Pub Date : 2019-12-13DOI: 10.5772/intechopen.89298
B. Cosset, S. Abdellaoui, H. Huvelle, Amine Fikani, F. Farhat
Type A aortic dissection (TAAD) is a serious condition requiring emergency surgical management. The main objective of the treatment is the patient survival. Thus, the surgeon has to perform a well-mastered surgical technique without extending the operative time and emphasizing operative risk. Nevertheless, patients with history of TAAD present long-term complications on the aorta, mainly aneurysmal evolution and dissection recurrence. In order to decrease the long-term excess mortality of this population, it is necessary to respect some rules during the surgery. Concerning the proximal segment of the ascending aorta, the aortic root has to be replaced by a composite graft (Bentall technique) or a valve sparing inclusion (David technique) when the dissection reaches the sinuses of Valsalva or when aortic valve regurgitation is observed. Concerning the distal segment of the ascending aorta, the distal anastomosis has to be performed without aortic clamp-ing. Concerning the descending thoracic aorta, hybrid surgery should be performed on patients with malperfusion syndrome and patients with high risk factors for aneurysmal evolution.
{"title":"Extensive Repair in Type A Aortic Dissection: To Save the Patient or to Ensure a Durable Repair?","authors":"B. Cosset, S. Abdellaoui, H. Huvelle, Amine Fikani, F. Farhat","doi":"10.5772/intechopen.89298","DOIUrl":"https://doi.org/10.5772/intechopen.89298","url":null,"abstract":"Type A aortic dissection (TAAD) is a serious condition requiring emergency surgical management. The main objective of the treatment is the patient survival. Thus, the surgeon has to perform a well-mastered surgical technique without extending the operative time and emphasizing operative risk. Nevertheless, patients with history of TAAD present long-term complications on the aorta, mainly aneurysmal evolution and dissection recurrence. In order to decrease the long-term excess mortality of this population, it is necessary to respect some rules during the surgery. Concerning the proximal segment of the ascending aorta, the aortic root has to be replaced by a composite graft (Bentall technique) or a valve sparing inclusion (David technique) when the dissection reaches the sinuses of Valsalva or when aortic valve regurgitation is observed. Concerning the distal segment of the ascending aorta, the distal anastomosis has to be performed without aortic clamp-ing. Concerning the descending thoracic aorta, hybrid surgery should be performed on patients with malperfusion syndrome and patients with high risk factors for aneurysmal evolution.","PeriodicalId":258976,"journal":{"name":"Aortic Aneurysm and Aortic Dissection","volume":"107 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123235506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-26DOI: 10.5772/INTECHOPEN.86329
O. Unlu, Zaid Almarzooq, Diala Steitieh, M. Brandorff, Parmanand Singh
Aortic root dilation (AoD) imparts increased risk of aortic complications such as dissection, rupture, and valvular regurgitation. Multiple etiologies of AoD exist, such as Marfan syndrome, bicuspid aortic valve, Ehler-Danlos syndrome, infections, and idiopathic conditions. Due to the variety of clinical conditions that can result in AoD, and the risks associated with worsening AoD, a thorough understanding of the pathophysiology of AoD, noninvasive imaging modalities, and pharmacologic therapies is critical. This chapter will review the various etiologies of AoD, pathophysiological basis of each disease entity, overview of the diagnosis of AoD, noninvasive imaging modalities employed for detection and surveillance, pharmacological therapies used in the prevention and management, and the factors that guide intervention such as surgical repair.
{"title":"Diagnosis and Surveillance of Aortic Root Dilation","authors":"O. Unlu, Zaid Almarzooq, Diala Steitieh, M. Brandorff, Parmanand Singh","doi":"10.5772/INTECHOPEN.86329","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.86329","url":null,"abstract":"Aortic root dilation (AoD) imparts increased risk of aortic complications such as dissection, rupture, and valvular regurgitation. Multiple etiologies of AoD exist, such as Marfan syndrome, bicuspid aortic valve, Ehler-Danlos syndrome, infections, and idiopathic conditions. Due to the variety of clinical conditions that can result in AoD, and the risks associated with worsening AoD, a thorough understanding of the pathophysiology of AoD, noninvasive imaging modalities, and pharmacologic therapies is critical. This chapter will review the various etiologies of AoD, pathophysiological basis of each disease entity, overview of the diagnosis of AoD, noninvasive imaging modalities employed for detection and surveillance, pharmacological therapies used in the prevention and management, and the factors that guide intervention such as surgical repair.","PeriodicalId":258976,"journal":{"name":"Aortic Aneurysm and Aortic Dissection","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134413949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-30DOI: 10.5772/INTECHOPEN.86711
Abdullah Al Amoudi, S. Srinivasan, M. Sikkandar
Aortic aneurysms (AA) can be the primary cause of over 10,000 deaths and indirect cause for another 18,000 deaths annually in the USA as per the recent data released by the Centers for Disease Control and Prevention. Among the several factors related to high mortality, imaging methods and intervention procedures could be important. The commonly used diagnostic imaging methods of aneurysms are computed tomography (CT), magnet resonance imaging (MRI), ultrasound (US), digital subtraction angiography (DSA) and amalgamation of fluoro-D-glucose (FDG) integrated with positron emission tomography (PET) and/or CT and PET with CT or MRI. Several research findings indicate that diagnostic efficiency of different imaging methods differ. As intervention procedures depend upon diagnosis, the choice of appropriate diagnostic imaging method for a given case is very important. If the critical characteristics of the swelling are not detected due to the choice of unsuitable imaging method, interventions may not be very suitable. The American College of Radiologists (ACR) prescribed some appropriateness guidelines for diagnostic imaging. Not complying with them fully or partially may also be a mortality factor. This chapter is written with recent research findings in the field of intelligent data analysis for medical applications supported by case studies and practical examples.
