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Aortic Aneurysm
Published in Charles Theisler, Adjuvant Medical Care, 2023
An aortic aneurysm is an abnormal bulging or “ballooning” of a weakened area in the wall of the body’s largest artery. Aneurysms in the abdominal portion of the aorta are more common than in the thoracic area. Typically, there are no symptoms unless the aneurysm grows large (i.e., over 5 cm in diameter). Then it can cause pain or rupture resulting in dangerous bleeding and death. Smoking, genetics, injury, and high blood pressure are risk factors for developing an aortic aneurysm.
Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Abdominal aortic aneurysms present in one of three ways: as an asymptomatic finding on routine clinical examination, as a cause of epigastric pain or pain in the back, and a pulsatile mass found on examination, or if leaking, with acute pain, hypotension and a pulsatile mass in the abdomen.
Repair of Extensive Aortic Aneurysms: A Single-Center Experience Using the Elephant Trunk Technique over 20 Years
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
We started looking into our experience with management of extensive aortic aneurysms in the late 1990s and have since reported our short, mid, and long-term outcomes periodically.2–5 In a recent review from our group, we provide an in-depth commentary on the changes in the techniques and evolution of the elephant trunk strategy in current times, along with the present-day indications for it with tips from our surgical technique and management during the staged repair of extensive aortic aneurysms using elephant trunk.6 Our 2014 paper5 presented at the 134th American Surgical Association Annual Meeting and published in the Annals of Surgery, extended Borst's pioneering work to assess the risk factors and outcomes of each stage of the procedure and also to review the experience of the patient cohort in the interval between the stages. This paper described the results of 503 operations in 348 patients using the elephant trunk technique. These patients were identified from a total cohort of 3,012 repairs of the aortic root, ascending, arch, descending thoracic, or thoracoabdominal aorta, performed between 1991 and 2013. Results for stage 1 were reported as 30-day outcomes following stage 1, interval outcomes were reported as outcomes occurring between 30 and 45 days post-stage 1, and stage 2 outcomes were reported as those occurring within 30 days following stage 2.
Covered stent placement for treatment of coarctation of the aorta: immediate and long-term results
Published in Acta Cardiologica, 2021
Jan Stassen, Pieter De Meester, Els Troost, Leen Roggen, Philip Moons, Marc Gewillig, Alexander Van De Bruaene, Werner Budts
Since the development of aortic aneurysms or pseudo-aneurysms is rarely clinical apparent, it is important to systematically survey for these adverse-advents during long-term follow-up. In our study, we did not have any follow-up data regarding imaging in 14 of the 89 patients (15.7%). Of the remaining 75 patients, 47 patients (62.7%) had follow-up imaging within the first five years of follow-up. Different imaging modalities were used during follow-up: CT scan was performed in 18 patients (38.3%), cardiac magnetic resonance (CMR) in 13 patients (27.7%) and both CT and CMR in 4 patients (8.5%). A second angiography was performed in 12 patients (25.5%) that did not have a CT or CMR during follow-up and reflected for a large part the expected reinterventions due to further dilatation to account for somatic growth. Of the 28 patients that did not have follow-up imaging within the first five years, 14 patients had a follow-up time of less than five years (Figure 3).
Incidence and predictors of thoracic aortic damage in biopsy-proven giant cell arteritis
Published in Scandinavian Journal of Rheumatology, 2021
MJ Koster, CS Crowson, C Labarca, KJ Warrington
This study reports the findings from a large, single-institution cohort of patients with biopsy-proven GCA with aortic imaging. Prevalent aortic aneurysm/dilatation was observed in 8% of patients on the first imaging study. Although several investigations have focused on the presence of baseline aortitis and subsequent aortic aneurysm/dilatation, few studies report the frequency of thoracic aorta aneurysm/dilatation at, or near, diagnosis; thus, estimates of prevalent AoSD are not well established. In a retrospective analysis of 52 patients who had undergone at least two positron emission tomography–computed tomography (PET-CT) scans performed after GCA diagnosis, Muratore et al demonstrated that 21.2% of patients had aortic dilatation at the time of the first imaging study (12). In a prospective cohort, Agard and colleagues noted a frequency of thoracic aortic aneurysm in 14% and thoracic aortic aneurysm/ectasia in 23% of 22 biopsy-proven GCA patients undergoing helical CT performed within 4 weeks of diagnosis (13). Although prevalent aneurysm rates in the current study are lower than in these previous studies, our results are similar to the large retrospective study by de Boysson and colleagues, where 398 GCA patients underwent baseline arterial imaging and 8.5% (n = 34) had prevalent aortic dilatation (6). Given the notable frequency of baseline aortic disease, it is considered reasonable to obtain routine thoracic aortic imaging at the time of GCA diagnosis, as suggested by American thoracic consensus guidelines (9).
Current practices and goals for mean arterial pressure and spinal cord perfusion pressure in acute traumatic spinal cord injury: Defining the gaps in knowledge
Published in The Journal of Spinal Cord Medicine, 2021
Sarah T. Menacho, Candace Floyd
In an article by Strohm et al.,13 3 patients who experienced an acute SCI after repair of thoracic or thoracoabdominal aortic aneurysms had lumbar drains placed for CSFD and elevation of MAPs within 24 h of recognition of the injury. All 3 patients experienced a neurologic improvement in American Spinal Injury Association (ASIA) score before discharge; however, there was no consistency in length of time for CSFD or MAP elevation, nor were the MAPs elevated to the same level. In fact, the guidelines for at-risk patients undergoing open or endovascular repair of thoracic or abdominal aortic aneurysms are vague and recommend elevating MAPs from 60 to 90–100 mmHg and using CSFD for anywhere from 36–48 h up to 5–8 days.14,15 Again, these interventions assume that SCPP = MAP – ITP (intrathecal pressure), an assumption for which we have no direct evidence in acute traumatic SCI patients.