Aortic Aneurysms: Pathogenesis and Treatment

384 Pages·2009·7.78 MB·English

by  John H. Lillvis

Aortic Aneurysms
For other titles published in this series, go to
www.springer.com/series/7677
Aortic Aneurysms
Pathogenesis and Treatment
Edited by
Gilbert R. Upchurch Jr.
University of Michigan, Ann Arbor, MI, USA
Enrique Criado
University of Michigan, Ann Arbor, MI, USA
Foreword by Raman Berguer
Editors
Gilbert R. Upchurch Jr., MD Enrique Criado, MD
University of Michigan University of Michigan
Health System Health System
Department of Surgery Department of Surgery
Sec. Vascular Surgery Sec. Vascular Surgery
1500 E. Medical Center Dr. 1500 E. Medical Center Dr.
Ann Arbor MI 48109-0329 Ann Arbor MI 48109-0329
TC2210N TC2210N
USA USA
ISBN: 978-1-60327-203-2 e-ISBN: 978-1-60327-204-9
DOI: 10.1007/978-1-60327-204-9
Library of Congress Control Number: 2008941006
© Humana Press, a part of Springer Science+Business Media, LLC 2009
All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher
(Humana Press, c/o Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for
brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and
retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed
is forbidden.
The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such,
is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.
While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the
authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The
publisher makes no warranty, express or implied, with respect to the material contained herein.
Printed on acid-free paper
springer.com
Foreword
This volume of the “Contemporary Cardiology” series updates the manage-
ment of aneurysms of the descending thoracic and abdominal aorta, incorpo-
rating recent advances in the endovascular therapies that are becoming the first
choice of treatment for aortic aneurysms. Aortic aneurysm has acquired new
relevance in the practice of medicine. The shift from direct to endovascular
repair continues to grow as the disease is diagnosed more frequently: the first
wave of baby boomers passes now through the 65-year old mark and the ultra-
sound screening of aortas in the population at risk has become an accepted
medical practice.
The dramatic differences in treatment outcomes between intact and ruptured
aortic aneurysms have stimulated the search for early diagnosis and treatment.
The genetics of aneurysms have established the indications for familial screen-
ing. Internists and cardiologists are usually the first physicians to identify an
aneurysm and should be aware of the new options for treatment available
today. The fast-evolving knowledge on aortic aneurysms is thoroughly sum-
marized in this book edited by Drs. Upchurch and Criado, two vascular sur-
geons who have made important contributions to this field.
Ramon Berguer
v
Preface
Aortic aneurysms are increasingly common and often lethal in the aging
population, making them among the leading causes of death in the United
States. The incidence and prevalence of aortic disease is also increasing as life
expectancy is extended. Aortic disease is often incidentally discovered when
performing tests, such as ultrasonography or CT scans, for other disease proc-
esses. For this reason, it is important that physicians who deal with the aging
population, such as cardiologists, are familiar with the diagnosis and manage-
ment principles of aortic aneurysms. The lack of effective medical therapy
makes timely surgical intervention the only viable treatment option for aortic
aneurysms once they attain a certain diameter. Unfortunately, aortic aneu-
rysms are clinically silent until patients present with catastrophic aortic rup-
ture. Therefore, the detection of aortic aneurysms prior to rupture is critical as
there is a large disparity in mortality between elective and emergent repair.
Until recently, treatment of aortic disease was primarily surgical, involv-
ing large incisions with the potential for large blood loss and life-threatening
perioperative complications.
Although effective and durable, the surgical treatment of aortic aneurysms
carries a relatively high mortality in this high-risk population, and is associ-
ated with prolonged convalescence and a delayed return to the preexisting
level of quality of life. For these reasons, minimally invasive treatment of
aortic aneurysms has become the most common therapeutic option for aortic
aneurysms. During recent years, we have witnessed a progressive increase in
the number of endovascular aortic repairs performed and significant techno-
logical improvements in stent graft design. The use of endovascular technol-
ogy in the treatment of abdominal and thoracic-aortic pathology, in expert
hands, can lower short-term mortality and morbidity. However, this comes at
an increased cost because of both the cost of the stent grafts and the need for
long-term serial imaging following endovascular repair of aneurysms.
This book, Aortic Aneurysms: Pathogenesis and Treatment, is part of the
“Contemporary Cardiology” series. As cardiologists will be the caregivers for
many patients with aortic aneurysms, the purpose of the book is to provide
a concise and authorative view of the current state of the management of
these patients. The book focuses on aneurysms of the descending thoracic
and abdominal aorta, and peripheral artery aneurysms, and does not include
the ascending aorta or the aortic arch. While the initial chapters deal with
such topics as genetics, inflammation, and the management of small aortic
vii
viii Preface
aneurysms, the bulk of the book is meant to serve as a primer on clinical care,
