The Experts below are selected from a list of 9681 Experts worldwide ranked by ideXlab platform
Hazim J Safi - One of the best experts on this subject based on the ideXlab platform.
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surgical management of primary aortoesophageal fistula secondary to Thoracic Aneurysm
The Annals of Thoracic Surgery, 2000Co-Authors: Michael J Reardon, Robert J Brewer, Scott A Lemaire, John C Baldwin, Hazim J SafiAbstract:Aortoesophageal fistula, secondary to Thoracic aortic Aneurysm, is an uncommon cause of gastrointestinal bleeding that is uniformly fatal without surgical intervention. These may be primary fistulas, in cases of Thoracic aortic Aneurysm without previous repair, or secondary fistulas occurring after surgical repair of Thoracic aortic Aneurysm. Surgical treatment has been successful in a small number of cases of primary aortoesophageal fistula, secondary to Thoracic aortic Aneurysm, but techniques used have varied. We report a successful repair of primary aortoesophageal fistula, secondary to descending Thoracic aortic Aneurysm, and review the evolution of management since the three previously reported successful repairs at our institution.
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predictive factors for acute renal failure in Thoracic and thoracoabdominal aortic Aneurysm surgery
Journal of Vascular Surgery, 1996Co-Authors: Hazim J Safi, Stuart Harlin, Charles C Miller, Dimitrios C Iliopoulos, Atul Joshi, Tibor G Mohasci, Roland Zippel, George V LetsouAbstract:Abstract Purpose: The purpose of this study was to analyze the factors associated with acute renal failure in total descending Thoracic and thoracoabdominal aortic Aneurysm surgery. Methods: A total of 234 patients underwent thoracoabdominal aortic Aneurysm or total descending Thoracic Aneurysm repair between January 1991 and January 1994. Eighty-five women and 149 men were evaluated. The median age was 67 years (range 8 to 88 years). Seventy-seven patients had type I thoracoabdominal aortic Aneurysm, 99 had type II, 51 had type III or IV, and 7 had total descending Thoracic Aneurysm. Factors such as age, sex, Aneurysm type, and visceral and distal aortic perfusion were examined with univariate fourfold table and multivariate logistic regression analysis. Results: Acute renal failure, defined as an increase in serum creatinine by 1 mg/dl per day for two consecutive days after surgery, occurred in 41 (17.5%) of 234 patients. Thirty-six (15%) of 234 patients required dialysis. Twenty (49%) of 41 patients with acute renal failure died. Of the 21 survivors with renal failure, renal failure resolved in 18 (86%) within 30 days of surgery. The univariate odds ratio of death, given acute renal failure, was 6.7 (95% confidence interval [CI] 3.2 to 14.2, p p p p p p Conclusion: Postoperative acute renal failure after thoracoabdominal and total descending Thoracic aortic Aneurysm surgery is associated with preoperative creatinine level, visceral perfusion, left renal artery reattachment, and simple cross-clamp technique. (J Vasc Surg 1996;24:338-45.)
Tetsuya Higami - One of the best experts on this subject based on the ideXlab platform.
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spinal cord protection with selective spinal perfusion during descending Thoracic and thoracoabdominal aortic surgery
Interactive Cardiovascular and Thoracic Surgery, 2010Co-Authors: Nobuyoshi Kawaharada, Tetsuya Koyanagi, Yoshihiko Kurimoto, Toshiro Ito, Ryo Harada, Hideki Hyodoh, Atsushi Watanabe, Tetsuya HigamiAbstract:Open repair of aortic Aneurysm causes spinal cord perfusion pressure to decrease due to the steal phenomenon from the bleeding of intercostal arteries and cross-clamping of the aorta. We attempted to perfuse the intercostal arteries for preoperative detection of the artery of Adamkiewicz using newly developed catheters. Fifteen patients underwent selective spinal perfusion with our original catheter as spinal protection during the procedure of distal descending Thoracic Aneurysm (DTA) or thoracoabdominal aortic Aneurysm (TAAA) repair. Seven patients had distal DTA and eight had TAAA. Monitoring of motor evoked potential (MEP) was performed in all patients throughout the operation. The perfusion flow was 30-40 ml/min for each intercostal artery and was adjusted to keep the proximal circuit pressure at 150-200 mmHg. The average number of perfused intercostal arteries was 2.3 per patient and the number of intercostal arteries reimplanted per patient was 2.5. Intercostal arteries were reimplanted using an interpositional graft. MEPs were still observable after graft replacement in all patients and there were no cases of paraparesis/paraplegia. All patients were discharged ambulatory. Selective spinal perfusion maintains the quantity of total blood flow in the spinal cord and is very useful for reducing the incidence of ischemic injury of the spinal cord during operation.
