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Aortic Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Traditional open aortic surgery procedures for pathologies involving the ascending aorta, aortic arch and descending thoracic aorta can be performed with excellent and durable results. Patient selection is nonetheless very important because some patients who require arch operations or procedures involving the descending thoracic aorta cannot tolerate full median sternotomy or left thoracotomy/thoracoabdominal incisions with cardiopulmonary bypass (CPB) and circulatory arrest. In cardiac surgery, minimally invasive technologies have emerged over the past few years to treat heart valve disease percutaneously and endovascular technologies to treat infrarenal aortic pathologies. As a result, minimally invasive procedures by means of surgical access are now considered alternative options for treating proximal aortic, arch and descending thoracic pathologies.
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.
Vascular emergencies
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Further management will depend on results of the imaging. Patients will require surgical intervention for Stanford type A aortic dissections, to prevent aortic rupture and pericardial tamponade. This is achieved through the implantation of composite aortic grafts, with or without re-implantation of coronary arteries. Repair can be achieved either through open aortic surgery or thoracic endovascular aortic repair (TEVAR). Type B aortic dissections, in contrast, are usually managed medically with regular clinical and ultrasound follow up.
Safety of epidural drugs: a narrative review
Published in Expert Opinion on Drug Safety, 2019
ML van Zuylen, W ten Hoope, EME Bos, J Hermanides, MF Stevens, MW Hollmann
Epidural opioids have been used for over three decades, after receiving their United States Food and Drugs Administrations (FDA) approval in 1984, with the first studies ranging back as far as 1979. Most epidural mixtures currently used combine a lipophilic opioid (fentanyl, sufentanil) with a long-acting LA (levo- or racemic bupivacaine, ropivacaine) because of their presumed synergism and the avoidance of delayed respiratory depression. A meta-analysis [22] suggested slightly better analgesic efficacy of epidural analgesia when compared with an intravenous pain regimen. A Cochrane systematic review supports this limited superior analgesic effect of epidural analgesia over systemic opioid administration in patients undergoing open aortic surgery, reporting a mean difference in VAS scores on movement on postoperative day 1 of −1.78 (95% CI −2.32 to −1.25) [24]. The clinical relevance of this difference is however debatable. According to the requirements for a clinically superior pain regimen of two points NRS reduction or 30% relative pain reduction from baseline recommended by the International Association for the Study of Pain (IASP), this difference cannot be seen as clinically superior.
Abdominal aortic and iliac aneurysm presented as lower limb deep vein thrombosis: case report
Published in Acta Chirurgica Belgica, 2020
Vedran Pazur, Inga Dakovic Bacalja, Ivan Cvjetko, Ana Borovecki
A lower limb DVT caused by the compression of the ICV or a common iliac vein by an AAA is rare. Routine screening of lower limb DVT might include abdominal aortic examination for an early detection. Pharmacological anticoagulation and a placement of an IVC filter could be the management strategy followed by the open aortic surgery repair.