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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Late survival rates were compared and analysed for 1070 patients undergoing repair of ruptured infrarenal abdominal aortic aneurysm (RAAA, n = 364, mean age 70.0 years, male:female ratio 5.6:1) and non-ruptured abdominal aortic aneurysm (AAA, n = 706, mean age 66.6 years, male: female ratio 5.4:1) between January 1970 and July 1992 at the Department of Thoracic and Cardiovascular Surgery of Helsinki University Central Hospital, Finland. There was a statistically significant difference in survival rates between the RAAA and AAA groups during the first three months after repair of abdominal aortic aneurysm. Operative mortality rates were 7.4% for electively repaired abdominal aortic aneurysms and 48.7% for ruptured abdominal aortic aneurysms. For 3-month postoperative survivors there existed no statistically significant difference in late survival rates, nor did these rates differ from those of an age- and sex-matched population. Five-year survival rates for 3-month postoperative survivors were 60% in the RAAA group and 67% in the AAA group. Median survival time was 5.7 years and 7.5 years, respectively. Coronary artery disease, hypertension, chronic obstructive pulmonary disease and renal insufficiency statistically significantly reduced late survival rates after 3 months post-surgery for non-ruptured abdominal aortic aneurysm, whereas these risk factors did not alter late prognosis after successful repair of ruptured abdominal aortic aneurysm. Cerebrovascular disease reduced late survival rates both in AAA (median survival time 6.3 years) and RAAA group (median survival time 4.9 years). Of late deaths 41% were caused by coronary artery disease in the AAA group and 38% in the RAAA group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of long-term survival after repair of ruptured and non-ruptured abdominal aortic aneurysm. 772 78

Due to an improvement of results after heart transplantation, there is a continuously growing number of long-term surviving patients. Aimed at a characterization of established diagnostic and therapeutic protocols, the Working Group of Thoracic Organ Transplantation within the German Society of Cardiology performed a survey among all German heart transplantation centers. Based on the experience of 1,500 patients, the clinical relevance as well as approaches for prevention and treatment of rejection, infection, cardiac allograft vasculopathy, malignancy, hypertension, renal insufficiency, and quality of life were assessed by a questionnaire. As a result, a time dependency of expected complications could clearly be shown. While early after HTX acute rejection and infection episodes were judged as clinically important, later on cardiac allograft vasculopathy, malignancy, and renal insufficiency predominate as relevant complications. This spectrum was reflected by a differentiated diagnostic protocol (early after HTX more frequent diagnostic procedures for rejection and infection, later intensified examinations to identify cardiac allograft vascular disease and malignancy) as well as by different intensities of immunosuppression and concomittant medication. Regarding further improvement of survival rates and quality of life, future clinical and scientific activities should be focused on the prevention of late complications after heart transplantation.
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PMID:[Long-term management after heart transplantation--an assessment of current status]. 1076 77

Thoracic endografting is emerging as an alternative option in the surgical management of patients who have thoracoabdominal aortic aneurysms (TAAA) or aortic dissection. Due to the high morbidity and mortality rates associated with open TAAA repair, vascular surgeons are searching for innovative methods to repair such aneurysms. A combined endovascular and open approach, otherwise known as the hybrid repair, involves aortic "debranching" (renal and mesenteric revascularization) to create a landing zone for the endograft. Although operative mortality with hybrid is equivalent to mortality found with open repair, reported paralysis rates are reduced. Limited data regarding hybrid graft patency and durability are available. Vascular nurses play a vital role in patient education pre and postoperatively; therefore, they should know the risks and benefits associated with both open and hybrid TAAA repair as well as the risk associated with TAAA rupture. Nurses caring for patients after hybrid repair should possess astute assessment skills in monitoring for postoperative complications. Close observation for stroke, paralysis, renal insufficiency/failure, bowel ischemia/dysfunction, lower extremity ischemia and basic hemodynamics is essential for favorable outcomes. Vascular nurses should provide surgery-specific instruction regarding lengths of stay, expected outcomes, activity restrictions, CT-scan follow-up and possible complications after surgery, including warning signs. In the evolving field of endovascular surgery, vascular nurses must remain current on new innovative techniques being used, such as thoracic endografting.
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PMID:Hybrid repair of thoracoabdominal aneurysms: a combined endovascular and open approach. 1902 68

