J Cardiovasc Surg
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Case Reports
Endovascular treatment of extracranial vertebral artery aneurysm and aberrant right subclavian artery aneurysm.
We report an endovascular approach that used to treat a symptomatic extracranial vertebral artery aneurysm associated to an asymptomatic aberrant right subclavian artery aneurysm. A 54-year-old man presented with neck pain, vertigo and loss of balance. The computed tomography (CT) scan demonstrated a left extracranial vertebral artery aneurysm that compressed and eroded the C5 vertebra associated to an aberrant right subclavian artery aneurysm. ⋯ The endovascular treatment represents a good option for these complex pathologies with excellent immediate results, reduces the complication rate and the hospital stay if compared to open repair. Long-term follow-up is necessary. To our knowledge this is a unique case in the literature.
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The aim of this review was to explore current literature pertaining to the use of permissive hypotension in the treatment of abdominal aortic aneurysms. A literature search using Metalib, a database search engine, provided at the Royal Free and University College of London (UCL) yielded articles using the keywords "permissive hypotension" and "hypotensive resuscitation" when linked to "abdominal aortic aneurysm" and "rupture". The articles studying permissive hypotension in animals and humans in trauma, and in patients with abdominal aortic aneurysm were reviewed. ⋯ The safety of permissive hypotension in patients with ruptured aortic aneurysms was documented and found to be widespread, but there were no randomized trials directly comparing this practice. Evidence from a prospective randomized study on the modality of treatment of ruptured aortic aneurysms suggest that the level of blood pressure is associated with the mortality and a prospective cohort study suggests that, using the complementary concept of "delayed volume resuscitation", the total volume of preoperative fluid resuscitation independent of the blood pressure is predictive of the risk of perioperative death in ruptured aortic aneurysms. To this end, recent clinical publications are now supportive of control of both the volume of preoperative fluid given and blood pressure in this group of patients but clinical studies are few.
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The aim of our study was to evaluate the earlier and long term survival as well the postoperative complications in high-risk patients who received endovascular aortic repair (EVAR) as first choice, or open repair when anatomical requirements for EVAR were not met. ⋯ Our results in open repair surgery show a perioperative low mortality rate with high survival rate in long term. This result could be successfully achieved even in high-risk patients unsuitable for EVAR.
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In type B double-barrel aortic dissection (AD), the fate of the affected aorta, causes of death, and very long-term clinical outcomes have not been completely elucidated. The purpose of this study was to clarify the fate of the affected aorta and long-term clinical outcomes in patients with type B AD during the chronic phase. ⋯ In type B chronic aortic dissection, the affected aortas have a high incidence of AD-related events during the follow-up period. Prophylactic surgery or endovascular treatment for patients at high risk may reduce the AD-related events.
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Review
Spinal cord ischemia in open and endovascular thoracoabdominal aortic aneurysm repair: new concepts.
For more than half a century ischemic spinal cord injury (SCI) and consecutively permanent paraplegia remained the most devastating complication after open and endovascular thoracoabdominal aortic aneurysm (TAAA) repair. Various neuroprotective strategies (e.g., motor-/somatosensory evoked potential monitoring and cerebrospinal fluid drainage) used as adjuncts have lowered the SCI; maybe most importantly, the modern collateral network (CN) has begun to replace the classic understanding of spinal cord blood supply implying several consequences. ⋯ Currently, two promising new concepts--potentially advancing spinal protection in open and endovascular TAAA repair--address these issues: 1) non-invasive real-time monitoring of the paraspinous CN-oxygenation via near-infrared spectroscopy (NIRS) as an alternative to the demanding direct neuromonitoring; and 2) preconditioning of the CN as minimally invasive, endovascular "first stage" to increase the resilience of spinal cord perfusion prior to definite aortic repair. This article illustrates both concepts discussing: 1) the clinical application of thoracic and lumbar collateral NIRS monitoring to indirectly detect spinal cord hypoperfusion; and 2) minimally invasive selective segmental artery coil-embolization (MISACE) for (arteriogenic) preconditioning of the CN prior to extensive open or endovascular staged TAAA repair.