| 1. |
- Acciari, V. A., et al.
(författare)
-
Radio Imaging of the Very-High-Energy gamma-Ray Emission Region in the Central Engine of a Radio Galaxy
- 2009
-
Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 325:5939, s. 444-448
-
Tidskriftsartikel (refereegranskat)abstract
- The accretion of matter onto a massive black hole is believed to feed the relativistic plasma jets found in many active galactic nuclei (AGN). Although some AGN accelerate particles to energies exceeding 10(12) electron volts and are bright sources of very-high-energy (VHE) gamma-ray emission, it is not yet known where the VHE emission originates. Here we report on radio and VHE observations of the radio galaxy Messier 87, revealing a period of extremely strong VHE gamma-ray flares accompanied by a strong increase of the radio flux from its nucleus. These results imply that charged particles are accelerated to very high energies in the immediate vicinity of the black hole.
|
|
| 2. |
- Aharonian, F., et al.
(författare)
-
SIMULTANEOUS OBSERVATIONS OF PKS 2155-304 WITH HESS, FERMI, RXTE, AND ATOM : SPECTRAL ENERGY DISTRIBUTIONS AND VARIABILITY IN A LOW STATE
- 2009
-
Ingår i: Astrophysical Journal Letters. - 2041-8205 .- 0004-637X .- 1538-4357. ; 696:2, s. L150-L155
-
Tidskriftsartikel (refereegranskat)abstract
- We report on the first simultaneous observations that cover the optical, X-ray, and high-energy gamma-ray bands of the BL Lac object PKS 2155-304. The gamma-ray bands were observed for 11 days, between 2008 August 25 and 2008 September 6 (MJD 54704-54715), jointly with the Fermi Gamma-ray Space Telescope and the HESS atmospheric Cherenkov array, providing the first simultaneous MeV-TeV spectral energy distribution (SED) with the new generation of gamma-ray telescopes. The ATOM telescope and the RXTE and Swift observatories provided optical and X-ray coverage of the low-energy component over the same time period. The object was close to the lowest archival X-ray and very high energy (VHE; > 100 GeV) state, whereas the optical flux was much higher. The light curves show relatively little (similar to 30%) variability overall when compared to past flaring episodes, but we find a clear optical/VHE correlation and evidence for a correlation of the X-rays with the high-energy spectral index. Contrary to previous observations in the flaring state, we do not find any correlation between the X-ray and VHE components. Although synchrotron self-Compton models are often invoked to explain the SEDs of BL Lac objects, the most common versions of these models are at odds with the correlated variability we find in the various bands for PKS 2155-304.
|
|
| 3. |
- Aharonian, F., et al.
(författare)
-
Very high energy gamma-ray observations of the binary PSR B1259-63/SS2883 around the 2007 Periastron
- 2009
-
Ingår i: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 507:1, s. 389-396
-
Tidskriftsartikel (refereegranskat)abstract
- Aims. This article presents very-high-energy (VHE; E > 100 GeV) data from the gamma-ray binary PSR B1259-63 as taken during the years 2005, 2006 and before as well as shortly after the 2007 periastron passage. These data extend the knowledge of the lightcurve of this object to all phases of the 3.4 year binary orbit. The lightcurve constrains physical mechanisms present in this TeV source. Methods. Observations of VHE gamma-rays with the HESS telescope array using the Imaging Atmospheric Cherenkov Technique were performed. The HESS instrument features an angular resolution of < 0.1 degrees and an energy resolution of < 20%. Gamma-ray events in an energy range of 0.5-70 TeV were recorded. From these data, energy spectra and lightcurve with a monthly time sampling were extracted. Results. VHE gamma-ray emission from PSR B1259-63 was detected with an overall significance of 9.5 standard deviations using 55 h of exposure, obtained from April to August 2007. The monthly flux of gamma-rays during the observation period was measured, yielding VHE lightcurve data for the early pre-periastron phase of the system for the first time. No spectral variability was found on timescales of months. The spectrum is described by a power law with a photon index of Gamma = 2.8 +/- 0.2(stat) +/- 0.2(sys) and flux normalisation Phi(0) = (1.1 +/- 0.1(stat) +/- 0.2(sys)) x 10(-12) TeV(-1) cm(-2) s(-1). PSR B1259-63 was also monitored in 2005 and 2006, far from periastron passage, comprising 8.9 h and 7.5 h of exposure, respectively. No significant excess of.-rays is seen in those observations. Conclusions. PSR B1259-63 has been re-confirmed as a variable TeV gamma-ray emitter. The firm detection of VHE photons emitted at a true anomaly theta approximate to -0.35 of the pulsar orbit, i.e. already similar to 50 days prior to the periastron passage, disfavors the stellar disc target scenario as a primary emission mechanism, based on current knowledge about the companion star's disc inclination, extension, and density profile.
