Acute Aortic Disease.. - Index of

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Surgical Procedures: A Primer 263 Figure 9 Schematic showing danger of obliterating false lumen in chronic aortic dissection—to do so may obliterate flow to vital organs dependent on the false lumen, including the brain. replacement of the descending aorta, as described in the chapter on “Rupture” earlier in this textbook. (We often identify a state of “impending rupture,” preferring to operate before the patient bleeds internally. This is usually a matter of clinical judgment and experience—with warning signs such as persistent pain, bloody pleural effusion, or small amounts of extravasated contrast on CT scan. Treatment is as for realized rupture.) Uncontrolled pain and rapid expansion of the aorta (on repeat imaging studies) also require operation, which once again should be formal aortic replacement. Organ ischemia is the most common complication, and this also requires operation—urgent operation, in fact, so as to save organs and/or limbs. Here, we prefer an operation different from aortic replacement—namely, the “fenestration” procedure (Fig. 11). Although developed many decades ago, this operation is predicated on the still valid concept that taking the pressure off the false lumen (by creating a wide communication—or “fenestra,” Latin for “window”—to drain the false lumen into the true lumen) can restore blood flow to the affected organ (Fig. 12). We have found this procedure, performed quickly and effectively through a retroperitoneal approach, to be extremely effective in
264 Elefteriades and Griepp Natural Behavior of 100 Consecutive, Type B Aortic Dissections 6 Aortic 9 Died 3 Non-aortic 100 Patients 12 Expansion 4 Uncontrolled pain 8 Rupture 91 Survived 31 Complicated 60 Uncomplicated 6 Retrograde dissection Vascular complications: 5 renal, 5 spinal cord 5 lower extremity 2 abdominal Figure 10 Outcome of 100 acute descending aortic dissections. Note relative benignity of outcome compared to ascending dissection. Source: From Ref. 23. Figure 11 The fenestration operation. A retroperitoneal approach is made (A). The infrarenal aorta is exposed (B). The aorta is transected (C). A large flap is removed from the upper portion (fenestration) (D). The distal aorta is reconstituted by reapproximating the dissected layers by simple suture. The two ends of the transected aorta—the upper fenestrated end and the lower reconstituted end—are reattached by running suture (E). No graft material is required. No perfusion adjuncts are required.
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Acute Aortic Disease
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15. Heart Failure: Basic Science an
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52. Clinical, Interventional, and I
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Informa Healthcare USA, Inc. 270 Ma
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Introduction Informa Healthcare has
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Foreword There is no disease more c
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Preface Over 100 years ago, the gre
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Preface xi Some distinguishing feat
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xiv Acknowledgments Above all, than
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xvi Contents 6. Genetic Basis of Th
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Contributors Nili Avidan Division o
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Contributors xxi Arun Raghupathy Di
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2 Nienaber and Ince Table 1 Risk Co
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4 Nienaber and Ince In addition to
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6 Nienaber and Ince CLASSIFICATION
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8 Nienaber and Ince Lansman’s Cla
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10 Nienaber and Ince Figure 4 Curve
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12 Nienaber and Ince Figure 6 Evolu
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14 Nienaber and Ince dissection, su
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16 Nienaber and Ince (A) (B) Probab
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18 Nienaber and Ince Table 5 Risk P
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20 Nienaber and Ince of the predila
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22 Nienaber and Ince 34. Pieters FA
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24 Nienaber and Ince 75. Mehta RH,
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26 Nienaber and Ince hematoma (IMH)
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28 Nienaber and Ince One good featu
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30 Isselbacher SYMPTOMS Pain Experi
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32 Isselbacher and wane in severity
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34 Isselbacher The mechanisms are u
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36 Isselbacher deficits are most co
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38 Isselbacher 3. Nallamothu BK, Me
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40 Danias spinal arteries) and the
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42 Danias Figure 2 Anteroposterior
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44 Danias However, due to the dista
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46 Danias TEE is highly sensitive f
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48 Danias faster, with higher resol
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50 Danias Figure 6 Transverse slice
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52 Danias hematoma, CT was reported
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54 Danias Figure 9 Transverse black
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56 Danias Figure 12 Single phase-co
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58 Danias restricted to the absolut
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60 Danias In conclusion, in the rig
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62 Danias DISCUSSION AND COMMENTARY
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64 Danias tomography, among others.
