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Umana J P - - 2000
Diseases of the thoracic aorta pose a significant challenge to the surgeon because of the complexity of the disease and the characteristics of the patient population. Frequent comorbidities and increasing age account for mortality rates between 5% and 20% for surgical repair of descending thoracic aortic aneurysms and in excess ...
Madan A K - - 2000
Aortoesophageal fistula (AEF) is an uncommon cause of upper gastrointestinal hemorrhage. Usually, but not always, patients present with a small sentinel bleed followed by a variable interval of apparent resolution, and then they experience a massive exsanguinating hemorrhage. The variable interval of time after the sentinel bleed is the period ...
Killen D - - 2000
During a 27-year period, resection of 690 aneurysms of the descending thoracic and/or abdominal aorta were performed. Thirty (4.3%) were thoracoabdominal aneurysms. Although the series of thoracoabdominal aneurysms is small, there was continued improvement in protection of the abdominal viscera and spinal cord from ischemic injury. Operative survivors experienced good ...
Segura I - - 2000
We present here two cases of asymptomatic thoracoabdominal aortic aneurysms that were successfully operated on in heart transplant patients 8 and 23 months after transplantation. Thoracoabdominal aortic aneurysm was present prior to transplantation in one patient. In the other patient only the abdominal aortic aneurysm was found before transplantation. Indications ...
Downey C - - 2000
Aneurysms result from damage to artery walls as a result of underlying athrosclerotic and/or thromboembolic disorders. A thoracoabdominal aortic aneurysm involves vessel damage and wall weakening in the thoracic and abdominal segments of the aorta. Thoracoabdominal aortic aneurysm repair is considered to be high risk due to the nature of ...
Bonser R S - - 2000
OBJECTIVE: To examine the expansion of aneurysmal aortic segments (> or = 35 mm) and to assess the impact of clinical and patho-anatomical factors on aneurysm expansion. DESIGN: 87 consecutive patients (mean age 63.6 years, range 22-84 years) were studied using serial (six month intervals) computed tomographic or magnetic resonance ...
Giulini S M - - 2000
INTRODUCTION: this retrospective study was undertaken to evaluate whether suprarenal aortic cross-clamping increased the perioperative mortality and morbidity as compared to infrarenal clamping, in order to create the rationale for a more extensive application of this apparently more traumatic manoeuvre. MATERIALS AND METHODS: in a series of 734 elective aortic ...
Sasaki S - - 2000
We have treated 10 patients with thoracic aortic aneurysms due to Takayasu's arteritis during the last 15 years and presented surgical results. In the surgical treatment of thoracic aortic aneurysm due to Takayasu's arteritis, therapeutic strategy is different from that for atherosclerotic aneurysm and should be determined by the location ...
Dougherty M J - - 2000
The source of emboli to large or medium sized arteries is most commonly the heart; occasionally, it is an aortic aneurysm. The unusual embolic source of aortic mural thrombus in an otherwise minimally diseased aorta has been infrequently reported, and the etiology and management of this entity are not well ...
Iha K - - 2000
A 67-year-old woman hospitalized with pleuritis was treated with antibiotics. Although the inflammation was resolved, saccular aneurysms in the aortic arch and thoracoabdominal aorta enlarged rapidly. We conducted graft replacement of the aortic arch, but despite careful blood pressure control, the thoracoabdominal aneurysm rapidly enlarged even further. We conducted graft ...
Ueda T - - 2000
BACKGROUND: Reattachment of segmental arteries is one method used to prevent paraplegia associated with thoracoabdominal aortic repair. Nevertheless, even when important segmental arteries are reattached, ischemia causing spinal injury may occur during anastomosis. METHODS: In 27 patients undergoing thoracoabdominal aortic repair, we attempted to perfuse the segmental arteries to be ...
Sueda T - - 2000
BACKGROUND: This clinical study evaluated changes in motor evoked potentials (MEP) elicited by direct cerebral cortical stimulation and evoked spinal cord potentials (ESCPs) elicited by direct spinal cord stimulation during selective intercostal arterial perfusion for thoracoabdominal aortic aneurysm (TAAA) repair. We also determined the efficacy of this perfusion method for ...
