The objective of this review is to show different types of treatment for abdominal
aortic aneurysms (AAA) - compare and evaluate the effectiveness of the
treatments.
The document discusses spinal cord ischemia that can occur during aortic interventions. It outlines the anatomy of the spinal cord blood supply, which involves a network of arteries. Risk factors for spinal cord ischemia include longer aneurysm extent, hypotension, emergency operations, and open repair procedures. The pathophysiology involves impairment of autoregulation and reduction of spinal cord perfusion pressure during aortic occlusion from cross-clamping. Prevention strategies aim to minimize ischemia time, increase tolerance, augment spinal cord perfusion, and allow early detection of ischemia.
Get the facts on Angioplasty (procedure to unblock arteries of heart), types, recovery, benefits and right candidate for Angioplasty, best Angioplasty hospitals in India and introducing free guidance on Angioplasty treatment by experienced patient advisors.
Acute aortic syndromes include aortic dissection, intramural hematoma, and penetrating aortic ulcer. They involve a breakdown of the aortic wall layers. Type A dissection requires urgent surgery while type B can be managed medically or with TEVAR for complications. Intramural hematoma and penetrating ulcers are generally treated medically but TEVAR is considered for complications. Guidelines provide algorithms for diagnosis and management based on syndrome type, complications, and patient factors. TEVAR has become preferred over surgery for some conditions when anatomy is favorable.
This document discusses surgical tips for bleeding control after aortic surgery. It describes two case studies of patients who underwent aortic surgery and subsequently experienced bleeding issues. Bleeding is a life-threatening complication for thoracic aortic surgery. Proper surgical technique and advances in graft materials and hemostasis techniques have helped reduce bleeding, but it remains a challenge, especially for acute aortic dissections. Both topical hemostatic agents and optimizing a patient's systemic hemostatic system can help manage bleeding.
Technique of peripheral angiogram and complicationMai Parachy
The document discusses techniques for peripheral angiograms and potential complications. It covers operating room preparation including equipment such as needles, guide wires, sheaths, and catheters. Access site selection is discussed including the common femoral, popliteal, tibial, brachial, subclavian, and radial arteries. The angiogram procedure is outlined including artery puncture, sheath placement, guidewire insertion, catheter selection, contrast injection, and closure techniques such as manual compression or closure devices. Complications from the procedure are also mentioned.
1. The document discusses various methods for evaluating aortic aneurysms including CT, MRI, and aortography. CT is useful for determining size and details of the aneurysm but risks radiation exposure, while MRI does not require contrast but has longer scan times and other limitations.
2. Factors such as aneurysm size greater than 5.5cm, shape, wall thickness, and presence of thrombus impact the risk of rupture. Open or endovascular repair options are discussed based on risk factors. Endovascular repair has lower short-term mortality but higher reintervention rates.
3. Details are provided on preparations, techniques, and steps for open surgery to replace the thoracic or thoracoabdom
Surgical repair of patent ductus arteriosus history timelineRamachandra Barik
Congenital cardiac surgery is one of the most challenging and fascinating branches of modern medicine which continues to
advance in areas and improving outcomes, post-operative and pre-operative care.
Patent Ductus Arteriosus was the first congenital heart lesion to be successfully corrected surgically. The landmark surgery was
performed by Dr. Robert E. Gross in 1938 and opened up the possibility of subsequent surgical correction of various other lesions,
which were considered to be untreatable previously. The first successful surgical closure of persistent ductus arteriosus (PDA)
was preceded by years of work and contributed by various surgeons, physicians, and anatomists, dating all the way back to
the 1st century. They are all worthy of recognition and praise.
This article covers the important events related to PDA lesions including its first identification, followed by its description
in various texts and sources over the course of time, failed attempts at surgical correction, and disputes regarding credits.
These contributions to the branch cannot be overstated and serves as an inspiration to cardiac surgeons all over the world
and to students, interns, and newly graduated doctors as well, who would one day like to be part of this fascinating branch.
The document discusses spinal cord ischemia that can occur during aortic interventions. It outlines the anatomy of the spinal cord blood supply, which involves a network of arteries. Risk factors for spinal cord ischemia include longer aneurysm extent, hypotension, emergency operations, and open repair procedures. The pathophysiology involves impairment of autoregulation and reduction of spinal cord perfusion pressure during aortic occlusion from cross-clamping. Prevention strategies aim to minimize ischemia time, increase tolerance, augment spinal cord perfusion, and allow early detection of ischemia.
Get the facts on Angioplasty (procedure to unblock arteries of heart), types, recovery, benefits and right candidate for Angioplasty, best Angioplasty hospitals in India and introducing free guidance on Angioplasty treatment by experienced patient advisors.
Acute aortic syndromes include aortic dissection, intramural hematoma, and penetrating aortic ulcer. They involve a breakdown of the aortic wall layers. Type A dissection requires urgent surgery while type B can be managed medically or with TEVAR for complications. Intramural hematoma and penetrating ulcers are generally treated medically but TEVAR is considered for complications. Guidelines provide algorithms for diagnosis and management based on syndrome type, complications, and patient factors. TEVAR has become preferred over surgery for some conditions when anatomy is favorable.
This document discusses surgical tips for bleeding control after aortic surgery. It describes two case studies of patients who underwent aortic surgery and subsequently experienced bleeding issues. Bleeding is a life-threatening complication for thoracic aortic surgery. Proper surgical technique and advances in graft materials and hemostasis techniques have helped reduce bleeding, but it remains a challenge, especially for acute aortic dissections. Both topical hemostatic agents and optimizing a patient's systemic hemostatic system can help manage bleeding.