根据疾病控制和预防中心最近发布的数据，动脉瘤(AA)可能是美国每年超过10,000人死亡的主要原因，并间接导致另外18,000人死亡。在与高死亡率相关的几个因素中，成像方法和干预程序可能是重要的。动脉瘤常用的诊断成像方法有计算机断层扫描(CT)、磁共振成像(MRI)、超声(US)、数字减影血管造影(DSA)以及氟- d -葡萄糖(FDG)与正电子发射断层扫描(PET)和/或CT、PET与CT或MRI合并。多项研究结果表明，不同影像方法的诊断效率存在差异。由于干预程序取决于诊断，因此针对特定病例选择合适的诊断成像方法非常重要。如果由于选择不合适的成像方法而没有检测到肿胀的关键特征，则干预措施可能不太合适。美国放射科医师学会(ACR)为诊断成像制定了一些适当的指导方针。不完全或部分遵守这些规定也可能是一个死亡因素。本章是写与智能数据分析领域的最新研究成果，为医疗应用的案例研究和实际例子的支持。
{"title":"Challenges for Intelligent Data Analysis Methods in Medical Image Analysis during Surgical Interventions of Aneurysms","authors":"Abdullah Al Amoudi, S. Srinivasan, M. Sikkandar","doi":"10.5772/INTECHOPEN.86711","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.86711","url":null,"abstract":"Aortic aneurysms (AA) can be the primary cause of over 10,000 deaths and indirect cause for another 18,000 deaths annually in the USA as per the recent data released by the Centers for Disease Control and Prevention. Among the several factors related to high mortality, imaging methods and intervention procedures could be important. The commonly used diagnostic imaging methods of aneurysms are computed tomography (CT), magnet resonance imaging (MRI), ultrasound (US), digital subtraction angiography (DSA) and amalgamation of fluoro-D-glucose (FDG) integrated with positron emission tomography (PET) and/or CT and PET with CT or MRI. Several research findings indicate that diagnostic efficiency of different imaging methods differ. As intervention procedures depend upon diagnosis, the choice of appropriate diagnostic imaging method for a given case is very important. If the critical characteristics of the swelling are not detected due to the choice of unsuitable imaging method, interventions may not be very suitable. The American College of Radiologists (ACR) prescribed some appropriateness guidelines for diagnostic imaging. Not complying with them fully or partially may also be a mortality factor. This chapter is written with recent research findings in the field of intelligent data analysis for medical applications supported by case studies and practical examples.","PeriodicalId":258976,"journal":{"name":"Aortic Aneurysm and Aortic Dissection","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130701357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-29DOI: 10.5772/INTECHOPEN.86328
Lucas Ribé Bernal, Lucía Requejo, Aida Ribes, Manuel Miralles
Various studies have evaluated the possibilities of surgical repair of mycotic aortic aneurysms (MAAs). Open surgical repair has usually been accepted as the gold standard treatment of MAAs. The main concern is that it carries a significant mortality risk, varying from 20 to 40% in different studies, and a 5-year survival rate of 30–50%. The largest study of open surgical treatment of mycotic aortic aneurysms (MAA) was published in 2018, and consisted of 187 patients of whom open repairs were performed in 107 patients (57%). Most of the endovascular series conclude that endovascular treatment of MAA is feasible and an acceptable alternative treatment to open repair. Although endovascular repair might be a durable option for some patients, late infection-associated complications frequently occur and are often lethal. An overall analysis of this rare pathology, its different diagnostic modalities, treatment options, and prognosis are presented and discussed in this chapter.
