DIAGNOSIS AND TREATMENT OF ABDOMINAL AND THORACIC AORTIC ANEURYSMS INCLUDING THE ASCENDING AORTA AND THE AORTIC ARCH Edited by Reinhart T. Grundmann Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch Edited by Reinhart T. Grundmann Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. 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ISBN 978-953-307-524-2 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Chapter 1 Definitions, History and General Considerations Related to the Aortic Aneurysms 1 Guillermo Careaga-Reyna Chapter 2 Presentation of Abdominal Aortic Aneurysm in Clinical Practice, a Review 15 Simone Knaap and Wayne Powell II Chapter 3 Screening for Abdominal Aortic Aneurysm 25 Sima Sayyahmelli and Rakhshandeh Alipanahi Chapter 4 Color-Doppler Ultrasonography in the Monitoring of Endovascular Abdominal Aortic Aneurysm Repair 37 Enrique M. San Norberto, James Taylor and Carlos Vaquero Chapter 5 Abdominal Aortic Aneurysm (AAA): The Decision Pathway in Ruptured and Non-Ruptured AAA 57 Saeid Shahidi Chapter 6 Abdominal Aortic Aneurysm in Patients with Coronary Artery Disease: A Review Article 71 Ahmed Elkalioubie, Brigitte Jude and Annabelle Dupont Chapter 7 Treatment of Ruptured Abdominal Aortic Aneurysms 89 J.A. Ten Bosch, E.M. Willigendael, P.W. Cuypers, M.R.H.M. van Sambeek and J.A.W. Teijink Chapter 8 Magnetic Resonance Imaging of the Thoracic Aorta: A Review of Technical and Clinical Aspects, Including Its Use in the Evaluation of Aneurysms and Acute Vascular Conditions 101 Vasco Herédia, Miguel Ramalho, Sérgio Duarte, Rafael O.P. de Campos, Mateus Hernandez, Nuno Jalles Tavares and Richard C. Semelka VI Contents Chapter 9 Combined Surgical and Endovascular Approach for the Treatment of Complex Thoracic Aortic Pathologies 127 M. Gorlitzer, G. Weiss, F. Waldenberger and M. Grabenwöger Chapter 10 Endovascular Repair of Thoracic Aortic Emergencies 141 Lucas Ribé, Juan Luis Portero, Juan Vicente Solís, Rosario García-Pajares, María Vila and Luis Manuel Reparaz Chapter 11 Ascending Aneurysms in Bicuspid Aortic Valve 161 Salah A. Mohamed and Hans H. Sievers Chapter 12 Reimplantation Valve Sparing Procedure in Type A Aortic Dissection: A Predictive Factor of Mortality and Morbidity? 175 Fadi Farhat, Theodora Bejan-Angoulvant, Hassane Abdallah and Olivier Jegaden Chapter 13 Prevention of Spinal Cord Injury After Thoracoabdominal Aortic Aneurysm Repair 187 Takashi Kunihara, Suguru Kubota, Satoru Wakasa, Norihiko Shiiya and Yoshiro Matsui Preface This book considers diagnosis and treatment of abdominal and thoracic aortic aneurysms. It addresses vascular and cardiothoracic surgeons and interventional radiologists, but also anyone engaged in vascular medicine. The book focuses amongst other things on operations in the ascending aorta and the aortic arch. Surgical procedures in this area have received increasing attention in the last few years and have been subjected to several modifications. Especially the development of interventional radiological endovascular techniques that reduce the invasive nature of surgery as well as complication rates led to rapid advancements. Thoracoabdominal aortic aneurysm (TAAA) repair still remains a challenging operation since it necessitates extended exposure of the aorta and reimplantation of the vital aortic branches. Among possible postoperative complications, spinal cord injury (SCI) seems one of the most formidable morbidities. Strategies for TAAA repair and the best and most reasonable approach to prevent SCI after TAAA repair are presented. Reinhart T. Grundmann Medical Expert Burghausen, Germany [...]... etiology of abdominal aortic aneurysms Later John Hunter showed that peripheral arteries can surely be ligated and Astley Cooper, one of his pupils, ligated an aneurysm of the aorta These researchers believed that the ligature could decrease or stop the movement 2 Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch of blood within the aneurysmal... Description The tear of the intimate usually originates in the proximal ascending aorta and extends to the ascending aorta, aortic arch, and variable-length to the thoracic aorta descending and abdominal The dissection is limited to the ascending aorta Dissection can be limited to the descending thoracic aorta (type IIIa) or extended proximally and affect the ascending aorta and aortic arch Table 2... finally ruptures If they are fortunate, the size of the aneurysm draws the attention of the patient and physician prior to rupture (Crawford et al., 2003) Mass screening will benefit this group since this is the only way to detect these 16 Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch 2.2 Symptomatic aortic aneurysm In the second category,... extent II In the clamp -and- sew technique, the clamp time and the extent of the aneurysm correlated to neurologic deficit (Svensson et al 1993) Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch 4 In regards to the aortic dissections present the classification of DeBakey (table 2), and in table 3 the Stanford proposed by Daly et al in 1970... years18, and now 48% at 10 years This is surprising as it might be expected that ruptures of the aneurysm in those originally screened as normal and incidental detection of abdominal aortic aneurysm in the control group would erode the benefit over time.45 26 Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch A crucial problem is the extent... utilizing magnetic 14 Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch resonance angiography with three dimensional surface rendering Journal of the American College of Cardiology, Vol.26, No.1, (July, 1995), pp.266-271, ISSN 0735-1097 Powell JT & Greenhalgh RM (2003) Small abdominal aortic aneurysms New England Journal of Medicine, Vol... that leads to the clinical humility than aneurysms of the aorta by the complexity and the limited treatment options and the outcome of the same In 1944, Alexander and Byron successfully resected an aneurysm of the descending aorta associated with aortic coarctation, but did not try to restore the aortic continuity In the same year, Ochsner treated a small sacular aneurysm of the descending aorta with... result and recovery for the patient (CareagaReyna et al., 2006) Is very important to define the diagnosis of aortic dissection vs acute myocardial infarction in aortic dissection because thrombolysis is contraindicated 10 Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch 5 Conclusion With this brief presentation, we can conclude that aortic. .. described a radical technique of resection of the aortic wall, carrying the small buttons of adjacent tissue to the coronary ostium, replacement of the Definitions, History and General Considerations Related to the Aortic Aneurysms 3 aorta with a graft, and prosthetic aortic valve replacement In 1968, Bentall and Bono described a technique for replacement of the ascending aorta and aortic valve with a tubular... slow the growth of the aneurysm (Brady et al., 2004) 18 Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch Inflammatory AAA represents 3% to 10% of all AAAs A significant percentage of patients with inflammatory AAA are active smokers, when compared to non-inflammatory AAA (Ahlawat & Cuddihy, 2002) There is an 8:1 preponderance of smokers . Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch 4 In regards to the aortic dissections present the classification of. researchers believed that the ligature could decrease or stop the movement Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch. DIAGNOSIS AND TREATMENT OF ABDOMINAL AND THORACIC AORTIC ANEURYSMS INCLUDING THE ASCENDING AORTA AND THE AORTIC ARCH Edited by Reinhart T. Grundmann Diagnosis