TY - CHAP M1 - Book, Section TI - Thoracic Aneurysms and Aortic Dissection A1 - LeMaire, Scott A. A1 - Gopaldas, Raja R. A1 - Coselli, Joseph S. A2 - Brunicardi, F. Charles A2 - Andersen, Dana K. A2 - Billiar, Timothy R. A2 - Dunn, David L. A2 - Hunter, John G. A2 - Matthews, Jeffrey B. A2 - Pollock, Raphael E. PY - 2015 T2 - Schwartz's Principles of Surgery, 10e AB - 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 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 growth and yearly rate of expansion.Endovascular repair devices are approved for the treatment of descending thoracic aortic aneurysms, and some of the newer devices are also approved for the treatment of aortic trauma and penetrating aortic ulcer.Practice guidelines were recently published that have helped to 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 should be repaired. This threshold is lowered for patients with connective tissue disorders.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 - accesssurgery.mhmedical.com/content.aspx?aid=1117746277 ER -