naa a22 4500 510727670 CHVBK 20180411082941.0 cr unu---uuuuu 180411e20130601xx s 000 0 eng 10.1007/s11748-013-0203-y doi (NATIONALLICENCE)springer-10.1007/s11748-013-0203-y Shaggy and calcified aorta: surgical implications [Elektronische Daten] [Ikuo Fukuda, Kazuyuki Daitoku, Masahito Minakawa, Wakako Fukuda] Atheroembolism is an emerging problem in cardiovascular surgery, especially in elderly patients. Severe atherosclerosis of the thoracic aorta usually reflects systemic atherosclerosis. Aggressive preoperative and intraoperative evaluation of the aorta using enhanced CT, transesophageal echocardiography and epiaortic ultrasound is important in elderly patients as well as those with systemic atherosclerosis. To prevent atheroembolism, it is important to select an adequate arterial perfusion site and to avoid touching the diseased aorta until circulatory arrest. In atherosclerotic aortic arch aneurysm, central cannulation under ultrasound guidance and directing the dispersive cannula toward the aortic root is a simple and effective perfusion strategy. Axillary perfusion is useful as an alternative to central cannulation in atherosclerotic aortic disease, but special care is necessary to avoid complications when the patient has a small axillary artery or flail atheroma around the arch vessels. In femoral artery perfusion, retrograde perfusion may induce paradoxical cerebral embolism, but the incidence of stroke is comparable with axillary perfusion when there is adequate preoperative screening using transesophageal echography. Circulatory arrest with/without cerebral perfusion is another important strategy when the aorta has severe atherosclerosis. Recent literature has shown that mild hypothermia may be safe for anterior cerebral perfusion during circulatory arrest, but optimal flow rates and time limitations are unknown. A simple calcified aorta called "porcelain aorta” may be managed by circulatory arrest, local debridement and the clamp method. Several surgical options are proposed for this clinical entity but their use will diminish in the future because of transcatheter valve replacement. The Japanese Association for Thoracic Surgery, 2013 Atheroembolism nationallicence Stroke nationallicence Mobile atheroma nationallicence Axillary perfusion nationallicence Aortic perfusion nationallicence Fukuda Ikuo Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, 036-8562, Hrosaki, Aomori, Japan aut Daitoku Kazuyuki Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, 036-8562, Hrosaki, Aomori, Japan aut Minakawa Masahito Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, 036-8562, Hrosaki, Aomori, Japan aut Fukuda Wakako Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, 036-8562, Hrosaki, Aomori, Japan aut General Thoracic and Cardiovascular Surgery Springer Japan 61/6(2013-06-01), 301-313 1863-6705 61:6<301 2013 61 11748 https://doi.org/10.1007/s11748-013-0203-y text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11748-013-0203-y text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Fukuda Ikuo Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, 036-8562, Hrosaki, Aomori, Japan aut NATIONALLICENCE 700 1- Daitoku Kazuyuki Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, 036-8562, Hrosaki, Aomori, Japan aut NATIONALLICENCE 700 1- Minakawa Masahito Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, 036-8562, Hrosaki, Aomori, Japan aut NATIONALLICENCE 700 1- Fukuda Wakako Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, 036-8562, Hrosaki, Aomori, Japan aut NATIONALLICENCE 773 0- General Thoracic and Cardiovascular Surgery Springer Japan 61/6(2013-06-01), 301-313 1863-6705 61:6<301 2013 61 11748 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer