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Related Concept Videos

Aneurysm III: Interprofessional Care01:26

Aneurysm III: Interprofessional Care

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Aneurysm IV: Nursing Management01:22

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Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
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Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Aneurysm II: Clinical Manifestations and Diagnostic Studies01:21

Aneurysm II: Clinical Manifestations and Diagnostic Studies

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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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Aortic Regurgitation I: Introduction01:15

Aortic Regurgitation I: Introduction

423
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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Aortic Regurgitation IV: Nursing Management01:17

Aortic Regurgitation IV: Nursing Management

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A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
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Novel and Innovative Hybrid Technique for Type A Aortic Dissection
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Aortic Dissection Following Endovascular Aneurysm Repair - A Systematic Review and Management Algorithm.

Angus Pegler1, Yogeesan Sivakumaran1

  • 1Department of Vascular Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia.

Vascular and Endovascular Surgery
|October 8, 2025
PubMed
Summary

Aortic dissection after endovascular aneurysm repair (EVAR) can cause serious complications like endograft compression. Early Type B dissections may be managed medically, while Type A and late Type B dissections have higher mortality rates.

Keywords:
aortic dissectionendovascular aneurysm repairtype A dissectiontype B dissection

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Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Aortic Disease

Background:

  • Aortic dissection following endovascular aneurysm repair (EVAR) can be iatrogenic or de novo.
  • Complications include endograft compression, endoleak, and rupture, impacting patient outcomes.
  • Management strategies vary based on dissection type and timing.

Purpose of the Study:

  • To systematically review dissections after EVAR and fenestrated/branched EVAR (F/BrEVAR).
  • To identify complications specific to iatrogenic and de novo dissections.
  • To develop a management algorithm based on clinical presentation.

Main Methods:

  • Comprehensive literature search of MEDLINE, Embase, and CENTRAL databases.
  • Data collection on timing, tear location, endograft involvement, complications, management, and outcomes.
  • Descriptive data analysis and outcome comparison based on dissection type and timing.

Main Results:

  • 46 patients from 37 studies were analyzed.
  • Endograft compression (52.2%), endoleak (15.2%), and rupture (13.0%) were common complications.
  • Type A dissection had high mortality (20.0%); early Type B dissection (diagnosed <4 weeks) had no mortality with medical management, while late Type B dissection (>4 weeks) had 25.8% mortality.

Conclusions:

  • Aortic dissection post-EVAR presents significant risks, including endograft compression, endoleak, and rupture.
  • Type A and late Type B dissections are associated with higher complication rates and mortality.
  • Early Type B dissection may be effectively managed non-surgically.