|
|
| 4. |
- Aharonian, F., et al.
(författare)
-
Discovery of VHE gamma-rays from the BL Lacertae object PKS 0548-322
- 2010
-
Ingår i: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 521, s. A69-
-
Tidskriftsartikel (refereegranskat)abstract
- Aims. PKS 0548-322 (z = 0.069) is a "high-frequency-peaked" BL Lac object and a candidate very high energy (VHE, E > 100 GeV) gamma-ray emitter, due to its high X-ray and radio flux. Observations at the VHE band provide insights into the origin of very energetic particles present in this source and the radiation processes at work. Methods. We report observations made between October 2004 and January 2008 with the HESS array, a four imaging atmospheric-Cherenkov telescopes. Contemporaneous UV and X-ray observations with the Swift satellite in November 2006 are also reported. Results. PKS 0548-322 is detected for the first time in the VHE band with HESS We measure an excess of 216 gamma-rays corresponding to a significance of 5.6 standard deviations. The photon spectrum of the source is described by a power-law, with a photon index of Gamma = 2.86 +/- 0.34(stat) +/- 0.10(sys). The integral flux above 200 GeV is similar to 1.3% of the flux of the Crab Nebula, and is consistent with being constant in time. Contemporaneous Swift/XRT observations reveal an X-ray flux between 2 and 10 keV of F2-10 keV = (2.3 +/- 0.2) x 10(-11) erg cm(-2) s(-1), an intermediate intensity state with respect to previous observations. The spectral energy distribution can be reproduced using a simple one-zone synchrotron self Compton model, with parameters similar those observed for other sources of this type.
|
|
| 5. |
- Aharonian, F., et al.
(författare)
-
Probing the ATIC peak in the cosmic-ray electron spectrum with HESS
- 2009
-
Ingår i: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 508:2, s. 561-564
-
Tidskriftsartikel (refereegranskat)abstract
- The measurement of an excess in the cosmic-ray electron spectrum between 300 and 800 GeV by the ATIC experiment has - together with the PAMELA detection of a rise in the positron fraction up to approximate to 100 GeV - motivated many interpretations in terms of dark matter scenarios; alternative explanations assume a nearby electron source like a pulsar or supernova remnant. Here we present a measurement of the cosmic-ray electron spectrum with H. E. S. S. starting at 340 GeV. While the overall electron flux measured by H. E. S. S. is consistent with the ATIC data within statistical and systematic errors, the H. E. S. S. data exclude a pronounced peak in the electron spectrum as suggested for interpretation by ATIC. The H. E. S. S. data follow a power-law spectrum with spectral index of 3.0 +/- 0.1(stat.) +/- 0.3(syst.), which steepens at about 1 TeV.
|
|
| 6. |
- Aharonian, F., et al.
(författare)
-
Discovery of very high energy γ-ray emission from centaurus a with H.E.S.S.