Yamada N - - 2000
OBJECTIVE: Investigating the possibility of magnetic resonance angiography (MRA) to visualize the Adamkiewicz artery of as a preoperative study of thoracic aortic aneurysms. METHODS: From February 1998 to March 1999, 26 consecutive patients who had aneurysms of the thoracoabdominal or descending aorta underwent preoperative MRA to visualize the Adamkiewicz artery. ...
Meylaerts S A - - 2000
During thoracoabdominal aortic aneurysm repair, a prolonged interruption of the spinal cord blood supply can result in irreversible spinal cord damage. The aim of this study was to investigate whether selective segmental artery perfusion during aortic clamping could prevent paraplegia in pigs. Specially designed segmental artery perfusion catheters, which could ...
Ninomiya M - - 2000
A 69-year-old woman with Takayasu's disease was referred to our hospital for surgical treatment of a descending aortic aneurysm. Preoperative angiography and computed tomography revealed abdominal aortic stenosis and severe calcification in the descending aorta. The abdominal aorta was first replaced, since the aortic stenosis would have disturbed blood flow ...
Rotstein D S - - 2000
A 12-yr-old female free-ranging Florida panther (Felis concolor coryi) was found dead in good flesh. The panther had a ruptured thoracoabdominal aneurysm and 0.5 L of unclotted blood in its thorax. Intimal plaques 6.0 x 3.0 x 3.0 cm and 4.0 x 3.0 x 1.0 cm were present in the ...
Robicsek F - - 2000
The authors present a technique consisting of retroperitoneal exposure, but not dissection of the inflammatory aneurysm, anastomosis of a bypass graft through a short thoracotomy to the lowermost thoracic aorta, carrying it down retroperitoneally to both femoral arteries and under brief occlusion of the descending thoracic aorta, opening of the ...
Martin G H - - 2000
The purpose of this study is to review our experience with surgical repair of lower thoracoabdominal and suprarenal aortic aneurysms to determine early and late survival rates and identify factors influencing morbidity and survival among these patients. From 1989 through 1998, 165 consecutive patients underwent repair of 108 thoracoabdominal (55 ...
Ohtani N - - 2000
The patient was a 77-year-old female who had been treated medically for angina pectoris since 5 years ago. Expanded aneurysms in the distal aortic arch and in the descending thoracic aorta were seen during follow-up. She presented continuous back-pain at rest along with increasing size of the aneurysms despite antihypertensive ...
Cartes-Zumelzu F - - 2000
The standard technique for the treatment of descending thoracic aortic aneurysms is elective open surgical repair with graft interposition. This standard approach, although steadily improving, is associated with high morbidity and substantial mortality rates and implies a major surgical procedure with lateral thoracotomy, use of cardiopulmonary bypass, long operation times ...
Reardon M J - - 2000
Aortoesophageal fistula, secondary to thoracic aortic aneurysm, is an uncommon cause of gastrointestinal bleeding that is uniformly fatal without surgical intervention. These may be primary fistulas, in cases of thoracic aortic aneurysm without previous repair, or secondary fistulas occurring after surgical repair of thoracic aortic aneurysm. Surgical treatment has been ...
Azizzadeh A - - 2000
Delayed neurologic deficits are an uncommon yet devastating complication of thoracoabdominal aortic aneurysm repair. The mechanisms involved in the development of delayed spinal cord ischemia remain ill defined. We report a case of complete reversal of delayed neurologic deficits with postoperative cerebrospinal fluid (CSF) drainage. After a thoracoabdominal aneurysm extent ...
Schils F - - 2000
Aortobronchic fistula is a very unusual complication of thoracic aneurysm. We report the case of a 71-year old man with rupture of a thoracic aortic aneurysm in the left main bronchus. The patient had suffered a car crash fifteen years ago, without any evidence of aortic rupture at the time. ...
Nissen T - - 2000
An hydropic fetus seen at 28-weeks gestation had a saccular aortic aneurysm in the descending thoracic aorta. Histology disclosed marked fibrointimal hyperplasia, thrombus, and attenuation of the tunica media. The remainder of the descending thoracic aorta showed fibrointimal hyperplasia. We speculate that the narrowed lumen and rigid aortic wall resulting ...
