Ruptured Abdominal Aortic Aneurysm: The Definitive Manual

Description:

This manual is designed to serve as the standard for the management of patients with ruptured abdominal aortic aneurysm (AAA) by means of modern techniques. All aspects are covered, from pathogenesis, clinical presentation, and diagnosis through to initial management, operative strategies, postoperative complications, outcomes and quality of life issues. The book is based on the experience gained at a leading U.S. institution (Harborview Medical Center, University of Washington) that treats up to 40 patients with ruptured AAA annually and is highly respected for its expertise in this medical emergency. The team at Harborview Medical Center has recently shown that the implementation of a structured protocol for the management of ruptured AAA, with emphasis on an “endovascular-first” strategy, dramatically reduces mortality and complications. This has led to a sea change in the way in which patients are managed. There is an increasing hunger for information on these codified protocols and Ruptured Abdominal Aortic Aneurysm: The Definitive Manual will be invaluable for both surgeons and critical care physicians.

 

Table of Contents:

 

Chapter 1: Historical Perspective on the Treatment of Ruptured Abdominal Aortic Aneurysms

References

Chapter 2: Background Scope of the Problem

Epidemiology

Clinical Presentations and Sites of Ruptured AAA

Anterior Intraperitoneal Rupture

Posterior Retroperitoneal Rupture

Chronic Contained Rupture AAA

Aortocaval Fistula

Aorto-left Renal Vein and Aortoduodenal Fistulae

Diagnostic Tests

Conclusions

References

Chapter 3: The Epidemiology of Ruptured Abdominal Aortic Aneurysm (rAAA)

Introduction

History

Incidence of rAAA

Incidence of rAAA in the Context of AAA

A Note on Pre-hospital Incidence of rAAA

rAAA Repair in the Era of EVAR

The Incidence of Rupture After Prior Repair

Risk Factors for rAAA

Aneurysm Diameter

Aneurysm Shape and Wall Stress

Aneurysm Expansion Rate

Current Smoking

Age

Symptom Status

Gender

Blood Pressure

Family History

Other Risk Factors

Protective Effect of Diabetes

Race and rAAA

Mortality of rAAA

Pre-hospital Mortality

Turndown Rate for rAAA

In-Hospital and Perioperative Mortality for rAAA

rEVARs Role in rAAA Mortality

Turndown Rates for Elective Repair and Its Effects on rAAA

Conclusion

References

Chapter 4: Pathogenesis of AAA Rupture

Introduction

References

Chapter 5: Wall Stress

Introduction

Maximum Diameter Is a Less than Ideal Predictor of AAA Rupture

Computational Biomechanics in the Prediction of AAA Rupture

Role of Wall Strength

Role of Wall Stress

Wall Stress as a Predictor of AAA Rupture and Dilatation

Role of Wall Stress in Other Pathologies

Thoracic Aortic Rupture Risk Prediction

Summary

References

Chapter 6: Clinical Presentation of RAAA

Acute Presentation of RAAA

Usual Presentation of RAAA

Retroperitoneal Rupture

Intraperitoneal Rupture

Unusual Presentation of RAAA

Aortocaval Fistula

Aorto-left Renal Vein Fistula

Aortoenteric Fistula

Arterio-ureteral Fistula

Chronic Presentation of RAAA

Chronic Contained Rupture

Presentation with Abdominal Compartment Syndrome

Presentation of Women with RAAA

Presentation of Children with RAAA

Misdiagnosis of RAAA

References

Chapter 7: The Ruptured Abdominal Aorta: Diagnostics

Introduction

Imaging Technique and Protocols

Imaging Findings

Ruptured Abdominal Aortic Aneurysm

Intramural Hematoma

Penetrating Atherosclerotic Ulcer

Conclusion

References

Chapter 8: Predictors of Certain Death

Introduction

Preoperative Variables

Glasgow Aneurysm Score (GAS)

Hardman Index

Vancouver Score

Edinburg Ruptured Aneurysm Score

VSGNE RAAA Risk Score

The University of Washington RAAA Score

Variables Consistently Associated with High Mortality

Age

Indices of Shock

Severe Hypotension

Cardiac Arrest

Loss of Consciousness

Renal Insufficiency or Increased Creatinine

Severe Anemia

Intraoperative Variables

Postoperative Variables

Other Considerations in Predicting Mortality After RAAA Repair

Endovascular Versus Open Repair of RAAA

Summary

References

Chapter 9: Prehospital Considerations for REVAR

Making a Rapid and Informative Diagnosis

Imaging Is Only Valuable if You Can See It

How Low Can It Go?