Technique of peripheral angiogram and complicationMai Parachy
The document discusses techniques for peripheral angiograms and potential complications. It covers operating room preparation including equipment such as needles, guide wires, sheaths, and catheters. Access site selection is discussed including the common femoral, popliteal, tibial, brachial, subclavian, and radial arteries. The angiogram procedure is outlined including artery puncture, sheath placement, guidewire insertion, catheter selection, contrast injection, and closure techniques such as manual compression or closure devices. Complications from the procedure are also mentioned.
1. The document discusses various methods for evaluating aortic aneurysms including CT, MRI, and aortography. CT is useful for determining size and details of the aneurysm but risks radiation exposure, while MRI does not require contrast but has longer scan times and other limitations.
2. Factors such as aneurysm size greater than 5.5cm, shape, wall thickness, and presence of thrombus impact the risk of rupture. Open or endovascular repair options are discussed based on risk factors. Endovascular repair has lower short-term mortality but higher reintervention rates.
3. Details are provided on preparations, techniques, and steps for open surgery to replace the thoracic or thoracoabdom
Surgical repair of patent ductus arteriosus history timelineRamachandra Barik
Congenital cardiac surgery is one of the most challenging and fascinating branches of modern medicine which continues to
advance in areas and improving outcomes, post-operative and pre-operative care.
Patent Ductus Arteriosus was the first congenital heart lesion to be successfully corrected surgically. The landmark surgery was
performed by Dr. Robert E. Gross in 1938 and opened up the possibility of subsequent surgical correction of various other lesions,
which were considered to be untreatable previously. The first successful surgical closure of persistent ductus arteriosus (PDA)
was preceded by years of work and contributed by various surgeons, physicians, and anatomists, dating all the way back to
the 1st century. They are all worthy of recognition and praise.
This article covers the important events related to PDA lesions including its first identification, followed by its description
in various texts and sources over the course of time, failed attempts at surgical correction, and disputes regarding credits.
These contributions to the branch cannot be overstated and serves as an inspiration to cardiac surgeons all over the world
and to students, interns, and newly graduated doctors as well, who would one day like to be part of this fascinating branch.
Coronary Balloon Angioplasty and Stents Procedure Information by We CareP Nagpal
Balloon Angioplasty Surgery India,Cost Balloon Angioplasty Surgery Delhi,Balloon Angioplasty Surgery Cost In India Info On Cost Balloon Angioplasty Surgery Mumbai Delhi Bangalore India,Balloon Angioplasty Surgery Center Hospitals India,Balloon Angioplasty Surgery Surgeon India,Balloon Angioplasty Surgery Doctors Mumbai India
This document discusses techniques for aortic valve repair surgery. It notes that valve preserving root replacement and aortic valve repair for isolated aortic insufficiency are being used more frequently. However, a limitation is the lack of a common framework for assessing the valve to guide repair approaches. The goal of repair is to restore normal leaflet geometry and mobility. Techniques discussed include remodeling, reimplantation, subcommissural annuloplasty, and triangular resection. Outcomes are generally good, especially for secondary insufficiency and tricuspid valves, but less so for isolated prolapse of one leaflet. Associated procedures and reproducibility of techniques need improvement. Echocardiography plays an important role in assessment and repair
Below the knee intervention; balloons or stentsMohamed Ashraf
This document discusses endovascular interventions for below-the-knee peripheral artery disease. It reviews the use of plain balloon angioplasty, bare-metal stents, drug-eluting stents, and drug-coated balloons. While balloon angioplasty alone has high restenosis rates, bare-metal stents provide improved outcomes but drug-eluting stents have been shown to further reduce restenosis and reintervention rates compared to bare-metal stents. Drug-coated balloons have potential benefits but large clinical trials have produced mixed results regarding their efficacy compared to plain balloon angioplasty. The optimal treatment remains an area of ongoing investigation.
This document discusses abdominal aortic aneurysms (AAAs). It notes that Albert Einstein died from an AAA, which affects over 700,000 people in Europe. AAAs are a silent killer as they often show no symptoms. The main risk factors are being male, smoking history, hypertension, family history, and increasing age. Ultrasound is an effective way to diagnose AAAs. If left untreated, AAAs over 5cm have a high risk of rupture. Small AAAs under 4cm should be monitored annually, while larger AAAs may require surgical or endovascular treatment.
13 nov 2017 intra operative thrombolysis in acute limb ischemiaMai Parachy
Intraoperative thrombolysis can be used to dissolve residual thrombus after embolectomy. It has the benefits of restoring patency and reducing the need for extensive surgery. The technique involves catheter placement within the thrombus to directly infuse thrombolytic agents. Studies show this approach is generally safe and can improve outcomes when used as an adjunct to surgery for acute limb ischemia. Long term patency depends on identifying and treating the underlying cause of occlusion.
Contrast-enhanced, cardiac-gated CT is highly accurate for determining the cause of acute aortic syndrome, which can be due to aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, or unstable thoracic aneurysm. CT accurately identifies the location and extent of disease and guides urgent surgical or endovascular repair when needed to treat life-threatening conditions such as type A aortic dissection or ruptured aneurysm.
The document discusses thoracic aortic aneurysms (TAAs), including:
1. TAAs can be true aneurysms involving all vessel layers, or pseudoaneurysms where the intimal and medial layers are disrupted. Common types are fusiform and saccular.
