The document discusses endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. It presents a case of a 62-year-old male undergoing EVAR for a 5.5cm AAA. EVAR involves deploying a graft via catheter to exclude the aneurysm from blood flow. Complications can include endoleaks, where blood leaks outside the graft but within the aneurysm sac. The main types of endoleaks are type I (inadequate seal at graft ends), type II (collaterals inside the sac), and type III (graft component disruption). EVAR has advantages over open repair like less invasiveness but risks like increased reintervention rates.
in endo era. aortic is one of the industrial driven medical proedure & one of the most expensive. Its morbidity are quoet acceptable, but......... surgeon if the best deal behind this awsome techno
in endo era. aortic is one of the industrial driven medical proedure & one of the most expensive. Its morbidity are quoet acceptable, but......... surgeon if the best deal behind this awsome techno
Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a procedure to dilated the mitral valve in the setting of rheumatic mitral valve stenosis. A catheter is inserted into the femoral vein, advanced to the right atrium and across the interatrial septum. Then the mitral valve is crossed with a balloon and it is inflated to relieve the fusion of the mitral valve commissures effectively acting to increase the mitral valve area and reduce the degree of mitral stenosis. Mitral regurgitation is a potential complication and thus PBMV is contraindicated if moderate or severe regurgitation is present. The Wilkins score examines mitral valve morphology and is determined via echocardiography to assess the likelihood of using PBMV based on certain echocardiographic criteria.
Intravascular lithotripsy (ivl) for peripheral arterial diseaseRamachandra Barik
There are a number of observations that suggest IVL produces
compliance changes in the vessel wall:Effacement of calcified stenoses with lithotripsy at low pressure with no change in angioplasty balloon pressure •Changes in echotexture on Duplex Ultrasound•Changes in appearances on Optical Coherence Tomography
Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a procedure to dilated the mitral valve in the setting of rheumatic mitral valve stenosis. A catheter is inserted into the femoral vein, advanced to the right atrium and across the interatrial septum. Then the mitral valve is crossed with a balloon and it is inflated to relieve the fusion of the mitral valve commissures effectively acting to increase the mitral valve area and reduce the degree of mitral stenosis. Mitral regurgitation is a potential complication and thus PBMV is contraindicated if moderate or severe regurgitation is present. The Wilkins score examines mitral valve morphology and is determined via echocardiography to assess the likelihood of using PBMV based on certain echocardiographic criteria.
Intravascular lithotripsy (ivl) for peripheral arterial diseaseRamachandra Barik
There are a number of observations that suggest IVL produces
compliance changes in the vessel wall:Effacement of calcified stenoses with lithotripsy at low pressure with no change in angioplasty balloon pressure •Changes in echotexture on Duplex Ultrasound•Changes in appearances on Optical Coherence Tomography
ANEURYSMS , TYPES AND THERE MANAGEMENT.pptxBipul Thakur
Discussion about different types of Aneurysm, details about Abdominal aorta aneurysm and brief discussion about some important peripheral aneurysms.
Includes approach to different forms of Abdominal aortic aneurysm, its management and complications related to the surgery.
Aneurysms of Visceral arteries, Splenic Artery Aneurysm in Childbearing.KHALID ALRAJHI
Splenic Artery Aneurysm is one of the vascular anomalies of visceral arteries.
Her's seminar of visceral artery aneurysms, and in pregnancy period.
Visceral aneurysms are clinically important that affect population and health socio-economical systems.
- Introduction
- Definition
- Classifications
- Causes
- Risk Factors
- Symptoms
- Diagnosis
- Management
- Endovascular Surgery
- Case Presentation
DEFINITION:
An aortic aneurysm is an enlargement (dilation) of the aorta to greater than 1.5 times normal size.
1)Abdominal aortic aneurysm:
2)Thoracic aortic aneurysm:
1)Hardening of the arteries ( Atherosclerosis).
2)Genetic conditions:
Aortic aneurysms in younger people often have a genetic cause –people who are born with Marfan syndrome.
3)Other medical conditions: Inflammatory conditions ,such as giant cell arteritis.
4)Problems with your hearts aortic valve:
Some times people who have problems with the valve.
5)Untreated infection: Such as syphilis or salmonella, and HIV.
6)Traumatic injury: Rarely ,some people who are injured in falls or motor vehicle crashes develop thoracic aortic aneurysms.
RISK FACTORS-1)Age
2)Male gender
3)Hypertension
4)Coronary artery disease
5)Family history
6)High cholesterol
7)Lower extremity
8)Carotid artery disease.
9)Previous stroke
10)Tobacco use
11)Excess weight.
SIGN & SYMPTOMS-
THORACIC AORTIC ANEURYSM.
•Constant boring pain, which may occur only when the patient is in the supine position.
Dyspnea, cough( parpoxysmal and brassy).
Hoarseness , stridor ,weakness or completer loss of the voice( aphonia).
Dysphagia.
Dilated superficial veins on chest ,neck, neck or arms.
Edematous areas on chest wall.
Cyanosis
Unequal pupils.
1.Patients complaints of “ heart beating” in abdomen when lying down or a feeling of an abdominal mass or abdominal throbbing.
2.Cyanosis and mottling of the toes if aneurysm is associated with thrombus.
DIAGNOSTIC MEASURE-Chest x.ray , CT angiography ( CTA), and transesophageal electrocardiography( TEE) , are done to reveal abnormal widening of the thoracic aorta.
