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Predicting the Biomechanics of the Aorta Using Ultrasound
Published in Ayman El-Baz, Jasjit S. Suri, Cardiovascular Imaging and Image Analysis, 2018
Mansour AlOmran, Alexander Emmott, Richard L. Leask, Kevin Lachapelle
In the formation of aortic aneurysms with various etiologies such as aging, hypertension, connective tissue disorders, and atherosclerosis, the organization and relative quantities of the aortic wall's structural components are disturbed. A shared endpoint of these etiologies is exaggerated extracellular matrix degradation leading to progressive aortic dilatation and eventual dissection or rupture [41, 42]. Features of medial disruption include the fragmentation of the elastic structure, excessive deposition of collagen and, occasionally, pooling of glycosaminoglycans [13] (Figure 17.4). Severe pathological medial remodeling can also include smooth muscle cell dropout [13]. Generally, aortic aneurysms are the result of an unproductive tissue remodeling that degenerates the medial layer structure. As the aneurysm grows, degradation of the ECM occurs and new tissue is synthesized, helping the vessel wall to maintain its thickness as the diameter grows [38].
Non-technical skills for surgeons: The NOTSS behaviour marker system
Published in Rhona Flin, George G. Youngson, Steven Yule, Enhancing Surgical Performance, 2015
A ruptured abdominal aortic aneurysm is a life-threatening event. Surgical mortality, for patients who actually survive to reach the hospital, is quite high. Communication and teamwork in the operating room are important to operative success. Upon entering the operating room, the surgeon should exchange information with the anesthesiologist, even prior to making incision. Decisions should be made about target blood pressure, as well as when to make incision, as patients are at risk for dramatic drop in blood pressure after induction of anesthesia. The surgeon needs to be prepared to operate immediately, and most recommend that the patient be prepped and draped prior to intubation so as to allow quick entry into the abdomen. The surgeon should also establish a shared understanding with the entire surgical team. All members must know the gravity and urgency of the procedure and be prepared for the critical events. Part of the surgeon’s role is to coordinate team activities, which includes confirming that the team is ready to begin, making certain that all necessary retractors, sutures, and vascular grafts are available, and notifying the team when medications such as intravenous heparin (if needed) should be administered.
The evolution of stent grafts for endovascular repair of abdominal aortic aneurysms: how design changes affect clinical outcomes
Published in Expert Review of Medical Devices, 2019
Blake R. Bewley, Andrew B. Servais, Payam Salehi
An Abdominal Aortic Aneurysm (AAA) is a life-threatening condition that results from the weakening and ballooning of the aortic wall above the Common iliac arteries. A total of 200,000 people are diagnosed with this condition every year in the United States alone and it is the 15th leading cause of death in the US. This affliction is particularly prevalent in men over 65 with a history of smoking [1]. As the aortic aneurysm expands, the risk of rupture and fatal hemorrhage increase. Thus, once an aneurysm has reached a certain diameter (5.5 cm in men, 5 cm in women) intervention is warranted to avoid rupture. The standard treatment for all AAA prior to the advent of specialized endografts was open surgical repair, which carries the cost of longer hospital stay, increased blood loss during the procedure, greater postoperative recovery time, and a higher risk for short-term mortality and morbidity. In his landmark study, Parodi demonstrated the feasibility of utilizing stent grafts to bypass the bloated aorta, paving the way for the development of a new treatment approach that was significantly less invasive as well as being potentially less expensive [2]. While Parodi designed custom grafts for the patients in his initial study, the market is now flooded with multiple endografts from various manufacturers who are constantly attempting to improve clinical outcomes, increase accuracy and versatility of the delivery and implantation system, and overcome hostile patient anatomy. This paper will look at the way in which stent grafts designed for abdominal aortic Endovascular Aneurysm Repair (EVAR) have improved over time and the design changes that have facilitated more favorable clinical outcomes.