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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3925_Библиотеки_им_академика_М_И_Перельмана
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362 Index
Aging, aortic aneurysms and trends, 95
Aneurysm growth, 186–188
Aneurysm growth limiters, future
prospects of, 348
Aneurysms
acute complication rate, 94
aortic, matrix metalloproteinases,
131–139
formation, 176–180
aortic wall, 176–180
imaging of, 39–60
magnetic resonance imaging, 52–58
screening programs, 94
Angiotensin converting enzyme
inhibitors, 313
Anti-hyperlipidemic agents, 313–314
Anti-impulse therapy, 233–234
Anti-inflammatory agents, 314
Aorta diagnostic imaging, future
prospects of, 346–347
Aorta
diameter of, 125–128
mechanical properties, 125–128
Aortic aneurysms
current pharmacologic treatment,
311–313
angiotensin converting enzyme
inhibitors, 313
beta-receptor antagonists, 312–313
calcium channel blockers, 313
future pharmacologic treatment
anti-hyperlipidemic agents,
313–314
anti-inflammatory agents, 314
doxycycline, 315
immunosuppressants, 314–315
losartan, 316
nuclear factor-kappa B inhibitors,
315–316
growth, 186–188
variables of, 187–188
Marfan’s disease, 95–96
matrix metalloproteinases (MMP),
131–139
pathobiology of, 308
cytokines, 310–311
inflammation, 310–311
matrix proteolysis, 308–310
[Aortic aneurysms
pathobiology of]
medial smooth muscle cells, loss of,
311
ruptured, 205–221
screening programs, 94
suppressive therapy, patient benefits,
316–319
thoracic, 173–192
trends, 95–96
aging of population, 95
diagnosis via imaging, 95
genetics, 95–96
Aortic arch, 256–257
intimal tears, 257
replacement, formal, 257–259
rupture, open repair of, 213–214
Aortic dissection
acute, 29–37, 227–241
aneurysms, acute complication rate, 94
classic, 10–11
classification of, 1–20
acuity, 13–15
atherosclerosis, 3–4
chronic hypertension, 3–4
complicated vs. noncomplicated, 17–18
etiology, 1–5
iatrogenic origin, 4–5
IRAD, 18–20
pregnancy, 5
prognostic impact, 15–20
trauma, 4–5
chronic, suppressive therapy and, 318
computed tomography, 47–52
diagnostic approach, 67–84
chest X-ray, 73–74
electrocardiogram, 73–74
modern aortic imaging, 74–82
predisposing conditions, 68–69
signs, 72–73
symptoms, 69–71
atypical, 70–71
typical, 69–70
epidemiology, 89–96
assessment challenges, 89–90
incidence of, 94
prevalence, 91
imaging, 39–60
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Index 363
[Aortic dissection
imaging]
chest X-ray, 40–43
echocardiography, 43–47
technologies and clinical usage, 58–60
IMH (class 2), 11
magnetic resonance
angiography, 52–58
resonance imaging, 52–58
matrix metalloproteinases, 131–139
plaque rupture/ulceration, 12–13
risk conditions, 2
subtle-discrete, 12
subtypes, 9
trigger of, 169–171
weight lifting, 161–167
implications, 165–167
patient characteristics, 164
treatment and outcomes, 164–165
Aortic imaging
future prospects of, 346–347
magnetic resonance imaging, 82
advantages, 52
modern modalities, 74–82
aortography, 80–82
computed tomography, 76
echocardiography, 76–77, 79–80
strengths and limitations of, 78
Aortic insufficiency, 35
Aortic valve management, 256
Aortic wall degradation, matrix
remodeling and, 152–153
Aortic wall disruption, 229–234
hemodynamic factors, 230–233
structural factors, 229–230
Aortic wall structure, 228–229
Aortic wall, aneurysm formation and,
176–180
Aortography, 80–82
Arch hybrids, thoracic aortic endovascular
repair and, 293
thoracoabdominal aneurysms, 294
Arch rupture, open repair of, 213–214
Arterial access to thoracic aortic
endovascular repair, 268–271
Arteriosclerosis, 304
thoracic aortic aneurysms and, 185
Atypical symptoms, aortic dissection
diagnosis and, 70–71
Beta blockers, 237, 240
Beta-receptor antagonists, 312–313
Biomarkers, future prospects and,
347–348
Blood pressure