Cohnert T U - - 2000
Patients with multiple aortic aneurysms represent a small subgroup with the need for extensive surgical treatment at considerable risk. Endovascular treatment in combination with conventional operation is possible. We demonstrate a case with simultaneous exclusion of aneurysms of the descending thoracic and the infrarenal aorta to outline the technical obligations. ...
Kasirajan K - - 2000
Delayed spinal cord ischemia after thoracic aortic aneurysm repair is an infrequent but devastating complication. The use of stent grafts to exclude aortic aneurysms is thought to decrease the incidence of the neurologic deficit because there is no period of significant aortic occlusion. We report a case of paraplegia that ...
Willens H J - - 2000
Transesophageal echocardiography (TEE) has provided an accurate new window for the evaluation of diseases of the thoracic aorta. Experience with TEE has led to an increased recognition of atherosclerosis of the thoracic aorta as a source of cerebral and systemic embolism. Certain features of aortic plaque morphology detected by TEE ...
Bogren H G - - 2000
Time-resolved cardiac gated three-directional velocity data obtained with magnetic resonance velocity-encoded phase contrast sequences were used to study blood flow patterns in thoracic aortic grafts. Twelve patients were studied, 6 with traumatic descending aortic pseudoaneurysms, 3 with atherosclerotic aneurysms, and 3 with dissecting aneurysms. All grafts had an inflow jet; ...
Hellberg A - - 2000
The purpose of this study was to evaluate the possibility of identifying alterations in blood supply to the spinal cord during thoracic aortic crossclamping. In 17 pigs, a multiparameter PO(2), PCO(2,) and pH sensor was introduced into the intrathecal space for continuous monitoring of cerebrospinal fluid (CSF) oxygenation during aortic ...
Ootaki Y - - 2000
The rupture of an aneurysm of the descending thoracic aorta into the right thoracic cavity is a comparatively rare event, and it is very difficult to establish a diagnosis immediately and rescue such patients. We describe herein the successful surgical treatment of a patient with this life-threatening emergency by initiating ...
Puttaswamy V - - 1999
Acute spinal cord ischemic injury after resection of thoracoabdominal aneurysm remains a relatively common and potentially devastating complication. The complete resolution of postoperative paraplegia after resection of a type II thoracoabdominal aneurysm, after treatment with hyperbaric oxygenation, is reported.
Hilgenberg A D - - 1999
Spinal cord protection is critical for successful outcomes after descending thoracic and thoracoabdominal aortic aneurysm repair. For descending thoracic aneurysms which end above T9, optimum protection is maintained by distal aortic perfusion via a left atrial to distal arterial bypass circuit with a centrifugal pump. In repairs of extensive thoracoabdominal ...
Taylor B V - - 1999
Most vascular surgeons believe that saccular aortic aneurysms have a more ominous natural history than the typical fusiform aneurysm, although this is not documented in the literature. Expeditious repair is indicated for symptomatic saccular aneurysms, and intervention is usually advocated even when they are asymptomatic because of the general belief ...
Cooley D A - - 1999
Until the late 19th century, treatment of thoracic aortic aneurysms relied on ligation of the parent vessel or introduction of foreign materials to promote coagulation or fibrosis. A major breakthrough occurred in 1888, when Rudolph Matas reported an internal repair technique known as endoaneurysmorrhaphy. In this approach, the clot was ...
Coselli J S - - 1999
Patients presenting with impending rupture of a thoracoabdominal aortic aneurysm require emergency operative repair. To prevent rupture and its associated mortality, elective repair of thoracoabdominal aortic aneurysms exceeding 5.5 cm to 6.0 cm in diameter is recommended in patients with adequate physiologic reserve. Similarly, surgery should be considered for patients ...
Cinà C S - - 1999
Modified atriofemoral bypass (AFB) was used for repair of thoracoabdominal aortic aneurysms (TAAA). The primary circuit consisted of a centrifugal pump and heat exchanger to perfuse and warm the systemic circulation. A parallel secondary circuit with a second heat exchanger perfused the viscera with cold blood. A progressive sequential cross-clamping ...
Koshino T - - 1999
We treated two cases of enlargement of ulcer-like projections in the descending thoracic aorta, which were recognized after emergency graft replacement from the ascending aorta to the aortic arch for acute type A aortic dissection. The intimal tear, which was near the left subclavian artery, was resected during the initial ...
