IntraAbdominal Graft Infection
If the infection involves the intracavitary portion of an aortic graft, the most commonly accepted treatment is removal of the infected intra-abdominal prosthesis, wide debridement and drainage, appropriate antibiotics and revascularization via extra-anatomic bypass through separate, clean operative fields. Though this is the recommended treatment, results of early reports varied and demonstrated a 25-50 amputation rate and a 36-79 mortality rate when total graft excision precedes...
Ruptured Abdominal Aortic Aneurysm
Abdominal aortic aneurysm AAA is a degenerative atherosclerotic condition characterized by progressive dilation of the abdominal aorta. In one-third to one-half of patients it expands and leads ultimately, if not managed appropriately, to rupture and exsanguination. The characteristic patient with an AAA is an elderly male with a smoking history such patients commonly are afflicted with coronary, cerebrovascular and other peripheral manifestations of atherosclerosis as well.1 All but 2 of such...
Surgical Treatment of Acute and Chronic Aortic Dissection Distal to the
Joseph S. Coselli, Cuneyt Koksoy, Zachary C. Schmittling, and Scott A. LeMaire Aortic dissection a tear in the intima and inner media with subsequent progressive separation of the aortic wall layers is the most common catastrophic event involving the aorta. Acute aortic dissection occurs in approximately 5-10 patients per million of population per year. The aorta distal to the left subclavian artery is involved in the vast majority of cases. Without treatment, 60 of patients with acute distal...
Suprarenal Aortic Aneurysm Repair
Surgical repair of abdominal aortic aneurysms AAAs that involve the renal arteries are more challenging than infrarenal AAA repairs. Morbidity is increased due to a longer operation, more extensive dissection and an increased risk of bleeding. In addition, there is a distinct risk of renal, visceral or, occasionally, spinal cord ischemia. Suprarenal or superceliac aortic cross-clamping results in increased after-load. Therefore, cardiac complications are more frequent in these cases than after...
Info Fpp
40-93 y.o. men and women 11 8.4 5 with carotid disease 1 PAD defined as peripheral arterial disease involving either the lower extremities claudication 82 , rest pain 11 or cerebrovascular disease 2 3 AAA defined as gt 3.5 cm or gt 5 mm that adjacent vessel 4 AAA defined as gt 3.5 cm or gt 1.5 times the aorta at the level of the renal arteries 5 AAA defined as at least 3 cm in diameter A total of 10,215 men and women aged 55 and older who live in this district have been invited by their general...
Selected Readings 1
1. Ballard JL, Killeen JD. Anatomy and surgical exposure of the vascular system. In Moore WS ed. Vascular Surgery A Comprehensive Review. Philadelphia W.B. Saunders Company. 1998 44-66. This chapter reviews pertinent vascular anatomy and surgical exposure of the vascular system from a surgeons perspective. Accompanying figures and radiographs nicely comple-ment the surgical descriptions. 2. Stoney R, Wylie E. Surgical management of arterial lesions of the thoracolumbar aorta. Am J Surg 1973 126...
Technical Issues Related to Thoracofemoral Bypass Grafting
Patients under consideration for grafting from the descending thoracic aorta to iliac or femoral artery need to undergo appropriate pulmonary function testing prior to the procedure, as documented severe pulmonary disease is a serious potential contraindication. As recently reviewed by Passman and associates,16 after induction of general anesthesia via a double-lumen endotracheal tube, the left thorax is elevated 45-60 to a right lateral decubitus position. The pelvis is usually left relatively...
Occlusive Disease of the Upper Abdominal Aorta
Rajabrata Sarkar and Ronald J. Stoney Occlusive disease of the primary paired and unpaired branches of the upper abdominal aorta exhibits a wide variety of clinical presentations from silent but insidious renal failure to fatal intestinal infarction. This chapter will review the patho-physiology, clinical presentation, diagnosis and treatment of these conditions. Pathophysiology and Clinical Presentation An embolus to the superior mesenteric artery is the most frequent 50 cause of acute...
Extraperitoneal Exposure of the External Iliac Arteries
This exposure begins with an oblique incision in the lower quadrant of the abdomen on the side of involved iliac artery occlusive disease. It is wise to start the incision near the pubic tubercle with extension obliquely lateral, staying medial to the anterior superior iliac spine of the pelvis. The external oblique aponeurosis is opened in the direction of its fibers and the incision continued into the fleshy portion of this muscle. The internal oblique and transversus abdominus muscles are...
Surgical Treatment of Infected Aortic Aneurysms
In 1885 Sir William Osler1 presented a comprehensive analysis of infected aneu-rysms and coined the term mycotic aneurysm specifically to refer to patients who presented with infected aneurysms secondary to endocarditis. Since then, however, the term has been used to refer to infected aneurysms regardless of pathogenesis. The fact that other sources of infection could also cause infection in the arterial wall was suggested by Stangel and Wolfed in 1923,2 describing 30 of 213 patients in whom...
Retroperitoneal Exposure of the Abdominal Aorta and Its Branch Vessels
Transperitoneal aortic exposure is generally regarded as the standard operative approach to the abdominal aorta. However, retroperitoneal aortic exposure has gained wider acceptance among vascular surgeons as it affords a more direct route to the aorta and facilitates complex aortic reconstruction above the level of the renal arteries. We and others have demonstrated that in comparison to transperitoneal aortic exposure, the retroperitoneal approach is associated with decreased perioperative...
Epidemiology of Aortic Aneurysmal Disease
Peter F. Lawrence, Gustavo S.C. Oderich, Kiran Bhirangi Aneurysm of the aorta is a common disease, representing 83 of all noncerebral aneurysms diagnosed in the United States.1 Although necropsy studies indicated a predominance of thoracic aortic aneurysms in the beginning of the century, this figure has dramatically changed since then. This is probably due to the loss of syphilis as an etiologic factor and an increase in degenerative atherosclerotic aneurysms of the abdominal aorta. In 1994,...