specifically on surgery for aortic aneurysms.
The treatment of aneurysms is a fast-evolving field. We are most grateful to
all the authors for their expert and updated contributions. We hope the readers
of this book and their patients will benefit from this work. We dedicate the
book to the memory of Dr George Johnson Jr., a mentor to both of us.
November 2008 Gilbert R. Upchurch Jr.
University of Michigan Enrique Criado
Cardiovascular Center
Ann Arbor, MI
Contents
Foreword .................................................................................................. v
Preface ...................................................................................................... vii
Contributors ............................................................................................ xiii
1 Genetics of Abdominal Aortic Aneurysms ..................................... 1
John H. Lillvis, Guy M. Lenk, and Helena Kuivaniemi
2 Infl ammatory Pathogenesis and Pathophysiology
of Abdominal Aortic Aneurysms ..................................................... 27
William H. Pearce and Vera P. Shively
3 Contemporary Imaging of Aortic Disease ...................................... 35
Peter S. Liu and David M. Williams
4 Medical Management of Small Aortic Abdominal
Aortic Aneurysms ............................................................................. 57
B. Timothy Baxter
5 Surgical Treatment of Nonruptured Infrarenal Abdominal
Aortic Aneurysms ............................................................................. 71
Michael Wilderman and Gregorio Sicard
6 Patient Selection Criteria for Endovascular Aortic
Aneurysm Repair .............................................................................. 95
Venkataramu N. Krishnamurthy and John E. Rectenwald
7 Endovascular Repair of Abdominal Aortic Aneurysms ................ 121
Sheela T. Patel and Juan C. Parodi
8 Complications and Secondary Procedures after Elective
Endovascular Aortic Aneurysm Repair .......................................... 133
Matthew J. Sideman and Kevin E. Taubman
ix
x Contents
9 Fenestrated Endovascular Stent-Grafts:
Current Applications ....................................................................... 149
E.L.G. Verhoeven, C.J. Zeebregts, I.F.J. Tielliu, T.R. Prins,
W.T.G.J. Bos, A.O. Sondakh, and J.J.A.M. van den Dungen
10 Open Surgical Treatment of Pararenal Abdominal
Aortic Aneurysms ............................................................................ 159
James C. Stanley
11 Pelvic Ischemia During Endovascular Abdominal Aortic
Aneurysm Repair ............................................................................ 169
Juan Fontcuberta, Manuel Doblas, Antonio Orgaz,
Angel Flores, Jose Gil, Ignacio Leal, and Enrique Criado
12 Open Operative Therapy for Ruptured Abdominal
Aortic Aneurysm ............................................................................. 183
Loay S. Kabbani and Gilbert R. Upchurch, Jr.
13 Endovascular Repair of Ruptured Abdominal
Aortic Aneurysm ............................................................................. 197
Paul J. Riesenman and Mark A. Farber
14 Complications After Endovascular Ruptured Abdominal
Aortic Aneurysm Repair................................................................. 207
Jonathan L. Eliason and Todd E. Rasmussen
15 Treatment of Mycotic Abdominal Aortic Aneurysms
and Infected Aortic Grafts.............................................................. 217
J. Gregory Modrall
16 Evaluation and Management of Aortoenteric Fistula ................. 237
Martin J. Carignan and Marc A. Passman
17 Management of Abdominal Aortic Aneurysm in the Setting
of Coexistent Renal and Splanchnic Disease ................................. 247
Houman Tamaddon, Peter Ford, and Robert Mendes
18 Management of Abdominal Aortic Aneurysms in Patients
with Renal Ectopia and Renal Fusion ........................................... 263
Patrick J. O’Hara
19 Abdominal Aortic Aneurysms in Transplant Patients ................ 277
Michael J. Englesbe
20 Inferior Vena Cava: Embryology and Anomalies ........................ 289
Brian Knipp, Paul Knechtges, Thomas Gest,
and Thomas Wakefi eld
21 Aortocaval Fistula ........................................................................... 309
Tamara N. Fitzgerald, Bart E. Muhs, and Alan Dardik
Contents xi
22 Acute Limb Ischemia After Abdominal
Aortic Aneurysm Repair................................................................. 315
Paul J. Riesenman and William A. Marston
23 Mesenteric Ischemia Following Abdominal Aortic
Aneurysm Repair ............................................................................ 325
Kerianne H. Quanstrum and Gilbert R. Upchurch, Jr.
24 Operative Therapy for the Descending
and Thoracoabdominal Aorta ........................................................ 337
Himanshu J. Patel, Gilbert R. Upchurch Jr.,
and G. Michael Deeb
25 Endovascular Repair of Thoracic Aortic Aneurysms ................. 343
Timothy A. M. Chuter
26 Evaluation and Treatment of Isolated Common Iliac
Artery Aneurysms ........................................................................... 353
Guillermo A. Escobar and Enrique Criado
27 Diagnosis, Evaluation, and Management of Isolated
Hypogastric Artery Aneurysms ..................................................... 359
Gautam Agarwal and Enrique Criado
28 True Femoral and Popliteal Artery Aneurysms:
Clinical Features and Treatment .................................................... 363
K. Barry Deatrick and Peter K. Henke
Index ......................................................................................................... 375