Acute Aortic Disease.. - Index of

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Endovascular Thoracic Aortic Stent Grafting 307 Figure C Cumulative freedom from aneurysm-related death. Note low attrition of survival in first three years of follow-up and rapid attrition in fourth year. Gp, Group. Groups represent increasing initial aneurysm size: Gp A = 4.0–5.4 cm, Gp B = 5.5–6.4, Gp C > 6.5 cm. Source: From Ref. 5. when follow-up extends to four years, especially for large aneurysms (5). This is shown vividly in Figure C; this figure suggests, in fact, that the aneurysm is indeed “ignoring” the endograft and merely expressing its natural tendency to rupture. In recognition of these sobering statistics, several major EUROSTAR publications end with serious cautions about endograft therapy, calling attention to concerns about the long-term effectiveness and safety: ● “The high incidence of late secondary interventions is a cause for concern with regard to broad application of endovascular AAA repair, and emphasizes the need for lifelong surveillance” (6). ● “Continuing need for surveillance for device related complications remains necessary” (7). ● “… the durability of this technique is currently unknown, and continued use of registries should provide data from long-term follow-up… . Only long-duration studies can tell us whether this type of therapy really works—whether it prevents aneurysm growth and rupture and patient death (8). ● The midterm outcome of large aneurysms after EVAR was associated with increased rates of aneurysm related death, unrelated death, and rupture … . This finding may justify reappraisal of currently accepted management strategies (5). The encyclopedic Health Services Technology Assessment Text of the Guide to Clinical Preventive Services, 3rd Edition, issued the following concluding statement on endografting.
308 Brinster et al. ● “Long-term complications, including AAA rupture … may result in significant long-term morbidity and mortality” (9). The pioneering investigations presented in this chapter should be viewed as extended short-term evaluations of endograft therapy. Despite these multiple concerns regarding endograft therapy, the work described in this chapter represents a bold venture into new territory with a promising, albeit unproven; less invasive modality of therapy. We are indebted to the investigators for this work. As the authors rightly point out, it is essential that each patient who has received endograft therapy be followed vigilantly for possible deterioration or complications as time passes. Moreover, it is incumbent on our profession not only to follow individual patients closely, but also to evaluate the durability of endograft therapy in general with a vigilant eye. We look forward to longer and more complete follow-up of these specific patients and to randomized studies in the future. The authors of this chapter have done groundbreaking clinical work, forging a very important initial foray into endograft treatment of thoracic aortic aneurysms and the evaluation of its early efficacy. References 1. Cooley DA, DeBakey ME. Surgical considerations of intrathoracic aneurysms of the aorta and great vessels. Ann Surg 1952; 135:660–680. 2. Coady MA, Rizzo JA, Hammond GL, et al. What is the appropriate size criterion for resection of thoracic aortic aneurysms? J Thorac Cardiovasc Surg 1997; 113: 476–491. 3. Lange C, Leurs LJ, Buth J, et al. Endovascular repair of abdominal aortic aneurysm in octogenarians: An analysis based on EUROSTAR data. J Vasc Surg 2005; 42:624–630. 4. Waasderp EJ, de Vries JP, Hobo R, et al. Aneurysm diameter and proximal aortic neck diameter influence clinical outcome of endovascular abdominal aortic repair: A 4-year EUORSTAR experience Ann Vasc Surg 2005; 19:757–759. 5. Peppelenbosch N, Buth J, Harris PL, et al. Diameter of abdominal aortic aneurysm and outcome of endovascular aneurysm repair: Does size matter? A report from EUROSTAR. J Vasc Surg 2004; 39:288–297. 6. Laheij RJ, Buth J, Harris PL, Moll FL, Stelter WJ, Verhoeven EL. Need for secondary interventions after endovascular repair of abdominal aortic aneurysm. Intermediateterm follow-up results of a European collaborative registry (EUROSTAR). Br J Surg 2000; 87:1666–1673. 7. Hobo R, Buth J, and the EUROSTAR investigators. Secondary interventions following endovascular abdominal aortic aneurysm repair using current endografts. A EUROSTAR report. J VascSurg 2006; 43:896–902. 8. Leurs LJ, Bell R, Degrieck Y, et al. Endovascular treatment of thoracic aortic diseases: Combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries. J Vasc Surg 2004; 40:670–680. 9. Health Services/Technology Assessment Text (HSTAT). Guide to Clinical Preventetive Services, 3rd Ed. Evidence Syntheses, formerly Systematic Evidence Reviews. National Library of Medicine and NCBI. hstat.nlm.nih.gov (accessed 9/24/06).
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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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224 Shahriari and Farkas 26. Svenss
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226 Shahriari and Farkas 63. Fehren
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14 Acute Aortic Dissection: Anti-im
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Acute Aortic Dissection 231 lamella
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Acute Aortic Dissection 233 P t is
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Acute Aortic Dissection 235 From th
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Acute Aortic Dissection 237 Figure
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Acute Aortic Dissection 239 concern
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Acute Aortic Dissection 241 Table 2
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Acute Aortic Dissection 243 dissect
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Acute Aortic Dissection 245 22. Bax
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Acute Aortic Dissection 247 62. Lin
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Acute Aortic Dissection 249 DISSCUS
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252 Elefteriades and Griepp ACUTE A
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254 Elefteriades and Griepp Figure
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Page 299 and 300: 270 Brinster et al. thoracic aneury
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Page 303 and 304: 274 Brinster et al. artery. Z3 land
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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 351 and 352: 322 Hackmann et al. ACKNOWLEDGMENTS
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Page 357 and 358: 328 Hackmann et al. 105. Marra DE,
Page 359 and 360: 330 Hackmann et al. DISCUSSION AND
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Page 371 and 372: 342 Elefteriades Figure 3 Computed
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The Key Lessons of This Book—In a
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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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