Interventions infobox Name PAGENAME Image Caption ICD10 ICD9 ICD9proc 38.1 MeshID D004691 OtherCodes Endarterectomy is a surgical procedure to remove the atheroma atheromatous plaque material, or blockage, in the lining of an artery constricted by the buildup of soft hardening deposits. It is carried out by separating the plaque from the arterial wall. It was first performed on a superficial femoral artery in 1946 by the Portuguese surgeon Jo o Cid dos Santos at the University of Lisbon . In 1951, E. J. Wylie, an American, performed it on the abdominal aorta . The first successful reconstruction of the carotid artery was performed by Carrea, Molins, and Murphy in Argentina, later in the same year. ref http stroke.ahajournals.org cgi content full 27 8 1427 Thompson, Jesse E., The Evolution of Surgery for the Treatment and Prevention of Stroke retrieved on 2007 04 24 ref The procedure is widely used on the carotid artery of the neck as a way to reduce the risk of cerebrovascular accident stroke , particularly when the carotid artery is narrowed by more than 70 . A carotid endarterectomy may itself cause a stroke at the time of operation. Endarterectomy is also used as a supplement to a vein bypass graft to open up distal segments. Pulmonary hypertension caused by chronic thromboembolic disease CTEPH may be amenable to pulmonary thromboendarterectomy of the pulmonary artery . This is a highly specialized procedure. The term atherectomy is used to describe reconstruction through a catheter . See also Pulmonary thromboendarterectomy References references External links MeshName Endarterectomy http www.springerlink.com content f0h55146r42q776l Connolly, John E. and Price, Thaine, Aortoiliac Endarterectomy A Lost Art? , 2005 abstract treatment stub Vascular procedures Category Vascular surgery de Endarteriektomie ... more details
carotid artery. Plaque often builds up at that division, and a carotid endarterectomy cuts open ..., which would be removed in an endarterectomy. Carotid endarterectomy CEA is a surgery surgical ... artery . Endarterectomy is the removal of material on the inside end of an artery . Atherosclerosis ... stenosis, and symptoms, should have urgent endarterectomy within 2 weeks. ref Sharon Swain, Claire ..., including fatal stroke, is 1 2 per year. The surgical mortality of endarterectomy ranges from 1 ... Carotid Atherosclerosis Study ACAS . Endarterectomy for asymptomatic carotid artery stenosis. Jama ... D. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without ... debate. ref In endarterectomy, the surgeon opens the artery and removes the plaque. The plaque forms ... higher with stenting than with endarterectomy 9.6 vs. 3.9 ref http general medicine.jwatch.org cgi content full 2008 1009 1 Carotid Stenting vs. Endarterectomy Longer Term Outcomes JournalWatch General ... Outcomes of Carotid Stenting and Endarterectomy Results From the SVS Vascular Registry , Sidawy AN, Zwolak ... for Vascular Surgery. J Vasc Surg 2009 49 71 9. ref The Carotid Revascularization Endarterectomy ... Endarterectomy Versus Stenting Trial CREST ClinicalTrials.gov. ref funded by the National Institutes of Health NIH reported that the results of stents and endarterectomy were comparable. However ... article PIIS0140 6736 10 60239 5 fulltext Carotid artery stenting compared with endarterectomy ... that this procedure, known as carotid stenting , was non inferior to carotid endarterectomy in total ... Protected carotid artery stenting versus endarterectomy in high risk patients journal N. Engl. J .... 2008 118 2852 2859. ref History The endarterectomy procedure was developed and first done ... gr049005.htm . Eastcott s procedure was not strictly an endarterectomy as we now understand it he ... Carotid Endarterectomy Trial NASCET and the European Carotid Surgery Trial ECST are both ... more details
Extirpation can refer to Local extinction removing solid matter from a part of the body, as in thrombectomy or endarterectomy disambig ... more details
Intimal hyperplasia is the thickening of the Tunica intima of a blood vessel as a complication of a reconstruction procedure or endarterectomy . Intimal hyperplasia is the universal response of a vessel to injury and is an important reason of late bypass graft failure, particularly in vein and synthetic vascular grafts. See also Hyperplasia Medical grafting External links http dissertations.ub.rug.nl faculties medicine 2002 g.j.toes Intimal hyperplasia, the obstacle in bypass grafts disease stub Category Diseases of arteries, arterioles and capillaries ... more details