- 2009
-
Ingår i: Astrophysical Journal Letters. - : Institute of Physics (IOP). - 2041-8205. ; 695:1, s. L40-L44
-
Tidskriftsartikel (refereegranskat)abstract
- We report the discovery of faint very high energy (VHE; E > 100 GeV) gamma-ray emission from the radio galaxy Centaurus A in observations performed with the High Energy Stereoscopic System (H.E.S.S.) experiment, an imaging atmospheric Cherenkov telescope array consisting of four telescopes located in Namibia. Centaurus A has been observed for more than 120 hr. A signal with a statistical significance of 5.0 sigma is detected from the region including the radio core and the inner kpc jets. The integral flux above an energy threshold of similar to 250 GeV is measured to be 0.8% of the flux of the Crab Nebula (apparent luminosity: L(> 250 GeV) approximate to 2.6 x 1039 erg s(-1), adopting a distance of 3.8 Mpc). The spectrum can be described by a power law with a photon index of 2.7 +/- 0.5(stat) +/- 0.2(sys). No significant flux variability is detected in the data set. However, the low flux only allows detection of variability on the timescale of days to flux increments above a factor of similar to 15-20 (3 sigma and 4 sigma, respectively). The discovery of VHE gamma-ray emission from Centaurus A reveals particle acceleration in the source to > TeV energies and, together with M 87, establishes radio galaxies as a class of VHE emitters.
|
|
| 7. |
- Aharonian, F., et al.
(författare)
-
Simultaneous multiwavelength observations of the second exceptional gamma-ray flare of PKS2155-304 in July 2006
- 2009
-
Ingår i: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 502:3, s. 749-770
-
Forskningsöversikt (refereegranskat)abstract
- Aims. The X-ray-TeV connection and the evolution of the emitting particle population is studied in high-energy peaked BL Lac objects, by obtaining spectral information in both bands on sub-hour timescales. Methods. Simultaneous observations with HESS, Chandra and the Bronberg optical observatory were performed on the BL Lac object PKS 2155-304 in the night of July 29-30 2006, when the source underwent a major gamma-ray outburst during its high-activity state of Summer 2006. This event took place about 44 h after the other major outburst of the night of July 27-28, which is known for its ultrafast variability. An unprecedented 6 to 8 h of simultaneous, uninterrupted coverage was achieved, with spectra and light curves measured down to 7 and 2 min timescales, respectively. Results. The source exhibited one major flare along the night, at high energies. The gamma-ray flux reached a maximum of similar to 11 times the Crab flux (>400 GeV), with rise/decay timescales of similar to 1 h, plus a few smaller-amplitude flares superimposed on the decaying phase. The emission in the X-ray and VHE gamma-ray bands is strongly correlated, with no evidence of lags. The spectra also evolve with similar patterns, and are always soft ( photon index G > 2), indicating no strong shift of the peaks in the spectral energy distribution towards higher energies. Only at the flare maximum is there evidence that the gamma-ray peak is inside the observed passband, at similar to 400-600 GeV. The VHE spectrum shows a curvature that is variable with time and stronger at higher fluxes. The huge VHE variations (similar to 22x) are only accompanied by small-amplitude X-ray and optical variations (factor 2 and 15% respectively). The source has shown for the first time in a high-energy peaked BL Lac object a large Compton dominance (L(C)/L(S) similar to 10) - rapidly evolving - and a cubic relation between VHE and X-ray flux variations, during a decaying phase. These results challenge the common scenarios for the TeV-blazar emission.
|
|
| 8. |
- Aharonian, F., et al.
(författare)
-
HESS upper limit on the very high energy gamma-ray emission from the globular cluster 47 Tucanae
- 2009
-
Ingår i: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 499:1, s. 273-277
-
Tidskriftsartikel (refereegranskat)abstract
- Observations of the globular cluster 47 Tucanae (NGC 104), which contains at least 23 ms pulsars, were performed with the HESS telescope system. The observations lead to an upper limit of F(E > 800 GeV) < 6.7 x 10(-13) cm(-2) s(-1) on the integral gamma-ray photon flux from 47 Tucanae. Considering millisecond pulsars as the unique potential source of gamma-rays in the globular cluster, constraints based on emission models are derived: on the magnetic field in the average pulsar nebula and on the conversion efficiency of spin-down power to gamma-ray photons or to relativistic leptons.
|
|
| 9. |
- Aharonian, F., et al.
