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Endovascular Thoracic Aortic Stent Grafting 275 Figure 5 (A) Angiogram and diagram of angulated arch without suitable proximal landing zone with high risk of Type I endoleak from “stove piping” of the graft (arrows). (B) Angiogram, which demonstrates a longer proximal landing zone without excessive angulation. (C) Successful stent graft placement in proximal landing zone with no endoleak. Figure 6 Inner radius should be 70 mm.
276 Brinster et al. or ischemia of the heart in patients with a previous left internal mammary artery to left anterior descending coronary artery bypass graft. An evaluation of the right vertebral artery and the adequacy of the circle of Willis are crucial when planning to cover the left subclavian artery. In those patients with inadequate collaterals through the circle of Willis, a stenotic right vertebral artery, or a dominant left vertebral artery, strong consideration should be made to bypass the left subclavian artery prior to covering. One option is to transpose the left subclavian artery to the left common carotid artery with oversewing of the proximal left subclavian artery. Another option is to bypass from the left common carotid artery to the left subclavian artery with an 8 mm Dacron graft. Either surgical ligation of the proximal left subclavian at the time of bypass or staged coil embolization of the proximal left subclavian artery at the time of graft delivery may be used. Bypass of the left subclavian may be preferable because it avoids any mediastinal dissection and there is no interruption of antegrade flow to the vertebral artery or internal mammary artery branch vessels (Fig. 7). Evaluation of the distal landing zone also requires careful preoperative workup. The distal landing zone should again have 15–20 mm of normal aorta with minimal calcification, angulation, and tapering. The celiac artery is the first distal branch vessel that must be avoided. Therefore, the length of the aortic graft must be correctly planned. Enough graft length should cover the aortic pathology while avoiding excessive coverage of the descending thoracic aorta. The goal is to preserve the distal intercostal arteries and perfusion to the spinal cord. When planning the length of the graft, the outer curvature of the aorta is assumed to be the correct area to measure (Fig. 8). However, the graft may lie along the lesser curvature instead. Therefore, a strategy must be developed to select a graft, which will be able to work in either the greater curvature or lesser curvature. Figure 7 (A) Image prior to translocation of left subclavian artery. Note the inadequate length of proximal landing zone. (B) Same patient after translocation of left subclavian artery to the left common carotid artery and status post successful stent graft placement.
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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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212 Shahriari and Farkas helpful if
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214 Shahriari and Farkas Figure 6 A
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216 Shahriari and Farkas (68). Many
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218 Shahriari and Farkas Figure 9 H
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220 Shahriari and Farkas fistula is
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222 Shahriari and Farkas MEGS is de
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Page 270 and 271: Acute Aortic Dissection 241 Table 2
Page 272 and 273: Acute Aortic Dissection 243 dissect
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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 295 and 296: 266 Elefteriades and Griepp CONCLUS
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
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Page 307 and 308: 278 Brinster et al. registry arm (2
Page 309 and 310: 280 Brinster et al. Table 3 Early P
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Page 331 and 332: 302 Brinster et al. 98. Liu ZG, Sun
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Page 351 and 352: 322 Hackmann et al. ACKNOWLEDGMENTS
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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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