2. Etiologies include atherosclerosis, cystic medial necrosis from conditions like Marfan syndrome, infections, vasculitides, trauma, and congenital factors.
3. Imaging plays a key role in evaluating TAAs to characterize morphology, size, relationships to other structures, and signs of rupture risk. Management depends on aneurysm location and size.
This document discusses the role of MRI in assessing the thoracic aorta. It provides details on various MRI techniques used including CE-MRA, bSSFP, phase contrast, and black-blood sequences. It reviews clinical applications of MRI for thoracic aortic aneurysm, acute aortic syndromes, and large vessel vasculitis. MRI is presented as a good non-invasive alternative to CT for evaluation and serial imaging of thoracic aortic pathology due to lack of ionizing radiation and ability to characterize soft tissues and evaluate flow.
This document discusses various aortic diseases and considerations for their assessment and treatment. It begins by outlining the objectives to discuss different aortic conditions, including acute syndromes, aneurysms, genetic diseases, and tumors. It then covers important anatomical considerations like the thoracic and abdominal divisions of the aorta. Subsequent sections provide details on endovascular zones, normal dimensions, histology, pathologies, clinical exam findings, imaging modalities like CT and their roles in evaluating the aorta.
This document provides an overview of interventional radiology procedures, with a focus on radiofrequency ablation (RFA). It describes how RFA works to coagulate and destroy tumor tissue using an electric current. Images show RFA being used to treat cancers of the liver, lung, bone, and other areas. The advantages of RFA are discussed, including preserving organ function, being minimally invasive, having local effects, and being repeatable. The document also reviews other interventional oncology procedures like chemoembolization and the use of TheraSphere microspheres to treat hepatocellular carcinoma. Additionally, it covers embolization procedures and their applications as well as treatments for arterial diseases and chronic venous insuff
Both the remodeling and reimplantation techniques aim to preserve the native aortic valve in patients with aortic root aneurysms. The remodeling technique involves excising the diseased sinuses and reattaching the valve within a graft, reconstructing the sinuses. The reimplantation technique reimplants the valve within a graft anchored at the aortoventricular junction. Studies have found slightly better long-term outcomes with reimplantation, especially in conditions like Marfan syndrome or dissection, though both techniques have good results. Neither technique fully restores the normal biomechanics and stress patterns of the native aortic root.
Catheter Based Intervention and Surgical Management of Peripheral Arterial Oc...Omar Haqqani
Dr. Omar P. Haqqani, MD discusses the details of catheter based blood vessel intervention, focussed on management of peripheral arterial disease (PAD).
Valve in-valve implantation into a failed mechanical prosthetic aortic valveRamachandra Barik
First successful transcatheter valve-in-valve implantation into a failed mechanical prosthetic aortic valve facilitated by fracturing of the leaflets: a case report
This document discusses surgical bypass options for aorto-iliac occlusive disease (AIOD). It defines AIOD and describes the standard TASC classification system. The main indications for surgical intervention are claudication or chronic limb-threatening ischemia. Surgical bypass options described include aortoiliac endarterectomy, aortobifemoral bypass, femorofemoral bypass, axillofemoral bypass, and obturator bypass. Postoperative patency rates for different procedures are provided.
The document discusses complications and limitations of the elephant trunk procedure for treating complex aortic aneurysms. Some key points:
- The elephant trunk procedure has acceptable short and long-term outcomes but carries risks of left recurrent nerve injury, aortic rupture early after surgery, and rupture before the second stage.
- Only 61% of patients underwent the planned second-stage repair, and some refused the second procedure.
- Alternatives like a single-stage approach or performing the distal anastomosis more distally can reduce risks but were not always favored in the past.
- Emerging techniques like using the elephant trunk graft to enable endovascular stent grafting of the descending aorta may address some limitations
Acute aortic syndrome (AAS) refers to emergency aortic conditions including aortic dissection, intramural hematoma, and penetrating ulcers that have similar clinical presentations. AAS is classified using the DeBakey or Stanford systems based on the location and extent of disease. Imaging with CT, MRI, or TEE is used to establish the diagnosis and guide treatment, which may involve medical management or emergent surgery depending on the specific condition and complications. Prognosis depends on factors like age, hypertension status, and involvement of other organs. Long term follow-up is needed due to risks of progressive aortic disease.
Angiography is the process of radiography of blood or lymph vessels, carried out after introduction of a radiopaque substance. Medifee Find the hospitals and clinics that offer Angiography in major Indian cities along with their prices.
Carotid stenosis is more prevalent with age and other risk factors. It increases the risk of stroke, myocardial infarction, and death. Doppler ultrasound is commonly used to evaluate carotid stenosis as it is noninvasive and provides information on blood flow velocities. While useful for screening, it has limitations and other imaging modalities like CTA, MRA, and DSA may be needed to fully characterize carotid plaque and stenosis.
1. The document describes the anatomy and classification of aortic aneurysms. It discusses the causes, imaging features, complications and management of thoracic and abdominal aortic aneurysms.
2. Key imaging modalities like CT, MRI, ultrasound are described for detecting and characterizing aortic aneurysms as well as complications like rupture, dissection and fistula formation.
3. Signs of impending rupture on CT like the high attenuating crescent sign and draped aorta sign are also summarized. Treatment involves open surgical repair or endovascular stent graft placement depending on the location and size of the aneurysm.