(författare)
-
Spectrum and variability of the Galactic center VHE gamma-ray source HESS J1745-290
- 2009
-
Ingår i: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 503:3, s. 817-825
-
Tidskriftsartikel (refereegranskat)abstract
- Aims. A detailed study of the spectrum and variability of the source HESS J1745-290 in the Galactic Center (GC) region using new data from the H. E. S. S. array of Cherenkov telescopes is presented. Flaring activity and quasi periodic oscillations (QPO) of HESS J1745-290 are investigated. Methods. The image analysis is performed with a combination of a semi-analytical shower model and the statistical moment-based Hillas technique. The spectrum and lightcurves of HESS J1745-290 are derived with a likelihood method based on a spectral shape hypothesis. Rayleigh tests and Fourier analysis of the H. E. S. S. GC signal are used to study the periodicity of the source. Results. With a three-fold increase in statistics compared to previous work, a deviation from a simple power law spectrum is detected for the first time. The measured energy spectrum over the three years 2004, 2005 and 2006 of data taking is compatible with both a power law spectrum with an exponential cut-off and a broken power law spectrum. The curvature of the energy spectrum is likely to be intrinsic to the photon source, as opposed to effects of interstellar absorption. The power law spectrum with an exponential cut-off is characterized by a photon index of 2.10 +/- 0.04(stat) +/- 0.10(syst) and a cut-off energy at 15.7 +/- 3.4(stat) +/- 2.5(syst) TeV. The broken power law spectrum exhibits spectral indices of 2.02 +/- 0.08(stat) +/- 0.10(syst) and 2.63 +/- 0.14(stat) +/- 0.10(syst) with a break energy at 2.57 +/- 0.19(stat) +/- 0.44(syst) TeV. No significant flux variation is found. Increases in the gamma-ray flux of HESS J1745-290 by at least a factor of two would be required for a 3 sigma detection of a flare with time scales of an hour. Investigation of possible QPO activity at periods claimed to be detected in X-rays does not show any periodicities in the H. E. S. S. signal.
|
|
| 10. |
- Aharonian, F., et al.
(författare)
-
Detection of very high energy radiation from HESS J1908+063 confirms the Milagro unidentified source MGRO J1908+06
- 2009
-
Ingår i: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 499:3, s. 723-728
-
Tidskriftsartikel (refereegranskat)abstract
- Aims. Detection of gamma-ray source above 300 GeV is reported, confirming the unidentified source MGRO J1908+06, discovered by the Milagro collaboration at a median energy of 20 TeV. Methods. The source was observed during 27 h as part of the extension of the HESS Galactic plane survey to longitudes > 30 degrees. Results. HESS J1908+063 is detected at a significance level of 10.9 sigma with an integral flux above 1 TeV of (3.76 +/- 0.29 (stat) +/- 0.75(sys)) x 10(-12) ph cm(-2) s(-1), and a spectral photon index Gamma = 2.10 +/- 0.07 (stat) +/- 0.2(sys). The positions and fluxes of HESS J1908+063 and MGRO J1908+06 are in good agreement. Possible counterparts at other wavelengths and the origin of the gamma-ray emission are discussed. The nearby unidentified GeV source, GRO J1908+0556 (GeV) which also remains unidentified and the new Fermi pulsar 0FGL J1907.5+0617, may be connected to the TeV source.
|
|
| 11. |
- Aharonian, F., et al.
(författare)
-
Energy Spectrum of Cosmic-Ray Electrons at TeV Energies
- 2008
-
Ingår i: Physical Review Letters. - : APS Physics. - 0031-9007 .- 1079-7114. ; 101:26
-
Tidskriftsartikel (refereegranskat)abstract
- The very large collection area of ground-based gamma-ray telescopes gives them a substantial advantage over balloon or satellite based instruments in the detection of very-high-energy (> 600 GeV) cosmic-ray electrons. Here we present the electron spectrum derived from data taken with the High Energy Stereoscopic System (H.E.S.S.) of imaging atmospheric Cherenkov telescopes. In this measurement, the first of this type, we are able to extend the measurement of the electron spectrum beyond the range accessible to direct measurements. We find evidence for a substantial steepening in the energy spectrum above 600 GeV compared to lower energies.
|
|
| 12. |
- Aharonian, F., et al.