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institutional report vascular Thoracic spinal cord protection with selective spinal perfusion during descending Thoracic and thoracoabdominal aortic surgery
2010Co-Authors: Nobuyoshi Kawaharada, Tetsuya Koyanagi, Yoshihiko Kurimoto, Toshiro Ito, Ryo Harada, Hideki Hyodoh, Atsushi Watanabe, Tetsuya HigamiAbstract:Open repair of aortic Aneurysm causes spinal cord perfusion pressure to decrease due to the steal phenomenon from the bleeding of intercostal arteries and cross-clamping of the aorta. We attempted to perfuse the intercostal arteries for preoperative detection of the artery of Adamkiewicz using newly developed catheters. Fifteen patients underwent selective spinal perfusion with our original catheter as spinal protection during the procedure of distal descending Thoracic Aneurysm (DTA) or thoracoabdominal aortic Aneurysm (TAAA) repair. Seven patients had distal DTA and eight had TAAA. Monitoring of motor evoked potential (MEP) was performed in all patients throughout the operation. The perfusion flow was 30–40 mlymin for each intercostal artery and was adjusted to keep the proximal circuit pressure at 150–200 mmHg. The average number of perfused intercostal arteries was 2.3 per patient and the number of intercostal arteries reimplanted per patient was 2.5. Intercostal arteries were reimplanted using an interpositional graft. MEPs were still observable after graft replacement in all patients and there were no cases of paraparesisyparaplegia. All patients were discharged ambulatory. Selective spinal perfusion maintains the quantity of total blood flow in the spinal cord and is very useful for reducing the incidence of ischemic injury of the spinal cord during operation. 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.
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hybrid treatment for aortic arch and proximal descending Thoracic Aneurysm experience with stent grafting for second stage elephant trunk repair
European Journal of Cardio-Thoracic Surgery, 2009Co-Authors: Nobuyoshi Kawaharada, Tetsuya Koyanagi, Yoshihiko Kurimoto, Toshiro Ito, Akihiko Yamauchi, Masanori Nakamura, Nobuyuki Takagi, Tetsuya HigamiAbstract:Background: Aortic Aneurysm affecting the arch and proximal descending Thoracic aorta may require a two-stage repair, which includes proximal elephant trunk graft placement and completion of descending Thoracic aortic repair. The combination of open surgery and endovascular grafting may improve the morbidity and mortality of the patient population at risk. Methods: Between February 2001 and March 2007, 258 patients underwent Thoracic aortic endovascular grafting at our institution, wherein 31 patients underwent a hybrid approach involving proximal arch repair and elephant trunk graft replacement, and endovascular completion procedures. All patients, who underwent combined endovascular and open procedures in the management of the aortic arch and proximal descending Thoracic aortic Aneurysms, were reviewed and analysed retrospectively. Results: The interval between the first and second stage ranged from 0 to 14 months with a mean interval of 3.1 months. Follow-up ranged from 0 to 70 months with a mean of 31 months. Technical success was achieved in all patients. The 1, 12, 36 and 60-month mortality rates were 6.4%, 16.5%, 26.7% and 26.7%, respectively. Caudal migration of the endograft occurred in three patients, who underwent conversion to open surgery. Two cases of paraparesis but no paraplegias or strokes were recorded. Conclusions: Staged procedures using endovascular grafting in the treatment of the arch and proximal descending Thoracic Aneurysm may have the potential to reduce morbidity and mortality rates. Although long-term results are still pending, this early experience demonstrates the safety and early-term effectiveness of this hybrid approach, which consists both of endovascular and open surgical procedures.
