الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
SUMMARYUMMARY UMMARY
he artery of adamkewics is the largest anterior medullary artery (artery radicularis magna). Its commennest origin is at T10. It is critical to know the course in order to prevent paralagia.
Blood pressure should be sufficient to keep the iliolumbar circulation after clamping of the aorta
Women are less frequently affected by AAS and also they are affects generally at a higher age than men
Patients with marfan, bicuspid valve and prior aortic surgery are associated with a younger age.
The commonest site is few centimeters from sinuses of valsalva. The other common site is the descending aorta just distal to the left SCA.
Left iliac artery and ilacs are the higher incidence of dissection among the aortic branches.
Re-enrty is common in celiac, SMA, right renal artery.
IMH most often occur due to rupture of atherosclerotic plaque.
T
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PAU often found in the descending aorta, and often more than one.
IMH or PAU may be ensued by true or false aneurysm.
Hypertension causes intimal thickening, fibrosis, calcifications, extracellular fatty acid depositions, rapid degeneration of the extra cellular matrix and elastosis which all predispose to fragile media.
Marfan and Ehler Danlos syndromes are the commonest genetic factors that predispose to AAS.
High clinical suspicioun should be conducted when dealing with the aortic pain patients.
Diagnosis and modality of intervention are determined via the results of TEE, CT, MRI.
The intimal flap which is a main feature in dissection can be displayed via contrast enhanced CT, while IMH are demonstrated in unenhanced CT.
Stable patients should perform CT study, while unstable patients should be explorated surgically.
Commence medical therapy in all patients whether complicated or not, medications are for pain relief and rigorous blood pressure control.
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Acute ascending aortic pathologies (acute dissection, IMH or PAU) are surgical emergencies.
Mainstay of uncomplicated type B is the medical treatment.
Complicated type can be treated with endo grafts.
Mortality for type A is 50% without surgical intervention. 10% with surgical intervention but may increase in the presence of comorbidities
Type A dissection can possibly be treated via endovascular intervention either as a permenant resolution or transient remedy until more difinitiveintervention is undertaken
Endoleaks are one of the most common complications in TAAD
TAAD endografting needs further studies in order to reach conclusive results about stents calibration and aortic dynamics
An endostabling system should also upgraded and integrated to prevent intimal injury during deployment.
The tracking wire can cause intimal injury and ventricular injury as well. This can be prevented by using
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short soft tips or nose cones along with the recommended J ended guidewires
Remodeling after TEVAR had been comleted after one year, while false lumen thrombosis was had been accomplishrd in three.
New designes for a branchd stent graf should be invented to enable the extent of the landing zone towards the aortic arch.
Ideal management for RTAD is still a controversy, but some studie showed that TEVAR has less peri-operative mortality and less hospitalization time
TEVAR is considered the no 1 choice in acute complicated TBAD
OMT should be commenced in any patient with TBAD whether treated via TEVAR or surgery
TEVAR should be associated with anti stroke measurements
TEVAR in uncomplicated TBAD should be propsed to the patient in the perspectives of age, gender, connective tissue disorder, hypertension and biomarkers. Besides, there are imaging findings such as fusiform index that my be usec AS AN INDEPENDENT FACTOR for aortic events.
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(A/B+C) > 0.64 (a is the max diameter of the proximal descending aorta, B is the diameter of distal aortic arch, while C is diameter of the descending aorta at the level of the pulmonary trunk)
Timing of TEVAR should be deferred after three weeksof the incidence to avoid the brittle adventitia and the vulnerable dissected flap in uncomplicated TBAD
Complications are more frequent in patients who developed RTAD on top of TBAD
Follow up thoroughly for long periods should be emphasized even after one year via CT contrast enhanced scans.
The Petticoat technique can be proposed to provide a chance for false lumen thrombosis but further research should be conducted still.