(författare)
-
Limits on an Energy Dependence of the Speed of Light from a Flare of the Active Galaxy PKS 2155-304
- 2008
-
Ingår i: Physical Review Letters. - : APS Physics. - 0031-9007 .- 1079-7114. ; 101:17
-
Tidskriftsartikel (refereegranskat)abstract
- In the past few decades, several models have predicted an energy dependence of the speed of light in the context of quantum gravity. For cosmological sources such as active galaxies, this minuscule effect can add up to measurable photon-energy dependent time lags. In this Letter a search for such time lags during the High Energy Stereoscopic System observations of the exceptional very high energy flare of the active galaxy PKS 2155-304 on 28 July 2006 is presented. Since no significant time lag is found, lower limits on the energy scale of speed of light modifications are derived.
|
|
| 13. |
- Aharonian, F., et al.
(författare)
-
Simultaneous HESS and Chandra observations of Sagitarius A(star) during an X-ray flare
- 2008
-
Ingår i: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 492:1, s. L25-L28
-
Tidskriftsartikel (refereegranskat)abstract
- The rapidly varying (similar to 10 min timescale) non-thermal X-ray emission observed from Sgr A(star) implies that particle acceleration is occuring close to the event horizon of the supermassive black hole. The TeV gamma-ray source HESS J1745-290 is coincident with Sgr A(star) and may be closely related to its X-ray emission. Simultaneous X-ray and TeV observations are required to elucidate the relationship between these objects. We report on joint HESS/Chandra observations performed in July 2005, during which an X-ray flare was detected. Despite a factor of approximate to 9 increase in the X-ray flux of Sgr A(star), no evidence is found for an increase in the TeV gamma-ray flux from this region. We find that an increase in the gamma-ray flux of a factor of 2 or greater can be excluded at a confidence level of 99%. This finding disfavours scenarios in which the keV and TeV emission are associated with the same population of accelerated particles and in which the bulk of the gamma-ray emission is produced within similar to 1014 cm (similar to 100 RS) of the supermassive black hole.
|
|
| 14. |
- Aharonian, F., et al.
(författare)
-
Very high energy gamma-ray observations of the galaxy clusters Abell 496 and Abell 85 with HESS
- 2009
-
Ingår i: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 495:1, s. 27-35
-
Tidskriftsartikel (refereegranskat)abstract
- Aims. The nearby galaxy clusters Abell 496 and Abell 85 are studied in the very high-energy (VHE, E > 100 GeV) band to investigate VHE cosmic rays (CRs) in this class of objects which are the largest gravitationally bound systems in the Universe. Methods. HESS, an array of four imaging atmospheric cherenkov telescopes (IACT), was used to observe the targets in the range of VHE gamma rays. Results. No significant gamma-ray signal is found at the respective position of the two clusters with several different source size assumptions for each target. In particular, emission regions corresponding to the high-density core, to the extension of the entire X-ray emission in these clusters, and to the very extended region where the accretion shock is expected are investigated. Upper limits are derived for the gamma-ray flux at energies E > 570 GeV for Abell 496 and E > 460 GeV for Abell 85. Conclusions. From the non-detection in VHE gamma rays, upper limits on the total energy of hadronic CRs in the clusters are calculated. If the cosmic-ray energy density follows the large-scale gas density profile, the limit on the fraction of energy in these non-thermal particles with respect to the total thermal energy of the intra-cluster medium (ICM) is 51% for Abell 496 and only 8% for Abell 85 due to its higher mass and higher gas density. These upper limits are compared with theoretical estimates. They predict about similar to 10% of the thermal energy of the ICM in non-thermal particles. The observations presented here can constrain these predictions especially for the case of the Abell 85 cluster.
|
|
| 15. |
- Heimisdottir, L.H., et al.