{"title":"Mycotic Aortic Aneurysms","authors":"Lucas Ribé Bernal, Lucía Requejo, Aida Ribes, Manuel Miralles","doi":"10.5772/INTECHOPEN.86328","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.86328","url":null,"abstract":"Various studies have evaluated the possibilities of surgical repair of mycotic aortic aneurysms (MAAs). Open surgical repair has usually been accepted as the gold standard treatment of MAAs. The main concern is that it carries a significant mortality risk, varying from 20 to 40% in different studies, and a 5-year survival rate of 30–50%. The largest study of open surgical treatment of mycotic aortic aneurysms (MAA) was published in 2018, and consisted of 187 patients of whom open repairs were performed in 107 patients (57%). Most of the endovascular series conclude that endovascular treatment of MAA is feasible and an acceptable alternative treatment to open repair. Although endovascular repair might be a durable option for some patients, late infection-associated complications frequently occur and are often lethal. An overall analysis of this rare pathology, its different diagnostic modalities, treatment options, and prognosis are presented and discussed in this chapter.","PeriodicalId":258976,"journal":{"name":"Aortic Aneurysm and Aortic Dissection","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134023964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-17DOI: 10.5772/INTECHOPEN.86477
M. Gong, Shu Liu, Zhenheng Guo
The renin-angiotensin-aldosterone system (RAAS) is implicated in the etiologies of many cardiovascular diseases, including abdominal aortic aneurysm (AAA) and thoracic aortic aneurysm (TAA). In particular, the infusion of angiotensin II (Ang II) in hyperlipidemia mice to induce AAA and TAA has been extensively used in the field, suggesting a critical role of Ang II in aortic aneurysm. In contrast, whether aldosterone (Aldo), a downstream effector of Ang II, is involved in aortic aneurysm is unknown. Here, we describe a new mouse model of AAA and TAA induced by subcutaneous implantation of deoxycorticosterone acetate (DOCA) pellets or infusion of Aldo using osmotic pumps to 10-month-old C57BL/6 male mice in the presence of high salt. The DOCA- or Aldo-salt-induced aortic aneurysm is dependent upon mineralocorticoid receptor activation but independent of Ang II and hypertension and exhibits several unique features that mimic human aortic aneurysm. This review aims to discuss the common animal models of AAA, TAA, and aortic dissection currently studied in the world with the most focus on the DOCA- or Aldo-salt mouse model of aortic aneurysm. significance and potential impact of the DOCA- or Aldo-salt mouse model of aortic aneurysm on the current basic research and clinical practice on the etiology, clinic diagnosis, evaluation, and treatment of AAA.
{"title":"A New Mouse Model of Aortic Aneurysm Induced by Deoxycorticosterone Acetate or Aldosterone in the Presence of High Salt","authors":"M. Gong, Shu Liu, Zhenheng Guo","doi":"10.5772/INTECHOPEN.86477","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.86477","url":null,"abstract":"The renin-angiotensin-aldosterone system (RAAS) is implicated in the etiologies of many cardiovascular diseases, including abdominal aortic aneurysm (AAA) and thoracic aortic aneurysm (TAA). In particular, the infusion of angiotensin II (Ang II) in hyperlipidemia mice to induce AAA and TAA has been extensively used in the field, suggesting a critical role of Ang II in aortic aneurysm. In contrast, whether aldosterone (Aldo), a downstream effector of Ang II, is involved in aortic aneurysm is unknown. Here, we describe a new mouse model of AAA and TAA induced by subcutaneous implantation of deoxycorticosterone acetate (DOCA) pellets or infusion of Aldo using osmotic pumps to 10-month-old C57BL/6 male mice in the presence of high salt. The DOCA- or Aldo-salt-induced aortic aneurysm is dependent upon mineralocorticoid receptor activation but independent of Ang II and hypertension and exhibits several unique features that mimic human aortic aneurysm. This review aims to discuss the common animal models of AAA, TAA, and aortic dissection currently studied in the world with the most focus on the DOCA- or Aldo-salt mouse model of aortic aneurysm. significance and potential impact of the DOCA- or Aldo-salt mouse model of aortic aneurysm on the current basic research and clinical practice on the etiology, clinic diagnosis, evaluation, and treatment of AAA.","PeriodicalId":258976,"journal":{"name":"Aortic Aneurysm and Aortic Dissection","volume":"90 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126064427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-04-17DOI: 10.5772/INTECHOPEN.85956
R. Meel, R. Gonçalves
Advances in human immunodeficiency virus (HIV) therapy with highly active antiretroviral agents has increased the longevity of patients afflicted with this disease. HIV vasculopathy is a unique disease entity presenting as aneurysms, dissections and vascular occlusion amongst others due to HIV related vasculitis. A few studies have investigated the pathogenesis of HIV related vasculopathy. This chapter provides a brief overview of aortic aneurysms in general. Further, the current understanding of the pathogenic mechanisms underlying HIV vasculopathy with an emphasis on inflammatory mediators, histology, clinical presentation and imaging are discussed. Finally, a summary regarding management of HIV associated large vessel disease is presented.
{"title":"Human Immunodeficiency Virus Associated Large Artery Disease","authors":"R. Meel, R. Gonçalves","doi":"10.5772/INTECHOPEN.85956","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.85956","url":null,"abstract":"Advances in human immunodeficiency virus (HIV) therapy with highly active antiretroviral agents has increased the longevity of patients afflicted with this disease. HIV vasculopathy is a unique disease entity presenting as aneurysms, dissections and vascular occlusion amongst others due to HIV related vasculitis. A few studies have investigated the pathogenesis of HIV related vasculopathy. This chapter provides a brief overview of aortic aneurysms in general. Further, the current understanding of the pathogenic mechanisms underlying HIV vasculopathy with an emphasis on inflammatory mediators, histology, clinical presentation and imaging are discussed. Finally, a summary regarding management of HIV associated large vessel disease is presented.","PeriodicalId":258976,"journal":{"name":"Aortic Aneurysm and Aortic Dissection","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130157613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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