abnormal, 34–35
control of, 233–234
Calcium channel blockers, 240, 313
Cardiac ischemia and pain, 32
Cellular remodeling, 151–153
hyperplastic, 151
Chest X-ray (CXR), 40–43
aortic dissection diagnostic approach
and, 73–74
Chronic arch dissection, 260
Chronic dissection, thoracic aortic
aneurysms and, 184
Chronic hypertension, 3–4
Classic aortic dissection, 10–11
Classification
acuity, 13–15
complicated vs. noncomplicated,
17–18
etiology, connective tissue disease, 1–3
IRAD, 18–20
prognostic impact, 15–20
Clinical diagnosis of acute aortic
dissection, 30–33
Closed distal anastomosis, 256
Collagenase activity, thoracic aortic
aneurysms and, 184
Complicated acute type B dissection,
282, 285–286
Complication rate, aneurysms and, 94
Complications
endovascular thoracic aortic stent
grafting and, 289–292
neurological, 289–292
stent migration, 292
thoracic aortic aneurysm and,
188–190
Computed tomography, 47–52, 76
Connective tissue disease, 1–3
Ehlers-Danlos syndrome (EDS), 1–3
familial thoracic aneurysm and
dissection, 1–3
Marfan’s syndrome (MFS), 1–3
CXR. See Chest X-ray
https://t.me/med1917
364 Index
Cytokines, aortic aneurysm pathology and,
310–311
Death, leading causes of, 93
DeBakey classification, 6
Descending aortic rupture, open repair of,
212–213
Descending thoracic aortic aneurysm,
thoracic aortic endovascular
repair and, 275–278
Diagnosis delay, acute aortic disease legal
considerations, 335–339
Diagnosis failure, acute aortic disease legal
considerations, 335–339
Diagnosis, aortic aneurysms and
trends, 95
Dissected aortic tissue handling, 257
Distal arch/proximal descending aortic
rupture, 212–213
Distal dissection vs. proximal, 15–17
Doxycycline, 315
Dyspnea, 34
Echocardiography, 43–47, 76–77, 79–80
criteria, 45
transesophageal, 40, 43–47
transthoracic echocardiography (TTE),
40, 43–47
Ehlers-Danlos syndrome (EDS), 1–3
Electrocardiogram, aortic dissection
diagnostic approach
and, 73–74
Endoaneurysms, thoracic aortic
endovascular repair and, 294
Endovascular repair of abdominal aortic
aneurysm, 217–221
Endovascular thoracic aortic stent grafting,
267–294
complications, 289–292
neurological, 289–292
stent migration, 292
Endovascular treatment
ruptured thoracic aortic aneurysm
and, 215–217
thoracoabdominal aortic aneurysm
and, 215–217
Environmental factors, future prospects
and, 348
Epidemiology
aortic dissection and, 89–96
ruptured aortic aneurysms, 206–208
Etiology, thoracic aortic aneurysms and,
174–176
European Working Group Classification,
10–13
classic aortic dissection, 10–11
IMH (class 2), 11
plaque rupture/ulceration, 12–13
subtle-discrete aortic dissection
(class 3), 12
Exertion, weight lifting and, 162–163
Familial aneurysms, epidemiology of, 208
Familial thoracic aortic aneurysm and
dissection, 1–3, 106–115
Family patterns, acute aortic disease legal
considerations and, 341
Fibrillin I, 152
Marfan’s disease and, 152
Formal aortic arch replacement, 257–259
Formation of aneurysm, 176–180
Gene directed conventional drug
development, future prospects
and, 349
Genetic basis for thoracic aortic
aneurysms, 176
Genetics
aortic aneurysms and trends, 95–96
thoracic aortic aneurysms and, 99–118
dissections, 100–106
Gore trial, thoracic aortic endovascular
repair and, 276
TAG trial, 276
“Great Masquerader,” 36–37
Hemodynamic factors, aortic wall
disruption and, 230–233
Hyperplastic cellular remodeling, 151
Hypertension, thoracic aortic aneurysms
and, 182–184
Iatrogenic origin, 4–5
Imaging
aneurysms and, 39–60
aortic dissection, 39–60
https://t.me/med1917
Index 365
[Imaging]
chest X-ray, 40–43
echocardiography, 43–47
technologies and clinical usage, 58–60
IMH (class 2) aortic dissection, 11
Immunosuppressants, 314–315
Incidence of aortic dissection, 94
Inflammation
aortic aneurysm pathology and,
310–311
thoracic aorta and, 147–155
Inflammatory cells