of risk factors for atherosclerosis Medical management plus carotid endarterectomy or carotid ... carotid endarterectomy or carotid stenting can cause stroke, however where the risk of stroke from ... with asymptomatic severe carotid artery stenosis, carotid endarterectomy by selected surgeons ... centers, carotid endarterectomy is associated with a 30 day stroke or mortality rate of about ... endarterectomy urgently, since the greatest risk of stroke is within days. Carotid endarterectomy ... risk of stroke of about 1 2 per year. Carotid endarterectomy has a surgical risk of stroke or death of about 2 4 in the best institutions. Carotid endarterectomy reduced major stroke and death ... date December 2008 Surgery Benefits of endarterectomy are greater than those of stenting. ref cite journal author Brott TG, Hobson RW, Howard G, et al. title Stenting versus endarterectomy for treatment ... NEJMoa0912321 ref A 2010 study found benefits reduced strokes from carotid endarterectomy in those .... title 10 year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis ACST ... more details
stenting versus endarterectomy in high risk patients. N Engl J Med. 2008 Apr 10 358 15 1572 ... endarterectomy. Patient Selection Warnings Lesion Characteristics Patients with evidence of intraluminal .... 2011 . Health related quality of life after carotid stenting versus carotid endarterectomy Results from CREST carotid revascularization endarterectomy versus stenting trial . Journal of the American ... versus endarterectomy for treatment of carotid artery stenosis. N Engl J Med. 2010 Jul 1 363 ... G EVA 3S investigators. Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid .... Long term results of carotid stenting versus endarterectomy in high risk patients. N Engl J Med ... journal author Biller J, Feinberg WM, Castaldo JE, et al. title Guidelines for carotid endarterectomy ... A, Greenhalgh RM, Davies AH title Systematic comparison of the early outcome of angioplasty and endarterectomy ... more details
Interventions infobox Name Atherectomy Image Caption ICD10 ICD9 ICD9proc 39.50 , ICD9proc 00.61 ICD9proc 00.62 MeshID D017073 OtherCodes Atherectomy is a minimally invasive surgical method of removing, mainly, atherosclerosis from a large blood vessel within the body. Today, it is generally used to effectively treat ref http www.jvascsurg.org article S0741 5214 2806 2901618 1 abstract ref ref http www.jvir.org article S1051 0443 2807 2960391 1 abstract ref peripheral arterial disease of the lower extremities. It has also been used to treat coronary artery disease , albeit ineffectively. ref http www2.cochrane.org reviews en ab003334.html ref Procedure Unlike angioplasty and stents , which push plaque into the vessel wall, atherectomy involves removing the plaque burden within the vessel. Increasing the blood vessel vessel lumen anatomy lumen by removing the plaque burden improves downstream wound healing, reduces claudication and pushes amputation levels more distal. While atherectomy is usually employed to treat artery arteries it can be used in vein s and vein graft s as well. Atherectomy falls under the general category of percutaneous revascularization , which implies re canalizing blocked vasculature via a needle puncture in the skin. The most common access point is near the groin through the femoral artery common femoral artery CFA . However, wire and catheter access can occur from wherever a doctor is willing to stick. Other common places are the brachial artery , radial artery , popliteal artery , dorsalis pedis , and others. Advantages The procedure is considered less invasive than endarterectomy , which involves the surgical cut down and removal of plaque from the inner wall of a diseased vessel. The advantages of atherectomy when compared to endarterectomy include less procedure time, ease of use, faster patient recovery, decreased systemic complications, repeatability in light of new occlusions. It also serves as a chance for non surgical candidates. The ... more details
The popliteal artery entrapment syndrome is a rather uncommon pathology , which results into claudication and chronic leg ischemia . The popliteal artery may be compressed behind the knee , due to congenital deformity of the muscle s or tendon insertions of the popliteal space . This repetitive trauma may result in Stenosis stenotic artery degeneration, complete artery Vascular occlusion occlusion or even formation of an aneurysm . History The syndrome was first described in 1879 by Anderson Stuart, a medical student , in a 64 year old male. Hamming and Vink in 1959 first described the management of the popliteal artery syndrome in a 12 year old patient. The patient was treated with myotomy of the medial head of the gastrocnemius muscle and http en.wiktionary.org wiki concomitant concomitant endarterectomy of the popliteal artery. They later reported four more cases and claimed that the incidence of this pathology in patients younger than 30 years old with claudication was 40 . Servello was the first to draw attention to diminished distal pulses observed with forced plantar or dorsiflexion in patients suffering from this syndrome. Bouhoutsos and Daskalakis in 1981 reported 45 cases of this syndrome in a population of 20,000 Greek soldiers. During the recent years the increasing frequency with which popliteal artery entrapment is reported, strongly suggests a greater awareness of the syndrome. Classification Love and Whelan proposed a classification of this pathology into four types, ref cite journal author Love J, Whelan T title Popliteal artery entrapment syndrome journal Am J Surg volume 109 issue 5 pages 620 4 year 1965 pmid 14281885 doi 10.1016 S0002 9610 65 80016 2 ref according to the various relationships between the popliteal artery and the muscles of the popliteal space. Rich and Hughes described popliteal vein compression, Fact date February 2007 thus adding a fifth type into the former classification. Vein ... but the article is about popliteal artery The ... more details