Keeping Your Patient’s Options Open

Inventory

Creation of an Acute Aortic Treatment Program

The Role for Simulation

Summary

References

Chapter 10: Guidelines for Transfer to Specialized Centers

Introduction

Current State

Emergency Department Deaths for Ruptured Abdominal Aortic Aneurysm

Transfer for Treatment of Ruptured Abdominal Aortic Aneurysm

Patient Selection

Key Components to Regionalization of Care

Optimizing Care During Transfer

The Potential Role for Best-Practice Guidelines

Future Directions

References

Chapter 11: Hypotensive Hemostasis in Patients Presenting with Ruptured Aortic Aneurysm

Introduction

Hypotensive Hemostasis Protocol and Experience at the University Hospital Zurich (USZ)

Vasoactive Drugs

Intra-aortic Balloon

Discussion

References

Chapter 12: Ruptured Abdominal Aortic Aneurysms: Aortic Occlusion Balloons

Introduction

RAAA Protocols

Technique

AOB Set

Technical Considerations

Clinical Results

Conclusion

References

Chapter 13: Operative Strategies

Transabdominal Repair of Ruptured Abdominal Aortic Aneurysms

History of Transabdominal Repair of Ruptured Abdominal Aortic Aneurysms

Modern Evolution of Open Rupture AAA Repair

Endovascular Aortic Balloon Occlusion During Open Repair

Patient Preparation, Positioning, Incision Planning, and Operative Adjuncts

Technical Aspects of Proximal Control

Distal Control

Aortic Exposure Near the Aneurysm

Aneurysm Repair

Removal of Transfemoral or Transbrachial Sheath and Bowel Assessment

Assessment for Intra-abdominal Hypertension and Abdominal Compartment Syndrome

Conclusion

Open Repair: Retroperitoneal

History and Perspective

Surgical Approach

Preoperative Patient Preparation

Left Posterolateral Retroperitoneal Approach

Retroperitoneal Exposure for Secondary Rupture After EVAR

Conclusion

Rupture EVAR Using Bifurcated Stent Grafts

Introduction

Approach to Ruptured EVAR

Endovascular Setup and Techniques

Ruptured EVAR Using Bifurcated Stent Grafts

Expanding the Proximal Stent Graft Landing Zone for Ruptured Pararenal AAA

Rupture After EVAR

Conclusions

EVAR-AUI: The European Experience

Introduction: The Origins of the AUI Graft

The European Experience: Graft Complications

“Peri-graft Extravasation”: The Risk of the Endoleak and Surveillance

AUI and the Ruptured AAA: A Victim of Its Own Success

AUI Devices/Occluders/Technique

Bifurcated Grafts Versus the AUI

Conclusion

Physician-Modified Endovascular Grafts for Treating Ruptured Abdominal Aortic Aneurysms

Introduction

Technique

Device Preparation

PMEG Procedural Details

Conclusions

Endovascular Aneurysm Sealing for Ruptured Abdominal Aortic Aneurysm

Introduction

Nellix® EVAS Procedure

Imaging Surveillance After Nellix® EVAS Procedure

Advantages of Nellix® EVAS in rAAA

Disadvantages of Nellix® EVAS in rAAA

Evidence Behind Nellix® EVAS in rAAA

Conclusions

Aortocaval Fistula

Background

Epidemiology

Anatomy and Pathophysiology

Clinical Presentation and Diagnosis

Management

Outcomes

Dealing with Ruptured Common Iliac Artery Aneurysms

Introduction

Incidence and Etiology

Clinical Presentation

Elective Repair and Incidence of Rupture

Surgical Approaches

Open Surgical Repair

Endovascular Repair

Proximal Landing Zone Management

Distal Landing Zone Management

Hypogastric Artery Preservation

Hypogastric Artery Sacrifice

Outcomes of Emergent Repair

Conclusions

Management of Ruptured Abdominal Aortic Aneurysms in Association with Aortic Dissection

Introduction

Diagnosis

Preoperative Management

Open Surgical Management

Endovascular Management

Conclusion

Surgical Conversion for Rupture After EVAR

Preoperative Considerations

Operative Approach

Technical Challenges

Device Removal

Limb Removal

Hybrid Reconstructions

Outcomes

Conclusions

References

Transabdominal Repair of Ruptured Abdominal Aortic Aneurysms

Open Repair-Retroperitoneal

Rupture EVAR Using Bifurcated Stentgrafts

EVAR-AUI The European Experience

Physician Modified Endovascular Grafts for Treating Ruptured Abdominal Aortic Aneurysms

Endovascular Aneurysm Sealing for Ruptured Abdominal Aortic Aneurysm

Aortocaval Fistula

Dealing with Ruptured Common Iliac Artery Aneurysms

Management of Ruptured Abdominal Aortic Aneurysms in Association with Aortic Dissection

Surgical Conversion for Rupture After EVAR

Chapter 14: Randomized Trials: What is the Evidence?

Randomized Trials: What is the Evidence?

