EVAR in management of Infra renal Abdominal Aortic Aneurysm
Mostafa Mamdouh Labib;
Abstract
The term aneurysm describes dilatation of any blood vessel. Arterial aneurysms occur throughout the body but are most prevalent in the infrarenal aorta. These aneurysms represent the primary cause of the significant death and disability attributed to arterial aneurysm disease. Aortic aneurysm disease was responsible for approximately 13,000 deaths in 1997.(David H. D, et al 2014)8
In the United States, ruptured AAAs are the 15th leading cause of death overall and the 10th leading cause of death in men older than 55 years, with the death rate increasing with age. (PETER J. E. H , et al 2014) 12
Generally speaking, the incidence of aneurysms increases with increasing age, but dangerous aneurysm disease can occur at any age as the result of multiple degenerative processes, including inflammatory, infectious, genetic, and traumatic processes. Whereas aortic aneurysms can cause a variety of symptomatic clinical conditions (e.g., embolism, obstruction of adjacent hollow viscera), the primary danger is from rupture and uncontrolled haemorrhage leading to death.(David H. D, et al 2014)8
The risk of rupture is related to both the absolute size of the aneurysm and its size relative to normal diameters on the basis of location, body size, and gender. A variety of other factors, including aetiology, growth rate, and aneurysm morphology (i.e., fusiform vs saccular), can also be critical in assessing aneurysm risk in certain circumstances. (David H. D, et al 2014)8
The abdominal aorta and its major branches supply oxygenated blood to virtually all of the organs in the abdominal cavity, so it is not surprising that patients with traumatic injury or generalised atherosclerotic occlusive disease of the visceral circulation, more often than not, present with life-threatening conditions. (Lewis , et al 1918)14
The rational management of patients with these problems mandates that surgeons have a thorough knowledge of the vascular anatomy of these vessels, the associated pattern of collateral variation, and necessary technical maneuvers required for adequate operative exposure. This article reviews the anatomy of the abdominal aorta and its major visceral arteries, their embryologic origins, and the common patterns of collateral flow.The surgical exposure of the abdominal aorta and its major branches are also described.(Lewis , et al 1918)14
The effect of smoking history on the risk of AAA was analysed in detail: it was higher for current smokers than past smokers, it increased with duration of smoking and quantity of cigarettes smoked per day, and it declined over time after quitting. Consumption of fruit, vegetables, nuts, and fish showed a strong dose-dependent and inverse correlation with respect to AAA prevalence in an age-adjusted analysis, whereas red meat and processed or fast food were associated with increased AAA prevalence, although this effect did not remain significant in multivariable analysis. (Kent et al. 2010)6
The risk factors that remained significantly associated with AAA were age, gender, high blood pressure, coronary artery disease, family history of AAA, high cholesterol, lower extremity peripheral arterial disease,carotid disease, history of a cerebrovascular event, smoking, and being overweight or obese. (K. C Kent et al2010)6
A negative association with AAA was found for certain racial and ethnic groups, diabetes, exercise at least once per week, and consumption of fruit, vegetables, and nuts more than three times per week. The risk attributable to smoking varied over a wide range: the lowest risk was for individuals who smoked up to a half-pack/day for 10 years and quit 10 years ago, whereas the highest risk was for current smokers who had been smoking 1 pack/day for 35 years. (K. C Kent et al2010)6
Endovascular aortic aneurysm repair (EVAR) is a minimally-invasive alternative to open repair and offers lower early mortality rates, reduction in morbidity and post-procedural stay. Patient suitability for EVAR requires that the aortic morphology meets anatomical inclusion criteria. Short, excessively dilated, angulated and thrombus-lined aortic necks are associated with suboptimal outcomes. (Andrew E, et al 2012 )68
Although early mortality rates are favourable, EVAR is also associated with a higher incidence of follow-up complications and reinterventions compared to open surgery. Endoleaks form the bulk of these and if device-related increase the risk of aneurysm rupture. Graft migration, occlusion and structural disintegration have also been reported following EVAR. (Andrew E, et al 2012 )68
