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Acute Limb Ischaemia
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
In this case, if you wanted to, you could try some crazy stuff I assure you. Why not do an open surgical repair of the descending thoracic aorta? How about percutaneous fenestration? Why not tell the FRCS examiner about true and false lumen access, intravascular ultrasound, talk about wires passing through the true lumen, into the false lumen, and renal arteries being stented …. This is all genuine vascular surgery practice and I have no problem with it. People out there do this routinely. However, do you really have much experience in this area? Would you be confident doing this? I certainly wouldn't be. And in this case, is it necessary? No, of course not. The patient does not have mesenteric or renal malperfusion. The problem is the ischaemic leg. So focus on treating his ischaemic leg with the simplest most pragmatic option. That is a femoro-femoral crossover in my book.
Emergence of Therapeutic Strategies
Published in Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos, McDonald's Blood Flow in Arteries, 2022
Therapeutic strategies are directed at reducing wave reflection when effects become no longer beneficial, i.e. in normal persons over 50 years or age or earlier in persons with hypertension or other arterial disease. In these persons, reduction of wave reflection reduces aortic pressure during systole and thereby improves flow ejection from the LV and optimizes filling from the atrium during diastole. One tries through use of drugs to minimize wave reflection using arterial-dilating drugs such as nitrates, ACEIs, ARBs and CCBs. Surgical options could represent extensions of what we do now—but might in the future include restoration of aortic dimensions and distensibility to youthful values if suitable physical or biological material could be introduced for wrapping of the thoracic aorta.
Adult Autopsy
Published in Cristoforo Pomara, Vittorio Fineschi, Forensic and Clinical Forensic Autopsy, 2020
Cristoforo Pomara, Monica Salerno, Vittorio Fineschi
A 68-year-old man was admitted to the cardiac surgery department because of symptomatic mitral valvular insufficiency. Coronarography was performed, and nonsignificant stenosis of the descending coronary artery (left anterior descending artery (LAD)) was diagnosed. He underwent an intervention of isolated mitral valve surgery for mitral regurgitation. During the procedure, an iatrogenic aortic dissection was observed from thoracic aorta to aortic bifurcation. The death was due to a ventricular arrhythmia. The prosecutor requested an autopsy because of a malpractice claim.
Prevalence and development of aortic dilation and dissection in women with Turner syndrome: a systematic review and meta-analysis
Published in Expert Review of Cardiovascular Therapy, 2023
F. Meccanici, J.W.C. de Bruijn, J.S. Dommisse, J.J.M. Takkenberg, A.E. van den Bosch, J. W. Roos-Hesselink
Ascending aortic dilatation in TS is common (23%) and largely dependent on its definition, the population under study, and the imaging modality used. Taking into account the study population characteristics and aortic dimensions in the included studies, we can conclude that larger dimensions were observed in the studies with relatively older patients and higher proportions of common risk factors BAV, CoA, and hypertension. Dilatation in the descending aorta is not frequently reported in women with Turner syndrome, as most research is focused on the ascending aorta. However, when compared to matched females in the normal population, descending aorta dimensions were also larger [32]. Most of the aortic dissection cases occurred in the proximal part of the thoracic aorta, although distal dissections were not uncommon (30%, 7/23). In the study by Yetman et al., vascular dissections in pulmonary and cerebral vessels were also observed [44]. These findings reflect a vasculopathy in the entire thoracic aorta and beyond [46]. No other study has reported vascular abnormalities beyond the aorta, so this might be important to include in future studies.
Risk reduction and pharmacological strategies to prevent progression of aortic aneurysms
Published in Expert Review of Cardiovascular Therapy, 2021
Gabe Weininger, Shin Mei Chan, Mohammad Zafar, Bulat a Ziganshin, John A. Elefteriades
Importantly, aortic aneurysms can be categorized by their location. The thoracic aorta refers to the section between the aortic annulus and the diaphragm; this can be further divided into the ascending aorta, the aortic arch, and the descending aorta. When any of these segments are affected by an aneurysm, they qualify as ‘thoracic aortic aneurysms’ (TAAs) which differ substantially from abdominal aortic aneurysms (AAAs), which occur below the diaphragm. Anatomically, the more distal aorta contains less elastin and fewer lamellar units than the proximal aorta [5]. Atherosclerosis is also more likely to affect the aorta below the diaphragm for reasons that are still unclear [6] (Figure 1). There exist formal screening strategies in to detect AAAs [7,8] by abdominal ultrasound, but unfortunately no such protocol for screening the general population exists for TAAs (which are often not accessible to ultrasonic detection), adding to the challenge of detecting and treating this potentially devastating disease.
Berberine reduces endothelial injury and arterial stiffness in spontaneously hypertensive rats
Published in Clinical and Experimental Hypertension, 2020
Gaoxing Zhang, Xiufang Lin, Yijia Shao, Chen Su, Jun Tao, Xing Liu
Thoracic aorta was cut transversally in ring segments (4-mm long). Each ring was placed inside a 5-mL heated bath filled with KHS (37°C) bubbled with a 95% O2–5%CO2 mixture, pH 7.4, and suspended between 2 L-shaped stainless steel hooks. The top one was attached to a force transducer (MLT 0201); in turn, this was connected to a model Powerlab/4SP polygraph for measurement of isometric tension. Rings were allowed to equilibrate for 90 min, with changes of buffer every 15 min and with several adjustments of length until baseline tension stabilized at 1 g to obtain comparable acetylcholine (ACh) relaxation in both strains. When tension was stable, experiments were initiated by obtaining a reference contractile response to 75 mmol/L KCl. Endothelium-dependent relaxations were studied by evaluating relaxations to ACh (10–8 to 10–6 mol/L) in noradrenaline (NE, 10−6mol/L) precontracted rings (1.2 ± 0.16 g). 22 Each dose–response curve was expressed as the percent of NE-precontraction after ACh-induced relaxations by each vessel by the formula: Vascular response (%) = [(Diameter before NE – Current diameter)/(Diameter before NE – Diameter after NE)] × 100.