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Published: 4 June 2021
Last updated: 21 February 2023

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1

Borst, H. G. Surgical treatment of aortic dissection. New York: Churchill Livingstone International, 1996.

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2

Kazui, Teruhisa. Advances in Understanding Aortic Diseases. Tokyo: Springer Japan, 2009.

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3

Klicpera, Martin. Chronic aortic regurgitation: Prognostic parameters for patients with chronic aortic regurgitation undergoing aortic valve replacement : value of invasive and non-invasive methods and pharmacological interventions (systemic vasodilation). Wien: Facultas Universitätsverlag, 1985.

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4

Upchurch, Gilbert R. Aortic Aneurysms: Pathogenesis and Treatment. Totowa, NJ: Humana Press, 2009.

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5

Bolooki, Hooshang. Clinical application of intra-aortic balloon pump. 3rd ed. Armonk, N.Y: Futura Pub. Co., 1998.

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6

G, Hakaim Albert, ed. Current endovascular treatment of abdominal aortic aneurysms. Oxford: Blackwell Pub., 2005.

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7

Morash, Mark D. Surgery of the aorta and its body branches. Shelton, Conn: People's Medical Pub. House-USA, 2010.

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8

Stoney, Ronald J. Wylie's atlas of vascular surgery. Philadelphia: J.B. Lippincott Co., 1992.

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9

Stoney, Ronald J. Wylie's atlas of vascular surgery. Philadelphia: Lippincott, 1993.

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10

Luther, Bernd, Ralph I. Ru ckert, and Wolfgang Ru diger Hepp. Chirurgie der abdominalen und thorakalen Aorta. Berlin: Springer-Verlag, 2010.

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11

Rahimi, Kazem. Aortic regurgitation. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0094.

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12

Davey, Patrick, and Jim Newton. Aortic stenosis. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0093.

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Aortic stenosis is characterized by thickening and reduced mobility of the aortic valve leaflets and results in restriction to the blood flow from the left ventricle to the aorta, and secondary left ventricular hypertrophy.
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13

Hakaim, Albert G. Current Endovascular Treatment of Abdominal Aortic Aneurysms. Wiley & Sons, Incorporated, John, 2008.

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14

Hakaim, Albert G. Current Endovascular Treatment of Abdominal Aortic Aneurysms. Wiley & Sons, Incorporated, John, 2008.

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15

Parodi, Juan, Alan B. Lumsden, Peter H. Lin, and Changyi Chen. Advanced Endovascular Therapy of Aortic Disease. Wiley & Sons, Limited, John, 2007.

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16

Changyi, Chen, Peter Lin, and Juan Parodi. Advanced Endovascular Therapy of Aortic Disease. Blackwell Publishing Limited, 2007.

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17

Kingeter, Adam J., and Bantayehu Sileshi. Aortic Disruption. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0006.

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This chapter covers the mechanism, classification, presenting signs, and basic principles of management for aortic dissection. Aortic disruption occurs when a tear develops in the aortic intima with passage of blood into the new space between the intima and media. A hypothetical patient presenting with signs of dissection is presented first, followed by sections covering classification systems of dissection, risk factors for dissection, and basic principles of management. Acute stabilization, diagnostic imaging, definitive management, and long-term follow up of patient management are discussed. In addition the dissection location and its implication on principles of management and outcome are covered. The chapter concludes with some discussion questions covering frequently encountered aspects of management touched on in the chapter.
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18

Parodi, Juan, Alan B. Lumsden, Peter H. Lin, and Changyi Chen. Advanced Endovascular Therapy of Aortic Disease. Wiley & Sons, Incorporated, John, 2008.

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19

Parodi, Juan, Alan B. Lumsden, Peter H. Lin, and Changyi Chen. Advanced Endovascular Therapy of Aortic Disease. Wiley & Sons, Incorporated, John, 2009.

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20

Hakaim, Albert G. Current Endovascular Treatment of Abdominal Aortic Aneurysms. Wiley & Sons, Limited, John, 2008.

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21

Appleyard, Robert Frank. A new hemodynamic index of proximal arterial function based on the aortic pressure-flow loop. 1986.

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22

Youssef, Samuel J., and John A. Elefteriades. Pathophysiology, diagnosis, and management of aortic dissection. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0148.

