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Aortic Pathology: AAA, Dissection, and Traumatic Transection

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Essentials of Vascular Surgery for the General Surgeon

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Abstract

The spectrum of aortic pathology ranges from acute life-threatening conditions that require immediate intervention to chronic abnormalities that call for medical therapy and long-term surveillance. Most general surgeons will encounter patients with abdominal aortic aneurysms (AAA), aortic dissections, and traumatic aortic injuries. This chapter will review the treatment considerations for these common aortic conditions so that general surgeons can provide effective initial management and treatment or facilitate more specialized care when appropriate.

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References

  1. Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg. 1991;13(3):452–8.

    Article  PubMed  CAS  Google Scholar 

  2. Silverberg E, Boring CC, Squires TS. Cancer statistics, 1990. CA Cancer J Clin. 1990;40(1):9–26.

    Article  PubMed  CAS  Google Scholar 

  3. Adam DJ, Mohan IV, Stuart WP, Bain M, Bradbury AW. Community and hospital outcome from ruptured abdominal aortic aneurysm within the catchment area of a regional vascular surgical service. J Vasc Surg. 1999;30(5):922–8.

    Article  PubMed  CAS  Google Scholar 

  4. Craig SR, Wilson RG, Walker AJ, Murie JA. Abdominal aortic aneurysm: still missing the message. Br J Surg. 1993;80(4):450–2.

    Article  PubMed  CAS  Google Scholar 

  5. Fleming C, Whitlock EP, Beil TL, Lederle FA. Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2005;142(3):203–11.

    Article  PubMed  Google Scholar 

  6. Darwood R, Earnshaw JJ, Turton G, et al. Twenty-year review of abdominal aortic aneurysm screening in men in the county of Gloucestershire, United Kingdom. J Vasc Surg. 2012;56(1):8–13.

    Article  PubMed  Google Scholar 

  7. Lee ES, Pickett E, Hedayati N, Dawson DL, Pevec WC. Implementation of an aortic screening program in clinical practice: implications for the Screen For Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act. J Vasc Surg. 2009;49(5):1107–11.

    Article  PubMed  Google Scholar 

  8. Chervu A, Clagett GP, Valentine RJ, Myers SI, Rossi PJ. Role of physical examination in detection of abdominal aortic aneurysms. Surgery. 1995;117(4):454–7.

    Article  PubMed  CAS  Google Scholar 

  9. Pavone P, Di Cesare E, Di Renzi P, et al. Abdominal aortic aneurysm evaluation: comparison of US, CT, MRI, and angiography. Magn Reson Imaging. 1990;8(3):199–204.

    Article  PubMed  CAS  Google Scholar 

  10. Ailawadi G, Eliason JL, Upchurch Jr GR. Current concepts in the pathogenesis of abdominal aortic aneurysm. J Vasc Surg. 2003;38(3):584–8.

    Article  PubMed  Google Scholar 

  11. Melton 3rd LJ, Bickerstaff LK, Hollier LH, et al. Changing incidence of abdominal aortic aneurysms: a population-based study. Am J Epidemiol. 1984;120(3):379–86.

    PubMed  Google Scholar 

  12. Webster MW, Ferrell RE, St Jean PL, Majumder PP, Fogel SR, Steed DL. Ultrasound screening of first-degree relatives of patients with an abdominal aortic aneurysm. J Vasc Surg. 1991;13(1):9–13; discussion 13–4.

    Article  PubMed  CAS  Google Scholar 

  13. Vorp DA, Raghavan ML, Webster MW. Mechanical wall stress in abdominal aortic aneurysm: influence of diameter and asymmetry. J Vasc Surg. 1998;27(4):632–9.

    Article  PubMed  CAS  Google Scholar 

  14. Nevitt MP, Ballard DJ, Hallett Jr JW. Prognosis of abdominal aortic aneurysms. A population-based study. N Engl J Med. 1989;321(15):1009–14.

    Article  PubMed  CAS  Google Scholar 

  15. Sterpetti AV, Cavallaro A, Cavallari N, et al. Factors influencing the rupture of abdominal aortic aneurysms. Surg Gynecol Obstet. 1991;173(3):175–8.

