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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Over the last 5 years an extended left flank retroperitoneal approach was used in 85 of 531 (16%) aortic reconstructions deemed technically complex. Abdominal aortic aneurysm repair was performed in 70 patients (82%), bypass of aortoiliac occlusive disease was performed in 11 (13%), and aortic endarterectomy for mesenteric and/or renovascular disease was performed in 4 (5%). Indications for use of this approach included a "hostile" abdomen (43 patients), juxta/suprarenal abdominal aortic aneurysm (35), large (greater than 10 cm) abdominal aortic aneurysm (12), extreme obesity (10), associated renal and/or visceral artery stenosis requiring endarterectomy (9), inflammatory abdominal aortic aneurysm (2), and horseshoe kidney (2). Suprarenal or supraceliac aortic clamping, averaging 31 minutes, was required in 43 patients (50%). Postoperative recovery was rapid (average length of stay, 10.2 days), and morbidity was minimal despite the complex nature of these reconstructions. The perioperative mortality rate in elective operations was 1.2%. This approach facilitated proximal abdominal aortic exposure and anastomosis, especially in large, pararenal aneurysms or in situations unfavorable to a transabdominal approach. Whereas a left flank retroperitoneal approach can be used in most aortic reconstructions, it seems especially suited to those that pose significant technical challenges.
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PMID:Left flank retroperitoneal exposure: a technical aid to complex aortic reconstruction. 183 61

During a 14-month period we used a left-flank, retroperitoneal, retrorenal approach in 23 high-risk patients with abdominal aortic aneurysm (AAA). Fourteen patients underwent suprarenal/celiac cross clamp for juxtarenal/suprarenal AAA and/or associated occlusive disease. Other indications for this approach included diminished cardiac and/or pulmonary reserve, previous extensive abdominal surgery, obesity, and inflammatory AAA. There was only one death (4%) in this high-risk group and minimal operative morbidity. The flexibility afforded by this approach for high aortic exposure allowed expeditious proximal anastomoses with minimal postoperative renal dysfunction. Pulmonary complications, ileus, and pain were reduced and patient mobilization was rapid despite the complex nature of the operative procedures. We believe that this approach offers significant advantages for all cases of AAA but particularly for anatomically complex lesions and medically high-risk patients.
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PMID:Retroperitoneal approach to high-risk abdominal aortic aneurysms. 395 89

To evaluate the prevalence of abdominal aortic aneurysm (AAA) and occlusive peripheral vascular disease (PVD) in Japanese residents, and to examine the correlations between these diseases and the risk factors of atherosclerosis, 348 residents of a village in central Japan aged between 60 and 79 years were screened. The screening for AAA was performed using ultrasonography (US) and that for PVD was performed by palpation and Doppler US. No AAA was found, and a right common iliac arterial aneurysm was detected in a 79-year-old man (0.3%). The mean diameter of the infrarenal abdominal aorta was 18.7 mm and an abdominal aorta of 25 mm or greater in diameter was seen in 16 participants (4.6%), all of whom need to be followed up. PVD was suspected in two patients (0.6%) with a low ankle brachial pressure index. Of a total of five patients diagnosed or suspected of having a common iliac arterial aneurysm or PVD, four (80%) had at least one risk factor for atherosclerosis. Thus, we conclude that Japanese residents with risk factors predisposing them to atherosclerosis such as hypertension, obesity, abnormal serum lipid levels, and a history of smoking should be selectively screened for AAA and PVD due to the low prevalence of these diseases and from the viewpoint of cost-effectiveness.
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PMID:Screening for abdominal aortic aneurysm and occlusive peripheral vascular disease in Japanese residents. 754 72

Heavily injured patients, patients who underwent operations on pelvis, hips, abdomen or malignoma surgery, as well as gynaecology patients suffering from malignoma or previous deep femoral vein thrombosis in connection with pregnancy or obesity are at risk to suffer from pulmonary embolism with potentially lethal course. In a retrospective study we evaluated the advantage of the prophylactic use of temporary vena cava filters and their side effects. The indications were 18 cases of surgery, with known iliacal vein or cava thrombosis, 3 cases of pregnancy thromboses, and 1 high-dose heparinisation after acute pulmonary embolism without lysis. Additionally a postoperative lysis therapy was performed due to a life-threatening pulmonary embolism in 1 patient. 1 Cook filter (transfemoral), 3 Angiocor filters (transbrachial), and 19 Antheor filters (3 transjugular, 5 transfemoral, 11 transbrachial) were implanted. In these patients no clinically visible pulmonary embolism occurred under therapy, 3 thrombi were detected in the filter. Complications were caused either by the underlying therapy alone (1 lethal outcome of abdominal aortic aneurysm surgery), by the combination of therapy and cava filter implantation (1 case of arm haematoma, 1 ascending thrombosis) or by filter implantation alone (2 cases of v. subclavia thrombosis, 1 dislocation, 1 basket rupture). Since temporary cava filters have no secondary complications per se, their use seems justified as long as there is strict indication including presence of iliacal vein or cava thrombosis and risk of thrombi mobilisation.
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PMID:[Indications and results of surgically treated, with temporary vena cava filter managed patients]. 909 30

