TY - CHAP M1 - Book, Section TI - Thoracic Aneurysms and Aortic Dissection A1 - LeMaire, Scott A. A1 - Preventza, Ourania A1 - Coselli, Joseph S. A2 - Brunicardi, F. Charles A2 - Andersen, Dana K. A2 - Billiar, Timothy R. A2 - Dunn, David L. A2 - Kao, Lillian S. A2 - Hunter, John G. A2 - Matthews, Jeffrey B. A2 - Pollock, Raphael E. PY - 2019 T2 - Schwartz's Principles of Surgery, 11e AB - Key Points Assessing urgency of repair is essential to developing the appropriate management plan. Although emergent repair carries greater operative risk than does elective repair, any inappropriate delay of repair risks death. The clinical progression of an aortic aneurysm is continued expansion and eventual dissection or rupture. Hence, regular noninvasive imaging studies, as part of a lifelong surveillance plan, are necessary to ensure long-term patient health. Even small asymptomatic aneurysms should be routinely imaged to assess overall size and yearly rate of expansion. Endovascular repair devices are approved for the treatment of descending thoracic aortic aneurysms, descending thoracic aortic dissections, aortic trauma, and penetrating aortic ulcer. Practice guidelines have been published to help standardize the decision-making process and select an appropriate surgical intervention, as well as to standardize the use of imaging studies for patients with thoracic aortic disease. Ascending aortic aneurysms that are symptomatic or ≥5.5 cm in diameter should be repaired regardless of whether the patient has a bicuspid or tricuspid aortic valve. This threshold is lowered for patients with certain heritable disorders affecting the aorta and for patients with additional risk factors, such as rapid aortic expansion (≥0.5 cm per year) or a family history of dissection. Surgical repair involves the development of a patient-tailored plan based on careful preoperative medical evaluation. When appropriate, optimizing a patient’s health status—to mitigate existing comorbidities—is important before surgical intervention. The development and use of surgical adjuncts like antegrade selective cerebral perfusion and cerebrospinal fluid drainage have significantly reduced the morbidity rates traditionally associated with complex aortic repair. Proximal aortic dissection is a life-threatening condition, and immediate operative repair is generally indicated, although definitive aortic repair may be delayed until after severe malperfusion has been treated. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1175970101 ER -