Introduction

RCT Trials: AJAX, ECAR, and IMPROVE (Design)

AJAX (Amsterdam Acute Aneurysm Trial)

ECAR (Ruptured Aortoiliac Aneurysm: Endo Versus Surgery)

IMPROVE

Analysis of Findings from the IMPROVE Trial

30-Day Outcomes

1-Year Follow-Up Data

Morphology

Individual Patient Meta-analysis of the Randomized Controlled Trials

Conclusion

The Recent Randomized Trials of EVAR Versus Open Repair for Ruptured AAAs Are Misleading

References

Randomized Trials: What Is the Evidence?

The Recent Randomized Trials of EVAR Versus Open Repair for Ruptured AAAs Are Misleading

Chapter 15: Postoperative Intensive Care Unit Management After Ruptured Abdominal Aortic Aneurysm

Introduction

From Operating Room to ICU

Initial Assessment and Stabilization

Intravascular Volume Assessment

Bleeding and Resuscitation

Evaluation and Management of Ongoing Hemodynamic Instability

Myocardial Infarction

Atrial Fibrillation

Ventilator Management

The Early Postoperative ICU Course

Abdominal Compartment Syndrome

Acute Kidney Injury

Acute Limb Ischemia

Adrenal Insufficiency

Ischemic Colitis

Standard Daily Critical Care Principles and Practice

Neurologic/Pain Management

Cardiac

Pulmonary

Renal and Genitourinary

Gastrointestinal/Nutrition

Endocrine

Prophylaxis

Daily Checklist

References

Chapter 16: Postoperative Complications

Ischemic Colitis After Ruptured Abdominal Aortic Aneurysm Repair

Introduction

Pathophysiology

Risk Factors for the Development of Ischemic Colitis

Diagnosis

Endoscopic Surveillance Following rAAA

Treatment Options

Conclusion

Abdominal Compartment Syndrome Following Ruptured Abdominal Aortic Aneurysm

Introduction

Definition of IAH/ACS

How Common Is IAH/ACS After rAAA Repair?

Risk Factors for ACS After rAAA Repair

Can ACS Be Prevented? Medical Management?

Decompression Laparotomy (DL)

Prophylactic Open Abdomen Treatment

Management of the Patient with Open Abdomen (OA)

Prognosis

Spinal Cord Protection in Emergency Aortic Surgery

Introduction

Pathogenesis and Risk Factors

Spinal Cord Protection

Conclusion

Multisystem Organ Failure After Ruptured Abdominal Aortic Aneurysm

Introduction

Pathogenesis

Incidence

Risk Assessment

Procedural Factors Associated with Development of MSOF After rAAA Repair

Reoperation and Reintervention

Abdominal Compartment Syndrome

Colon Ischemia

Cardiac Dysfunction

Renal Dysfunction

Respiratory Failure

Limb Ischemia

Spinal Ischemia

Strategies to Reduce Multisystem Organ Failure After rAAA

Management of Endoleaks After rEVAR

Background

Classification

Management Options

Type I Endoleaks

Type II Endoleaks

Type III Endoleaks

Conclusions

References

Ischemic Colitis After Ruptured Abdominal Aortic Aneurysm Repair

Abdominal compartment syndrome following ruptured abdominal aortic aneurysm

Spinal Cord Protection in Emergency Aortic Surgery

Multisystem Organ Failure After Ruptured Abdominal Aortic Aneurysm

Management of Endoleaks After rEVAR

Chapter 17: Outcomes of Ruptured Aortic Aneurysm: Early and Late

Overview of Outcomes

Permissive Hypotension

Regionalization of Care

Standardized Protocols for Diagnosis and Management

Outcomes from Retrospective Studies

Open Repair

Endovascular Repair

Comparison of Open and Endovascular Repair

Randomized Controlled Trials

Amsterdam Acute Aneurysm Trial

Immediate Management of Patients with Rupture: Open Versus Endovascular Repair (IMPROVE) Trial

Predicting Outcomes After Repair of Ruptured Abdominal Aortic Aneurysm

Glasgow Aneurysm Score

Hardman Index

Edinburgh Ruptured Aneurysm Score

Vascular Study Group of New England Score

Summary of Evidence

References

Chapter 18: Quality of Life After RAAA

References

Chapter 19: Ethical Issues Regarding rAAA

Introduction

Body

Basic Ethical Principles

Decision-Making

Effective Communication with Families of Critically Ill Patients

The Role of Palliative Care

End-of-Life Issues

Conclusion

References

Chapter 20: US Coding and Reimbursement

Introduction

Open Surgical Repair

Infrarenal Endovascular Repair

Fenestrated Endovascular Repair

Upcoming Changes

References

Chapter 21: Technique of Supraceliac Balloon Control of the Aorta During Endovascular Repair of 

Technique

Discussion

References

Index

 

 

An aparitie	18 April 2017
Autor	Benjamin W. Starnes , Manish Mehta , Frank J. Veith
Dimensiuni	16.51 x 2.29 x 23.62 cm
Editura	Springer
Format	Hardcover
ISBN	9783319238432
Limba	Engleza
Nr pag	412