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Aortic dissection represents a splitting apart of the layers of the aortic wall, with blood under pressure entering the dissection plane and propagating for long distances along the aorta. The pain is said to be the most severe that a human being can experience. Pain is felt substernally with ascending dissection and between the shoulder blades for descending dissection. A high degree of clinical suspicion is essential in order for the diagnosis not to be missed. Because the dissection process can impair any branch of the aorta, the patient may present with symptoms related to any organ in the body. D-dimer is 100% sensitive at detecting aortic dissection (but non-specific). The ‘Triple Rule-Out CT Scan’ can confirm the clinical suspicion of aortic dissection, while at the same time ruling-out the other two cardiac conditions that can take a patient’s life acutely. Ascending dissection (Type A) is a surgical emergency because of the likelihood of intra-pericardial rupture. Descending dissection (Type B) is usually treated medically (with ‘anti-impulse’ therapy with β‎-blockers and afterload reducers). This condition is highly litigated and lethal if missed on initial presentation. Using D-dimer and liberal imaging will prevent mis-diagnosis and save lives.
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23

Hugh, Beebe, and Royal Society of Medicine, eds. Endovascular repair of AAA: An update on the use of Vanguard. London: Royal Society of Medicine, 1999.

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24

Combes, Alain, and Nicolas Bréchot. Intra-aortic balloon counterpulsation in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0153.

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The intra-aortic balloon pump (IABP) is a mechanical device consisting of a cylindrical polyethylene balloon that sits in the aorta, approximately 2 cm from the left subclavian artery. A computer-controlled console linked to either an electrocardiogramor a pressure transducer inflates the balloon with helium during diastole (counterpulsation) and actively deflates in systole. This results in an increase in coronary artery blood flow and cardiac output, and reduced left ventricular afterload. These actions combine to decrease myocardial oxygen demand and increase supply. Major complications include bleeding at the insertion site and retroperitoneal haemorrhage, critical ischaemia of the catheterized leg, catheter infection, and stroke. IABP duration usually varies from 48 to 72 hours. Weaning from IABP is not well defined; the most common approach is to reduce cycling of inflation to 1:2 or 1:4 for 15 minutes to several hours before device removal.
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25

Changes in CW-Doppler aortic blood flow responses with passive tilting in normo- and borderline hypertensive men. 1990.

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26

Changes in CW-Doppler aortic blood flow responses with passive tilting in normo- and borderline hypertensive men. 1990.

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27

Changes in CW-Doppler aortic blood flow responses with passive tilting in normo- and borderline hypertensive men. 1990.

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28

Changes in CW-Doppler aortic blood flow responses with passive tilting in normo- and borderline hypertensive men. 1989.

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29

Changes in CW-Doppler aortic blood flow responses with passive tilting in normo- and borderline hypertensive men. 1990.

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30

Changes in CW-Doppler aortic blood flow responses with passive tilting in normo- and borderline hypertensive men. 1990.

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31

Laura, McAuley, and Canadian Coordinating Office for Health Technology Assessment., eds. Endovascular repair compared with open surgical repair of abdominal aortic aneurysm: Canadian practice and a systematic review. Ottawa, Ont: Canadian Coordinating Office for Health Technology Assessment, 2002.

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32

Parikh, Roshni A., and David M. Williams. Obtaining True Lumen Access in Aortic Dissections with Iliac Extension. Edited by S. Lowell Kahn, Bulent Arslan, and Abdulrahman Masrani. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199986071.003.0012.

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Aortic dissection resulting in lower extremity ischemia is an emergent condition requiring urgent endovascular treatment of the aorta and iliofemoral arteries to restore blood flow to the lower extremities. This chapter describes the management, applications, challenges, and potential complications when obtaining bilateral true lumen access during the urgent endovascular treatment of lower extremity ischemia after an aortic dissection. Most interventions require retrograde access to the true lumen; however, if one of the common femoral arteries is dissected, then retrograde access can be a challenge. Utilizing the contralateral true lumen, retrograde access can be confidently obtained through the true lumen of a dissected artery. This chapter illustrates the steps involved in successfully obtaining bilateral retrograde access to the common femoral arteries when these challenging cases arise.
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33

Romagnoli, Stefano, and Giovanni Zagli. Blood pressure monitoring in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0131.