    PubMed  CAS  Google Scholar 

  16. Lederle FA, Wilson SE, Johnson GR, et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. 2002;346(19):1437–44.

    Article  PubMed  Google Scholar 

  17. United Kingdom Small Aneurysm Trial Participants. Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. 2002;346(19):1445–52.

    Article  Google Scholar 

  18. Faggioli GL, Stella A, Gargiulo M, Tarantini S, D’Addato M, Ricotta JJ. Morphology of small aneurysms: definition and impact on risk of rupture. Am J Surg. 1994;168(2):131–5.

    Article  PubMed  CAS  Google Scholar 

  19. Limet R, Sakalihassan N, Albert A. Determination of the expansion rate and incidence of rupture of abdominal aortic aneurysms. J Vasc Surg. 1991;14(4):540–8.

    Article  PubMed  CAS  Google Scholar 

  20. Lederle FA, Johnson GR, Wilson SE, et al. The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators. Arch Intern Med. 2000;160(10):1425–30.

    Article  PubMed  CAS  Google Scholar 

  21. Dent TL, Lindenauer SM, Ernst CB, Fry WJ. Multiple arteriosclerotic arterial aneurysms. Arch Surg. 1972;105(2):338–44.

    Article  PubMed  CAS  Google Scholar 

  22. Hultgren R, Larsson E, Wahlgren CM, Swedenborg J. Female and elderly abdominal aortic aneurysm patients more commonly have concurrent thoracic aortic aneurysm. Ann Vasc Surg. 2012;26(7):918–23.

    Article  PubMed  Google Scholar 

  23. Waterhouse DF, Cahill RA, Sheehan F, Sheehan SJ. Concomitant detection of systemic atherosclerotic disease while screening for abdominal aortic aneurysm. World J Surg. 2006;30(7):1350–9.

    Article  PubMed  CAS  Google Scholar 

  24. Qureshi AI, Alexandrov AV, Tegeler CH, Hobson 2nd RW, Dennis Baker J, Hopkins LN. Guidelines for screening of extracranial carotid artery disease: a statement for healthcare professionals from the multidisciplinary practice guidelines committee of the American Society of Neuroimaging; cosponsored by the Society of Vascular and Interventional Neurology. J Neuroimaging. 2007;17(1):19–47.

    Article  PubMed  Google Scholar 

  25. Nitecki SS, Hallett Jr JW, Stanson AW, et al. Inflammatory abdominal aortic aneurysms: a case-control study. J Vasc Surg. 1996;23(5):860–8; discussion 8–9.

    Article  PubMed  CAS  Google Scholar 

  26. Tennant WG, Hartnell GG, Baird RN, Horrocks M. Radiologic investigation of abdominal aortic aneurysm disease: comparison of three modalities in staging and the detection of inflammatory change. J Vasc Surg. 1993;17(4):703–9.

    Article  PubMed  CAS  Google Scholar 

  27. Baskerville PA, Blakeney CG, Young AE, Browse NL. The diagnosis and treatment of peri-aortic fibrosis (‘inflammatory’ aneurysms). Br J Surg. 1983;70(6):381–5.

    Article  PubMed  CAS  Google Scholar 

  28. Gomes MN, Choyke PL, Wallace RB. Infected aortic aneurysms. A changing entity. Ann Surg. 1992;215(5):435–42.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  29. Reddy DJ, Shepard AD, Evans JR, Wright DJ, Smith RF, Ernst CB. Management of infected aortoiliac aneurysms. Arch Surg. 1991;126(7):873–8; discussion 8–9.

    Article  PubMed  CAS  Google Scholar 

  30. Oderich GS, Panneton JM, Bower TC, et al. Infected aortic aneurysms: aggressive presentation, complicated early outcome, but durable results. J Vasc Surg. 2001;34(5):900–8.

    Article  PubMed  CAS  Google Scholar 

  31. Clagett GP, Bowers BL, Lopez-Viego MA, et al. Creation of a neo-aortoiliac system from lower extremity deep and superficial veins. Ann Surg. 1993;218(3):239–48; discussion 48–9.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  32. Brewster DC, Cambria RP, Moncure AC, et al. Aortocaval and iliac arteriovenous fistulas: recognition and treatment. J Vasc Surg. 1991;13(2):253–64; discussion 64–5.