An abdominal aortic aneurysm is a dilatation of the abdominal aorta that is 50% greater than the normal diameter or greater than 3 cm. They are usually asymptomatic but can cause pain or rupture. Ultrasound is used to monitor AAA size and growth rate, with more frequent scans needed as the aneurysm enlarges. For aneurysms between 5-5.5 cm in men or 5 cm in women, the risk of rupture increases and surgical repair is considered. The goal is to repair before the aneurysm reaches 6 cm in diameter to reduce the risk of fatal rupture.
Endovascular repair of thoracic and abdominal aortic aneurysmsApollo Hospitals
Endovascular repair of thoracic and abdominal aortic aneurysms has significantly reduced mortality and morbidity compared to open surgery. It involves placing stent grafts using catheters to exclude aneurysms from blood flow. Proper patient selection based on aneurysm anatomy and vessel access is important for success. Follow up imaging is needed to monitor for complications like endoleaks. Mid-term results show endovascular repair provides good outcomes with 85% survival at 18-24 months for thoracic aneurysms. It has emerged as an alternative to open surgical repair for properly selected abdominal aortic aneurysm cases.
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
Coronary Balloon Angioplasty and Stents Procedure Information by We CareP Nagpal
Balloon Angioplasty Surgery India,Cost Balloon Angioplasty Surgery Delhi,Balloon Angioplasty Surgery Cost In India Info On Cost Balloon Angioplasty Surgery Mumbai Delhi Bangalore India,Balloon Angioplasty Surgery Center Hospitals India,Balloon Angioplasty Surgery Surgeon India,Balloon Angioplasty Surgery Doctors Mumbai India
This document discusses techniques for aortic valve repair surgery. It notes that valve preserving root replacement and aortic valve repair for isolated aortic insufficiency are being used more frequently. However, a limitation is the lack of a common framework for assessing the valve to guide repair approaches. The goal of repair is to restore normal leaflet geometry and mobility. Techniques discussed include remodeling, reimplantation, subcommissural annuloplasty, and triangular resection. Outcomes are generally good, especially for secondary insufficiency and tricuspid valves, but less so for isolated prolapse of one leaflet. Associated procedures and reproducibility of techniques need improvement. Echocardiography plays an important role in assessment and repair
Below the knee intervention; balloons or stentsMohamed Ashraf
This document discusses endovascular interventions for below-the-knee peripheral artery disease. It reviews the use of plain balloon angioplasty, bare-metal stents, drug-eluting stents, and drug-coated balloons. While balloon angioplasty alone has high restenosis rates, bare-metal stents provide improved outcomes but drug-eluting stents have been shown to further reduce restenosis and reintervention rates compared to bare-metal stents. Drug-coated balloons have potential benefits but large clinical trials have produced mixed results regarding their efficacy compared to plain balloon angioplasty. The optimal treatment remains an area of ongoing investigation.
This document discusses abdominal aortic aneurysms (AAAs). It notes that Albert Einstein died from an AAA, which affects over 700,000 people in Europe. AAAs are a silent killer as they often show no symptoms. The main risk factors are being male, smoking history, hypertension, family history, and increasing age. Ultrasound is an effective way to diagnose AAAs. If left untreated, AAAs over 5cm have a high risk of rupture. Small AAAs under 4cm should be monitored annually, while larger AAAs may require surgical or endovascular treatment.
13 nov 2017 intra operative thrombolysis in acute limb ischemiaMai Parachy
Intraoperative thrombolysis can be used to dissolve residual thrombus after embolectomy. It has the benefits of restoring patency and reducing the need for extensive surgery. The technique involves catheter placement within the thrombus to directly infuse thrombolytic agents. Studies show this approach is generally safe and can improve outcomes when used as an adjunct to surgery for acute limb ischemia. Long term patency depends on identifying and treating the underlying cause of occlusion.
Contrast-enhanced, cardiac-gated CT is highly accurate for determining the cause of acute aortic syndrome, which can be due to aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, or unstable thoracic aneurysm. CT accurately identifies the location and extent of disease and guides urgent surgical or endovascular repair when needed to treat life-threatening conditions such as type A aortic dissection or ruptured aneurysm.
The document discusses thoracic aortic aneurysms (TAAs), including:
1. TAAs can be true aneurysms involving all vessel layers, or pseudoaneurysms where the intimal and medial layers are disrupted. Common types are fusiform and saccular.
2. Etiologies include atherosclerosis, cystic medial necrosis from conditions like Marfan syndrome, infections, vasculitides, trauma, and congenital factors.
3. Imaging plays a key role in evaluating TAAs to characterize morphology, size, relationships to other structures, and signs of rupture risk. Management depends on aneurysm location and size.
This document discusses the role of MRI in assessing the thoracic aorta. It provides details on various MRI techniques used including CE-MRA, bSSFP, phase contrast, and black-blood sequences. It reviews clinical applications of MRI for thoracic aortic aneurysm, acute aortic syndromes, and large vessel vasculitis. MRI is presented as a good non-invasive alternative to CT for evaluation and serial imaging of thoracic aortic pathology due to lack of ionizing radiation and ability to characterize soft tissues and evaluate flow.
This document discusses various aortic diseases and considerations for their assessment and treatment. It begins by outlining the objectives to discuss different aortic conditions, including acute syndromes, aneurysms, genetic diseases, and tumors. It then covers important anatomical considerations like the thoracic and abdominal divisions of the aorta. Subsequent sections provide details on endovascular zones, normal dimensions, histology, pathologies, clinical exam findings, imaging modalities like CT and their roles in evaluating the aorta.