The disturbances in the balance of pro- and antifibrinolytic activity, as observed in AAA and obesity, respectively, have considerable potential for influencing both intra- and extravascular fibrinolytic events and may be causally related to the development of vascular disease. For example, the wall of the aortic atherosclerotic aneurysm seems to host an uneven distribution and imbalanced expression of the various components of the fibrinolytic system. The sites of increased proteolytic activity may contribute to localized neovascularization and promote the rapid breakdown of ECM components, which result in mural weakening and eventual rupture of untreated aortic aneurysms. On the other hand, the disturbance of the normal hemostatic balance observed in obesity appears to result from the elevated expression of PAI-1 by the adipose tissue. Our data strongly suggest that the adipocyte is one of the primary cells in the adipose tissue capable of expressing PAI-1 both in obesity, and in response to cytokines and hormones like TNF-alpha and insulin. Since both TNF-alpha and insulin are known to increase in obesity, the elevated levels of PAI-1 observed in the plasma of obese individuals may result from TNF-alpha and/or insulin induction of PAI-1 in the adipose tissue itself.
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PMID:Expression of fibrinolytic genes in tissues from human atherosclerotic aneurysms and from obese mice. 918 10

The correlation between abdominal aortic dilatation and arteriosclerotic risk factors was studied in 2514 Japanese residents (947 men, 1567 women, mean age 70 years old). The aortic diameter was measured by ultrasound and an aortic dilatation was defined as above 30 mm in diameter, including abdominal aortic aneurysm (AAA). Forty-three (1.7%) patients with a dilated aorta and 2471 with a normal-sized aorta were compared. Abdominal aortic dilatation was significantly (p < 0.01) more frequent in men than in women (3% vs 0.7%). Obesity and hyperlipidemia were slightly (p < 0.1) more frequent in patients with a dilated aorta than in those with a normal-sized aorta. There were no significant differences between the two groups in mean age, frequency of smoking, diabetes mellitus, and coronary artery disease. In conclusion, male obesity and hyperlipidemia may be risk factors for aortic dilatation in Japan. Women may not be screened because of cost-effectiveness. The prevalence of aortic dilatation in Japan was lower than in European countries. However, screening for AAA using ultrasound would be advantageous when considering the grave prognoses of ruptured AAA.
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PMID:Abdominal Aortic Dilatation in Japanese Residents. 982 3

In this prospective, nonrandomized study, we compared outcome with percutaneous femoral artery closure to that with open femoral arteriotomy in 95 patients who underwent endovascular AAA repair. Devices were introduced using 22 Fr and/or 16 Fr sheaths. The 8 Fr/10 Fr Perclose devices (Perclose Inc., Redwood City, CA) were used in an off-label "preclose technique." Thirty-three patients had bilateral open femoral arteriotomies, 44 patients had bilateral attempted percutaneous closure, and 18 patients had open femoral arteriotomy on one side and attempted percutaneous closure on the other side. Percutaneous closure was successful in 85% (47/55) of 16 Fr sheaths and 64% (29/45) of 22 Fr sheaths (p < 0.027). Bilateral percutaneous closure was successful in 63% (28/44) of patients. Conversion to open femoral arteriotomy due to bleeding occurred in 24 of 106 percutaneous attempts. There were no dissections, arterial thromboses, or pseudoaneurysms associated with percutaneous arterial closure. Wound complications were seen in 3.6% (3/84) of open arteriotomies and 0.9% (1/106) of all percutaneous attempts and arterial closures (p > 0.05). Gender, previous femoral access, obesity, and iliac occlusive disease were not predictive of percutaneous failure. Procedural success for percutaneous AAA repair is affected by sheath size. Devices delivered through 16 Fr or smaller sheaths will have successful femoral artery closure rates of at least 85%.
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PMID:Percutaneous endovascular abdominal aortic aneurysm repair. 1190 3

