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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."
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]
For abdominal aneurysms, the current treatment guidelines for abdominal aortic aneurysms suggest elective surgical repair when the diameter of the aneurysm is greater than 5 cm (2 in). However, recent data on patients aged 60–76 suggest medical management for abdominal aneurysms with a diameter of less than 5.5 cm (2 in).
In 1963, Christiaan Barnard and Velva Schrire were the first to use DHCA to repair an aortic aneurysm, cooling the patient to 10 °C. [13] Randall B. Griepp , in 1975, is generally credited with demonstrating DHCA as a safe and practical approach for aortic arch surgery.
Aortic valve repair or aortic valve reconstruction is the reconstruction of both form and function of a dysfunctional aortic valve. Most frequently it is used for the treatment of aortic regurgitation. [1] It can also become necessary for the treatment of aortic aneurysm, less frequently for congenital aortic stenosis.
Diagram of the human heart. Several adaptations of the Ross procedure have evolved, but the principle is essentially the same; to replace a diseased aortic valve with the person's own pulmonary valve (autograft), and replace the person's own pulmonary valve with a pulmonary valve from a cadaver (homograft) or a stentless xenograft.
Modern treatment of aortic diseases stems from development and advancements from Michael DeBakey and Denton Cooley. In 1955, DeBakey and Cooley performed the first replacement of a thoracic aneurysm with a homograft. In 1958, they began using the Dacron graft, resulting in a revolution for surgeons in the repair of aortic aneurysms. He also was ...
Common features of both techniques of the replacement process are the clamping of the aorta and the use of a length of Dacron tube (also known as an "aortic graft"), typically 5 cm, to constrict the aortic root to the normal diameter, while the patient is cooled to 20°C and placed on life support. The procedure typically takes 4 to 6 hours in ...
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