Abdominal aortic aneurysm : Pulsation of pulsatile mass in the middle and upper abdomen , duplex ultrasonography or CTA is used to determine the size ,length and location of the aneurysm.
Dissecting aneurysm : Arteriography ,CTA,TEE duplex ultrasonography and magnetic resonance angiography ( MRA).
COMPLICATION
•Rupture of an aneurysm is the most serious complication.
•If rupture occurs into the retroperitoneal space , bleeding may be controlled by surrounding anatomic structures, preventing exsanguination and death.
MEDICALMANAGEMENT
•The goal of both medical and surgical management is to prevent aneurysm rupture.
•Early detection and prompt treatment are essential .
•Conservative therapy of small asymptomatic AAA’s ( 4-5.5) is the best practice.
This consists of risk factor modification ( ceasing tobacco use , decreasing B.P, optimizing of aneurysm size using ultrasound ,CT, or MRI.
•Growth rates may be lowered with B- adrenergic blocking agents ( eg. Propranolol) , Statins ( eg. Simvastatin) and antibiotics( eg. Doxycycline).
SURGICAL MANAGEMENT-Surgical repair is recommended in patients. with asymptomatic aneurysm 5-5 cm in diameter or larger.
•Surgical procedure are
1)Open aneurysm repair (OAR)
2)Endovascular graft procedure
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
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One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
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Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
5. ABDOMINAL AORTIC ANEURYSMS
Abdominal Aortic Aneurysm is a permanent pathologic dilation of the
abdominal aorta with a greater than 50% increase in its diameter
The most significant pathology is “elastin degradation due to MMPs
(mainly 2,9,12) in the aortic media
Risk Factors: smoking, ♂, hypertension, genetics
Annual risk of rupture of diameters between 5-5.9: 5%
6. ABDOMINAL AORTIC ANEURYSMS
Management of AAAs
• Imaging: Plain radiographs, USS, CT, MRA
• Screening: recommended for men over 65 years (single USS)
• Treatment:
Aim is to prevent death from aortic rupture
Pharmacologic: control risk factors (e.g. Blood Pressure: β-
blockers, Losartan), Doxycycline (↓ MMP 9), Statins (anti-
inflammatory), Curcumin (reduces cytokines)
11. ABDOMINAL AORTIC ANEURYSMS
INDICATIONS FOR AAA REPAIR
• Diameter ≥ 5.5 cm (5 cm in females)
• Diameter ≥ 2.5 times the normal aortic diameter
• Aneurysm annual growth rate ≥ 1 cm
• AAA rupture
• Symptomatic (e.g. back pain)
12. ABDOMINAL AORTIC ANEURYSMS
EVAR versus OR
• No laparotomy
• Less postoperative pain
• Shorter hospital stay
• Lower operative mortality
• Similar mid-term all cause mortality and quality of life
• No survival benefit compared with “NO INTERVENTION” in unfit patients
• Higher re-intervention rates and graft specific problems
13. EVAR
EVAR for AAA represents an advance in patient
care, serving as an effective alternative to
traditional open surgical AAA repair, and is now
the most common treatment method for AAA
repair in the United States.
14. EVAR
Juan Carlos Parodi
• 1970s:
Proposed the concept
of using endoluminal
route to deliver fabric
grafts reinforced with
metal stents
• 1990:
First Human Implant
Unfit patient
The patient lived for 9
years before dying from
pancreatic carcinoma
15. EVAR
Graft Characteristics
• Active fixation at the proximal end (e.g. hooks)
• Resting flow divider at the distal end
• Low permeability ePTFE
• Polymer filled ring at the proximal sealing zone
to protect the aortic neck
• Kink-resistant iliac limbs
• Radio-opaque markers to assist positioning
16. EVAR
Preoperative workup (almost identical to OR)
• Planning CT for accurate assessment of the aortic
morphology:
With contrast
Arterial phase
Reconstructed at a max. 3 mm axial slices (1.5 mm
for fenestrated / branched grafts)
Diaphragm – Groin
Measurement: adventitia – adventitia (most grafts)
Formally reported by a radiologist
17. EVAR
Preoperative workup (almost identical to OR)
• Planning CT for accurate assessment of the aortic morphology:
1 – 2 mm diameter variation is expected (phase of cardiac cycle)
Standard instructions for use IFUs (according to the graft)
18. EVAR
EVAR is not favored in the following:
• Heavy calcifications
• Excessive iliacs tortuosity
• Excessive angulation of the aneurysm neck
19. EVAR
Preoperative workup (almost identical to OR)
• Planning CT for accurate assessment of the aortic
morphology
• Theatre environment to reduce the infection
rates
• Fixed high specification angiographic
fluoroscopy units
• General / regional anaesthesia preferred
(excessive patient discomfort may be encountered due
to lower limb ischaemia as the delivery system may
occludes femorals)
49. ENDOLEAKS
Types of Endoleaks
Type IV
Type IV endoleaks are not true leaks but
represent passage of blood through the
graft fabric as a result of porosity. Typically
this type of endoleak is transient and only
noted at the time of repair appearing as a
blush on the post-deployment angiogram,
when patients are often fully
anticoagulated, and resolve spontaneously
after the withdrawal of anticoagulation.
This type of endoleak has been eliminated
by changes in graft porosity