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Prior to the advent of endovascular aneurysm repair (EVAR), OAS was the only surgical treatment available for aortic aneurysms. The shift away from open aortic surgery towards endovascular surgery since 2003 has been driven by worse perioperative mortality associated with OAS, particularly in patients in relatively frail health. [2]
Endovascular aneurysm repair (EVAR) is a type of minimally-invasive endovascular surgery used to treat pathology of the aorta, most commonly an abdominal aortic aneurysm (AAA). When used to treat thoracic aortic disease, the procedure is then specifically termed TEVAR for "thoracic endovascular aortic/aneurysm repair."
A stent graft placed in the thoracic aorta to treat a thoracic aortic aneurysm. The size cut off for aortic aneurysm is crucial to its treatment. A thoracic aorta greater than 4.5 cm is generally defined as aneurysmal, while a size greater than 5.5 cm is the distinction for treatment, which can be either endovascular or surgical, with the ...
For aneurysms of the thoracic aorta, thoracic endovascular aortic repair (TEVAR) has become a valid alternative to open repair. This method may even be applied to pathologies of the aortic arch and the distal descending aorta. [12] A common complication of EVAR are endoleaks. These may be missed by 2D angiographic evaluation.
Thoracic aortic injury is the 2nd leading cause of death involving both blunt trauma. 80% of patients that have a thoracic aortic injury will die immediately. [4] Of the patients that do make it to be evaluated only 50% will survive 24 hours. [1] Of the patients that do survive the first 24 hours 14% develop paraplegia. [6]
Hazim J. Safi, MD, FACS, (born 1946) [2] is a physician and surgeon who is well known for his research in the surgical treatment of aortic disease. Safi and his colleagues at Baylor College of Medicine were the first to identify variables associated with early death and postoperative complications in patients undergoing thoracoabdominal aortic operations. [3]
Valve sparing aortic root replacement (VSARR) is an alternative procedure to the composite aortic valve graft (CAGVR, Bentall procedure). A notable benefit of VSARR is the reduced need for anticoagulation, as the patient's own aortic valve is spared and does not need to be replaced with a mechanical or bioprosthetic valve.
Current methods for aortic valve replacement include open-heart surgery, minimally invasive cardiac surgery (MICS), surgical aortic valve replacement (SAVR) and percutaneous or transcatheter aortic valve replacement (TAVR; also PAVR, PAVI, TAVI). A cardiologist can evaluate whether a heart valve repair or valve replacement would be of benefit. [1]
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