normal thoracic aortic histology,
148–149
thoracic aorta and, 148–151
thoracic aortic aneurysms
and, 149–151
vascular associated lymphoid tissues,
149–151
types and activity, 148–151
Intimal tears, aortic arch and, 257
Intramural hematoma, acute ascending
aortic dissection surgery
and, 251–254
Intravenous agents, acute aortic dissection
and, 238–239
IRAD classification, 18–20
Ischemia
cardiac, 32
renal, 33
Landing zones, thoracic aortic
endovascular repair and,
271–274
Lansman’s classification, 8–10
clinical characteristics, 9
Legal considerations, acute aortic diseases
and, 329–342
Long-term suppressive therapy, 307–319
Losartan, 316
Magnetic resonance angiography
(MRA), 52–58
Magnetic resonance imaging, 52–58, 82
aortic imaging, 52
Marfan’s disease, 95–96, 101–102
Fibrillin I, 152
Marfan’s syndrome (MFS), 1–3
Matrix metalloproteinase antagonists, 348
Matrix metalloproteinases (MMP), aortic
aneurysm and dissection,
131–139
Matrix proteolysis, aortic aneurysm
pathology and, 308–310
Matrix remodeling, 151–153
degradation within aortic wall, 152–153
Mechanical forces, remodeling and, 153
Mechanical properties, future prospects
and, 348
Medial smooth muscle cells, aortic
aneurysm pathology
and, 311
Medical treatment, acute aortic dissection
and, 234–241
Medtronic VALOR trial, thoracic aortic
endovascular repair and,
275–277
MFS. See Marfan’s syndrome
MMP. See Matrix metalloproteinases
Molecular diagnosis, future prospects
of, 345–346
MRA. See Magnetic resonance
angiography
Myocotic aneurysms
open repair of, 214–215
thoracic aortic endovascular repair
and, 294
Neurological complications of
endovascular thoracic aortic
stent grafting, 289–292
Nonaortic operations, suppressive therapy
and, 318
Open distal anatomosis, 256
Open repair of ruptured aortic aneurysm,
212–213
Pain
abdominal, 32–33
cardiac ischemia, 32
peripheral neurologic symptoms, 33
pleuritic component, 32
renal ischemia, 33
Paraplegia, acute aortic disease legal
considerations and, 341
https://t.me/med1917
366 Index
Pathoanatomy classification, 6–13
DeBakey, 6
European Working Group, 10–13
Lansman’s, 8–10
Stanford, 7
Pathobiology of aortic aneurysms, 308
Pathogenesis, thoracic aortic aneurysms
and, 176–192
Patient benefits of aortic aneurysm
suppressive therapy,
316–319
chronic aortic dissection, 318
nonaortic operations, 318
predisposing conditions, 318
small aneurysms, 316–317
surgical candidacy, 317
Penetrating aortic ulcer, acute ascending
aortic dissection surgery and,
251–254
Pharmacologic treatment
acute aortic dissection and, 237–241
aortic aneurysms and, 311–313
angiotensin converting enzyme
inhibitors, 313
beta-receptor antagonists, 312–313
calcium channel blockers, 313
future of,
anti-hyperlipidemic agents, 313–314
anti-inflammatory agents, 314
doxycycline, 315
immunosuppressants, 314–315
losartan, 316
nuclear factor-kappa B inhibitors,
315–316
Plaque rupture/ulceration (class 4), 12–13
Pleuritic component, pain and, 32
Population aging, aortic aneurysms and
trends, 95
Postpseudoaneurysms, thoracic aortic
endovascular repair and, 294
Predisposing conditions
aortic dissection and, 68–69
suppressive therapy and, 318
Pregnancy, 5
Prevalence of aortic dissection, 94
Prognostic impact, proximal vs. distal
dissection, 15–17
Proximal dissection vs. distal, 15–17
Proximal resection extent, 255–256
Pulse deficits, 35–36
Remodeling
cellular and matrix, 151–153
fibrillin I, 152
future of, 153–155
mechanical forces and, 153
thoracic aorta and, 147–155
Renal ischemia, 33
Resected aortic arch, acute ascending
aortic dissection and, 256–257
Resuscitative management, 209–211
Retrograde extension, acute ascending aortic
dissection surgery and, 250–251
Risk conditions, aortic dissection and, 2
Risk factors, thoracic aortic aneurysms
and, 180–185
arteriosclerosis, 185
chronic dissection, 184