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66 Danias cardiac silhouette. The a
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68 Raghupathy and Eagle the inciden
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70 Raghupathy and Eagle Figure 1 Sp
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72 Raghupathy and Eagle SIGNS A tho
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74 Raghupathy and Eagle patients ma
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76 Raghupathy and Eagle Table 5 Dia
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78 Raghupathy and Eagle Table 6 A S
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80 Raghupathy and Eagle Figure 6 (A
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82 Raghupathy and Eagle Figure 9 (A
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84 Raghupathy and Eagle EDITOR’S
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86 Raghupathy and Eagle 30. Erbel R
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88 Raghupathy and Eagle is highly l
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90 Elefteriades and Rizzo required
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92 Elefteriades and Rizzo Table 1 S
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94 Elefteriades and Rizzo 70s, this
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96 Elefteriades and Rizzo Table 3 C
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98 Elefteriades and Rizzo DISCUSSIO
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100 Milewicz et al. KNOWN GENETIC S
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102 Milewicz et al. Table 2 Quick G
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104 Milewicz et al. ascending aorti
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106 Milewicz et al. Turner syndrome
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108 Milewicz et al. dissection in t
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110 Milewicz et al. Figure 5 Haplot
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112 Milewicz et al. A genome wide s
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114 Milewicz et al. Structural anal
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116 Milewicz et al. assembly of a h
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118 Milewicz et al. in the nuclei o
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120 Milewicz et al. 22. Furlong J,
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122 Milewicz et al. DISCUSSION AND
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124 Milewicz et al. Figure A Distri
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126 Elefteriades and Koullias Figur
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128 Elefteriades and Koullias prope
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8 Matrix Metalloproteinases in Aort
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Matrix Metalloproteinases in Aortic
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INTRODUCTION 9 Inflammation and Rem
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Inflammation and Remodeling in the
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10 Weight Lifting and Aortic Dissec
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Weight Lifting and Aortic Dissectio
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11 Timing of Acute Aortic Events: H
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Timing of Acute Aortic Events 171 F
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SECTION IV: TREATMENT OF ACUTE AORT
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Natural History of Thoracic Aortic
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206 Shahriari and Farkas properties
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208 Shahriari and Farkas Figure 2 E
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210 Shahriari and Farkas Less than
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Page 270 and 271: Acute Aortic Dissection 241 Table 2
Page 272 and 273: Acute Aortic Dissection 243 dissect
Page 274 and 275: Acute Aortic Dissection 245 22. Bax
Page 276 and 277: Acute Aortic Dissection 247 62. Lin
Page 278: Acute Aortic Dissection 249 DISSCUS
Page 281 and 282: 252 Elefteriades and Griepp ACUTE A
Page 283 and 284: 254 Elefteriades and Griepp Figure
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Page 297 and 298: 268 Elefteriades and Griepp DISCUSS
Page 299 and 300: 270 Brinster et al. thoracic aneury
Page 301 and 302: 272 Brinster et al. Figure 1 Retrop
Page 303 and 304: 274 Brinster et al. artery. Z3 land
Page 305 and 306: 276 Brinster et al. or ischemia of
Page 307 and 308: 278 Brinster et al. registry arm (2
Page 309 and 310: 280 Brinster et al. Table 3 Early P
Page 311 and 312: 282 Brinster et al. According to th
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Page 329 and 330: 300 Brinster et al. 60. Elefteriade
Page 331 and 332: 302 Brinster et al. 98. Liu ZG, Sun
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Page 335 and 336: 306 Brinster et al. 100% 90% 80% 70
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Page 339 and 340: 310 Hackmann et al. treatment. New
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314 Hackmann et al. Table 1 Pharmac
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316 Hackmann et al. Some anti-hyper
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318 Hackmann et al. inhibits NF-κB
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320 Hackmann et al. Patients with C
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322 Hackmann et al. ACKNOWLEDGMENTS
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324 Hackmann et al. 34. Thompson RW
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326 Hackmann et al. 70. LeMaire SA,
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328 Hackmann et al. 105. Marra DE,
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330 Hackmann et al. DISCUSSION AND
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332 Elefteriades Diseases of the th
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334 Elefteriades Table 1 Individual
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336 Elefteriades Table 1 Individual
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338 Elefteriades Failure to Diagnos
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340 Elefteriades of physicians on t
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342 Elefteriades Figure 3 Computed
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344 Elefteriades reviewed over the
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346 Elefteriades DISCUSSION AND COM
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348 Elefteriades Figure 1 (See colo
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350 Elefteriades that are the subje
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SECTION VII: SYNTHESIS 20 The Key L
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The Key Lessons of This Book—In a
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362 Index Aging, aortic aneurysms a
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364 Index Cytokines, aortic aneurys
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366 Index Pathoanatomy classificati
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368 Index [Thoracic aortic aneurysm
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Figure 1.C Note from schematic depi
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Figure 8.1 Dramatic clinical exampl
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Figure 11.2 Proposed schema for the
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Figure 19.1 Future prospects in car
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