DIAGNOSIS, SCREENING AND TREATMENT OF ABDOMINAL, THORACOABDOMINAL AND THORACIC AORTIC ANEURYSMS Edited by Reinhart T. Grundmann Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms 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. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published articles. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Mirna Cvijic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright Sebastian Kaulitzki, 2011. Used under license from Shutterstock.com First published August, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms, Edited by Reinhart T. Grundmann p. cm. 978-953-307-466-5 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Chapter 1 The Abdominal Aortic Aneurysm – Prognosis, Treatment, Screening and Cost-Effectiveness 1 Reinhart T. Grundmann Chapter 2 Pathophysiology of Abdominal Aortic Aneurysm – Genetic Factors and Homocysteine Metabolism 19 Christopher L Delaney, Hafees A Saleem, Yew-Toh Wong and J Ian Spark Chapter 3 The Pathohistology of Abdominal Aortic Aneurysm 37 Gregory T Jones Chapter 4 Actual Pharmacological Treatment to Reduce Growth of Small Abdominal Aneurysm 59 Guillermo Moñux Ducajú, Javier Modrego, Antonio López Farré and Javier Serrano Chapter 5 Diagnosis of Aortic Aneurysm 69 Serosha Mandika Wijeyaratne Chapter 6 Ultrasound in Abdominal Aortic Aneurysm 87 Reidar Brekken, Torbjørn Dahl and Toril A. N. Hernes Chapter 7 Motion Calculations on Stent Grafts in AAA 109 Almar Klein, W. Klaas Jan Renema, J. Adam van der Vliet, Luuk J.Oostveen, Yvonne Hoogeveen, Leo J. Schultze Kool and Cornelis H. Slump Chapter 8 A Prospective Clinical Economic and Quality of Life Analysis of Open Repair, Endovascular Aortic Repair and Best Medical Treatment in High Risk Patients with AAA 129 Sherif Sultan and Niamh Hynes VI Contents Chapter 9 Incidence and Predictors of Clinical Failures Following Catheter-Based Treatment of Abdominal Aortic Aneurysms 145 Daniel R. Watson, Angela Kruse, Jeffrey Weiner and Christina Prabhu Chapter 10 12-Year Experience with the Endologix Powerlink R Device in Endovascular Repair of Abdominal Aortic Aneurysms 161 Ziheng Wu, Lefeng Qu, Dieter Raithel and Konstantinos Xiromeritis Chapter 11 Ruptured Abdominal Aortic Aneurysms 179 Antonello M. Chapter 12 Endovascular Repair of the Ruptured Aneurysm 199 Jane Cross, Peter Harris and Toby Richards Chapter 13 Late Complications Following Aortic Aneurysm Repair 211 Michiel L.P. van Zeeland and Lijckle van der Laan Chapter 14 Abdominal Aortic Graft Infection 227 Dimitrios Tsapralis, Anestis Charalampopoulos and Andreas M. Lazaris Chapter 15 Gastrointestinal Complications of Abdominal Aortic Aneurysms 245 Emmeline Nugent and Paul Neary Chapter 16 The Importance of Venous and Renal Anomalies for Surgical Repair of Abdominal Aortic Aneurysms 269 Roberto Jiménez and Francisco Morant Chapter 17 Isolated Iliac Artery Aneurysm 293 Shinichi Hiromatsu, Atsuhisa Tanaka and Kentarou Sawada Chapter 18 Concomitant Abdominal Aortic Aneurysm and Malignancy: Simultaneous Minimally Invasive Repair 301 Gabriele Piffaretti, Luigi Boni, Matteo Tozzi, Nicola Rivolta, Giovanni Mariscalco and Patrizio Castelli Chapter 19 Aortic Aneurysms in Takayasu Arteritis 311 Guido Regina, Domenico Angiletta, Alessandro Bortone, Martinella Fullone, Davide Marinazzo and Raffaele Pulli Chapter 20 Conventional Surgery in Type IV Thoracoabdominal Aortic Aneurysm 329 Arash Mohammadi Tofigh Contents VII Chapter 21 Spinal Cord Protection for Descending or Thoracoabdominal Aortic Aneurysm Repair 347 Nobuyoshi Kawaharada, Toshiro Ito and Tetsuya Higami Chapter 22 Rehabilitation for Spinal Cord Injury Caused by Thoracic Aortic Aneurysm 363 Suguru Ohsawa and Shinji Hirabayashi Chapter 23 Relationships Between AAA and Cauda Equina Syndrome 385 Masood Rehman Moghul and Bassel El-Osta Chapter 24 Anesthetic Management of Aortic Aneurysm 397 Zsófia Verzár and Sándor Szabados Preface This book considers mainly diagnosis, screening, surveillance and treatment of abdominal, thoracoabdominal and thoracic aortic aneurysms. It addresses vascular and cardiothoracic surgeons and interventional radiologists, but also anyone engaged in vascular medicine. The high mortality of ruptured aneurysms certainly favors the recommendation of prophylactic repair of asymptomatic aortic aneurysms (AA) and therewith a generous screening. However, the comorbidities of these patients and their age have to be kept in mind if the efficacy and cost effectiveness of screening and prophylactic surgery should not be overestimated. The treatment recommendations, which will be outlined here, have to regard on the one hand the natural course of the disease, the risk of rupture, and the life expectancy of the patient, and on the other hand the morbidity and mortality of the prophylactic surgical intervention. The book describes perioperative mortality after endovascular and open repair of AA, long-term outcome after repair, and the cost-effectiveness of treatment. Prof. Dr. Reinhart T. Grundmann Medical Expert Burghausen, Germany [...]