Back to Vascular Web

 Aneurysmal Disease

William H. Pearce, M.D., Christopher Zarins , M.D., John W. Hallett , M.D.

Includes:

  • Aortic and Iliac Artery Aneurysms
  • Peripheral Artery Aneurysms
  • Extra-cranial Carotid Aneurysms
  • Subclavian/Axillary Artery Aneurysms
  • Femoral/ Popliteal Artery Aneurysms
  • Splanchnic and Renal Artery Aneurysms
  • Thoracoabdominal Aortic Aneurysms
  • Thoracic Aortic Aneurysms
  • Thoracic/Abdominal Aortic Dissection

I. Basic Science

1. To describe aortic architecture and functions.

2. To describe hemodynamic changes at major bifurcation and Laplace 's Law.

3. To describe the role of aging and atherosclerosis in aortic enlargement.

4. To describe the role of inflammation and proteases in aneurysm formation.

5. To describe the differences in Marfan's disease and Ehlers Danlos syndrome.

II . Diagnostic Evaluation

1. To understand the incidence and prevalence of aneurysmal disease according to age.

2. To understand the natural history of abdominal aortic aneurysms.

3. To understand the genetic distribution of the disease.

4. To understand the roles of ultrasound, angiography, CT and MRI/MRA in screening and in planning surgery.

III . Treatment

1. To understand the indications for surgical repair and the factors which contribute to surgical decision making.

2. To understand the technical aspects of aortic aneurysm repair and surgical options and alternatives.

3. To describe the surgical management of complex aortic aneurysms ( including horseshoe kidneys, aortocaval and aorto duodenal fistulae, mycotic , inflammatory).

4. To have knowledge of both the immediate and long-term outcomes of surgery for aortic aneurysmal disease (including symptomatic, asymptomatic, thoracoabdominal , juxtarenal , infrarenal and recurrent).

5. To describe the management and prevention of surgical complications including spinal cord ischemia, distal embolization , myocardial infarction, graft infection.

References

1. Dietz HC, Pyeritz RE, Puffenberger EG, et al. Marfan phenotype variability in a family segregating a missense mutation in the epidermal growth factor - like motif of the fibrillin gene. J Clin Invest. 1992 ;89:1674 - 1680.

2. Dobrin PD, Baker WH, Gley WC. Elastolytic and collagenolytic studies of arteries: Implications for the mechanical properties of aneurysms. Arch Surg . 1984 ;119:405 - 409.

3. Dobrin PD. Mechanical properties of arteries. Physiol Rev. 1978 ;58:397 - 460

4. Finkbohner R, Johnston D, Crawford ES, Coselli J, Milewicz DM. Marfan syndrome: Long - term survival and complications after aortic aneurysm repair. Circulation. 1995 ;91:728 - 733.

5. Glagov S, Weisenberg E, Kolettis G, Stankunavicius R, Zarins CK. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med. 1987 ;316:1371 - 1375.

6. Kivirikko KI. Collagens and their abnormalities in a wide spectrum of diseases. Ann Med 1993 ;25:113 - 26.

7. Mattar SG, Kumar AG, Lumsden AB. Vascular complications in Ehlers - Danlos syndrome. The American Surgeon 1994 ;60:827 - 31.

8. Pearce WH, Slaughter MS, LeMaire S, Salyapongse AN, Feinglass J, McCarthy WJ, Yao JST: Aortic diameter as a function of age, gender and body surface area. Surgery, 1993 ;114:691 - 697.

9. Rizzo RJ, McCarthy WJ, Dixit SN, Lilly MP, Shively VP, Flinn WR. Collagen types and matrix protein content in human abdominal aortic aneurysms. J Vasc Surg . 1989 ;10:365 - 373.

10. Sumner DS, Hokanson DE , Strandness DE. Stress - strain characteristics and collagen - elastin content of abdominal aortic aneurysms. Surg Gynecol Obstet . 1970 ;130:459 - 466.

11. Zarins CK, Xu C, Glagov S. Aneurysmal enlargement of the aorta during regression of experimental atherosclerosis. J Vasc Surg . 1992 ;15:90 - 101.

12. Zatina MA, Zarins CK, Gewertz BL, Glagov S. Role of medial lamellar architecture in the pathogenesis of aortic aneurysms. J Vasc Surg . 1984 ;1 (3):442 - 8.

13. Bergquist D, Bengtsson H, Svensjo S. Prevlaence of abdominal aortic aneurysms: Experience from Malmo , Sweden In: Yao JST, Pearce WH, eds. Aneurysms: New Findings and Treatment, Appleton & Lange, Norwalk CT, 1994, pp 49 - 61.