Infobox rfam Name GAIT element image RF00179.jpg width caption Predicted secondary structure and sequence conservation of GAIT Symbol GAIT AltSymbols Rfam RF00179 miRBase miRBase family RNA type Cis regulatory element Cis reg Tax domain Eukaryota GO SO SO 0000233 CAS number EntrezGene HGNCid OMIM PDB RefSeq Chromosome Arm Band LocusSupplementaryData The gamma interferon inhibitor of translation element or GAIT element is a cis acting RNA element located in the 3 UTR of the ceruloplasmin Cp mRNA . The GAIT element forms a stem loop secondary structure. The GAIT element is involved in selective translational silencing of the Cp transcript. Cp is a multifunctional, copper containing glycoprotein produced by the liver and secreted into the plasma. As an acute phase protein, its plasma concentration can double during multiple inflammatory conditions. Plasma Cp has been reported to be an independent risk factor for cardiovascular disease , including atherosclerosis, carotid restenosis after endarterectomy, and myocardial infarction. Translational silencing of Cp, and possibly other transcripts, mediated by the GAIT element may contribute to the resolution of the local inflammatory response following cytokine activation of macrophages. ref cite journal last Sampath first P coauthors Mazumder B, Seshadri V, Fox PL year 2003 title Transcript selective translational silencing by gamma interferon is directed by a novel structural element in the ceruloplasmin mRNA 3 untranslated region journal Mol Cell Biol volume 23 issue 5 pages 1509&ndash 1519 pmid 12588972 pmc 151701 doi 10.1128 MCB.23.5.1509 1519.2003 ref The silencing of Cp requires binding of the IFN gamma activated inhibitor of translation GAIT inhibitor complex to the GAIT element. ref name pmid16267389 cite journal author Mazumder B, Sampath P, Fox PL title Regulation of macrophage ceruloplasmin gene expression one paradigm of 3 UTR mediated translational control journal Mol Cells volume 20 issue 2 pages 167 72 year 2 ... more details
Iatrogenic Amaurosis fugax can present as a complication following carotid endarterectomy , carotid ... Beneficial effect of carotid endarterectomy in symptomatic patients with high grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators journal N. Engl. J. Med. volume ... I, Kerstein MD title Carotid endarterectomy for amaurosis fugax without angiography journal Am ... lesion, aspirin is indicated, and a carotid endarterectomy if the stenosis is surgically ... the indication for endarterectomy. Amaurosis fugax appears to be a particularly favorable indication for carotid endarterectomy. Left untreated, this event carries a high risk of stroke after carotid endarterectomy, which has a low operative risk, there is a very low postoperative stroke rate. ref name bernstein cite journal author Bernstein EF, Dilley RB title Late results after carotid endarterectomy ... more details
content.nejm.org cgi content abstract 339 20 1415 Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial ... more details
. Circ Cardiovasc Genet Apr 2010 3 215 221 ref Appropriate carotid endarterectomy Showed in 2005 ref ... stenosis cannot benefit from endarterectomy or stenting , and that the very small proportion 10 ... more details
Infobox SCC case name Reibl v. Hughes full case name John Reibl v. Robert A. Hughes heard date June 5, 1980 decided date October 7, 1980 citations 1980 2 SCR 880 docket history subsequent ruling ratio In order to obtain medical consent, physicians must provide the patient with enough information so that an objective, reasonable person in the patient s position could make an informed decision. SCC 1980 1982 PerCuriam yes NotParticipating Ritchie and Estey JJ. LawsApplied Reibl v. Hughes 1980 2 S.C.R. 880 is a leading decision of the Supreme Court of Canada on negligence, medical malpractice, informed consent , the duty to warn, and causation. The case settled the issue of when a physician may be sued for battery crime battery and when it is more appropriate to sue the doctor in negligence. The Court wrote unanimously that unless there has been misrepresentation or fraud to secure consent to the treatment, a failure to disclose the attendant risks, however serious, should go to negligence rather than to battery. The case also marked the creation of a standard whereby a physician must give the patient sufficient information so that an objective, reasonable person in the patient s position would be able to make an informed choice about a medical procedure. Background Robert A. Hughes, a physician, was in the process of competently performing an endarterectomy on his patient, John Reibl, when Reibl suffered a massive stroke. Paralysis and impotence resulted. Reibl alleged that he had not truly given informed consent, and as such the surgery constituted battery. ref name Reibl http scc.lexum.umontreal.ca en 1980 1980scr2 880 1980scr2 880.html , Reibl v. Hughes Court Ruling ref Although Reibl was aware that the surgery was not without risks, he felt that Hughes had implied that the risks of not having the surgery were greater. Reibl was eighteen months away from obtaining a lifetime pension, and the stroke prevented him from earning that pension. He stated that if he had b ... more details