The endovascular repair of thoracic aortic aneurysm and abdominal aortic aneurysm has become a promising alternative for open surgical graft replacement. The benefits of EVAR include less invasiveness, no need for cardiopulmonary bypass or differential lung ventilation, less blood loss, shorter hospital stay and reduced perioperative morbidity and mortality. Therefore EVAR is especially desirable for patients with impaired cardiopulmonary function or multiple comorbidities and they are at high risk of complications following general anesthesia such as stroke, myocardial infarction, acute renal insufficiency, infection and failure to wean from ventilator. Thoracic endovascular aortic repair (TEVAR) also carries the risk of paraplegia induced by spinal cord ischemia. Previous abdominal aortic aneurysm repair, prolonged hypotension, severe atherosclerosis of the thoracic aorta, injury to the external iliac artery, and more extensive coverage of the thoracic aorta by the graft are reported to be the risk factors for paraplegia after TEVAR. In such cases, strategies to protect the spinal cord from ischemia including lumbar cerebrospinal fluid drainage should be taken.
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PMID:[Anesthetic considerations for endovascular aortic repair (EVAR)]. 2323 25

A 49-year-old man was diagnosed with an interrupted aortic arch (IAA), a massive saccular thoracic collateral aneurysm, ischemic renal insufficiency, and multiple abdominal collateral aneurysms. A bypass from the left subclavian artery to the descending aorta and thoracic collateral aneurysmectomy proceeded simultaneously through a posterolateral thoracotomy. The pressure gradient between upper and lower extremities disappeared and renal function was normalized. Thoracic collateral aneurysmectomy and a simultaneous bypass from the left subclavian artery to the descending aorta with postoperative normalization of ischemic renal insufficiency are extremely rare in adult patients with IAA, and the remaining abdominal collateral aneurysms require careful monitoring.
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PMID:Interrupted aortic arch with massive saccular collateral aneurysm in an adult. 2499 11

Injury of the aortic isthmus is the second most frequent cause of death in cases of blunt traumatic injury. Conventional open repair is related to significant morbidity and mortality. Thoracic endovascular aortic repair (TEVAR) has increasing role in traumatic isthmic rupture, as it avoids the thoracotomy-related morbidity, aortic cross clamping, and cardiopulmonary bypass. Additionally to the technical difficulties of open repair, multi-trauma patients may not tolerate the manipulations necessary to undergo open surgery, due to concomitant injuries. TEVAR is a procedure easier to perform compared to open surgery, despite that a considerable degree of expertise is necessary. Direct comparison of the two methods is difficult, but TEVAR appears to offer better results than open repair in terms of mortality, incidence of spinal cord ischemia, renal insufficiency, and graft infection. TEVAR is related to a-statistically not significant-trend for higher re-intervention rates during the follow-up period. Current guidelines support TEVAR as a first-line repair method for traumatic isthmic rupture. Certain specific considerations related to TEVAR, such as the timing of the procedure, the type and oversizing of the endograft, heparinization during the procedure, the necessity of cerebrospinal fluid drainage, type of anesthesia, and the necessary follow-up strategy remain to be clarified. TEVAR should be considered advantageous compared to open surgery, but future developments in endovascular materials, along with accumulating long-term clinical data, will eventually improve TEVAR results in traumatic aortic isthmic rupture (TAIR) cases. This publication reviews the role, outcomes, and relevant issues linked to TEVAR in the repair of TAIR.
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PMID:Endovascular Repair of Traumatic Isthmic Ruptures: Special Concerns. 2866 Jan 96