14. Bickerstaff LK, Pairolero PC, Hollier LH, et al. Thoracic aortic aneurysms: a population - based study. Surgery. 1982 ;92:1103 - 1108.

15. Blebea J, Kempczinski RF. Mycotic aneurysms. In: Yao JST, Pearce WH, eds. Aneurysms: New Findings and Treatment, Appleton & Lange, 1994 pp 389 - 410.

16. Collin J, Epidemiological aspects of abdominal aortic aneurysm. Eur J Vasc Surg . 1990 ;4:113 - 116.

17. Ernst CB. Abdominal aortic aneurysm. N Engl J Med. 1993 ;328:1167 - 1172. Goldstone J. Aneurysm and fistula to vena cava or gastrointestinal tract: Diagnosis and management. In: Yao JST, Pearce WH, eds. Aneurysms: New Findings and Treatment, Appleton & Lange, 1994 pp 287 - 303.

18. Hallett JW. Abdominal aortic aneurysm: Natural history and treatment. Heart Dis Stroke. 1992 ;1:303 - 308.

19. Hollier LH, Taylor LM, Ochsner J. Recommended indications for operative treatment of abdominal aortic aneurysms :Report of a subcommittee of the Joint Council of the Society for Vascular Surgery and the North American Chapter of the International Society for Cardiovascular Surgery. J Vasc Surg . 1992 ;15 (6):1046 - 56.

20. Johnston KW. Canadian study of the late results of abdominal aortic aneurysm repair. In: Yao JST, Pearce WH, eds. Aneurysms: New Findings and Treatment, Appleton & Lange, 1994 pp 79 - 87.

21. Johnston KW. Multicenter pospective study of nonruptured abdominal aortic aneurysm. Part II. Variables predicting morbidity and mortality. J Vasc Surg . 1988 ;9:437 - 447.

22. Reddy DJ. Surgical treatment of infected abdominal aortic aneurysm: In: Ernst CB, Stanley JC, eds. Current Therapy in Vascular Surgery. 2nd ed. Philadelphia : Decker ;1991:272 - 276.

23. Calcagno D, Hallett JW, Ballard DJ, Naessens JM, Cherry KJ, Gloviczki P, Pairolero PC. Late iliac artery aneurysms and occlusive disease after aortic tube grafts for abdominal aortic aneurysm repair. A 35 - year experience. Ann Surg . 1991 ;214 (6):733 - 6.

24. Coselli JS, Crawford ES. Thoracoabdominal aortic aneurysms. In: Yao JST, Pearce WH, eds. Long - Term Results in Vascular Surgery. Appleton & Lange, Norwalk , CT , 1993 pp 135 - 147.

25. Coselli JS. Contribution of E. Stanley Crawford in thoracoabdominal aortic aneurysms. In: Yao JST, Pearce WH, eds. Aneurysms: New Findings and Treatment. Appleton & Lange, Norwalk , CT , 1994 pp 173 - 194.

26. Crawford ES, Beckett WC, Greer MS. Juxtarenal infrarenal abdominal aortic aneurysm. Ann Surg . 1986 ;203:661 - 670.

27. Crawford ES, DeNatale RW. Thoracoabdominal aortic aneurysm: observations regarding the natural course of the disease. J Vasc Surg . 1986 ;3:578 - 582.

28. Crawford ES, Svensson LG, Coselli JS, et al. Aortic dissection and dissecting aortic aneurysms. Ann Surg . 1988 ;208:254 - 273.

29. Hallett JW. The fate of aortic tube grafts for abdominal aortic aneurysm repair. In: Yao JST, Pearce WH, eds. Long - Term Results in Vascular Surgery. Appleton & Lange, Norwalk , CT , 1993 pp 163 - 170.

30. Katz KA, Cronenwett JL. The cost - effectiveness of early surgery versus watchful waiting in the management of small abdominal aortic aneurysms. J Vasc Surg . 1994 ;19 (6):980 - 90.

31. Kieffer E, le Blevec D, Koskas F, Bahnini A, Godet G, Chiras J. Spinal cord protection in surgical repair of thoracoabdominal aneurysm: preoperative and intraoperative measures. In: Yao JST, Pearce WH, eds. Aneurysms: New Findings and Treatment. Appleton & Lange, Norwalk , CT , 1994 pp 195 - 205.

32. Pennell RC, Hollier LH, Lie JT, Bernatz PE, Joyce JW, Pairolero PC, Cherry KJ, Hallett JW. Inflammatory abdominal aortic aneurysms: a thirty - year review. J Vasc Surg . 1985; 2(6):859 - 69.

33. Svensson LG, Crawford ES, Hess KR, et al. Dissection of the aorta and dissecting aortic aneurysms: improving early and long-term surgical results. Circulation. 1990 ;82:IV -24-38.

Posted June 2010