khomeini Hospital, Department of Neurovascular Intervention, between March 2016 and March 2021. A total number of 229 patients with intracranial aneurysms who underwent therapeutic intravascular interventions were enrolled, of which 89 were treated with SC, 111 with SAC, 25 with flow diversion stent, and 4 with flow disruption stent. The mean age of the subjects was 51.8±12.6 years, and 51.1% were male. Modified Raymond-Roy classification (MRRC) was used to define the occlusion outcome. The success rate, considered as Class I and Class II of MRRC at treatment time was 89% (94.4% in SC, and 84.7% in SAC), which was increased to 90.9% (94% in SC, 93% in SAC, 69.6% in flow diversion stenting, 100% in flow disruption) at 6-month follow-up, and 84.6% (80.8% in SC, 87.8% in SAC, 78.3% in flow diversion stenting, and 100% in flow disruption) at 12-month follow-up. The mean modified Rankin Scale (mRS) before the procedure was 0.05±0.26 which was increased to 0.22±0.76 after the procedure, 0.22±0.76 at 6 months, and 0.30±0.95 at 12 months (P<0.001). Similar to previous studies, the present study demonstrates that neurovascular intervention can treat ruptured aneurysms as the first therapeutic modality with favourable outcomes. A double-blind, randomized clinical trial is needed to eliminate the confounding factors and better demonstrate the outcome.

• Klíčová slova
• Endovascular treatment, Flow disruption, Flow diversion stenting, Intracranial aneurysm, Simple coiling, Stent assisted coiling,
• MeSH
• dospělí MeSH
• endovaskulární výkony * metody   MeSH
• intrakraniální aneurysma * terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• retrospektivní studie MeSH
• stenty MeSH
• terapeutická embolizace * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

A case of a 40-year-old male patient with a right subclavian artery aneurysm of fibromuscular dysplasia origin is reported. The patient presented with thoracic outlet-like symptoms and underwent aneurysm resection. Microscopic examination revealed intimal and medial fibroplasia. Additional cases of fibromuscular dysplasia at this rare location are reviewed, indicating a male and right-sided predominance. The most frequent clinicopathological manifestation was an aneurysm, with the histopathological pattern characterized by medial fibroplasia. Treatment modalities included the use of either graft prosthesis or end-to-end anastomosis.

• Klíčová slova
• Aneurysm, Fibromuscular dysplasia, Subclavian artery,
• MeSH
• aneurysma * patologie   chirurgie   diagnostické zobrazování   MeSH
• arteria subclavia * patologie   chirurgie   diagnostické zobrazování   MeSH
• cévy - implantace protéz MeSH
• dospělí MeSH
• fibromuskulární dysplazie * patologie   komplikace   chirurgie   MeSH
• lidé MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH