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Thoracic Endovascular Aortic Repair
Georghios Nicolaou, MB, BCh, FRCPC, Mohamed Ismail, MB, BCh, MSc, Davy Cheng, MD, MSc, FRCPC, FCAHS Anesthesiology Clinics Volume 31, Issue 2, Pages (June 2013) DOI: /j.anclin Copyright © 2013 Elsevier Inc. Terms and Conditions
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Fig. 1 The zones of proximal aortic endograft attachment sites.
(Adapted from Criado F, Abul-Khoudoud O, Domer G, et al. Endovascular repair of the thoracic aorta: lessons learned. Ann Thorac Surg 2005;80:857–63; with permission.) Anesthesiology Clinics , DOI: ( /j.anclin ) Copyright © 2013 Elsevier Inc. Terms and Conditions
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Fig. 2 Left common carotid to left subclavian artery (LSCA) bypass. The proximal LSCA has been ligated to prevent retrograde type II endoleak. (From Criado FJ, Barnatan MF, Rizk Y, et al. Technical strategies to expand stent-graft applicability in the aortic arch and proximal descending thoracic aorta. J Endovasc Ther 2002;(9 Suppl 2):II32–8; with permission.) Anesthesiology Clinics , DOI: ( /j.anclin ) Copyright © 2013 Elsevier Inc. Terms and Conditions
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Fig. 3 Aortic angiograms. (Left) A prerepair angiogram after LSCA to carotid transfer. Shown are aneurysm (single arrow), LSCA stump (double arrow), and LSCA to carotid transfer (triple arrow). (Right) Postrepair angiography. (From Gutsche JT, Szeto W, Cheung Al. Endovascular stenting of thoracic aortic aneurysm. Anesthesiol Clin 2008;26:481–99.) Anesthesiology Clinics , DOI: ( /j.anclin ) Copyright © 2013 Elsevier Inc. Terms and Conditions
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Fig. 4 Aortic dissection (left), penetrating atherosclerotic ulcer (PAU) (middle), and intramural hematoma (IMH) (right), all causing acute aortic syndrome. (From Coady MA, Rizzo JA, Elefteriades JA. Pathologic variants of thoracic aortic dissections: penetrating atherosclerotic ulcers and intramural hematomas. Cardiol Clin 1999;17:640.) Anesthesiology Clinics , DOI: ( /j.anclin ) Copyright © 2013 Elsevier Inc. Terms and Conditions
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Fig. 5 (A) Multiplanar reconstruction of a patient with acute type B aortic dissection. (B) Multiplanar reconstruction of the same patient 6 months after successful endovascular repair. (From Adams JD, Garcia LM, Kern JA. Endovascular repair of the thoracic aorta. Surg Clin North Am 2009;89:895–912.) Anesthesiology Clinics , DOI: ( /j.anclin ) Copyright © 2013 Elsevier Inc. Terms and Conditions
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Fig. 6 A fenestration placed in the distal end of a thoracic device. There upper left photo shows a balloon-expandable stent placed through the fenestration, inflated to a diameter matching the target vessel (upper right). A larger balloon is then placed into the aortic portion of the stent and used to flare the stent against the aortic graft wall (lower panels). (From Greenberg R, Eagleton M, Mastracci T. Branched endografts for thoracoabdominal aneurysms. J Thorac Cardiovasc Surg 2010;140(Suppl 6):S171–8; with permission.) Anesthesiology Clinics , DOI: ( /j.anclin ) Copyright © 2013 Elsevier Inc. Terms and Conditions
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Fig. 7 (A, B) Anterior and lateral views of a 3-dimensional reconstruction of a type II thoracoabdominal aortic aneurysm treated with a branched endovascular graft. The celiac and superior mesenteric branches (white arrows) are attached to the aortic graft as a side arm and oriented in the direction of the mesenteric vessel. The patient had 2 right renal arteries. The lowest was embolized with coils (yellow arrow). The upper right and left renal arteries were incorporated into the repair with reinforced fenestrations (green arrows) mated with stent grafts. (From Greenberg RK, Lu Q, Roselli EE, et al. Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair: a comparison of endovascular and open techniques. Circulation 2008;118:808–17; with permission.) Anesthesiology Clinics , DOI: ( /j.anclin ) Copyright © 2013 Elsevier Inc. Terms and Conditions
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Fig. 8 Relationship between mean arterial pressure, cerebrospinal fluid pressure (CSFP), and the near-infrared spectroscopy (NIRS) saturation over the spinal cord region at risk. (From Nicolaou G, Murkin J, Forbes T, et al. Use of spinal near-infrared spectroscopy for monitoring spinal cord perfusion in endovascular repair of thoracoabdominal aneurysm [abstract]. In: outcomes 2009, The Key West Meeting. Barbados, May 27–30, 2009.) Anesthesiology Clinics , DOI: ( /j.anclin ) Copyright © 2013 Elsevier Inc. Terms and Conditions
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