    Article  PubMed  CAS  Google Scholar 

  33. Egorova N, Giacovelli J, Greco G, Gelijns A, Kent CK, McKinsey JF. National outcomes for the treatment of ruptured abdominal aortic aneurysm: comparison of open versus endovascular repairs. J Vasc Surg. 2008;48(5):1092–100, 100 e1–2.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Alric P, Ryckwaert F, Picot MC, et al. Ruptured aneurysm of the infrarenal abdominal aorta: impact of age and postoperative complications on mortality. Ann Vasc Surg. 2003;17(3):277–83.

    Article  PubMed  Google Scholar 

  35. Akers Jr DL, Fowl RJ, Kempczinski RF, Davis K, Hurst JM, Uhl S. Temporary closure of the abdominal wall by use of silicone rubber sheets after operative repair of ruptured abdominal aortic aneurysms. J Vasc Surg. 1991;14(1):48–52.

    Article  PubMed  Google Scholar 

  36. Loftus IM, Thompson MM. The abdominal compartment syndrome following aortic surgery. Eur J Vasc Endovasc Surg. 2003;25(2):97–109.

    Article  PubMed  CAS  Google Scholar 

  37. Bortone AS, Schena S, D’Agostino D, Dialetto G, Paradiso V, Mannatrizio G, et al. Immediate versus delayed endovascular treatment of post-traumatic aortic pseudoaneurysms and type B dissections: retrospective analysis and premises to the upcoming European trial. Circulation. 2002;96 suppl 1:234–40.

    Google Scholar 

  38. Harris PL, Vallabhaneni SR, Desgranges P, Becquemin JP, van Marrewijk C, Laheij RJ. Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: The EUROSTAR experience. J Vasc Surg. 2000;32:739–49.

    Article  PubMed  CAS  Google Scholar 

  39. Semba CP, Kato N, Kee ST, et al. Acute rupture of the descending thoracic aorta: repair with use of endovascular stent-grafts. J Vasc Interv Radiol. 1997;8(3):337–42.

    Article  PubMed  CAS  Google Scholar 

  40. Demetriades D, Velmahos GC, Scalea TM, et al. Operative repair or endovascular stent graft in blunt traumatic thoracic aortic injuries: results of an American Association for the Surgery of Trauma Multicenter Study. J Trauma. 2008;64(3):561–70; discussion 70–1.

    Article  PubMed  Google Scholar 

  41. Tang GL, Tehrani HY, Usman A, et al. Reduced mortality, paraplegia, and stroke with stent graft repair of blunt aortic transections: a modern meta-analysis. J Vasc Surg. 2008;47(3):671–5.

    Article  PubMed  Google Scholar 

  42. Demetriades D, Velmahos GC, Scalea TM, et al. Diagnosis and treatment of blunt thoracic aortic injuries: changing perspectives. J Trauma. 2008;64(6):1415–8; discussion 8–9.

    Article  PubMed  Google Scholar 

  43. Xenos ES, Abedi NN, Davenport DL, et al. Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture. J Vasc Surg. 2008;48(5):1343–51.

    Article  PubMed  Google Scholar 

  44. Neschis DG, Moainie S, Flinn WR, Scalea TM, Bartlett ST, Griffith BP. Endograft repair of traumatic aortic injury-a technique in evolution: a single institution’s experience. Ann Surg. 2009;250(3):377–82.

    PubMed  Google Scholar 

  45. Parmley LF, Mattingly TW, Manion WC, Jahnke Jr EJ. Nonpenetrating traumatic injury of the aorta. Circulation. 1958;17(6):1086–101.

    Article  PubMed  CAS  Google Scholar 

  46. Fabian TC, Richardson JD, Croce MA, et al. Prospective study of blunt aortic injury: Multicenter Trial of the American Association for the Surgery of Trauma. J Trauma. 1997;42(3):374–80; discussion 80–3.