collagenase activity, 184
hypertension, 182–184
size, 180, 182
syphilis, 184
Rupture, thoracic aortic
aneurysm complications and, 188–190
endovascular repair and, 288–289
Ruptured abdominal aortic aneurysm
endovascular repair, 217–221
open repair, 217–219
Ruptured aortic aneurysms
decision making, 209–211
epidemiology, 206–208
abdominal, 207–208
familial, 208
thoracic, 206–207
management of, 211–221
general considerations, 211
open repair, 211–213
open repair of
aortic arch rupture, 213–214
distal arch/proximal descending
aortic rupture, 212–213
myocotic, 214–215
ruptured thoracoabdominal aneurysm,
214
pathology, 206
presentation, 209–211
https://t.me/med1917
Index 367
[Ruptured aortic aneurysms]
resuscitative management, 209–211
surgical results, 215
treatment of, 205–221
Ruptured thoracic aortic aneurysm,
endovascular treatment,
215–217
Ruptured thoracoabdominal aneurysm,
open repair of, 214
Screening programs aneurysms and, 94
Signs of aortic dissection
abnormal blood pressure, 34–35
aortic insufficiency, 35
Great Masquerader, 36–37
knowledge of, 72–73
pulse deficits, 35–36
Size, thoracic aortic aneurysms and,
180, 182
Small aneurysms, suppressive therapy and,
316–317
Stanford classification, 7
STARZ TX2. See Zenith TX2 trial
Stent migration, complications of
endovascular thoracic aortic
stent grafting, 292
Stents, anatomical requirements,
268–271
Structure, aortic wall disruption
and, 229–230
Subtle-discrete aortic dissection
(class 3), 12
Suppressive therapy
aortic aneurysm and, patient benefits,
316–319
long-term, 307–319
Surgery
ruptured aortic aneurysm and, 215
thoracic aortic aneurysm and,
190–191
Surgical candidacy, suppressive therapy
and, 317
Surgical procedures, 249–264
acute ascending aortic dissection
chronic arch dissection, 260
intramural hematoma, 251–254
operation type, 254–259
penetrating aortic ulcer, 251–254
[Surgical procedures
acute ascending aortic dissection]
retrograde extension, 250–251
when to operate, 250
acute descending aortic dissection,
260–263
Surgical therapy delay, acute aortic disease
legal considerations and,
340–341
Symptoms
aortic dissection diagnosis and, 69–71
atypical, aortic dissection diagnosis and,
70–71
typical, aortic dissection diagnosis and,
69–70
Syncope, 33–34
Syphilis, thoracic aortic aneurysms and, 184
TAA. See Thoracic aortic aneurysms.
TAAD. See Thoracic aortic aneurysms and
dissections
TEE. See Transesophageal
echocardiography
TEVAR. See Thoracic aortic endovascular
repair
TGF-β pathway involvement, thoracic
aortic aneurysms and
dissections and, 115–118
Thoracic aorta
inflammation, 147–155
inflammatory cells, 148–151
remodeling, 147–155
cellular and matrix, 151–153
Thoracic aortic aneurysms (TAA),
131–139, 173–192
clinical decision making, 185–192
growth, 186–188
complications, 188–190
rupture, 188–190
dissections (TAAD), 99
familial, 106–115
genetic causes, 100–106
Marfan’s disease, 101–102
nonfamilial forms, 118
TGF-β aortic aneurysms,
epidemiology of, 206–207
etiology, 174–176
genetic basis for, 99–118, 176
https://t.me/med1917
368 Index
[Thoracic aortic aneurysms (TAA)]
growth rates, 181
growth risk factors, 180–185
inflammatory cells and, 149–151
vascular associated lymphoid tissues,
149–151
pathogenesis, 176–192
formation, 176–180
risk factors
arteriosclerosis, 185
chronic dissection, 184
collagenase activity, 184
hypertension, 182–184
size, 180, 182
syphilis, 184
surgical intervention, 190–191
Thoracic aortic endovascular repair
(TEVAR), 267–294
acute aortic syndrome, 278–289
rupture, 288–289
traumatic transection, 286–288
type A dissection, 278
type B dissection, 279–286
meta-analysis, 283–284
anatomical considerations, 268–274
arterial access, 268–271
landing zones, 271–274
descending thoracic aortic aneurysm,
275–278
Gore TAG trial, 276
Medtronic VALOR trial, 275–276
