Abstract:Acute aortic syndrome (AAS) is a modern term used to describe interrelated emergency aortic conditions with similar clinical characteristics and challenges including aortic dissection, intramural hematoma (IMH) and penetrating aortic ulcer (PAU). Population-based studies suggest that the incidence of aortic dissection ranges from 2.6 to 3.5 cases per 100,000 inhabitants per year; hypertension and a variety of genetic disorders with altered connective tissue are the most prevalent risk conditions. In general, o… Show more
Cardiovascular diseases are one of the leading causes of morbidity and mortality in Germany. In these patients, the high-risk profile necessitates an interdisciplinary and multimodal approach to treatment. Endovascular interventions and vascular surgery have become established as an important element of this strategy in the past; however, the different anatomical localizations of pathological vascular alterations make it necessary to use a wide spectrum of procedural options and methods; therefore, the requirements for management of anesthesia are variable and necessitate a differentiated approach. Endovascular procedures can be carried out with the patient under general or regional anesthesia (RA); however, in the currently available literature there is no evidence for an advantage of RA over general anesthesia regarding morbidity and mortality, although a reduction in pulmonary complications could be found for some endovascular interventions. Epidural and spinal RA procedures should be carefully considered with respect to the risk-benefit ratio and consideration of the recent guidelines on anesthesia against the background of the current study situation and the regular use of therapy with anticoagulants. The following article elucidates the specific characteristics of anesthesia management as exemplified by some selected endovascular interventions.
Cardiovascular diseases are one of the leading causes of morbidity and mortality in Germany. In these patients, the high-risk profile necessitates an interdisciplinary and multimodal approach to treatment. Endovascular interventions and vascular surgery have become established as an important element of this strategy in the past; however, the different anatomical localizations of pathological vascular alterations make it necessary to use a wide spectrum of procedural options and methods; therefore, the requirements for management of anesthesia are variable and necessitate a differentiated approach. Endovascular procedures can be carried out with the patient under general or regional anesthesia (RA); however, in the currently available literature there is no evidence for an advantage of RA over general anesthesia regarding morbidity and mortality, although a reduction in pulmonary complications could be found for some endovascular interventions. Epidural and spinal RA procedures should be carefully considered with respect to the risk-benefit ratio and consideration of the recent guidelines on anesthesia against the background of the current study situation and the regular use of therapy with anticoagulants. The following article elucidates the specific characteristics of anesthesia management as exemplified by some selected endovascular interventions.
Summary: Aortic dissection is a tearing in the inner wall of the aorta which spreads along the wall of the vessel. Acute aortic dissection is one of acute aortic syndromes, that is, sudden clinical conditions which are associated with abnormalities of the aortic wall and threaten patient's life. It is estimated that the number of aortic dissections in Poland amounts to around 1000 cases per year. The symptoms of aortic dissection are so equivocal that they may suggest other diseases of various organs in the thorax and abdominal cavity. The described case of a 57-year-old man is an example of a complication of hypertension which, as a result of an isometrical physical effort, caused tearing of an inner membrane and forming of an aortic dissection of type I in the DeBakey classification. After performing medical imagining the patient with the diagnosis of aortic dissection, hematoma in the pseudoaneurysm cavity and renal infarction was submitted to emergency cardiac surgery. The diagnostics and selection of a place at cardiac surgery were carried out within an hour. However, the surgery did not take place, because the patient died due to a circulatory collapse. Acute aortic dissection is subject to high mortality rate during the first hour since the onset of symptoms. Therefore, rapid recognition is crucial for the further prognosis of the patient.
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