(författare)
-
Metabolomics Insights in Early Childhood Caries
- 2021
-
Ingår i: Journal of Dental Research. - : Sage Publications. - 0022-0345 .- 1544-0591. ; 100:6, s. 615-622
-
Tidskriftsartikel (refereegranskat)abstract
- Dental caries is characterized by a dysbiotic shift at the biofilm–tooth surface interface, yet comprehensive biochemical characterizations of the biofilm are scant. We used metabolomics to identify biochemical features of the supragingival biofilm associated with early childhood caries (ECC) prevalence and severity. The study’s analytical sample comprised 289 children ages 3 to 5 (51% with ECC) who attended public preschools in North Carolina and were enrolled in a community-based cross-sectional study of early childhood oral health. Clinical examinations were conducted by calibrated examiners in community locations using International Caries Detection and Classification System (ICDAS) criteria. Supragingival plaque collected from the facial/buccal surfaces of all primary teeth in the upper-left quadrant was analyzed using ultra-performance liquid chromatography–tandem mass spectrometry. Associations between individual metabolites and 18 clinical traits (based on different ECC definitions and sets of tooth surfaces) were quantified using Brownian distance correlations (dCor) and linear regression modeling of log2-transformed values, applying a false discovery rate multiple testing correction. A tree-based pipeline optimization tool (TPOT)–machine learning process was used to identify the best-fitting ECC classification metabolite model. There were 503 named metabolites identified, including microbial, host, and exogenous biochemicals. Most significant ECC-metabolite associations were positive (i.e., upregulations/enrichments). The localized ECC case definition (ICDAS ≥1 caries experience within the surfaces from which plaque was collected) had the strongest correlation with the metabolome (dCor P = 8 × 10−3). Sixteen metabolites were significantly associated with ECC after multiple testing correction, including fucose (P = 3.0 × 10−6) and N-acetylneuraminate (p = 6.8 × 10−6) with higher ECC prevalence, as well as catechin (P = 4.7 × 10−6) and epicatechin (P = 2.9 × 10−6) with lower. Catechin, epicatechin, imidazole propionate, fucose, 9,10-DiHOME, and N-acetylneuraminate were among the top 15 metabolites in terms of ECC classification importance in the automated TPOT model. These supragingival biofilm metabolite findings provide novel insights in ECC biology and can serve as the basis for the development of measures of disease activity or risk assessment.
|
|
| 16. |
|
|
| 17. |
- McGinigle, Katharine L., et al.
(författare)
-
Perioperative care in open aortic vascular surgery : A Consensus Statement by the Enhanced Recovery after Surgery (ERAS®) Society and Society for Vascular Surgery
- 2022
-
Ingår i: Journal of Vascular Surgery. - : Elsevier. - 0741-5214 .- 1097-6809. ; 75:6, s. 1796-1820
-
Tidskriftsartikel (refereegranskat)abstract
- The Society for Vascular Surgery and the Enhanced Recovery After Surgery (ERAS®) Society formally collaborated and elected an international, multi-disciplinary panel of experts to review the literature and provide evidence-based recommendations related to all of the health care received in the perioperative period for patients undergoing open abdominal aortic operations (both transabdominal and retroperitoneal approaches, including supraceliac, suprarenal, and infrarenal clamp sites, for aortic aneurysm and aortoiliac occlusive disease). Structured around the ERAS® core elements, 36 recommendations were made and organized into preadmission, preoperative, intraoperative, and postoperative recommendations.
|
|
| 18. |
- Bath, Jonathan, et al.