This document provides an overview of interventional radiology procedures, with a focus on radiofrequency ablation (RFA). It describes how RFA works to coagulate and destroy tumor tissue using an electric current. Images show RFA being used to treat cancers of the liver, lung, bone, and other areas. The advantages of RFA are discussed, including preserving organ function, being minimally invasive, having local effects, and being repeatable. The document also reviews other interventional oncology procedures like chemoembolization and the use of TheraSphere microspheres to treat hepatocellular carcinoma. Additionally, it covers embolization procedures and their applications as well as treatments for arterial diseases and chronic venous insuff
Both the remodeling and reimplantation techniques aim to preserve the native aortic valve in patients with aortic root aneurysms. The remodeling technique involves excising the diseased sinuses and reattaching the valve within a graft, reconstructing the sinuses. The reimplantation technique reimplants the valve within a graft anchored at the aortoventricular junction. Studies have found slightly better long-term outcomes with reimplantation, especially in conditions like Marfan syndrome or dissection, though both techniques have good results. Neither technique fully restores the normal biomechanics and stress patterns of the native aortic root.
Catheter Based Intervention and Surgical Management of Peripheral Arterial Oc...Omar Haqqani
Dr. Omar P. Haqqani, MD discusses the details of catheter based blood vessel intervention, focussed on management of peripheral arterial disease (PAD).
Valve in-valve implantation into a failed mechanical prosthetic aortic valveRamachandra Barik
First successful transcatheter valve-in-valve implantation into a failed mechanical prosthetic aortic valve facilitated by fracturing of the leaflets: a case report
This document discusses surgical bypass options for aorto-iliac occlusive disease (AIOD). It defines AIOD and describes the standard TASC classification system. The main indications for surgical intervention are claudication or chronic limb-threatening ischemia. Surgical bypass options described include aortoiliac endarterectomy, aortobifemoral bypass, femorofemoral bypass, axillofemoral bypass, and obturator bypass. Postoperative patency rates for different procedures are provided.
The document discusses complications and limitations of the elephant trunk procedure for treating complex aortic aneurysms. Some key points:
- The elephant trunk procedure has acceptable short and long-term outcomes but carries risks of left recurrent nerve injury, aortic rupture early after surgery, and rupture before the second stage.
- Only 61% of patients underwent the planned second-stage repair, and some refused the second procedure.
- Alternatives like a single-stage approach or performing the distal anastomosis more distally can reduce risks but were not always favored in the past.
- Emerging techniques like using the elephant trunk graft to enable endovascular stent grafting of the descending aorta may address some limitations
Acute aortic syndrome (AAS) refers to emergency aortic conditions including aortic dissection, intramural hematoma, and penetrating ulcers that have similar clinical presentations. AAS is classified using the DeBakey or Stanford systems based on the location and extent of disease. Imaging with CT, MRI, or TEE is used to establish the diagnosis and guide treatment, which may involve medical management or emergent surgery depending on the specific condition and complications. Prognosis depends on factors like age, hypertension status, and involvement of other organs. Long term follow-up is needed due to risks of progressive aortic disease.
Angiography is the process of radiography of blood or lymph vessels, carried out after introduction of a radiopaque substance. Medifee Find the hospitals and clinics that offer Angiography in major Indian cities along with their prices.
Carotid stenosis is more prevalent with age and other risk factors. It increases the risk of stroke, myocardial infarction, and death. Doppler ultrasound is commonly used to evaluate carotid stenosis as it is noninvasive and provides information on blood flow velocities. While useful for screening, it has limitations and other imaging modalities like CTA, MRA, and DSA may be needed to fully characterize carotid plaque and stenosis.
1. The document describes the anatomy and classification of aortic aneurysms. It discusses the causes, imaging features, complications and management of thoracic and abdominal aortic aneurysms.
2. Key imaging modalities like CT, MRI, ultrasound are described for detecting and characterizing aortic aneurysms as well as complications like rupture, dissection and fistula formation.
3. Signs of impending rupture on CT like the high attenuating crescent sign and draped aorta sign are also summarized. Treatment involves open surgical repair or endovascular stent graft placement depending on the location and size of the aneurysm.
An abdominal aortic aneurysm is a dilatation of the abdominal aorta that is 50% greater than the normal diameter or greater than 3 cm. They are usually asymptomatic but can cause pain or rupture. Ultrasound is used to monitor AAA size and growth rate, with more frequent scans needed as the aneurysm enlarges. For aneurysms between 5-5.5 cm in men or 5 cm in women, the risk of rupture increases and surgical repair is considered. The goal is to repair before the aneurysm reaches 6 cm in diameter to reduce the risk of fatal rupture.
Endovascular repair of thoracic and abdominal aortic aneurysmsApollo Hospitals
Endovascular repair of thoracic and abdominal aortic aneurysms has significantly reduced mortality and morbidity compared to open surgery. It involves placing stent grafts using catheters to exclude aneurysms from blood flow. Proper patient selection based on aneurysm anatomy and vessel access is important for success. Follow up imaging is needed to monitor for complications like endoleaks. Mid-term results show endovascular repair provides good outcomes with 85% survival at 18-24 months for thoracic aneurysms. It has emerged as an alternative to open surgical repair for properly selected abdominal aortic aneurysm cases.
