Aortic dissection and aortic aneurysm surgery: Clinical observations, experimental investigations, and statistical analyses part I

Svensson, Lars; Crawford, E. Stanley

doi:10.1016/0011-3840(92)90019-y

Cited by 23 publications

(22 citation statements)

References 295 publications

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“…Ayrıca beyinde no-reflow fenomeni gelişmesini önle-mek ve yeterli bir periferal dolaşım sağlamak için kan hemotokriti 18-20ºC'de %20 düzeyinde olmalıdır [15] . Soğuk kanın akışkanlığı azalacağından gerektiğinde hemodilüsyon yapılabilir.…”

Section: Discussionunclassified

Our Experience with Anestetic Management of Pulmonary Thromboendarterectomies

Örki¹,

Oğuş²,

Erkılınç³

et al. 2018

GKDA Derg

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Section: Discussionunclassified

Our Experience with Anestetic Management of Pulmonary Thromboendarterectomies

Örki¹,

Oğuş²,

Erkılınç³

et al. 2018

GKDA Derg

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“…2 Whereas the intact aortic wall is highly resistant to infection, congenital defects and intimal diseases (such as atherosclerosis) can render the aortic wall susceptible. Mycotic aneurysms are most often caused by gram-negative bacilli, gram-positive cocci, Candida species, Bacteroides fragilis, mycobacteria, and clostridia.…”

Section: Discussionmentioning

confidence: 99%

Management of a Mycotic Thoracoabdominal Aortic Aneurysm Involving the Celiac Artery

Dolapoglu¹,

Cruz²,

Coselli³

2016

Texas Heart Institute Journal

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A mycotic aortic aneurysm (AA) is a rare and dangerous condition that is associated with substantial morbidity and mortality rates. It is defined as an aortic aneurysm with one or more of the following clinical signs: fever, elevated white blood cell count, positive blood or aneurysmal wall cultures, or purulent operative findings. Of all aortic aneurysms, 0.8% to 3.4% are mycotic.1 Those mycotic AAs that involve visceral arteries can result in disastrous sequelae, such as gangrene of the intestine. Here we present an account of the successful treatment of a mycotic thoracoabdominal aortic aneurysm (TAAA) that was accompanied by celiac artery occlusion. Case ReportIn May 2015, a 60-year-old woman presented with a 2-month history of back pain, which was associated with postprandial nausea and unintended weight loss. Before her admission, her gastric symptoms had led her to undergo esophagogastroduodenoscopy and colonoscopy, the results of which were specific for gastritis, hemorrhoids, and anal fissure. She had a history of hypertension and fibromyalgia and was taking nitrofurantoin for a recent urinary tract infection.Computed tomographic (CT) scans revealed a saccular aneurysm of the thoracoabdominal aorta, together with occlusion of the celiac artery and reconstitution via multiple small collateral arteries (Figs. 1 and 2). Her laboratory values were notable for leukocytosis (white blood cell count, 17 ×10 3 /mL) and a platelet count of 778,000/ mm 3 . Her blood and urine cultures on admission were negative. We chose to perform an open Crawford extent III TAAA repair, with reimplantation of the celiac axis using a prefabricated single-branched graft. Cerebrospinal fluid was drained preoperatively to protect the spinal cord. With the patient under endotracheal general anesthesia, a left thoracoabdominal incision was made through the 8th intercostal space. The left lung was collapsed with a double-lumen endotracheal tube. We divided the diaphragm and exposed the aneurysm (Fig. 3A). After administering heparin, we cross-clamped the mid-descending thoracic aorta. The aneurysm was opened, and the intraluminal thrombus was evacuated. We widely débrided the opened aortic wall, the appearance of which was consistent with infection. After soaking an 18-mm Dacron graft in rifampin (our standard choice of antibiotic when treating mycotic aneurysms), we anastomosed the graft to the affected segment of the aorta in an end-to-end fashion, with the distal anastomosis performed just proximal to the origins of the superior mesenteric artery. After endarterectomy, we sutured (also end-to-end) an 8-mm prefabricated side branch to the celiac artery (Fig. 3B).

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“…The average number of units of packed red cells per patient transfused perioperatively is between 2.8 and 11 units. [2][3][4] Many surgeons therefore consider the risk of ascending aortic dissection repair without the use of blood products as prohibitive. Nonetheless, major operations in the heart and great vessels can be carried out safely without blood transfusions.…”

Section: Discussionmentioning

confidence: 99%