(författare)
-
Contemporary outcomes after treatment of aberrant subclavian artery and Kommerell's diverticulum
- 2023
-
Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214 .- 1097-6809. ; 77:5, s. 1339-1348.e6
-
Tidskriftsartikel (refereegranskat)abstract
- 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. We report the early and mid-term clinical outcomes including stroke and mortality, technical success, and other operative outcomes including reintervention rates, patency, and endoleak.Results: Overall, 285 patients were identified during the study period. The mean patient age was 57 years; 47% were female and 68% presented with symptoms. A right-sided arch was present in 23%. The mean KD diameter was 47.4 mm (range, 13.0-108.0 mm). The most common indication for treatment was symptoms (59%), followed by aneurysm size (38%). The most common symptom reported was dysphagia (44%). A ruptured KD was treated in 4.2% of cases, with a mean diameter of 43.9 mm (range, 18.0-100.0 mm). An open procedure was performed in 101 cases (36%); the most common approach was ASA ligation with subclavian transposition. An endovascular or hybrid approach was performed in 184 patients (64%); the most common approach was thoracic endograft and carotid-subclavian bypass. A staged operative strategy was employed more often than single setting repair (55% vs 45%). Compared with endovascular or hybrid approach, those in the open procedure group were more likely to be younger (49 years vs 61 years; P < .0001), female (64% vs 36%; P < .0001), and symptomatic (85% vs 59%; P < .0001). Complete or partial symptomatic relief at 1 year after intervention was 82.6%. There was no association between modality of treatment and symptom relief (open 87.2% vs endovascular or hybrid approach 78.9%; P = .13). After the intervention, 11 subclavian occlusions (4.5%) occurred; 3 were successfully thrombectomized resulting in a primary and secondary patency of 95% and 96%, respectively, at a median follow-up of 39 months. Among the 33 reinterventions (12%), the majority were performed for endoleak (36%), and more reinterventions occurred in the endovascular or hybrid approach than open procedure group (15% vs 6%; P = .02). The overall survival rate was 87.3% at a median follow-up of 41 months. The 30-day stroke and death rates were 4.2% and 4.9%, respectively. Urgent or emergent presentation was independently associated with increased risk of 30-day mortality (odds ratio [OR], 19.8; 95% confidence interval [CI], 3.3-116.6), overall mortality (OR, 3.6; 95% CI, 1.2-11.2) and intraoperative complications (OR, 8.3; 95% CI, 2.8-25.1). Females had a higher risk of reintervention (OR, 2.6; 95% CI, 1.0-6.5). At an aneurysm size of 44.4 mm, receiver operator characteristic curve analysis suggested that 60% of patients would have symptoms.Conclusions: Treatment of ASA/KD can be performed safely with low rates of mortality, stroke and reintervention and high rates of symptomatic relief, regardless of the repair strategy. Symptomatic and urgent operations were associated with worse outcomes in general, and female gender was associated with a higher likelihood of reintervention. Given the worse overall outcomes when symptomatic and the inherent risk of rupture, consideration of repair at 40 mm is reasonable in most patients. ASA/KD can be repaired in asymptomatic patients with excellent outcomes and young healthy patients may be considered better candidates for open approaches versus endovascular or hybrid modalities, given the lower likelihood of reintervention and lower early mortality rate.
|
|
| 19. |
|
|
| 20. |
|
|
| 21. |
- Moffatt, Clare, et al.
(författare)
-
International Multi-Institutional Experience with Presentation and Management of Aortic Arch Laterality in Aberrant Subclavian Artery and Kommerell's Diverticulum
- 2023
-
Ingår i: Annals of Vascular Surgery. - : Elsevier. - 0890-5096 .- 1615-5947. ; 95, s. 23-31
-
Tidskriftsartikel (refereegranskat)abstract
- 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.RESULTS: 288 patients with ASA with or without KD were identified; 222 left-sided aortic arch (LAA), and 66 right-sided aortic arch (RAA). Mean age at repair was younger in LAA 54 vs. 58 years (P = 0.06). Patients in RAA were more likely to undergo repair due to symptoms (72.7% vs. 55.9%, P = 0.01), and more likely to present with dysphagia (57.6% vs. 39.1%, P < 0.01). The hybrid open/endovascular approach was the most common repair type in both groups. Rates of intraoperative complications, death within 30 days, return to the operating room, symptom relief and endoleaks were not significantly different. For patients with symptom status follow-up data, in LAA, 61.7% had complete relief, 34.0% had partial relief and 4.3% had no change. In RAA, 60.7% had complete relief, 34.4% had partial relief and 4.9% had no change.CONCLUSIONS: In patients with ASA/KD, RAA patients were less common than LAA, presented more frequently with dysphagia, had symptoms as an indication for intervention, and underwent treatment at a younger age. Open, endovascular and hybrid repair approaches appear equally effective, regardless of arch laterality.
|
|
| 22. |
- Schiller, D, et al.
(författare)
-
The Human Affectome
- 2024
-
Ingår i: Neuroscience and biobehavioral reviews. - 1873-7528. ; 158, s. 105450-
-
Tidskriftsartikel (refereegranskat)
|
|
