Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice最新文献

Treatment of the Progressive Endoleak Type 2 After EVAR EVAR后进行性2型内漏的治疗

Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice Pub Date : 2019-05-29 DOI: 10.5772/INTECHOPEN.84517

D. Dobeš

{"title":"Treatment of the Progressive Endoleak Type 2 After EVAR","authors":"D. Dobeš","doi":"10.5772/INTECHOPEN.84517","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.84517","url":null,"abstract":"An endoleak type 2 (EL2) is a relatively frequent event after an EVAR but 30–35% of EL2 can become progressive, which can cause a loss in the important sealing zone of the stent graft. Diagnosis is made by three-phase CT angiogram or by contrast-enhanced duplex scan. EL2 should be treated if the aortic sac grows more than 5 mm in 6 months time. The first suitable treatment is the endovascular approach with embolization of the inferior mesenteric artery (IMA) or lumbar arteries. Paravertebral puncture, under CT navigation to embolize the lumbar artery or a part of the aortic sac with the EL2, is another alterna- tive. If the endovascular treatment is not successful in 2–3 times, we should consider a surgical approach. The operative approach can be a laparoscopic or an open operation: the laparoscopic approach allows us to clip the IMA and lumbar arteries. The open surgery involves laparotomy, ligation of the IMA, and endoaneurysmorrhaphy (suture of lumbar artery origins from inside) and then the suture of the aortic sac tightly around the stent graft in situ. The aortic occlusion balloon should be inserted below the renal arteries prior to open surgery. The surgical procedures have good outcomes and should be considered when the endovascular treatment is unsuccessful.","PeriodicalId":448129,"journal":{"name":"Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice","volume":"3 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":"127127588","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}

引用次数: 2

Open Conversion after EVAR: Indications and Technical Details EVAR后开放转换:适应症和技术细节

Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice Pub Date : 2018-11-12 DOI: 10.5772/INTECHOPEN.78017

A. Siani, F. Accrocca, Tommaso Castrucci, G. Smedile, G. Ianni, S. Corona, G. D. Vivo, S. Bartoli

引用次数: 1

Biomechanic and Hemodynamic Perspectives in Abdominal Aortic Aneurysm Rupture Risk Assessment 腹主动脉瘤破裂风险评估的生物力学和血流动力学观点

Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.76121

N. Kontopodis, K. Tzirakis, E. Tavlas, S. Lioudaki, C. Ioannou

{"title":"Biomechanic and Hemodynamic Perspectives in Abdominal Aortic Aneurysm Rupture Risk Assessment","authors":"N. Kontopodis, K. Tzirakis, E. Tavlas, S. Lioudaki, C. Ioannou","doi":"10.5772/INTECHOPEN.76121","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.76121","url":null,"abstract":"Abdominal aortic aneurysms (AAAs) pose a significant source of mortality for the elderly, especially if they go on undetected and ultimately rupture. Therefore, elective repair of these lesions is recommended in order to avoid risk of rupture which is associ - ated with high mortality. Currently, the risk of rupture and thus the indication to inter vene is evaluated based on the size of the AAA as determined by its maximum diameter. Since AAAs actually present original geometric configurations and unique hemody namic and biomechanic conditions, it is expected that other variables may affect rup - ture risk as well. This is the reason why the maximum diameter criterion has often been proven inaccurate. The biomechanical approach considers rupture as a material failure where the stresses exerted on the wall outweigh its strength. Therefore, rupture depends on the pointwise comparison of the stress and strength for every point of the aneurysmal surface. Moreover, AAAs hemodynamics play an essential role in AAAs natural history, progression and rupture. This chapter summarizes advances in AAAs rupture risk esti - mation beyond the “one size fits all” maximum diameter criterion.","PeriodicalId":448129,"journal":{"name":"Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125541304","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}

引用次数: 3

Abdominal Aortic Aneurysm and Malignancies 腹主动脉瘤及恶性肿瘤

Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.76811

J. Molacek, K. Houdek, P. Novák, J. Baxa, V. Opatrny, V. Treska

{"title":"Abdominal Aortic Aneurysm and Malignancies","authors":"J. Molacek, K. Houdek, P. Novák, J. Baxa, V. Opatrny, V. Treska","doi":"10.5772/INTECHOPEN.76811","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.76811","url":null,"abstract":"Concomitant AAA and abdominal malignancy are always very complicated conditions requiring early management of both pathologies. This is undoubtedly a dilemma for a surgeon who cannot currently rely on any large randomized trials or mandatory guide- lines. When making decisions, a surgeon most often relies on personal experience, the experience of his/her center and/or limited literary guidelines and recommendations. Efforts should be aimed at achieving a consensual multidisciplinary decision about which pathology requires “more acute” management. The decision-making process is easier if one of the pathologies is life-threatening, and such pathology should be managed first. In most cases, however, AAA is asymptomatic and a malignancy is found randomly, as a secondary finding during the follow-up of AAA patients, or vice versa, AAA is found randomly during the staging of cancer patients. In these cases, the thera - peutic algorithm already admits several possible variants. Endovascular repair of AAA (EVAR) resulted in an absolute change in the management of these patients. EVAR can be used in simultaneous or stage procedures with minimal time delay. Also, surgical open resection is an option (simultaneously or staged). It is necessary to know the advantages and risks of all approaches.","PeriodicalId":448129,"journal":{"name":"Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice","volume":"111 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124258470","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}