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
This document is a research paper that compares the effectiveness of endovascular stent graft repairs and open bypass repairs for popliteal artery aneurysms (PAAs). The author conducted a study using patient data from 2010-2012 from a vascular surgical office to compare post-operative complication rates between the two procedures. The study found differing complication rates between the procedures. Further research is needed to determine if one procedure results in fewer complications and is therefore safer. The author aims to inform doctors of any safer option so they can select the treatment that reduces complications for patients.
Angioplasty is a minimally invasive procedure used to open blocked blood vessels by inserting a balloon catheter and inflating the balloon to compress plaque and widen the vessel. It is commonly used to treat coronary artery disease and heart attacks. During angioplasty, a balloon is guided to the blockage where it is inflated to open the artery. Sometimes a stent is placed to keep the artery open. Angioplasty allows faster treatment of heart attacks with good long-term outcomes and is generally safer than alternative procedures like bypass surgery.
This document provides a guide on abdominal aortic aneurysms (AAAs) for medical students. It defines AAAs as abnormal dilatations of the aorta between the diaphragm and iliac arteries. AAAs are usually asymptomatic but can rupture, causing severe abdominal pain and shock. Risk factors include smoking, male sex, age, and family history. Ultrasound is used to detect AAAs by measuring diameter. Larger AAAs have higher rupture risks and may require elective open or endovascular repair surgery to prevent rupture. Complications after endovascular repair include endoleaks, where blood bypasses the graft. Ruptured AAAs require emergency open repair surgery.
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Risks of ileocolic anastomosis
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2. 1. Abstract
Abdominal aortic aneurysm (AAA), associated with the expansion of a new
section of the aorta. As the aneurysm grows larger the ratio between the
diameter and the surface area and the pressure on the side, because of the
greater risk of outbreak or tear (rupture) as when inflated balloon too. Aneurysms
are usually caused by damage to the blood vessel wall. Is generally from
atherosclerosis caused by the accumulation of cholesterol and other fatty
deposits lining the blood vessels.
This paper reviews different methods for treating abdominal aortic aneurysm, the
paper gathers several articles that divided to two different approach treatments,
and compare them regarding the advantage and disadvantage of each one.
The paper relay on research conducted on 22,830 patients that had a open
repair procedure and 22.830 patients had a endovascular repair procedure. The
main medical aspects are rates of death, medical complications, and surgical
complications.
In the review there is comparison between 4 different companies that each one
developed a technology for noninvasive treatments.
The parameters for the comparison are: stent placement, surgeon skills,
invasiveness, surgery time, modularity.
3. 2. Introduction
Anatomy
Aorta is the main blood vessels leading from the heart blood throughout the
body. Aorta leaves the room left up, going through arched back and to the left,
above the heart and pulmonary artery, and down the front of the spine to the
abdomen. Over the course aortic arteries divergent body until finally, below the
navel, it splits into two iliac arteries. According to the structure is divided into the
aorta into three parts: the ascending aorta, which goes from the heart up, aortic
arch and descending aorta, which is above the diaphragm called the thoracic
aorta and abdominal aorta below it.
Figure 1 - showing the aorta in the human body
4. Pathology
Aneurysms of the aorta are usually caused by damage to the wall of the aorta. Is
generally from atherosclerosis, which is caused by the accumulation of
cholesterol and other fatty deposits on the vessel. This condition is more
common in men, and age-related diseases aggravated presence, such as
hypertension, diabetes and smoking. However, there are situations in which
there is a congenital weakness in the walls of blood vessels in the body. In these
situations, may develop aneurysms of the aorta younger people - in their younger
years. Weakness in the wall of the aorta can lead to expansion of the artery,
rupture and life-threatening bleeding without precursors. At risk for abdominal
aneurysm include: men over 65, current or former smokers, relatives of people
with aortic aneurysm, heart patients and patients with atherosclerosis. There
aortic aneurysms by more than 3% of people over age 60, and is a cause of
death in - 1/250 of people over age 50. You can find abdominal aortic aneurysm
before fatal complication appears very easily by a single ultrasound examination,
simple and non-invasive. Indeed, because of the recognition that the diagnosis
omission of Western countries, including the United States and England, were
led national programs to detect early aortic aneurysms in the population.
3. Objective
The objective of this review is to show different types of treatment for abdominal
aortic aneurysms (AAA) - compare and evaluate the effectiveness of the
treatments.
4. Methods
4.1 Searching strategy
Literature search was performed in Internet database Google Scholar
using the following key words: Endovascular, Open Repair,
Transabdominal Repair, Abdominal Aortic Aneurysm, AAA, Stent graft.
No limitation was applied during the search. All relevant articles were
initially selected by title and abstract.
5. 4.2 Review and comparison
The main comparison between endovascular and trans-abdominal
repair were reviewed from different articles and compared to each
other in a table. An additional comparison was made among different
companies with high technology advancing solution, the source of
each solution was taken from the official website of the company.
5. Review
Open repair procedure
The infrarenal aorta can be approached via a transabdominal midline or
paramedian incision, or via a retroperitoneal approach. The paravisceral and
thoracic aorta are approached via a left-sided posteriolateral thoracotomy incision
in approximately the 9th intercostal space. The Surgery preformed under a
general endotracheal anesthesia. The aneurysm may be exposed through either
a long midline incision for the transperitoneal approach or an oblique flank
incision for the retroperitoneal approach.
In a nutshell, open repair of an abdominal aortic aneurysm involves an incision of
the abdomen to directly visualize the aortic aneurysm. The procedure is
performed in an operating room under general anesthesia. The surgeon will
make an incision in the abdomen either lengthwise from below the breastbone to
just below the navel or across the abdomen and down the center. Once the
abdomen is opened, the aneurysm will be repaired by the use of a long cylinder-
like tube called a graft that acting like artificial artery.