Zenith TX2 trial, 276, 278
future of, 292–294
arch hybrids, 293
mycotic aneurysms, 294
postoperative pseudoaneurysms, 294
Thoracic aortic histology, 148–149
Thoracoabdominal aneurysms, 294
Thoracoabdominal aortic aneurysm
endovascular treatment, 215–217
open repair of, 214
ruptured abdominal aortic aneurysm
endovascular repair, 217
open repair, 217–219
thoracic aortic endovascular repair
and, 294
Transesophageal echocardiography (TEE),
40, 43–47
Transthoracic echocardiography (TTE),
40, 43–47
Trauma, 4–5
Traumatic transection, thoracic aortic
endovascular repair
and, 286–288
Trends, aortic aneurysms and, 95–96
aging of population, 95
diagnosis via imaging, 95
genetics, 95–96
Triggering of aortic dissection,
169–171
Trimethaphan camsylate, 240–241
TTE. See Transthoracic echocardiography
Type A dissection, thoracic aortic
endovascular repair
and, 278–279
Type B dissection
complicated acute type B dissection,
282, 285–286
meta analysis, 283–284
thoracic aortic endovascular repair
and, 279–286
uncomplicated acute, 280–282
Typical symptoms, aortic dissection
diagnosis and, 69–70
Uncomplicated acute type B dissection,
280–282
VALOR trial, thoracic aortic endovascular
repair and, 275–277
Vascular associated lymphoid tissues
(VALT), 149–151
Vasodilators, 241
Weight lifting, 161–167
aortic dissection and
implications, 165–167
patient characteristics, 164
treatment and outcomes, 164–165
extreme exertion, 162–163
X-ray, 40–43
Zenith TX2 trial, thoracic aortic
endo vascular repair
and, 276, 278
https://t.me/med1917
Figure 2 (from Preface—see text page x) Albert Einstein, Lucille Ball, Jonathan Larson
(author of “Rent”), Flo Hyman (Olympic volleyball player), George C. Scott, and John
Ritter are just a few among scores of brilliant people whose lives were cut short by acute
aortic diseases.
Figure 1.B Note multiple penetrating aortic ulcers, although only one was suspected
radiographically.
https://t.me/med1917
Figure 6.2 Variable clinical presentation of individuals with transforming growth factor
β
receptor (TGFBR1 or TGFBR2) mutations. Individuals may present with hypertelorism
and malar flattening (A); bifid uvula (B); marked hypertelorism with exotropia (C);
premature fusion of the coronal suture of the skull (arrow, D); marked tortuosity of the
aorta (arrow head ), aortic root and subclavian artery aneurysms (arrows) or tortuous
abdominal aorta (arrow) (E,F,H); micrognathia, retrognathia, downslanting palpebral
fissures, and skeletal features including pectus excavatum, scoliosis, and pes planus (G,I,J).
Source: From Refs. 21, 51.
Figure 1.C Note from schematic depictions that typical dissection (1) often impairs
branch vessel flow, but this never happens with IMH and PAU (2). Abbreviations: IMH,
intramural hematoma; PAU, penetrating aortic ulcer.
https://t.me/med1917
Figure 6.10 A potential molecular pathway of dysregulation of transforming growth
factor (TGF)-
β
leading to aneurysms and dissections. TGF-
β
is secreted in a biologically
inactive form and stored in the extracellular matrix in a complex termed as the large latent
TGF-
β
complex, consisting of a TGF-
β
homodimer associated with the latency-associated
peptide, and the latent TGF-
β
binding protein-1. Dysregulated TGF-
β
signaling results
from mutations in FBN1, TGFBR1, or TGFBR2, leading to altered transcription of TGF-
β
responsive genes, and ultimately resulting in degenerative changes in the vessel wall lead-
ing to aneurysms and dissections. Abbreviations: LAP, latency- associated peptide; TGF,
transforming growth factor; TGFBR, transforming growth
β
- receptor. Source: From Ref. 59.
Figure 7.1 The technique of
epi-aortic echo cardiography. Note
the fluid-filled interface between
the probe and the aortic wall.
https://t.me/med1917
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