Michael Mcgarvey - One of the best experts on this subject based on the ideXlab platform.
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Heat shock proteins as biomarkers for the rapid detection of brain and spinal cord ischemia: a review and comparison to other methods of detection in Thoracic Aneurysm repair
Cell Stress and Chaperones, 2011Co-Authors: James G. Hecker, Michael McgarveyAbstract:The heat shock proteins (HSPs) are members of highly conserved families of molecular chaperones that have multiple roles in vivo. We discuss the HSPs in general, and Hsp70 and Hsp27 in particular, and their rapid induction by severe stress in the context of tissue and organ expression in physiology and disease. We describe the current state of knowledge of the relationship and interactions between extra- and intracellular HSPs and describe mechanisms and significance of extracellular expression of HSPs. We focus on the role of the heat shock proteins as biomarkers of central nervous system (CNS) ischemia and other severe stressors and discuss recent and novel technologies for rapid measurement of proteins in vivo and ex vivo. The HSPs are compared to other proposed small molecule biomarkers for detection of CNS injury and to other methods of detecting brain and spinal cord ischemia in real time. While other biomarkers may be of use in prognosis and in design of appropriate therapies, none appears to be as rapid as the HSPs; therefore, no other measurement appears to be of use in the immediate detection of ongoing severe ischemia with the intention to immediately intervene to reduce the severity or risk of permanent damage.
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Heat shock proteins HSP70 and HSP27 in the cerebral spinal fluid of patients undergoing Thoracic Aneurysm repair correlate with the probability of postoperative paralysis
Cell Stress and Chaperones, 2008Co-Authors: James G. Hecker, Joseph E. Bavaria, Hari Sundram, Shaomin Zou, Amy Praestgaard, Sindhu Ramchandren, Michael McgarveyAbstract:An understanding of the time course and correlation with injury of heat shock proteins (HSPs) released during brain and/or spinal cord cellular stress (ischemia) is critical in understanding the role of the HSPs in cellular survival, and may provide a clinically useful biomarker of severe cellular stress. We have analyzed the levels of HSPs in the cerebrospinal fluid (CSF) from patients who are undergoing Thoracic Aneurysm repair. Blood and CSF samples were collected at regular intervals, and CSF was analyzed by enzyme-linked immunosorbent assay for HSP70 and HSP27. These results were correlated with intraoperative somatosensory-evoked potentials measurements and postoperative paralysis. We find that the levels of these proteins in many patients are elevated and that the degree of elevation correlates with the risk of permanent paralysis. We hypothesize that sequential measurement intraoperatively of the levels of the heat shock proteins HSP70 and HSP27 in the CSF can predict those patients who are at greatest risk for paralysis during Thoracic Aneurysm surgery and will allow us to develop means of preventing or attenuating this severe and often fatal complication.
Lars G Svensson - One of the best experts on this subject based on the ideXlab platform.
