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Open and Endovascular Surgery for Diseases of the Abdominal Aorta

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PanVascular Medicine

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Abstract

Abdominal and thoracoabdominal aortic aneurysms are life-threatening diseases which are a frequent cause of death throughout the world. The etiology, risk factors, and indications for treatment are discussed. The history and outstanding results achieved with open surgical treatment utilizing modern practices are reviewed. The indications, techniques, outcomes, and complications of endovascular therapy, which has radically transformed the treatment approach to aortic disease, are evaluated in detail. Finally, novel approaches, including combined hybrid surgical and endovascular treatment, and new technologies, including branched and fenestrated stent grafts for the treatment of complex aortic pathology, are examined.

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Abbreviations

Aneurysm:

Permanent localized dilation of an artery having at least a 50 % increase in diameter compared to the normal contiguous artery.

Branched Endograft:

Endograft with branching limbs which provide direct blood flow to important side branches.

Endoleak:

Complication of endovascular aneurysm repair resulting in persistent blood flow within the aneurysm sac.

Endotension:

Endoleak characterized by an increase in aneurysm diameter by persisting pressure in the excluded aneurysm sac without radiologic evidence of an endoleak.

Fenestrated Endografts:

Endograft with holes in the main graft body which maintain perfusion of important side branches.

Juxtarenal Aortic Aneurysms:

Aneurysms with an upper margin which extends to the lower renal artery ostium and require suprarenal or supraceliac aortic clamp placement to obtain proximal control for surgical repair.

Stent Migration:

Greater than 10 mm movement of the endograft or any movement of the device leading to symptoms or requiring intervention.

Suprarenal Aneurysms:

Aneurysms involving the suprarenal aorta including at least one renal artery but terminating below the superior mesenteric artery.

Thoracoabdominal Aortic Aneurysms:

Aneurysms that involve the descending thoracic aorta with the distal portion extending into all or part of the abdominal aorta.

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Authors and Affiliations

  1. Division of Cardiothoracic and Vascular Surgery, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Suite A3306, Los Angeles, CA, 90048, USA

    Aamir S. Shah M.D.

  2. Cedars-Sinai Heart Institute, 127 S. San Vicente Blvd, Suite A3306, Los Angeles, CA, 90048, USA

    Prof. Ali Khoynezhad M.D., Ph.D.

  3. Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard., 8215 NT, Los Angeles, CA, 90048, USA

    Bruce L. Gewertz M.D., Ph.D. (Surgeon-in-Chief; H and S Nichols Distinguished Endowed Chair; Vice-President, Interventional Services; Vice-Dean, Academic Affairs)

Authors
  1. Aamir S. Shah M.D.
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  2. Prof. Ali Khoynezhad M.D., Ph.D.
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  3. Bruce L. Gewertz M.D., Ph.D.
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Corresponding authors

Correspondence to Aamir S. Shah M.D. or Bruce L. Gewertz M.D., Ph.D. .

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Editors and Affiliations

  1. Akademisches Lehrkrankenhaus MLU, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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Shah, A.S., Khoynezhad, A., Gewertz, B.L. (2014). Open and Endovascular Surgery for Diseases of the Abdominal Aorta. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37393-0_122-1

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