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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3850_Библиотеки_им_академика_М_И_Перельмана
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https://t.me/med1917
IX. Conclusions
endovascular procedures, with greater likelihood of expected benefit. Research in imaging remains vital for
future advances in endovascular techniques, with two
essential techniques driven by clinical requirements: lesion modelization and virtual angioscopy.
On a more practical point of view, real improvements
have been made in delivery devices. For technical reasons, stent-grafts used to be relatively short, making it
necessary to deploy several interconnected segments to
bridge long lesions. Now, to avoid late endoleaks due to
migration of segments, the trend is to use longer stentgrafts, especially for degenerative aneurysms. With the
increase of coverage length, the risk of paraplegia becomes greater, and bypassing of the supra-aortic trunks
(especially the left subclavian artery) could become
necessary more frequently in the future.
To sum up, this new trend in the treatment of aortic
pathologies focuses the major interests of a multidisciplinary approach, knowledge sharing and training in
both surgery and diagnostic and interventional imag-
ing. This synergy is necessary for the optimal choice of
surgical or interventional strategies. This cooperative
management leads us to consider hybrid training,
which will impose itself on the future generations of
physicians.
Randomized controlled studies will probably be difficult to build up owing to the low incidence of the various diseases, but prospective multicentric studies, complying with guidelines still to be defined, are the necessary evaluation tools for the next 10 years.
Thanks to the cooperation of all the authors of this
book, to whom we are deeply and sincerely grateful,
our wish is to promote this challenging spirit of partnership between surgery and interventional radiology
driven by the rapid evolution of treatments of aortic
pathologies.
To describe which routes must be followed was the
primary reason for which this work was undertaken.
Thank you for having read it.
Subject Index
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acute aortic syndrome 55, 190, 277, 289
acute renal failure 105
acute traumatic rupture of the aorta
(ATRA) 341
adenosine 110
adjunctive procedures 186
aduncts
± pharmacological 86
± physiological 94
aneurism 268
± infectious 271
± mycotic 270
± sacciform 271
aneurysmal aorta 305
aneurysm 116, 157±159, 365±366, 368
antegrade cerebral perfusion 120
antegrade perfusion 117±118
antibioprophylaxia 111
anticoagulation 110
antifibrinolytics 105
aorta
± dorsal 21
± ventral 21
aortic
± arch 353
± isthmus 353
aortic aneurysms 15, 55
aortic arch 126, 228
aortic arch replacement 157±158
aortic banding 157
aortic bicuspid 55
aortic branch ischemia 201
aortic clamping, simple 153
aortic coarctation 13
aortic dissection 15, 149, 157, 199, 209
aortic grafts
± homograft 268
± infected 267
aortic injuries 319
± associated injuries 321
± hospital mortality 319
± lesions associated 319
± polytraumatism 319, 328
± violent accident 319
aortic lesion 325
± seldom isolated 325
aortic regurgitation 76
aortic remodelling 284
aortic repair 321±322, 325
± associated injuries 321
± delay 321
± direct suture 322
± emergency 325
± endoprosthesis 321±322
aortic tear 331
aortic ulcers 55
aortitis 55
± fungal 255
± salmonellosis 255
± syphilis 255
± tuberculosis 255
aortogram 321
arch reconstruction 133
arches pairs 21
± abnormal 21
± displacement 21
±fourth21
± interruption 21
± third 21
arteria lusoria 12
arterial cannulation 119
artery of Adamkiewicz 82
ascending aortic replacement 122