    Article  PubMed  CAS  Google Scholar 

  47. Fabian TC, Davis KA, Gavant ML, et al. Prospective study of blunt aortic injury: helical CT is diagnostic and antihypertensive therapy reduces rupture. Ann Surg. 1998;227(5):666–76; discussion 76–7.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  48. Kipfer B, Leupi F, Schuepbach P, Friedli D, Althaus U. Acute traumatic rupture of the thoracic aorta: immediate or delayed surgical repair? Eur J Cardiothorac Surg. 1994;8(1):30–3.

    Article  PubMed  CAS  Google Scholar 

  49. Pate JW, Fabian TC, Walker W. Traumatic rupture of the aortic isthmus: an emergency? World J Surg. 1995;19(1):119–25; discussion 25–6.

    Article  PubMed  CAS  Google Scholar 

  50. Malhotra AK, Fabian TC, Croce MA, Weiman DS, Gavant ML, Pate JW. Minimal aortic injury: a lesion associated with advancing diagnostic techniques. J Trauma. 2001;51(6):1042–8.

    Article  PubMed  CAS  Google Scholar 

  51. van Prehn J, van Herwaarden JA, Muhs BE, Arnofsky A, Moll FL, Verhagen HJ. Difficulties with endograft sizing in a patient with traumatic rupture of the thoracic aorta: the possible influence of hypovolemic shock. J Vasc Surg. 2008;47(6):1333–6.

    Article  PubMed  Google Scholar 

  52. Idu MM, Reekers JA, Balm R, Ponsen KJ, de Mol BA, Legemate DA. Collapse of a stent-graft following treatment of a traumatic thoracic aortic rupture. J Endovasc Ther. 2005;12(4):503–7.

    Article  PubMed  Google Scholar 

  53. Neschis DG, Moaine S, Gutta R, et al. Twenty consecutive cases of endograft repair of traumatic aortic disruption: lessons learned. J Vasc Surg. 2007;45(3):487–92.

    Article  PubMed  Google Scholar 

  54. Brenner DJ, Hall EJ. Computed tomography–an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277–84.

    Article  PubMed  CAS  Google Scholar 

  55. Azizzadeh A, et al. Blunt traumatic aortic injury: initial experience with endovascular repair. J Vasc Surg. 2009;49:1403–8.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Baltimore Washington Medical Center, 301 Hospital Drive, Glen Burnie, MD, 21061, USA

    David G. Neschis MD

  2. Department of Vascular Surgery, University of Maryland Baltimore Washington Medical Center, Maryland Vascular Center, University of Maryland, Glen Burnie, MD, USA

    Marshall E. Benjamin MD

  3. Department of Vascular Surgery, University of Maryland Baltimore Washington Medical Center, Maryland Vascular Center, University of Maryland School of Medicine, Glen Burnie, MD, USA

    Justin K. Nelms MD & William R. Flinn MD

Authors
  1. David G. Neschis MD
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  2. Marshall E. Benjamin MD
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  3. Justin K. Nelms MD
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  4. William R. Flinn MD
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Corresponding author

Correspondence to David G. Neschis MD .

Editor information

Editors and Affiliations

  1. Chief, Division of Vascular Surgery and Endovascular Services, and Lead Physician, Vascular Surgery Department of Veterans Affairs Healthcare, SUNY Upstate Medical University, and Network Upstate New York at Syracuse, Syracuse, New York, USA

    Vivian Gahtan

  2. Director of Endovascular Services, Division of Vascular Surgery and Endovascular Services, and Vascular Surgeon, Department of Veterans Affairs Healthcare, SUNY Upstate Medical University, and Network Upstate New York at Syracuse, Syracuse, New York, USA

    Michael J. Costanza

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Neschis, D.G., Benjamin, M.E., Nelms, J.K., Flinn, W.R. (2015). Aortic Pathology: AAA, Dissection, and Traumatic Transection. In: Gahtan, V., Costanza, M. (eds) Essentials of Vascular Surgery for the General Surgeon. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1326-8_21

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  • DOI: https://doi.org/10.1007/978-1-4939-1326-8_21

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