In the United States, ruptured AAAs are the 15th leading cause of death overall and the 10th leading cause of death in men older than 55 years, with the death rate increasing with age. (PETER J. E. H , et al 2014) 12
Generally speaking, the incidence of aneurysms increases with increasing age, but dangerous aneurysm disease can occur at any age as the result of multiple degenerative processes, including inflammatory, infectious, genetic, and traumatic processes. Whereas aortic aneurysms can cause a variety of symptomatic clinical conditions (e.g., embolism, obstruction of adjacent hollow viscera), the primary danger is from rupture and uncontrolled haemorrhage leading to death.(David H. D, et al 2014)8
The risk of rupture is related to both the absolute size of the aneurysm and its size relative to normal diameters on the basis of location, body size, and gender. A variety of other factors, including aetiology, growth rate, and aneurysm morphology (i.e., fusiform vs saccular), can also be critical in assessing aneurysm risk in certain circumstances. (David H. D, et al 2014)8
The abdominal aorta and its major branches supply oxygenated blood to virtually all of the organs in the abdominal cavity, so it is not surprising that patients with traumatic injury or generalised atherosclerotic occlusive disease of the visceral circulation, more often than not, present with life-threatening conditions. (Lewis , et al 1918)14
The rational management of patients with these problems mandates that surgeons have a thorough knowledge of the vascular anatomy of these vessels, the associated pattern of collateral variation, and necessary technical maneuvers required for adequate operative exposure. This article reviews the anatomy of the abdominal aorta and its major visceral arteries, their embryologic origins, and the common patterns of collateral flow.The surgical exposure of the abdominal aorta and its major branches are also described.(Lewis , et al 1918)14
The effect of smoking history on the risk of AAA was analysed in detail: it was higher for current smokers than past smokers, it increased with duration of smoking and quantity of cigarettes smoked per day, and it declined over time after quitting. Consumption of fruit, vegetables, nuts, and fish showed a strong dose-dependent and inverse correlation with respect to AAA prevalence in an age-adjusted analysis, whereas red meat and processed or fast food were associated with increased AAA prevalence, although this effect did not remain significant in multivariable analysis. (Kent et al. 2010)6
The risk factors that remained significantly associated with AAA were age, gender, high blood pressure, coronary artery disease, family history of AAA, high cholesterol, lower extremity peripheral arterial disease,carotid disease, history of a cerebrovascular event, smoking, and being overweight or obese. (K. C Kent et al2010)6
A negative association with AAA was found for certain racial and ethnic groups, diabetes, exercise at least once per week, and consumption of fruit, vegetables, and nuts more than three times per week. The risk attributable to smoking varied over a wide range: the lowest risk was for individuals who smoked up to a half-pack/day for 10 years and quit 10 years ago, whereas the highest risk was for current smokers who had been smoking 1 pack/day for 35 years. (K. C Kent et al2010)6
Endovascular aortic aneurysm repair (EVAR) is a minimally-invasive alternative to open repair and offers lower early mortality rates, reduction in morbidity and post-procedural stay. Patient suitability for EVAR requires that the aortic morphology meets anatomical inclusion criteria. Short, excessively dilated, angulated and thrombus-lined aortic necks are associated with suboptimal outcomes. (Andrew E, et al 2012 )68
Although early mortality rates are favourable, EVAR is also associated with a higher incidence of follow-up complications and reinterventions compared to open surgery. Endoleaks form the bulk of these and if device-related increase the risk of aneurysm rupture. Graft migration, occlusion and structural disintegration have also been reported following EVAR. (Andrew E, et al 2012 )68
Other data
| Title | EVAR in management of Infra renal Abdominal Aortic Aneurysm | Other Titles | استخدام الدعامة المغطاة في علاج تمدد الشريان الاورطى البطنى تحت شرايين الكلي | Authors | Mostafa Mamdouh Labib | Issue Date | 2015 |
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