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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Renal artery aneurysm is an uncommon cause of renovascular hypertension. Nephrectomy or, more recently ex vivo arterial reconstruction have been recommended as the treatment of choice. In contrast, we advocate in situ repair of the aneurysm and any associated lesions. Twenty-five hypertensive patients with 30 renal artery aneurysms were treated by tangential aneurysmectomy with primary arteriorrhaphy, saphenous vein patch angioplasty, or bypass graft. Nephrectomy was performed in two patients, one for a ruptured aneurysm. There was no operative mortality. Follow-up was obtained on all patients six months to 19 years after operation. Hypertension was relieved immediately and in the long-term in the majority of survivors. We believe these results indicate that despite the presence of severe renovascular disease, the affected kidney can be preserved and hypertension successfully relieved by a direct surgical approach without recourse to either nephrectomy or ex vivo reconstruction.
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PMID:Renal artery aneurysm. Long-term relief of renovascular hypertension by in situ operative correction. 53 60

The clinical course of 23 patients with 28 renal artery aneurysms (RAAs) is reported. The RAAs were recorded over a period of 10 years. Thirty-five per cent of the RAAs (eight of 23 patients) were detected during the investigation of hypertension, whereas 26% (six of 23 patients) were discovered incidentally while imaging atherosclerotic arterial disease in the aorto-iliac region by angiography. Twenty-two aneurysms were treated surgically and primary nephrectomy was necessary in one case. The surgical technique used was excision of the aneurysm with bypass grafting in 13 cases (seven Dacron, five vein, one arterial bypass), a running suture following aneurysm excision in four cases and an end-to-end anastomosis in two cases. The results (for a period of 1-10 years) were excellent in all but three cases: two early graft occlusions (vein interposition) and one late occlusion (Dacron bypass) in the course of a re-operation which had become necessary because of a ruptured aneurysm of the gastro-epiploic artery after 3 months. Three of 23 patients were treated by embolisation of four intraparenchymal aneurysms. The follow-up of a non-treated saccular aneurysm showed a total thrombosis of the aneurysm within 4 years and fixed renal hypertension developed later in this patient. We suggest surgical repair of an RAA regardless of its size and the clinical symptoms, in order to prevent microembolism into the renal parenchyma and to avoid the development of fixed renal hypertension. Intrarenal aneurysms can be treated by embolisation to stop severe haematuria thus preserving the kidney.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Renal artery aneurysm: surgical indications and results. 139 40

After a ruptured aneurysm has been clipped in patients with multiple aneurysms, the question often arises whether to use volume expansion and/or hypertensive treatment to prevent delayed cerebral ischemia (vasospasm). There is understandable concern regarding the possible rupture of unprotected aneurysms under additional hemodynamic stress. In a series of 199 patients with aneurysmal subarachnoid hemorrhage who underwent early surgery, 31 were left with one or more unprotected aneurysms postoperatively. All patients were treated with prophylactic volume expansion based on a previously reported protocol. Mean central venous pressure during treatment was 10.3 cm H2O and mean arterial blood pressure 141/76 mm Hg; volume expansion was continued for 7 to 10 days. Eight patients developed symptoms of delayed cerebral ischemia and required additional volume expansion and induced hypertension. After institution of hypertension, four of these patients experienced a reversal of their symptoms, while four others developed cerebral infarcts. One patient died from massive cerebral infarction following vasospasm refractory to all measures. No patient suffered rupture of an unprotected aneurysm during hypervolemic treatment. It is concluded that the benefit of prophylactic hypervolemic hypertension in postoperative aneurysm patients warrants its use even in patients with unprotected aneurysms.
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PMID:Unruptured aneurysms and postoperative volume expansion. 833 19

Between 1979 and 1988, 656 patients were operated upon for abdominal aortic aneurysm. Elective operation was performed in 287 patients (44%) and acute operation in 369 patients. A ruptured aneurysm was found in 218 patients (33%). Patients with arteriosclerotic heart disease, hypertension, impaired renal function or chronic pulmonary disease showed an increased perioperative mortality. Development of postoperative cardiac and renal complications could not be related to previous cardiac or renal diseases. The major postoperative complications were renal failure in 81 patients (12%), pulmonary insufficiency in 77 patients (11%) and cardiac complications in 96 patients (13%). Failure of one or more organs occurred in 153 patients (23%) and the mortality rate for patients with multiorgan failure was 68%. Complications leading to reoperation occurred in 93 patients (14%). The perioperative mortality was 18.8%. The mortality for elective cases was 4.8%, for symptomatic cases 17.2% and 37% for ruptured aneurysms. The five-year survival rate was 48% for ruptured aneurysms, 70% for symptomatic cases and 75% for elective cases. After six months the life expectancy in these three groups of patients were identical and comparable to the expected survival for a sex and age matched control population.
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PMID:Surgery for abdominal aortic aneurysms. A survey of 656 patients. 193 27

We present a 33-year-old female who had a ruptured aneurysm at the trifurcation of the right middle cerebral artery accompanied by coarctation of the aorta. The aneurysm was successfully clipped 15 hours after the attack of subarachnoid hemorrhage and approximately 3 months later the coarctation was surgically treated. Many authors reported that the incidence of cerebral aneurysm was higher in the patients with coarctation than the general population. Our review of the literatures, however, revealed that the incidence of cerebral aneurysm was the same in the population with or without coarctation. The incidence of rupture was higher when the aneurysms was accompanied by coarctation. The average age of the patients at the aneurysmal rupture was younger in the patients with coarctation than the patients without coarctation. These findings suggested that the growth and rupture of aneurysm in the patient with coarctation are related to the hypertension and atherosclerosis. Treatment of the patients with intracranial ruptured aneurysm accompanied by coarctation should begin with the clipping of the aneurysm, and then the coarctation surgically repaired. If the aneurysm is unruptured coarctation should be repaired first, and then the aneurysm clipped.
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PMID:[Ruptured cerebral aneurysm associated with coarctation of the aorta]. 207 50

