Acute aortic disease 1st Edition by John Elefteriades 084937023X 9780849370236

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ISBN 10: 084937023X

ISBN 13: 9780849370236

Author: John A. Elefteriades

Covering the pathophysiology, imaging, diagnosis, and treatment of a variety of aortic aneurysms and dissections, this source helps physicians effectively examine and evaluate affected individuals in clinical or emergency care settings. Offering a wide array of illustrations, x-rays, and operative photographs to emphasize key anatomic observations, this guide contains cutting-edge insight on the latest biologic, radiologic, clinical, and surgical developments that have taken place in the field. Presented in a reader-friendly format, this source provides end-of-chapter questions and a point-counterpoint format to analyze differing perspectives from renowned experts on these diseases. The Q & A and counterpoint involve the reader in an interactive interchange by opinion leaders.

Table of contents:

Section I: The Clinical Entities
1. Classification of Aortic Dissection
Introduction
Classification According To Etiology
Connective Tissue Disease
Chronic Hypertension and Atherosclerosis
Trauma and Iatrogenic Origin
Pregnancy
Classification with Respect To Pathoanatomy
DeBakey Classification
Stanford Classification
Lansman’s Classification
European Working Group Classification
Classic Aortic Dissection (Class 1)
IMH (Class 2)
Subtle-Discrete Aortic Dissection (Class 3)
Plaque Rupture/Ulceration (Class 4)
Traumatic/Iatrogenic Aortic Dissection (Class 5)
Classification Related To Acuity
Acute Phase
Subacute Phase
Chronic Phase
Classification with Prognostic Impact
Proximal vs. Distal Dissection
Complicated vs. Noncomplicated Dissection
The IRAD Classification (Combining Anatomic and Prognostic Information)
Conclusion
References
Discussion and Commentary
Question for the Authors
Editor’s Counterpoint
Utility of Stanford Classification
Categorization of Dissections with Arch Tear Propagating Distally
Dissection Variants—Penetrating Aortic Ulcer and Intramural Hematoma
References

Section II: Imaging and Diagnosis
2. The Symptoms and Signs of Acute Aortic Dissection: Clinical Diagnosis of “The Great Masquerader”
Introduction
Symptoms
Pain
Experience of Pain
Location of Pain
Severity of Pain
Abrupt Onset of Pain
Tearing Quality of Pain
Variability of Pain
Waxing and Waning of Pain
Pleuritic Component of Pain
True Cardiac Ischemia
Abdominal Pain
Renal Ischemia
Leg Pain
Peripheral Neurologic Symptoms
Other Symptoms
Syncope
Dyspnea
Signs (Table 2)
Abnormal Blood Pressure
Aortic Insufficiency
Pulse Deficits
Other Signs
The Great Masquerader
Editor’s Comment
References

3. Imaging of Aneurysms and Dissections: Chest X-Ray, Echo, Computed Tomography, Magnetic Resonance Imaging
Introduction
Chest X-Ray
Echocardiography
Computed Tomography
Aneurysms and Dissections: Role of Magnetic Resonance Imaging
Comparison Between Technologies and Clinical Implications
References
Discussion and Commentary
Questions for the Author
References
Editor’s Counterpoint

4. Putting It All Together: Symptoms, Signs, and Images
Introduction
Predisposing Factors
Symptoms
Typical Symptoms
Atypical Symptoms
Signs
Electrocardiogram and Chest X-Ray
Modern Aortic Imaging
Computed Tomography
Echocardiography
Aortography
Magnetic Resonance Imaging
Putting It All Together
Editor’s Comment
Bibliography
References
Discussion and Commentary
Questions for the Authors

Section III: The Biology of Acute Aortic Conditions
5. Epidemiology: Incidence, Prevalence, and Trends
Introduction
Prevalence
Incidence
Rate of Acute Complications of Chronic Aortic Conditions
Benefits of Screening Programs
Trends
Improved Diagnosis in This Era of Common Application of Three-Dimensional Imaging
The Aging of Our Population
True Increase in Disease Incidence, Independent of Diagnosis and Population Age
Genetics
References
Discussion and Commentary
Question for the Authors