引用次数: 1

Experiment and Animal Models of AAA AAA的实验及动物模型

Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.78988

K. Houdek

{"title":"Experiment and Animal Models of AAA","authors":"K. Houdek","doi":"10.5772/INTECHOPEN.78988","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.78988","url":null,"abstract":"Introduction: The incidence of abdominal aortic aneurysms has been increasing through- out the world. The etiology and pathophysiology of this disease are very complicated and complex and include biomechanical aspects as well as biological processes. The effect of these mechanisms is the degradation of the aortic wall, which leads to its dilation and rupture. The possibilities for studying such complex pathophysiology in humans are very limited. That is why we use various mathematical models and a number of different animal models of aneurysm. Methods: A summary of the basic characteristics, findings and examples of using the most widely used animal models of abdominal aortic aneurysm. Information has been obtained from our own experience with laboratory animals and from studies published and available on the Pubmed Internet database. The following search terms were used: aneurysm, aorta, animal model and experiment. Conclusion: Animal models of aortic aneurysms are a usable and useful tool in the study of AAA etiopathogenesis. They also serve as a means to find novel therapeutic pathways. Each model, like any animal species, is different and has its own limitations, advantages and disadvantages, which we should always consider during their use and while interpreting the results.","PeriodicalId":448129,"journal":{"name":"Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128068047","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}

引用次数: 0

Experimental Models in Abdominal Aortic Aneurysm 腹主动脉瘤的实验模型

Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.79393

Zerrin Pulathan

{"title":"Experimental Models in Abdominal Aortic Aneurysm","authors":"Zerrin Pulathan","doi":"10.5772/INTECHOPEN.79393","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79393","url":null,"abstract":"Abdominal aortic aneurysm (AAA) is a potentially fatal disease and survival rate is very low when rupture occurs. Experimental models related with abdominal aortic aneurysm are performed on intact and ruptured aneurysm (RAAA) models. By using AAA models; complex mechanisms of aneurysm formation, aneurysm progression, chance of rupture, preventative and treating methods are researched. Most commonly used methods for creating aneurysm are utilization of transgenic or knockout animals; intra/extraluminal pharmacologic treatments such as elastase, calcium chloride or angiotensin II; hyperlip- idemic diet application and surgical interventions such as xenograft, stenosis or graft. Pathogenesis of aneurysm is predominantly examined on rodents whereas studies aimed at development of treatment modalities such as surgical or endovascular interventions are predominantly performed on large animals like rabbit, porcine or dog. Experimental studies modeling aneurysm rupture (RAAA) simulate shock (total hypoperfusion) occurred due to rupture and ischemia/reperfusion (I/R) occurred due to surgical treat- ment; without creating aneurysm. In this model, end organ or distal organ injuries and methods for reducing these injuries or their hemodynamic effects are investigated by creating shock +I/R. After performing median laparotomy, aortic exploration and entrance right above aortic tri-furcation; balloon plasty and elastase infusion are performed. Amount of administered elastase when a pig weighting approximately 30 kg is 10 ml; and stenosing cuff is placed below renal arteries by performing balloon dilatation after infusion. Presence of palpable thrill on aorta is the indicator of adequate stenosis. Parameters like “pulsatility index” which provides quantitative measurement of degree of stenosis may also be used [ 44].","PeriodicalId":448129,"journal":{"name":"Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129703955","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}

引用次数: 1

Postimplantation Syndrome after Endovascular Aneurysm Repair 血管内动脉瘤修复后植瘤后综合征

Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.77392

R. Ferreira, F. Gonçalves

{"title":"Postimplantation Syndrome after Endovascular Aneurysm Repair","authors":"R. Ferreira, F. Gonçalves","doi":"10.5772/INTECHOPEN.77392","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.77392","url":null,"abstract":"Endovascular aneurysm repair is associated, in a significant proportion of patients, to a systemic inflammatory response denominated postimplantation syndrome (PIS). PIS is characterized by fatigue, fever, and a rise in inflammatory biomarkers after the operation. However, the exact definition is still a matter of debate. There are several proposed definitions for PIS in the literature resulting in significant vari- ability of PIS incidence (ranging from 2% to 100%). The etiology of PIS is not entirely clear. Endograft composition, aortic thrombus, intestinal bacterial translocation, and contrast media may contribute to PIS but the first seems to be the most important determinant. This clinical entity may have clinical consequences in length of hospital stay, readmissions, renal function, cardiovascular events, endoleak rate, and quality of life, but current data are insufficient for definitive conclusions. Despite of absence of stablished treatment for PIS, non-steroid and steroid anti-inflammatory drugs are currently advocated when clinical suspicion arises. Prevention may be achieved with perioperative administration of a steroid drug. Since it may have adverse effects, further knowledge of the real incidence of PIS and its clinical consequences is imperative.","PeriodicalId":448129,"journal":{"name":"Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127467728","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}

引用次数: 1

Difficult Neck in Endovascular Aneurysm Repair (EVAR) 血管内动脉瘤修复(EVAR)中的颈部困难

Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.76645

Krzysztof Szaniewski

引用次数: 0

Planning and Sizing with OsiriX/Horos 规划和大小与OsiriX/Horos

Abdominal Aortic Aneurysm - From Basic Research to Clinical Practice Pub Date : 2018-11-05 DOI: 10.5772/INTECHOPEN.78018

G. P. Molinari

引用次数: 0