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Dr. Jashvant Patel 1st nominated by : The American Biographical Institute for GREAT MINDS OF THE 21ST CENTURY

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Aortic Arch Replacement

Aneurysmal degeneration can occur anywhere in the human aorta. By definition, an aneurysm is a localized or diffuse dilation of an artery with a diameter at least 50% greater then the normal size of the artery.

Most aortic aneurysms (AAs) occur in the abdominal aorta, termed abdominal aortic aneurysms (AAAs). Although most abdominal aortic aneurysms are asymptomatic at the time of diagnosis, the most common complication remains life-threatening rupture with hemorrhage.

Aneurysmal degeneration that occurs in the thoracic aorta is termed a thoracic aneurysm (TA). Aneurysms that coexist in both segments of the aorta (thoracic and abdominal) are termed thoracoabdominal aneurysms (TAAs). Thoracic aneurysms and thoracoabdominal aneurysms are also at risk for rupture. A recent population-based study suggests an increasing prevalence of thoracic aortic aneurysms. Thoracic aortic aneurysms are subdivided into 3 groups depending on location: ascending aortic, aortic arch, and descending thoracic aneurysms or thoracoabdominal aneurysms. Aneurysms involving the ascending aorta may extend as proximally as the aortic annulus and as distally as the innominate artery, whereas descending thoracic aneurysms begin beyond the left subclavian artery. Arch aneurysms are as the name implies.

Dissection is another condition that may affect the thoracic aorta. A false passage for blood develops between the layers of the aorta. This false passage may extend into branches of the aorta in the chest or abdomen, causing ischemia or occlusion with resultant complications. Dissection can also lead to aneurysmal change and early or late rupture. Dissection should not be termed dissecting aneurysm because it can occur with or without aneurysmal enlargement of the aorta.

Treatment of abdominal aortic aneurysms, thoracoabdominal aneurysms, and thoracic aneurysms involves surgical repair in good-risk patients with aneurysms that have reached a size sufficient to warrant repair. Surgical repair may involve endovascular stent grafting (in suitable candidates) or traditional open surgical repair.

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