The transcranial doppler (T.C.D.) is a non-invasive technique useful for the evaluation of vasospasm and intracranial hypertension in patients with subarachnoid hemorrhage (S.A.H.). Eighteen patients with recent S.A.H. were studied by means of T.C.D. device: in 14 patients the source of bleeding was a ruptured aneurysm of the circle of Willis, while the remaining 4 presented a negative four-vessels angiography. All the patients were studied 5 and 10 days after the bleeding. Our data showed that the ultrasonographic demonstration of vasospasm and/or I.C.H. is clearly related to the clinical status of the patients. No significant T.C.D. difference was noticed between the "sine materia" S.A.H. patients and the ones with ruptured aneurysm.
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PMID:The transcranial Doppler ultrasonography in the evaluation of vasospasm and of intracranial hypertension after subarachnoid hemorrhage. 228 38

Intraventricular and intracerebral hemorrhage were observed in two patients (36-year-old male and 45-year-old female) whose ischemic deficits from vasospasm after subarachnoid hemorrhage due to ruptured aneurysm were treated or prevented with hemodynamic therapy. Both patients had a long history of arterial hypertension and showed high values of urinary catecholamine after subarachnoid hemorrhage. The cause of hemorrhage seemed to be the induced hypertension and the volume expansion in one case and the uncontrolled hypertension and the volume expansion in the other case. Although two patients were treated with the volume expansion therapy continuously after hemorrhage, neurological status deteriorated due to infarction caused by vasospasm. We discussed the limit and risk of hemodynamic therapy for patients who had a long history of arterial hypertension and increased catecholamine release after subarachnoid hemorrhage.
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PMID:[Intraventricular and intracerebral hemorrhage as complication of hemodynamic therapy for vasospasm after subarachnoid hemorrhage--analysis of 2 cases]. 241 82

The incidence of perioperative complications was retrospectively reviewed in 103 patients who underwent replacement of the abdominal aorta from 1981 to 1987. Eighty-nine of the patients had associated systemic diseases, with hypertension being the most frequent (63%). Ischemic heart disease and cerebrovascular disease had an incidence of 12% and 13%, respectively. Combined anesthesia with lumbar epidural and light general anesthesia (group I) was compared with general anesthesia alone (group II). Excluding patients with a ruptured aneurysm, 39 of 97 patients (40%) had associated intraoperative hypertension, which was related to the presence of preexisting hypertension, but not to the anesthetic technique. Postoperative hypertension also occurred in 39 patients, but the incidence was not related to preoperative hypertension. More patients in group I had postoperative hypertension than in group II (P less than 0.05). In group I, 6 of 22 patients who received epidural morphine developed hypertension compared to 23 out of 37 patients not given epidural morphine (P less than 0.01). There were no significant differences in the overall complication rate between the two groups; however, the incidence of liver dysfunction was significantly higher in group II. Deterioration in renal function occurred in 6 patients, but with no difference between groups. There were three perioperative deaths (2.9%), with two of them resulting from cerebrovascular accidents in patients with a history of cerebrovascular disease. The overall morbidity and mortality were independent of the anesthetic technique.
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PMID:Anesthetic management of abdominal aortic surgery: a retrospective review of perioperative complications. 252 Sep 38

We report three cases of fatal retrograde dissection of the aortic arch after exclusion-bypass with metal clamps according to Carpentier's thromboexclusion method. All three patients were male, aged 59, 66, and 73 years. Initial operative indications were chronic dissections in two cases and atheromatous aneurysm of the descending thoracic aorta in the other. Two of these patients were operated on in an emergency setting for a ruptured aneurysm. In all three cases, an extraanatomic bypass between the ascending aorta and abdominal aorta was performed as the first step: The proximal clamp was then placed distal to the origin of the left subclavian artery. Death occurred two hours, 12 hours, and eight days after operation, respectively. Autopsy revealed retrograde dissection initiating in the aortic arch and reaching the aortic ring as the cause of death. Pathological examination of aortic specimens confirmed that the dissections began just proximal to the site of clamping. To explain this complication, two etiologic factors, occurring either alone or together, have been postulated: postoperative hypertension and trauma to the aortic wall from the clamp.
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PMID:Retrograde dissections of the aortic arch after exclusion-bypass of the descending thoracic aorta: a report of three cases. 259 19

Among 528 cases with ruptured aneurysm, 10 cases (1.9%) developed hemorrhagic infarction following vasospasm. There was no obvious relationship between the occurrence and location of aneurysm and the neurological grade on admission. Hemorrhagic infarction occurred from day 9 to 25 (mean day 16) after aneurysmal rupture, and the major neurological symptoms were aggravation of consciousness level, which appeared in 6 cases. On the CT scans of the hemorrhagic infarction following vasospasm, nine cases revealed heterogeneous hemorrhage as assembled of spotty or linear hemorrhages within the ischemic infarction, and 5 cases had massive hemorrhagic infarction in size with mass effect. Although surgical therapy for 2 cases and conservative therapy for 8 cases were performed, the results were unfavorable; ie, 2 cases were good, 5 fair or poor, and 3 died. Especially, 5 cases with massive hemorrhagic infarction obviously resulted in poor prognosis. In our series, induced hypertension therapy for vasospasm was considered as a risk factor. In conclusion, it is necessary to avoid induced hypertension therapy in the remission stage of vasospasm and serial SPECT study might be recommended as a useful prospective method estimating the vasospasm.
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PMID:[Hemorrhagic infarction following cerebral vasospasm]. 260 44


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