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spinal cord protective strategies during descending and thoracoabdominal aortic Aneurysm repair in the modern era the role of intrathecal papaverine
The Journal of Thoracic and Cardiovascular Surgery, 2012Co-Authors: Brian Lima, Edward R Nowicki, Eugene H Blackstone, Sarah J Williams, Eric E Roselli, Joseph F Sabik, Bruce W Lytle, Lars G SvenssonAbstract:Objectives An array of neuroprotective strategies has evolved to limit spinal cord injury during descending Thoracic Aneurysm and thoracoabdominal aortic Aneurysm repair. This study prospectively assessed the neuroprotective impact of intrathecal papaverine added to other techniques in aortic Aneurysm repairs. Methods From January 2002 to January 2010, 398 consecutive patients underwent descending Thoracic Aneurysm and thoracoabdominal aortic Aneurysm repairs at Cleveland Clinic, 68 under hypothermic circulatory arrest. We focused on the remaining 330, in whom a combination of neuroprotective adjuncts was used intraoperatively to mitigate spinal cord ischemia. These included distal aortic perfusion with moderate hypothermia, cerebrospinal fluid drainage, and intrathecal papaverine. Two patient groups were discriminated according to whether intrathecal papaverine was (n = 250) or was not (n = 80) administered. Postoperative outcomes were analyzed from a prospectively maintained clinical database. Results Preoperative patient characteristics and comorbidities were similar between groups. Extent of aortic disease was also similar: descending Thoracic Aneurysm (34% with papaverine vs 28%) and Crawford types I (25% vs 34%), II (27% vs 24%), III (13% vs 13%), and IV (2% vs 2.5%). Groups had similar in-hospital mortality (6.4% vs 11%; P = .11) and permanent stroke (4.4% vs 7.5%; P = .3). Permanent paraplegia (3.6% vs 7.5%; P = .01) and paraparesis (1.6% vs 6.3%; P = .01) were significantly lower in the intrathecal papaverine group. Conclusions Adding intrathecal papaverine to the neuroprotective protocol for descending Thoracic Aneurysm and thoracoabdominal aortic Aneurysm repairs may enhance spinal cord perfusion and provide additional spinal cord protection.
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contemporary analysis of descending Thoracic and thoracoabdominal Aneurysm repair a comparison of endovascular and open techniques
Circulation, 2008Co-Authors: Roy K Greenberg, Eric E Roselli, Lars G Svensson, Michael C Moon, Adrian V Hernandez, Joseph F Dowdall, Marcelo Cury, C Francis, Kathryn Pfaff, Daniel G ClairAbstract:Background— Endovascular repair of Thoracic Aneurysm has demonstrated low risks of mortality and spinal cord ischemia (SCI), but few large series have been published on endovascular thoracoabdominal Aneurysm repair, and reports suffer from a lack of accurate comparison with similar open surgical procedures. Methods and Results— A consecutive cohort of patients with Thoracic and thoracoabdominal Aneurysms treated electively with endovascular repair (ER) or surgical repair (SR) techniques between 2001 and 2006 were analyzed. The association between repair technique and SCI was evaluated with univariable analysis. Adjustments for potential confounders and for the propensity to receive ER or SR were also performed in multivariable analysis. A total of 724 patients (352 ER, 372 SR) underwent repair. The mean age was 67 years, and 65% were male. ER patients were on average 9 years older (P<0.001), had more comorbid conditions, and more frequently had prior distal repair (P<0.001) or underwent a type I or IV rep...
Nobuyoshi Kawaharada - One of the best experts on this subject based on the ideXlab platform.
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spinal cord protection with selective spinal perfusion during descending Thoracic and thoracoabdominal aortic surgery
Interactive Cardiovascular and Thoracic Surgery, 2010Co-Authors: Nobuyoshi Kawaharada, Tetsuya Koyanagi, Yoshihiko Kurimoto, Toshiro Ito, Ryo Harada, Hideki Hyodoh, Atsushi Watanabe, Tetsuya HigamiAbstract:Open repair of aortic Aneurysm causes spinal cord perfusion pressure to decrease due to the steal phenomenon from the bleeding of intercostal arteries and cross-clamping of the aorta. We attempted to perfuse the intercostal arteries for preoperative detection of the artery of Adamkiewicz using newly developed catheters. Fifteen patients underwent selective spinal perfusion with our original catheter as spinal protection during the procedure of distal descending Thoracic Aneurysm (DTA) or thoracoabdominal aortic Aneurysm (TAAA) repair. Seven patients had distal DTA and eight had TAAA. Monitoring of motor evoked potential (MEP) was performed in all patients throughout the operation. The perfusion flow was 30-40 ml/min for each intercostal artery and was adjusted to keep the proximal circuit pressure at 150-200 mmHg. The average number of perfused intercostal arteries was 2.3 per patient and the number of intercostal arteries reimplanted per patient was 2.5. Intercostal arteries were reimplanted using an interpositional graft. MEPs were still observable after graft replacement in all patients and there were no cases of paraparesis/paraplegia. All patients were discharged ambulatory. Selective spinal perfusion maintains the quantity of total blood flow in the spinal cord and is very useful for reducing the incidence of ischemic injury of the spinal cord during operation.