... their life, and men and women with a family history of AAA On this basis, a total of 2918 veteran males 65 to 75 years of age (average age, 71 +/- 6 years) were screened for AAA over a 1-year period (Lee et al., 2009) An AAA was diagnosed in 5.1% (148/2918) of patients The majority of aneurysms (83%) 10 Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms were... aneurysm repair would have to be modified and the cost effectiveness of screening would be diminished Moreover, the introduction of EVAR could have a negative impact on cost effectiveness of screening what must be evaluated in the future Provided that screening 12 Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms and/ or repair are employed on a much wider... whenever possible, did so in 28% to 79% of their patients, and had a 30-day mortality of 19.7% for 680 EVAR patients and 36.3 % for 763 open repair patients In addition, outcome following endovascular and open repair of rAAA was evaluated by Giles et al., 2009 interrogating the 8 Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms Nationwide Inpatient Sample... Group.(2010) Long-term outcome of open or endovascular repair of abdominal aortic aneurysm N Engl J Med 362(20): 1881-1889 Dillon M, Cardwell C, Blair PH, Ellis P, Kee F & Harkin DW (2007) Endovascular treatment for ruptured abdominal aortic aneurysm Cochrane Database Syst Rev (1): CD005261 14 Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms Dimick JB, Upchurch... by fibroblasts and becomes incorporated 24 Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms into the insoluble microfibrils which appear to provide a scaffold for the deposition of elastin (Kielty et al, 2002) Fibrillin appears to be particularly susceptible to the process of homocysteinylation This involves a post-biosynthetic acylation of free amino groups... reinterventions and hospitalizations after open repair (overall, at 4 years these interventions occurred in 4.1% of patients in the EVAR group and 9.7 % in the open 6 Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms repair group) This research team reported subsequently long-term results without any change in the conclusion (Giles et al., 2011) Through 6 years of follow-up,... risk of surgery It must be ensured that the untreated disease would progress to rupture of the AAA with fatal outcome The benefits of screening and subsequent prophylactic operation must be contrasted its risk and cost It is the objective of the following remarks to outline the value of screening for AAA on the basis of studies on the prevalence of AAA, risk of rupture, and the results of surgical treatment. .. cost effectiveness results from the randomised Multicentre Aneurysm Screening Study BMJ 338: b2307 18 Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms United Kingdom EVAR Trial Investigators, Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D & Sculpher MJ (2010a) Endovascular versus open repair of abdominal aortic aneurysm N Engl J Med 362(20):... Brief summary of homocysteine metabolism 20 Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms 2 Historical perspective HyperHcy has been linked to vascular disease since the early 1960’s when children with mental retardation, accelerated growth and propensity to arterial and venous thrombosis were found to have homocysteinuria An emerging pattern of atherosclerosis... EVAR compared to open repair, 4 Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms the PIVOTAL study has sought to determine whether EVAR for AAA measuring 4 to 5 cm in diameter compared to surveillance might be of benefit (Ouriel et al., 2010) Among patients randomized to treatment, 89% underwent aneurysm repair Among patients randomized to surveillance, 31 . DIAGNOSIS, SCREENING AND TREATMENT OF ABDOMINAL, THORACOABDOMINAL AND THORACIC AORTIC ANEURYSMS Edited by Reinhart T. Grundmann Diagnosis, Screening and Treatment. as an aortic diameter  3cm. If clinically important aneurysms are only taken into account (AAA Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms. 5.1% (148/2918) of patients. The majority of aneurysms (83%) Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms 10 were small (3.0 - 4.4 cm).