Endovascular repair procedure
Also known as EVAR, is a minimally invasive (without a large abdominal
incision), with a regional anesthesia (epidural or spinal anesthesia), a small
incision is made in each groin to visualize the femoral arteries in each leg or one
leg (contingent on the technology). With X-ray images for guidance, a stent-graft
will be inserted through the femoral artery and advanced up into the aorta to the
site of the aneurysm. A stent-graft is a long cylinder-like tube made of a thin
6. metal framework (stent), while the graft portion is made of various materials such
as Dacron or polytetrafluoroethylene (PTFE) land may cover the stent. The stent
helps to hold the graft in place. The stent-graft is inserted into the aorta in a
collapsed position and placed at the aneurysm site. Once in place, the stent-graft
will be expanded, attaching to the wall of the aorta to support the wall of the
aorta. The aneurysm will eventually shrink down onto the stent-graft.
Open repair versus Endovascular
Several researches have been taken under consideration to determine which
procedure is preferable and pros and cons of each one. In the following lines we
will discuss the ratio between 3 main medical aspects that are taken from the
results of a research conducted on 22,830 patients that had a open repair
procedure and 22.830 patients had a endovascular repair procedure. The main
medical aspects are rates of death, medical complications, and surgical
complications.
Graph 1 shows the percentage medical complications developed in patients that
were under the supervision of the research. The complications that were studied
were myocardial infarction, pneumonia, acute renal failure, renal failure requiring
dialysis and deep-vein thrombosis or pulmonary embolism. The orange color
represents the open repair and the blue one represents the endovascular repair
according to the diseases.
Graph 1
0.0
5.0
10.0
15.0
20.0
Mycardial
infrac;on
Pneumonia Acute renal
failure
Renal failure
requiring
dialysis
Deep-vein
thrombosis or
pulmonary
embolism
Percent(%)
Medical complica=ons
Endovascular Repair
Open Repair
7. Graph 2 shows the surgical complications that accrued during the surgery. The
problems that were under examination were acute mesenteric ischemia,
reintervention for bleeding, Tracheostomy (incision in breathing canal) and
embolectomy (in operation to remove thrombosis).
Graph 2
In graph 3 we can see the follow up of the all the patients in the research during
4 years time period and suffered from severe rupture despite the operation.
Graph 3
0.0
0.5
1.0
1.5
2.0
2.5
Acute
mesenteric
ischemia
Reinterven;on
for bleeding
Tracheostomy Thrombectomy
Percent(%)
Surgical complica=ons
Endovascular Repair
Open Repair
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
Year 1 Year 2 Year 3 Year 4
Percent(%)
Rupture for long term
Endovascular
Open Repair
8. Graph 4 shows the death ratio between both procedures.
Graph 4
The death fatalities are caused by the complications before and after the
operation as shown in graph 1,2,3.
In the last 10 years many development have been made in the field of EVAR and
significant improvements to the durability of the stents. This review details 4
companies that use different unique approaches and technology: LOMBARD
MEDICAL, JOTEC, BIFLOW and ENDOSPAN. We gather all the specification
from each one and compared between them.
Lombard Medical
The Aorfix Endovascular Stent Graft is designed to be flexible and to more easily
treat AAAs with severe bends or angles. This flexibility allows some patients to
be treated with a stent graft where open surgery was previously their only option.
Aorfix is also appropriate for patients who have AAAs with less severe bends or
angles.
This technology leap reducing the chances to suffer from endoleak after the
procedure, therefore death ratio is decreasing.
0.0
1.0
2.0
3.0
4.0
5.0
6.0
Endovascular
Repair
Open Repair
Percent(%)
Death
Death
9. JOTEC
With E-vita ABDOMINAL XT, JOTEC provides an abdominal stent graft system
that – based on the latest catheter technology – makes even difficult vascular
anatomies passable, thus enabling endovascular treatment of abdominal aortic
aneurysms. The reason this technology is reviewed in this paper is due to 3
dominant characteristics:
Smooth delivery - the hydrophilic coating facilitates the introduction and advance
of the stent graft even in narrow and tortuous vessels.
Highest flexibility - the multi-zone catheter specifically developed for E-vita
ABDOMINAL XT is particularly flexible, enabling safe push- ability and precise
track ability even in strongly tortuous vessels. The catheter’s working length is 55
cm.
Precise release - the Squeeze-to- Release mechanism allows for gradual or
continuous release at minimum effort.
With this kind of catheter the doctors can achieve better results and reduced the
procedure time.
BIFLOW
BIFLOW Medical is developing a unique side-branch stent to be used during
percutaneous procedures in endovascular stent grafting. During the procedure,
the side-branch stent is introduced in a secondary artery. It penetrates the main
graft in the main artery, and then it opens for total sealing. This enables easier,
shorter, and less costly procedures. The BiFlow stent presents significantly lower
risk to the patient.
In every person the renal position is different thus making it hard to manufacture
one type of implant for everyone, they invent special system that enables to
install the main stent graft and adjust the renal opening according to each
individual unique blood vessels by piercing the graft with side-branch stent.
10. ENDOSPAN
ENDOSPAN develops advanced low profile stent-grafts systems for the
treatment of aneurysms and dissection throughout the aorta: infarenal, visceral
and thoracic. Endospan’s Horizon takes a different approach, enabling a single-
sided procedure, transforming the procedure into a shorter, simplified, and more
flexible procedure that need less technical expertise. The HORIZON AAA stent-
graft is constructed in a bottom-up sequence, providing more stability.