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Two major systems are available for measuring blood pressure (BP)—the indirect cuff method and direct arterial cannulation. In critically-ill patients admitted to the intensive care unit, the invasive blood pressure is the ‘gold standard’ as a tight control of BP values, and its change over time is important for choosing therapies and drugs titration. Since artefacts due to the inappropriate dynamic responses of the fluid-filled monitoring systems may lead to clinically relevant differences between actual and displayed pressure values, before considering the BP value shown as reliable, the critical care giver should carefully evaluate the presence/absence of artefacts (over- or under-damping/resonance). After the arterial pressure waveform quality has been verified, the observation of each component of the arterial wave (systolic upstroke, peak, systolic decline, small pulse of reflected pressure waves, dicrotic notch) may provide a number of useful haemodynamic information. In fact, changes in the arterial pulse contour are due the interaction between the heart beat and the whole vascular properties. Vasoconstriction, vasodilatation, shock states (cardiogenic, hypovolaemic, distributive, obstructive), valve diseases (aortic stenosis, aortic regurgitation), ventricular dysfunction, cardiac tamponade are associated with particular arterial waveform characteristics that may suggest to the physician underlying condition that could be necessary to investigate properly. Finally, the effects of positive-pressure mechanical ventilation on heart–lung interaction, may suggest the existence of an absolute or relative hypovolaemia by means of the so-called dynamic indices of fluid responsiveness.
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34

Carlos, Parodi Juan, Veith Frank J. 1931-, and Marin Michael L, eds. Endovascular grafting techniques. Baltimore: Williams & Wilkins, 1999.

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35

R, Money Samuel, ed. Cardiothoracic and vascular surgery. Philadelphia: W.B. Saunders Co., 1998.

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36

Ronald J., M.D. Stoney and David J. Effeney. Wylie's Atlas of Vascular Surgery: Thoracoabdominal Aorta and Its Branches. Lippincott Williams & Wilkins, 1992.

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37

Manual Of Thoracic Endoaortic Surgery. Springer, 2010.

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38

Reproducibility of a continuous-wave Doppler ultrasound system for assessment of ascending aortic blood flow responses: During graged [i.e. graded] exercise testing with healthy individuals. 1987.

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39

Reproducibility of a continuous-wave Doppler ultrasound system for assessment of ascending aortic blood flow responses during graged [i.e. graded] exercise testing with healthy individuals. 1988.

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40

Clason, A. E. Peripheral vascular surgery. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198510567.003.0012.

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Arterial anastomosis 380Exposure of major blood vessels 386Profundaplasty 396Endarterectomy 398Carotid endarterectomy 400Excision of carotid body tumour 404Aneurysmal internal carotid artery repair 406Sympathectomy 408Repair of abdominal aortic aneurysm 416Embolectomy 422Aortoiliac occlusive disease 428Extra-anatomic bypass 432...
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41

Kovanen, Petri T., and Magnus Bäck. Valvular heart disease. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198755777.003.0015.

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The heart valves, which maintain a unidirectional cardiac blood flow, are covered by endothelial cells and structurally composed by valvular interstitial cells and extracellular matrix. Valvular heart disease can be either stenotic, causing obstruction of the valvular flow, or regurgitant, referring to a back-flow through the valve. The pathophysiological changes in valvular heart disease include, for example, lipid and inflammatory cell infiltration, calcification, neoangiogenesis, and extracellular matrix remodelling. The present chapter addresses the biology of the aortic and mitral valves, and the pathophysiology of aortic stenosis and mitral valve prolapse.
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42

Central Aortic Blodd Pressure (French Edition). ELSEVIER-MASSON, 2008.

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43

Greenhalgh, R. M. Vascular and Endovascular Opportunities. W.B. Saunders Company, 2000.

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44

Marin, Michael L. Endovascular Grafting: Devices and Techniques. Wiley & Sons, Incorporated, John, 2000.

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45

(Editor), Michael L. Marin, and Larry H. Hollier (Editor), eds. Endovascular Grafting: Advanced Treatment for Vascular Disease (Endovascular Intervention: Today and Tomorrow Series,Volume 1). Futura Publishing Company, 2000.

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46

Michel, Jean-Baptiste. Biology of vascular wall dilation and rupture. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198755777.003.0016.