Szwerc M F - - 1999
To analyze the indications, results, and limitations of using left atrial to femoral artery (LA-FA) bypass to provide distal perfusion during repair of traumatic aortic injuries. There is no consensus about the best method for repair of traumatic aortic transection. Distal aortic perfusion with LA-FA bypass and a centrifugal pump ...
Kochi K - - 1999
We report on 2 patients who underwent successful concomitant operation of coronary artery bypass grafting and stent grafting to descending thoracic aortic aneurysms. The device was inserted through a small linear incision on the anterior wall of the aortic arch. Intraoperative stent grafting to descending thoracic aortic aneurysms is an ...
Okura T - - 1999
An asymptomatic 88-year-old woman underwent a screening medical examination. The chest x-ray film showed a large mediastinal mass with calcification. Both chest computed tomography and nuclear magnetic resonance imaging revealed an unruptured aortic aneurysm, predominantly affecting the ascending aorta and the proximal part of the aortic arch. Its maximum diameter ...
Safi H J - - 1999
A technique of aortic graft replacement in thoracoabdominal aortic aneurysm repair is described. The author's experience with the surgical adjuncts of cerebrospinal fluid drainage and distal aortic perfusion, and the evolution and rationale of thoracoabdominal aortic aneurysm classification are discussed. Interpretation of the large amount of data that the author ...
Webb T H - - 1999
Aneurysms that extend from the descending thoracic aorta into the abdomen and also those that involve the visceral segments of the upper abdominal aorta are traditionally classified as thoracoabdominal. Besides the surgical exposure difficulties associated with repair of these aneurysms, the temporary interruption of renal, splanchnic, and perhaps even spinal ...
Okada K - - 1999
An 82-year-old man underwent thoracoabdominal aortic replacement under cardiopulmonary bypass with left femoral artery cannulation. Lumber descending evoked spinal cord potentials and segmental evoked spinal cord potentials were monitored simultaneously for detecting spinal cord damage. When the cardiopulmonary bypass was terminated, a peripheral nerve ischemia pattern was evident. Left peroneal ...
Bethel S A - - 1999
Thoracoabdominal aortic aneurysm repairs present many challenges, and the complication of paraplegia remains a concern for both the surgeon and the nurse caring for the patient in the postoperative period. Paraplegia can occur secondary to spinal cord ischemia from prolonged aortic clamping during the repair of the descending thoracic aorta. ...
Mastroroberto P - - 1999
OBJECTIVE: Emergency repair of thoracoabdominal aortic aneurysm remains a formidable operation with high morbidity and mortality. Although advanced surgical and perioperative care techniques have reduced the risks in elective repair of these aneurysms, the mortality rate has remained high when emergency surgery is performed. We have evaluated the outcome of ...
Safi H J - - 1999
We reviewed our categorization of patients at high risk for neurologic complications in the repair of descending thoracic and thoracoabdominal aortic aneurysm in which we used cerebrospinal fluid drainage and distal aortic perfusion (adjuncts). A total of 409 patients were operated on by one surgeon for descending thoracic or thoracoabdominal ...
Iha K - - 1999
This case was an 85-year-old female who developed left ventricular free wall rupture (LVFWR) of the anterior wall 13 days after an acute myocardial infarction. She was further complicated with an ascending aortic aneurysm and severe aortic regurgitation. The wall was repaired using a sutureless technique with an autologous pericardial ...
Edmondston S J - - 1999
Evaluation of the movement response to posteroanterior (PA) loads applied to the spinous processes is a recognized part of the physical examination of the thoracic spine. During this clinical procedure the thoracic spine is supported by the ribcage which may contribute to the movement response. However, the contribution of ribcage ...
Moro H - - 1999
BACKGROUND: For surgical treatment of the ruptured thoracic aortic aneurysm (TAA), it is important to control bleeding and to protect the brain, spinal cord, and myocardium. We have developed and performed a new procedure on 6 patients with a ruptured TAA, a true aneurysm in 3 patients and a type ...
Uezu T - - 1999
In a case of successful surgery for impending thoracoabdominal aortic aneurysmic rupture, an 83-year-old man with severe pulmonary emphysema was transferred to our hospital diagnosed with impending aneurysmic rupture. The aneurysm had been pointed out 2.5 years ago but surgical repair was not undertaken due to the patient's severe pulmonary ...
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