6. Genetic Basis of Thoracic Aortic Aneurysms and Dissections
Introduction
Known Genetic Syndromes Associated with Thoracic Aortic Aneurysms and Dissections
Familial Thoracic Aortic Aneurysms and Dissections
Tgf-β Pathway Involvement in Genetic Forms
Genes Predisposing To Nonfamilial Forms of Disease
References
Discussion and Commentary
Questions for the Authors
Editor’s Comments

7. Mechanical Properties of the Aorta—6 cm Is “Special”
References
Discussion and Commentary
Question for the Authors

8. Matrix Metalloproteinases in Aortic Aneurysm and Dissection
References
Discussion and Commentary
Questions for the Authors
– Are MMP levels followed clinically, or does assessment of levels of these important enzymes remain a research tool?
– Doxycycline has been shown to inhibit MMPs. Why is doxycycline-based treatment not applied more widely?

9. Inflammation and Remodeling in the Thoracic Aorta
Introduction
Inflammatory Cell Types and Activity
Normal Thoracic Aortic Histology
Vascular Associated Lymphoid Tissue
Cellular and Matrix Remodeling
Hyperplastic Cellular Remodeling
The Role of Fibrillin I
Matrix Degradation
Interplay Between Mechanical Forces and Remodeling
What Is Measurable and What Is Modifiable?
Conclusion
References

10. Weight Lifting and Aortic Dissection
Introduction
Patient Characteristics
Treatment and Outcomes
Implications
References
Discussion and Commentary
Questions for the Author
– How much weight is OK for someone with a small aneurysm, say 4.5 cm?
– How about other lifts?
– How about aerobic activity?

11. Timing of Acute Aortic Events: How Does Dissection Pick a Date, Time, and Moment to Occur?
Discussion and Commentary
Question for the Author
– Is not your schema speculative?

Section IV: Treatment of Acute Aortic Conditions
12. The Natural History of Thoracic Aortic Aneurysms: Etiology, Pathogenesis, and Evidence-Based Decision Making for Surgical Intervention
Introduction
Etiology
Genetic Basis
Pathogenesis
Risk Factors for Aneurysm Growth
Evidence-Based Clinical Decision-Making
Surgical Decision Making
Conclusion
References
Discussion and Commentary
Questions for the Authors

13. Treatment of Ruptured Aortic Aneurysms
Introduction
Pathology
Epidemiology
Presentation and Management
Ruptured Aneurysm Repair (Open and Endovascular)
References
Discussion and Commentary
Questions for the Authors

14. Acute Aortic Dissection: Anti-impulse Therapy
Introduction
Aortic Wall Structure
Contributors To Aortic Wall Disruption
Anti-impulse Therapy
Medical Treatment
Pharmacological Options
References
Discussion and Commentary
Questions for the Authors

15. Surgical Procedures: A Primer
Introduction
Acute Ascending Aortic Dissection
Descending Aortic Dissection
Variants (IMH/PAU)
Surgical Options
Arch Replacement
Chronic Dissection
Conclusion
References
Discussion and Commentary
Questions for the Authors

16. Endovascular Thoracic Aortic Stent Grafting in Acute Aortic Catastrophes
Introduction
Anatomical Requirements
Access and Landing Zones
Results of TEVAR
Acute Aortic Syndrome
Complications
Future Directions
Conclusion
References
Discussion and Commentary
Editor’s Counterpoint

17. Long-Term Suppressive Therapy: Clinical Reality and Future Prospects
Introduction
Pathobiology
Current Treatment Options
Potential Future Therapies
Candidate Patient Populations
Future Directions
Acknowledgments
References
Discussion and Commentary
Questions for the Authors

Section V: Litigation in Aortic Aneurysm Disease
18. Legal Considerations in Acute Aortic Diseases
Introduction
Case Materials
Findings
Failure to Diagnose
Delay in Surgical Therapy
Failure to Prevent Paraplegia
Family Patterns
Conclusion
References
Discussion and Commentary
Questions for the Authors

Section VI: Prospects for the Future
19. Future Prospects: Molecular Diagnosis, Enhanced Imaging, Molecular-Based Conventional Drugs, and Gene Therapy
Introduction
Molecular Diagnosis
Advancements in Imaging
Biomarkers
Mechanical Properties
Environmental Factors
MMP Antagonists
Gene Therapy
References

Section VII: Synthesis
20. The Key Lessons of This Book—In a Nutshell

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