asystoly 110
atherosclerotic penetrating ulcers
± gravity score 299
± risk factors 298
atherosclerotic penetrating ulcers
(APU) 297
atherosclerotic risk factors 118
atherosclerosis 166
axillary artery 119±120
barbiturates 118
beta-blockade 73
bilateral thoracotomy 118±119
biochemical markers 57
bland intimal tear 303
blood flow 29
blunt chest trauma 314
blunt trauma 311
bovine trunk 10
branched stent-graft 133, 159
bronchial arteries 8
bypass 30
C-reactive protein (CRP) 59
calcium antagonists 104
cannulation 119
2+
101
Ca
cerebral edema 118
cerebral embolization 135
cerebral ischemic tolerance 118
cerebral protection 117
cerebrospinal fluid drainage 111, 142,
147, 204
chest pain 116
chronic dissection 169, 192
chronic obstructive pulmonary
disease 117
chronic post-traumatic aneurysm
316
chronic renal insufficiency 291
CK isozymes 62
classification 346±347
± decision algorithm 346±347
coarctation 25, 41, 166, 256
± arch 353
± postductal 353
cognitive dysfunction 117
color Doppler imaging 34
common carotid artery 7
complete arch replacement 120
computed tomography (CT) 117, 289,
320, 321
connective tissue disease 166
contained aortic rupture 284
contrast echographic agent 36
coronarography 291
coronary aneurysms 10
coronary arteries 6
coronary heart disease 117
corticosteroids 118
cross-clamping 83
CSF drainage 86, 154
cystic medial necrosis 55, 190
3D rotational angiography 5
D-dimer 60
delayed repair 332
delayed rupture 326
descending aorta posttraumatic false
aneurysms 345
± discovered fortuitously 345
± misdiagnosed 345
DeBakey 189
direct repair 342
dissection 55, 209, 247
± acute 200
± chronic 181, 200
± descending aortic 181
± enlargement 181
± iliac involvement 186
± type B 181
± uncomplicated 181
distal aortic perfusion 143, 144, 147,
153
ductal patency 358
ductus arteriosus 21
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Subject Index
during rewarming 103
dynamic obstruction 169
echocardiography 75, 117, 289
Ehlers-Danlos syndrome (EDS) 55, 224
elephant trunk 158
± anastomosis 125
± frozen 126
± technique 125
elephant trunk extension 120
embolism 118
embryo 21
endarteritis 255
endocarditis 255, 268
endografting 199
endoleak 205, 214±215
endovascular
± aneurysm 157
± branch stent-graft 159
± complications 157
± endoleak 157
± graft-covered supraaortic vessels
157
± hemostatic seal 157
± landing zone 157
± modular stent-graft 159
± open stent-graft placement 159
± type A dissection 158
± type B dissection 159
endovascular stenting 85
endovascular therapy 326
entry sites 291
entry tear 165, 202
exercise 72
extraanatomical bypasses 159
false aneurysms 116, 120
false lumen thrombus 192
familial AAA 63
familial TAA 63
femoral±femoral bypass 153
fenestration 30, 248
FEV1 118
fifth intercostal space 177
filter device 135
fragility of the acute dissected aorta
177
full heparinization 155
fusiform 116
general anaesthesia 110
genetic markers 63
graft, non stented 126
graft interposition 342
graft migration 135
hemodynamics 27
hippocampus 101
HIV 257
hoarseness 116
homemade vascular prosthesis 126
homocysteine (Hcy) 61
hospital mortality 322, 325
± associated lesions 325
hyperhomocysteinemia 61
hypoplasia
± arch 353
± tublar 353
hypothermia 153
hypothermic circulatory arrest 117±118
IAH 281
± classification 281
± echo-free spaces 280
± evolutive patterns 281
± predictors of progression 282
IMH endovascular treatment 303
infection 255, 270
inflammatory syndrome 111
inherited connective tissue disor-
ders 55, 190
innominate 7
intentional exclusion of the left sub-
clavian artery 378
intercostal arteries 144
± reattachment 186
internal elastic lamina 283
intimal flap 34
intimal tear 34, 181
intraluminal thrombus 55
intramural aortic hematoma 277
intramural haemorrhage 165