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Arterial pathologies, important causes of death and morbidity in humans, are closely related to modifications in the circulatory system during evolution. With increasing intraluminal pressure and arterial bifurcation density, the arterial wall becomes the target of interactions with blood components and outward convection of plasma solutes and particles, including plasma zymogens and leukocyte proteases. Abdominal aortic aneurysms of atherothrombotic origin are characterized by the presence of an intraluminal thrombus (ILT), a major source of proteases, including plasmin, MMP-9, and elastase. Saccular cerebral aneurysms are characterized by the interaction of haemodynamics and arterial bifurcation defects, of either genetic or congenital origin. They also develop an intrasaccular thrombus, implicated in rupture. Aneurysms of the ascending aorta (TAAs) are not linked to atherothrombotic disease, and do not develop an ILT. The most common denominator of TAAs, whatever their aetiology, is the presence of areas of mucoid degeneration, and increased convection and vSMC-dependent activation of plasma zymogens within the wall, causing extracellular matrix proteolysis. TAA development is also associated with an epigenetic phenomenon of SMAD2 overexpression and nuclear translocation, potentially linked to chronic changes in mechanotransduction. Aortic dissections share common aetiologies and pathology (areas of mucoid degeneration) with TAAs, but differ by the absence of any compensatory epigenetic response. There are main experimental animal models of aneurysms, all characterized by the cessation of aneurysmal progression after interruption of the exogenous stimuli used to induce it. These new pathophysiological approaches to aneurysms in humans pave the way for new diagnostic and therapeutic tools.
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47

Gidwani, Hitesh, and Chenell Donadee. Hypertensive Emergencies (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0009.

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Hypertensive emergencies may be encountered by rapid response teams (RRTs). Various forms of acute organ dysfunction separate hypertensive urgency from hypertensive emergency. These include acute heart failure, acute coronary syndrome, acute aortic dissection, ischemic stroke, hemorrhagic stroke, hypertensive encephalopathy, sympathetic crisis, postoperative hypertension, and hypertensive emergencies in pregnancy. RRTs must be able to rapidly assess the patient’s condition, initiate treatment, and triage the patient to the appropriate level of care. This chapter summarizes the initial evaluation and triage of the patient as well as the blood pressure reduction goals in the acute period for the various conditions associated with hypertensive emergencies, discussing suggested drugs with the dosages, and looking at common pitfalls.
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48

Thoracoabdominal Aorta Surgical And Anesthetic Management. Springer, 2010.

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49

Pérez-Pomares, José M., and Robert Kelly, eds. The ESC Textbook of Cardiovascular Development. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198757269.001.0001.

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A rapid inspection of the table of contents shows that we have grouped relevant cardiovascular developmental topics in five different sections, which move progressively from basic research to clinical relevance, concluding with a glance at the near future of this fast-moving field. All of these sections deal with concepts that are critical to understanding from where and how cardiac chambers (atria and ventricles), valves (atrioventricular and arterial), great vessels (aortic and pulmonary trunks), cardiac conduction system (nodes, bundles, and Purkinje fibres), and coronary blood vessels form. Throughout the book there is continuous reference to experimental animal models for developmental processes, including the mouse, chick, and zebrafish, often involving the application of state of the art technological innovations. This has allowed us to illustrate the more likely origins of specific forms of congenital heart disease, and to elaborate on the developmental substrate of certain forms of adult cardiovascular disease.
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50

Fye, W. Bruce. The Expansion of Open-Heart Surgery and Cardiac Catheterization. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199982356.003.0011.

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Several groups began performing open-heart surgery during the late 1950s as simpler and less expensive heart-lung machines were marketed. Some surgeons attempted to develop operations to treat obstructed or leaking heart valves. Doctors who hoped to invent operations to treat diseased aortic and mitral valves (on the left side of the heart) stimulated the invention of new cardiac catheterization techniques. Until the mid-1950s, catheterization was limited to the right side of the heart. Catheterizing the left side of the heart presented several problems that were eventually solved. This procedure improved the accuracy of preoperative diagnosis, which contributed to better surgical outcomes. Cardiac catheters that were used to withdraw blood samples or measure intracardiac pressures could also be used to inject radiopaque contrast into the heart. This technique, angiocardiography, produced shadow pictures of the heart’s chambers that complemented data derived from catheterization and traditional clinical methods.
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