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Chronic Limb-Threatening Ischaemia (CLTI)
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
The lung function tests reveal he has an obstructive lung disease pattern. The vascular anaesthetist advises that aortic surgery is possible, but it would be high risk. The patient himself would rather avoid major open surgery if at all possible, but he does not think he can cope with his symptoms at the moment and does not feel conservative management is appropriate because he can barely walk 20 m before his claudication forces him to stop and rest ….“In this case then I think bilateral common femoral endarterectomies with iliac stents is a suitable compromise. I would consider dual consultant operating (one for each groin) to make the operation faster. I would also work collaboratively with the anaesthetist, and perhaps a spinal/epidural approach would be better given his bad chest. If this were the plan I would also stop the patient's clopidogrel and switch him to aspirin to allow the spinal approach.”
Aortic Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
No specific guidelines exist for the use of minimally invasive aortic surgery for pathologies of the ascending aorta and aortic arch (aneurysms and dissections), and the expertise of the operator plays a pivotal role. In addition, no endovascular devices are currently approved in the US to treat the ascending aorta and the arch totally endovascularly, so this application is off-label.
Complications of open repair of juxtarenal aortic aneurysm
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
All open aortic surgery should be performed under general anesthesia. It is preferable for the anesthesia team to evaluate the patient prior to the day of surgery, so that appropriate time for developing an anesthetic plan, lines, and other means of hemodynamic monitoring is allowed. The use of an epidural for pain control in the postoperative period is useful. In addition, arrangements should be made for autotransfusion given the unavoidable amount of intraoperative blood loss.
Pre-implantation genetic testing for Marfan syndrome using mini-sequencing
Published in Journal of Obstetrics and Gynaecology, 2022
Sirivipa Piyamongkol, Krit Makonkawkeyoon, Vorasuk Shotelersuk, Opas Sreshthaputra, Tawiwan Pantasri, Rekwan Sittiwangkul, Theera Tongsong, Wirawit Piyamongkol
The genetic basis of Marfan syndrome is from various mutations within the fibrillin-1 (FBN-1) gene, with over 400 mutations having been reported. About a quarter of MFS are a result of de novo mutations (Robinson et al. 2002). The FBN-1 gene is 230-kb in size, located on 15q21.1 (Lee et al. 1991). The FBN-1 gene is composed of 65 exons, encoding a 2871 amino acid long profibrillin. Profibrillin is then cleaved into FBN-1 by the furin convertase enzyme. Structural defects in fibrillin protein caused decreased vascular strength (Robinson et al. 2006). Some Marfan patients require emergency surgery for aortic root dissection and many need prophylactic aortic root replacement. Aortic surgery is a major surgical procedure with a high intraoperative and postoperative mortality risk even in experienced centres (Fletcher et al. 2020). Permanent paraplegia is one of the most devastating complications with an incidence of 3–5% in elective cases and 19% in emergency cases (Robinson et al. 2006). In addition, re-operative cardiac surgery is not uncommon in Marfan syndrome patients with aortopathy due to dissection of other parts of the aorta (Fletcher et al. 2020).
Incidental descending thoracic aortic thrombus: the conundrum of medical versus surgical therapy
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Kay Khine, Amit Toor, Koroush Khalighi, Mahesh Krishnamurthy
In accordance with the knowledge of the pathophysiologic mechanisms, appropriate therapy for an aortic thrombus is still controversial, varying between long-term anticoagulation and surgical options. The conventional method is conservative therapy. In our case report, the thrombus was successfully treated with warfarin anticoagulation therapy for about 3 months in duration. In acute patients who are hemodynamically unstable, aortic surgery was found to be beneficial. Combined therapy such as pharmacotherapy and surgery can sometimes be used for treatment. One emerging technology is an aortic stent graft which is used in emergency situations. However, in some previous studies, it is said that long-term anticoagulant is more reliant than surgery. [13] As our patient was asymptomatic and hemodynamically stable, conservative treatment with warfarin was prescribed along with follow-up. There was no incidence of recurrent thrombosis or distal embolization after termination of therapy.
Aortic Arch. The Final Frontier in Cardiac Surgery
Published in Journal of Investigative Surgery, 2019
Dimos Karangelis, Apostolos Roubelakis, Dimitris Mikroulis, Matthew Panagiotou
Complex thoracic aorta pathology may involve aneurysm or dissection of the ascending aorta and may extend to the aortic arch and descending aorta. It therefore represents a challenge for cardiac surgeons. During the last decades we have witnessed significant technical achievements in the field of aortic surgery, which enabled surgeons to operate on the aortic arch with acceptable morbidity and mortality rates. Two important and worth mentioning milestones were a) the technique of deep hypothermia and circulatory arrest (DHCA) first described by Drew in 19593 and later introduced as common practice in aortic surgery by Griepp and colleagues in 19794 and b) the antegrade selective cerebral perfusion by the Stanford team of Frist and colleagues,5 who introduced brachiocephalic perfusion with low cardiopulmonary bypass flow during the arrest period. These techniques are combined with the surgical procedures currently used in aortic arch plus ascending and/or descending aortic surgery.