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institutional report vascular Thoracic spinal cord protection with selective spinal perfusion during descending Thoracic and thoracoabdominal aortic surgery
2010Co-Authors: Nobuyoshi Kawaharada, Tetsuya Koyanagi, Yoshihiko Kurimoto, Toshiro Ito, Ryo Harada, Hideki Hyodoh, Atsushi Watanabe, Tetsuya HigamiAbstract:Open repair of aortic Aneurysm causes spinal cord perfusion pressure to decrease due to the steal phenomenon from the bleeding of intercostal arteries and cross-clamping of the aorta. We attempted to perfuse the intercostal arteries for preoperative detection of the artery of Adamkiewicz using newly developed catheters. Fifteen patients underwent selective spinal perfusion with our original catheter as spinal protection during the procedure of distal descending Thoracic Aneurysm (DTA) or thoracoabdominal aortic Aneurysm (TAAA) repair. Seven patients had distal DTA and eight had TAAA. Monitoring of motor evoked potential (MEP) was performed in all patients throughout the operation. The perfusion flow was 30–40 mlymin for each intercostal artery and was adjusted to keep the proximal circuit pressure at 150–200 mmHg. The average number of perfused intercostal arteries was 2.3 per patient and the number of intercostal arteries reimplanted per patient was 2.5. Intercostal arteries were reimplanted using an interpositional graft. MEPs were still observable after graft replacement in all patients and there were no cases of paraparesisyparaplegia. All patients were discharged ambulatory. Selective spinal perfusion maintains the quantity of total blood flow in the spinal cord and is very useful for reducing the incidence of ischemic injury of the spinal cord during operation. 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.
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hybrid treatment for aortic arch and proximal descending Thoracic Aneurysm experience with stent grafting for second stage elephant trunk repair
European Journal of Cardio-Thoracic Surgery, 2009Co-Authors: Nobuyoshi Kawaharada, Tetsuya Koyanagi, Yoshihiko Kurimoto, Toshiro Ito, Akihiko Yamauchi, Masanori Nakamura, Nobuyuki Takagi, Tetsuya HigamiAbstract:Background: Aortic Aneurysm affecting the arch and proximal descending Thoracic aorta may require a two-stage repair, which includes proximal elephant trunk graft placement and completion of descending Thoracic aortic repair. The combination of open surgery and endovascular grafting may improve the morbidity and mortality of the patient population at risk. Methods: Between February 2001 and March 2007, 258 patients underwent Thoracic aortic endovascular grafting at our institution, wherein 31 patients underwent a hybrid approach involving proximal arch repair and elephant trunk graft replacement, and endovascular completion procedures. All patients, who underwent combined endovascular and open procedures in the management of the aortic arch and proximal descending Thoracic aortic Aneurysms, were reviewed and analysed retrospectively. Results: The interval between the first and second stage ranged from 0 to 14 months with a mean interval of 3.1 months. Follow-up ranged from 0 to 70 months with a mean of 31 months. Technical success was achieved in all patients. The 1, 12, 36 and 60-month mortality rates were 6.4%, 16.5%, 26.7% and 26.7%, respectively. Caudal migration of the endograft occurred in three patients, who underwent conversion to open surgery. Two cases of paraparesis but no paraplegias or strokes were recorded. Conclusions: Staged procedures using endovascular grafting in the treatment of the arch and proximal descending Thoracic Aneurysm may have the potential to reduce morbidity and mortality rates. Although long-term results are still pending, this early experience demonstrates the safety and early-term effectiveness of this hybrid approach, which consists both of endovascular and open surgical procedures.