intramural hematoma (IMH) 39, 190,
297
intramural hematomas
± gravity score 299
± risk factors 298
± ulcerlike projections 298
intramural hemorrhage 284
intraparietal hemorrhage 279
ischemia 248
± renal, chronic 186
± reperfusion 187
isthmus 311
lamellar units 278
left heart bypass 178
left heart catheterization 117
left subclavian artery 7, 133
local anaesthesia 111
loco-regional anaesthesia 111
malperfusion 175, 248
± dynamic 248
± static 248
malperfusion syndrome 189
Marfan syndrome (MFS) 55, 71, 166,
224
matrix metalloproteinases (MMPs) 55
MD-CT 3, 289
mechanical failure 219
medial degeneration 166
median sternotomy 118±119
medullar protection 111
mega-aortic syndrome 116
migration 211
monitoring of spinal cord function
84
monitoring site 102
monogenic disorders 63
mortality 117, 121, 325
motor-evoked potentials, monitor-
ing 84
motor-evoked potentials (MEPs) 84
MR angiography 4
MRI 117, 289
mycotic aneurysm 255
neurological deficit 147
new intimal tear 203
NMDA and AMPA receptors 104
noncommunicating dissection 279
Noonan syndrome 64
osteogenesis imperfecta 55
paraplegia 81, 204, 319, 322, 325±326
± active distal perfusion 326
± centrifugal pump 326
± delayed 82
± distal perfusion 325
± postoperative 81, 186
partial arch replacement 120
PAU 278
± internal elastic lamina 284
penetrating aortic ulcers 39, 190, 284,
293, 301
percutaneous balloon fenestration 194,
202
polycystic kidney disease (PKD) 55
postimplantation syndrome 212
posterolateral thoracotomy 118
pressure measurements 242
prognosis 116
protection
± CNS 153
± spinal cord 153
protective measures 185
pseudoaneurysm 284, 303
pseudoaneurysm 332
pulmonary function testing 117
pulse deficits 227
radiculomedullary arteries 8
recurrent coarctation 364
reentry 217
reentry tear 202
remodeling 205
renal failure 148
respiratory failure 187
retrograde perfusion 118, 154
retrograde type A dissection 192
saccular 116
saccular aneurysms 116, 120, 304
segmental vessels, sacrifycing 90
sentgraft
± covered 126
± diameter 126
single-branched stent-graft 133
smooth muscle myosin heavy chain
(SMMHC) 57
soluble elastin fragments (sELAF) 58
spinal
± blood flow 82
± perfusion pressure 83
spinal cord ischemia 343
spinal cord protection 142, 322, 342
± conventional CPB 322
Stanford 189
static obstruction 169
steal 86
stent 248
stent graft, non covered 127
stent-graft 31, 210
stent-grafts 346
± ruptures 346
± sudden 346
stroke 117±118, 122, 186
subclavian artery, aberrant 24
subclavian flap angioplasty 355
Subject Index
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387
supraaortic transposition 157
surgery 74
surgical repair 322, 328
± arterial cannulation 322
± cell-saver device 323
± delayed 328
± direct reconstruction 323
± distal perfusion 328
± emergency 328
± graft interposition 323
± hemorrhage 323
± sternotomy 323
± thoracotomy 322
surgical treatment
± acute hoarseness 176
± malperfusion 175
± rapidly expanding aortic diame-
ter 176
± rupture 175
± uncontrollable hypertension and/or
pain 175
systemic hypothermia, profound 88
temporary asystole 135
temporary neurologic dysfunction 122
therapeutic strategy 327
thoracic aorta 5
thoracoabdominal 141, 143
thoracolaparotomy 184
total arch replacement 120
transesophageal echocardiography
(TEE) 33, 321
traumatic aortic rupture (TAR) 45,
311, 331
triple-branched stent-graft 133
true aneurysms 116
true channel 185
true-lumen collapse 28
ulcer-like projection (ULP) 201
ulcerlike images 283, 284
vasa vasorum 39, 165, 278
± deep plexus 278
± superficial plexus 278
vascular rings 12, 353
vessel compromise
± dynamic 244
± static 244
vessel obstruction
± embolism 244
± thrombosis 244
visceral and renal perfusion 146
X-fragile syndrome 55
Z-stents 203
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