Rutherford's 101: Brachiocephalic Artery Disease: Surgical Treatment скачать в хорошем качестве

Rutherford's 101: Brachiocephalic Artery Disease: Surgical Treatment

#BrachiocephalicArteryDisease #SuprAorticTrunks #VascularSurgery #EndovascularTherapy #StrokePrevention #Atherosclerosis #AnatomicalVariations #Diagnosis #Treatment #Rutherfords This video delves into Brachiocephalic Artery Disease, focusing on the supr-aortic trunks branching off the aorta: the innominate, left common carotid, and left subclavian arteries. Based on Rutherford's Vascular Surgery and Endovascular Therapy, 10th Edition, it explores conditions and surgical treatments. Common issues include atherosclerosis (plaque buildup), aneurysms (ballooning), dissections (artery wall tears), trauma, inflammatory conditions like Takayasu arteritis, and infections. These can cause reduced blood flow to the arms (pain) or, more seriously, the brain, leading to TIAs or strokes. Other consequences include compression of nearby structures or "steel" syndromes, diverting blood away from the brain or heart grafts. Anatomical variations are common and critical for planning. The "bovine arch," where the innominate and left common carotid share an origin, occurs in 21-27% of people. Diagnosis involves physical exam (pulse/BP differences) and non-invasive imaging like carotid duplex ultrasound, CTA, and MRA, which provide detailed maps. Treatment is primarily for symptomatic disease (neurologic or arm symptoms, steal syndromes). Asymptomatic cases might be treated in specific situations like needing access for dialysis or heart grafts. Treatment strategies include traditional open surgery (transthoracic approach, often with bypass grafts from the aorta) or extra-anatomic cervical procedures (neck-only bypasses like carotid-subclavian or subclavian-carotid transposition). Hybrid procedures combine techniques. Open surgery carries higher immediate risks but can offer durable results, while cervical bypasses have lower immediate risks but potentially less long-term patency. Endovascular methods (stents, balloons) are also used, often in hybrid approaches. Treatment decisions are highly personalized based on the patient's health and specific anatomy.