Bøger af Reinhart Grundmann

This book considers mainly etiology, pathogenesis, and pathophysiology of aortic aneurysms (AA) and aneurysm rupture and addresses anyone engaged in treatment and prevention of AA. Multiple factors are implicated in AA pathogenesis, and are outlined here in detail by a team of specialist researchers. Initial pathological events in AA involve recruitment and infiltration of leukocytes into the aortic adventitia and media, which are associated with the production of inflammatory cytokines, chemokine, and reactive oxygen species. AA development is characterized by elastin fragmentation. As the aorta dilates due to loss of elastin and attenuation of the media, the arterial wall thickens as a result of remodeling. Collagen synthesis increases during the early stages of aneurysm formation, suggesting a repair process, but resulting in a less distensible vessel. Proteases identified in excess in AA and other aortic diseases include matrix metalloproteinases (MMPs), cathepsins, chymase and others. The elucidation of these issues will identify new targets for prophylactic and therapeutic intervention.

This book considers mainly diagnosis, screening, surveillance and treatment of abdominal, thoracoabdominal and thoracic aortic aneurysms. It addresses vascular and cardiothoracic surgeons and interventional radiologists, but also anyone engaged in vascular medicine. The high mortality of ruptured aneurysms certainly favors the recommendation of prophylactic repair of asymptomatic aortic aneurysms (AA) and therewith a generous screening. However, the comorbidities of these patients and their age have to be kept in mind if the efficacy and cost effectiveness of screening and prophylactic surgery should not be overestimated. The treatment recommendations which will be outlined here, have to regard on the one hand the natural course of the disease, the risk of rupture, and the life expectancy of the patient, and on the other hand the morbidity and mortality of the prophylactic surgical intervention. The book describes perioperative mortality after endovascular and open repair of AA, long-term outcome after repair, and the cost-effectiveness of treatment.