Paolo Macchiarini , M.D., Ph.D. was head and chairman of the Hospital Cl nic Barcelona Metro de Barcelona, University of Barcelona in Barcelona, Spain, as well as professor of surgery at the University of Barcelona in Spain, and at the Hannover Medical School in Hannover, Germany. Presently he is Professor of Regenerative Medicine at Karolinska Institutet in Stockholm Sweden , as well as director of the ACTREG Advanced Center for Regenerative Medicine in the same Institute. He is also Honorary Professor at London University College. Dr. Macchiarini completed his residency in thoracic surgery at the University of Pisa in Pisa, Italy. Dr. Macchiarini completed a fellowship in the department of thoracic surgery at the University of Alabama at Birmingham in Birmingham, Alabama, with an additional fellowship completed in the department of thoracic and vascular surgery and heart lung transplantation, H pital Marie Lannelongue, Paris Sud University, Le Plessis Robinson, France. Dr. Macchiarini s interests include extended surgery for lung, esophageal, and mediastinal tumors adult and pediatric tracheal surgery lung and heart lung transplantation pulmonary endarterectomy bio artificial lung and experimental research, education, training. ref http www.reachmd.com xmradioguest.aspx?pid 44903 ReachMD Paolo Macchiarini, MD ref ref http www.ctsnet.org home pmacchiarini Paolo Macchiarini CTSNET Member Homepage ref Dr. Macchiarini has contributed to the field of Regenerative medicine when in 2008 he performed the first Adult stem cell grown trachea transplant. ref http www.bristol.ac.uk news 2008 6010.html Adult stem cell breakthrough University of Bristol , November 19, 2008 ref ref http www.sciencedaily.com releases 2008 11 081119092939.htm Adult Stem Cell Breakthrough First Tissue Engineered Trachea Successfully Transplanted Science Daily , November 18, 2008 ref ref http www.nydailynews.com lifestyle health 2008 11 19 2008 11 19 doctors give woman a new windpipe using .html Doc ... more details
excision and homograft replacement. Postgrad Med 1954 16 334 342 ref First successful carotid endarterectomy in the world. ref name Twenty five years ref Cooley DA. Carotid endarterectomy from first ... 4. ref First laser coronary endarterectomy procedure in the United States. ref name Milestones ref Livesay JJ, Cooley DA Laser coronary endarterectomy proposed treatment for diffuse coronary atherosclerosis ... MS, Frazier OH, Cooley DA. Preliminary report on laser coronary endarterectomy in patients. Circulation ... more details
Infobox Anatomy Name Carotid sinus Latin sinus caroticus GraySubject GrayPage Image Gray513.png Caption Arteries of the neck. The carotid sinus is at the origin of the internal carotid artery . Image2 Caption2 Precursor System Artery Vein Nerve branch of glossopharyngeal nerve to carotid sinus Lymph MeshName Carotid Sinus MeshNumber A07.231.114.186.456 DorlandsPre s 12 DorlandsSuf 12738619 In human anatomy , the carotid sinus is a localized dilation of the internal carotid artery at its origin, the common carotid artery . Functions Unreferenced section date February 2009 The carotid sinus contains numerous baroreceptors , which function as a sampling area for many homeostasis homeostatic mechanisms for maintaining blood pressure . The carotid sinus baroreceptors are innervated by the sinus nerve of Hering, which is a branch of cranial nerve IX glossopharyngeal nerve . The glossopharyngeal nerve synapses in the Solitary nucleus nucleus tractus solitarius NTS located in the medulla of the brainstem. The NTS indirectly modulates the activity of sympathetic and parasympathetic vagal neurons in the medulla and pons through the hypothalamus. These neurons then regulate the autonomic control of the heart and blood vessels. The aortic arch baroreceptors are innervated by the aortic nerve Nerve of Cyon , which combines with CN X vagus nerve and travels to the NTS. Disease of the carotid sinus This section is linked from Swimming The carotid sinus often has atherosclerotic plaque s because of disturbed hemodynamics low wall shear stress , flow reversal recirculation . ref Glagov S, Zarins C, Giddens DP, Ku DN. Hemodynamics and atherosclerosis. Insights and perspectives gained from studies of human arteries. biod degradable Arch Pathol Lab Med. 1988 Oct 112 10 1018 31. PMID 3052352 ref Since these plaques, if large and unstable, predispose to Stroke Ischemic stroke 2 ischemic stroke s and transient ischemic attack s, carotid endarterectomy carotid endarterectomies are frequent ... more details
Encyclopedia
top
