scholarly journals Aortic Dissection: Novel Surgical Hybrid Procedures

2017 ◽  
Vol 12 (01) ◽  
pp. 56
Author(s):  
Alessandro Cannavale ◽  
Mariangela Santoni ◽  
Fabrizio Fanelli ◽  
Gerard O’sullivan ◽  
◽  
...  

The management of patients with aortic dissection is challenging and its treatment is an area of development and innovation. Conventional surgical techniques are associated with significant risks in terms of mortality and morbidity in such high-risk patients. As a result of cumulative advances in technology, classical surgical techniques have been improved and enhanced by the newer endovascular approaches, leading to novel surgical hybrid procedures. Impressive early results have been seen with frozen elephant techniques, revascularisation of the supra-aortic branches and branched/fenestrated thoracic endovascular aortic repair-alone procedures. This review describes the techniques involved in the latest hybrid procedures for aortic dissection and their outcomes.

2016 ◽  
Vol 50 (2) ◽  
pp. 257-263 ◽  
Author(s):  
Takayuki Shijo ◽  
Toru Kuratani ◽  
Kei Torikai ◽  
Kazuo Shimamura ◽  
Tomohiko Sakamoto ◽  
...  

2017 ◽  
Vol 66 (1) ◽  
pp. 9-20.e3 ◽  
Author(s):  
Igor Voskresensky ◽  
Salvatore T. Scali ◽  
Robert J. Feezor ◽  
Javairiah Fatima ◽  
Kristina A. Giles ◽  
...  

2009 ◽  
Vol 9 (1) ◽  
pp. 61-65 ◽  
Author(s):  
Victor X. Mosquera ◽  
José M. Herrera ◽  
Milagros Marini ◽  
Francisco Estevez ◽  
Ignacio Cao ◽  
...  

2016 ◽  
Vol 98 (8) ◽  
pp. 554-559 ◽  
Author(s):  
M Mak ◽  
AR Hakeem ◽  
V Chitre

BACKGROUND Following evidence suggestive of high mortality following emergency laparotomies, the National Emergency Laparotomy Audit (NELA) was set up, highlighting key standards in emergency service provision. Our aim was to compare our NHS trust’s adherence to these recommendations immediately prior to, and following, the launch of NELA, and to compare patient outcome. METHODS This was a retrospective study of patients who underwent an emergency laparotomy over the course of 6 months – 3 months either side of the initiation of NELA. RESULTS There were 44 patients before the initiation of NELA (pre-NELA, PN group) and 55 in the first 3 months of NELA (N group). We saw a significant increase in the proportion of patients whose decision to operate was made by the consultant: 75.0% in the PN group vs 100% in N group (subsequent data presented in this order) (P < 0.001). The presence of a consultant surgeon (75.0% vs 83.6%, P = 0.321) and anaesthetist (100.0% vs 90.9%, P = 0.064) in theatres were comparable in both groups. Risk stratification based on Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (P-POSSUM) score showed no difference in high-risk patients in both groups (47.7% vs 36.4%, P = 0.306). With the NELA initiative, however, significantly more patients were admitted directly from theatres to the critical care unit, when compared with the pre-NELA period (9.1% vs 27.3%, P = 0.038). This also reflected a significant reduction in unexpected escalation to a higher level of care during this period (10.0% vs 0%, P = 0.036). Significantly more patients had uneventful recovery in the NELA period (52.3 vs 76.4%, P = 0.018), although there was no difference in 30-day mortality between the groups (2.3% vs 7.3%, P = 0.378). CONCLUSIONS This study demonstrated a greater degree of consultant involvement in the decision to operate during NELA. More high-risk patients have been identified preoperatively with diligent risk assessment and, hence, have been proactively admitted to critical care units following laparotomy, which may account for the significant reduction in unexpected escalation to level 2 or level 3 care and thus in overall better patient outcomes.


2009 ◽  
Vol 8 (3) ◽  
pp. 199-201 ◽  
Author(s):  
Roberto Chiesa ◽  
Alexandre Campos Moraes Amato

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