The uniqueness of ENDOSPAN is that the entrance to the body is made by one
cut only in the femoral artery in different from other applications that need two or
more incisions. This technique requires less operational skills from the medical
stuff and therefore decrease the amount of medical complications.
Summarizing table (table 1) of technology elements.
# LOMBARD JOTEC BIFLOW ENDOSPAN OPEN REPAIR
Material Nitinol,
polyester
Nitinol,
polyester
Nitinol, polyester Nitinol, polyester Polyester
Stent placement Fixation with
hook uses a
balloon to
expand.
Regular
fixation with
hooks.
By placing stents
in renal and
hooks.
Hooks and artery
support.
Sewing stent into the
artery.
Surgeon skills Medium, using
two catheters
and balloon.
Medium, using
two catheters,
easy
technology.
Medium, using 3
different catheters
and balloon
Medium, using 3
catheters, without
balloon.
Requires high skill of
the doctor.
Invasiveness Minimal
invasive, entry
on both
arteries.
Minimal
invasive, entry
on both
arteries.
Minimal invasive,
entry on both
arteries.
Minimally invasive,
single artery entry.
Highly invasive, open
surgery.
Surgery time 2-4(hr) 2-4(hr) 2-4(hr) 2-4(hr) 4-6(hr)
Modularity Flexible and
adapts over
time.
Wide variety of
sizes and
dimensions.
Suitable for
different anatomy
because renals
are not a factor.
Adapts With 3
different parts.
Precise match to the
artery.
Table 1 – Comparison among treatment methods
11. 6. Discussion
In the review we presented two kinds of procedures for abdominal aortic
aneurysm treatments. The comparison was between two researches that
followed on patients that needed surgery for aneurysm treatment.
The procedure of open repair itself is highly dangerous and can lead to severe
complications like critical bleeding, infections and liquids accumulation. The
healing from the surgery is more prolong than the endovascular and consist of
many hours or lying in bed. In doctors eyes the procedure is more complex and
requires a high skills.
Has shown in the graph mentioned above in the short term we can see that the
complication and the rates of death is higher in open repair then endovascular,
On the contrary for the long term we can see that the open repair is more reliable
through time and the chances for ruptures after the first 2 years is lower.
In my perspective lower death rate is the most important criterion that needed to
pay attention to. In every case that was studied the open repair has higher
probability to develop complication in the tested subjects.
We reviewed 4 different companies that have technology in the field of
endovascular and compared the most valuable parameters:
Material – all the technologies use nitinol and polyester except the open repair
that is use only polyester.
Stent placement - open repair due to because the graft is sewed directly to the
aorta.
Surgeon skills – JOTEC due to catheter abilities and the stent is consist only by 2
parts without the need of inflate a balloon.
Invasiveness – ENDOSPAN due to only one incision.
Surgery time – all the treatments were the same except the open repair that is
longer.
Modularity – open repair due to perfect compatibility between the graft and the
artery.
12. 7. Conclusions
Despite all the advantages in open repair it is recommended for younger people
to take the open repair treatment, because it is more reliable trough time. For
mature patients it is more recommended to use the endovascular treatment.
It is important to mention that open repair has high risks because the trauma the
body suffers from.
8. References
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M.D., F.A.C.S: Repair of infrarenal abdominal aortic aneurysms.
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Philip Cotterill, Ph.D., Frank Pomposelli, M.D., and Bruce E. Landon, M.D.,
M.B.A: Endovascular vs. Open Repair of Abdominal Aortic Aneurysms in the
Medicare Population., 2008.
3. W. Charles Sternbergh III, MD, and Samuel R. Money, MD, New Orleans, La:
Hospital cost of endovascular versus open repair of abdominal aortic
aneurysms: A multicenter study, 2000.
4. Wesley S. Moore, MD, Vikram S. Kashyap, MD, Candace L. Vescera, RN,
and William J. Quin˜ ones-Baldrich, MD: A 6-Year Comparison of
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Thomas J. Fogarty, MD, for the investigators of the Medtronic AneuRx
Multicenter Clinical Trial, Stanford, Calif: AneuRx stent graft versus open
surgical repair of abdominal aortic aneurysms: Multicenter prospective clinical
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13. 7. Frank A. Lederle, M.D., Julie A. Freischlag, M.D., Tassos C. Kyriakides,
Ph.D., Jon S. Matsumura, M.D., Frank T. Padberg, Jr., M.D., Ted R. Kohler,
M.D., Panagiotis Kougias, M.D., Jessie M. Jean-Claude, M.D., Dolores F.
Cikrit, M.D., and Kathleen M. Swanson, M.S., R.Ph: Long-Term Comparison
of Endovascular and Open Repair of Abdominal Aortic Aneurysm, 2012.
8. Moore WS, Rutherford RB. Transfemoral endovascular repair of abdominal
aortic aneurysms: results of the North-American EVT phase 1 trial. J Vasc
Surg 1996.
9. James May, MS, FRACS, FACS, Geoffrey H. White, FRACS, Weiyun Yu,
MS, BS, BSc, Cameron N. Ly, Richard Waugh, FRACR, Michael S. Stephen,
FRACS, Manjula Arulchelvam, MSc, and John P. Harris, MS, FRACS, FACS,
Sydney, Australia: Concurrent comparison of endoluminal versus open repair
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