An aneurysm is an abnormal dilatation of an artery, often as a result of atherosclerotic disease. Hypertension, connective-tissue disease and a family history of aneurysms are predisposing risk factors. They may occur at any point in the vasculature from the aortic root to distal peripheral vessels, but they are most common in the abdominal aorta. Many times they are asymptomatic and undiagnosed, but as they progressively enlarge, they may compress on surrounding structures, release atherosclerotic debris or thrombi and possibly rupture. Aneurysms occur in approximately 3% of people older than 50; some of these do not rupture. An aneurysm is not typically painful until it dissects or ruptures. [table: see text] The abdominal aorta splits at the level of the umbilicus, so the abdomen must be palpated above the level of the umbilicus to feel for aortic enlargement. Obese patients make detection more difficult, as the presence of a pulsatile mass may be covered. An aneurysm will still conduct blood flow into the lower extremities, so pulses will not be compromised, and capillary refill and temperature will be normal. An acute rupture is a catastrophic event characterized by poor perfusion or frank shock and pain in the abdomen, back or groin. Accompanying symptoms may include a pulsatile abdominal mass, absence of distal pulses, and radiating pain into the lower back that is often described as "tearing" or "ripping." The risk of rupture has a direct correlation with an aneurysm's size. Generally, elective surgery is considered with an abdominal aneurysm larger than 4.5 centimeters, but there are many factors which may preclude repair. Non-surgical treatment of an aneurysm has been performed by percutaneously placing a prosthetic graft at the site, anchoring the graft above and below the aneurysm, thereby isolating the aneurysm from the circulation. Surgical treatment for elective repair of an aneurysm that is not ruptured is still very difficult and has a significant risk of complications. A ruptured abdominal aortic aneurysm has a very high incidence of mortality. Early identification and rapid transport to a facility with vascular surgery services are the keys to survival. This case demonstrates early recognition by the EMS crew and successful resuscitation from a cardiac arrest due to profound shock. In other cases, EMS providers may have the first and only opportunity to recognize a ruptured aneurysm and direct the ED and surgical teams to the cause of sudden shock or cardiac arrest.
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PMID:Gut feeling. 1465 9

A progressively enlarging left common iliac artery aneurysm developed in a 72-year-old man 7 years after open abdominal aortic aneurysm repair with a bifurcated Dacron graft. Because both the right hypogastric and inferior mesenteric arteries had been ligated at the initial operation, preservation of left hypogastric flow was critical to avoid pelvic or intestinal ischemia. He was a poor open surgical candidate owing to obesity, a hostile abdomen, and multiple medical comorbidities. Therefore, a novel hybrid approach was used consisting of left transbrachial selective left hypogastric artery catheterization, followed by deployment of two, overlapping, antegrade, covered stent grafts extending from the proximal left graft limb into the left hypogastric artery. A right-to-left femorofemoral crossover bypass was added to perfuse the left lower extremity and was performed in end-to-end fashion to the left common femoral artery to exclude and prevent retrograde flow into the iliac aneurysm. Also presented are potential procedural pitfalls and a detailed review of open, endovascular and hybrid options to preserve hypogastric flow when treating iliac aneurysms in complex, high-risk patients.
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PMID:A novel hybrid approach to the treatment of common iliac aneurysms: antegrade endovascular hypogastric stent grafting and femorofemoral bypass grafting. 1754 89

Previous reports suggest that percutaneous access for endovascular abdominal aortic aneurysm repair (P-EVAR) is as safe as open access (O-EVAR) in patients with favorable femoral anatomy. Severe femoral artery calcification and obesity have been considered relative contraindications to P-EVAR, but these criteria have not been evaluated. The purpose of this study was to assess the postoperative anatomic changes associated with P-EVAR versus O-EVAR using three-dimensional (3-D) computed tomographic (CT) reconstruction and to evaluate the overall results of the two procedures in a group of patients with suboptimal femoral anatomy. During a recent 26-month period, 173 patients underwent EVAR at our institutions, including 35 P-EVARs. Of these, 22 (63%) had complete pre- and postoperative CT imaging of the femoral arteries. These subjects were compared to 22 matched controls who underwent O-EVAR during the same period. Automated 3-D reconstructions were used to measure the following anatomic femoral artery parameters before and after EVAR: arterial depth, calcification score, minimum diameter and area, and maximum diameter and area. Of the 88 study arteries, 50 underwent open access and 38 percutaneous access (Proglide, n=11; Prostar XL, n=27). Both groups were similar regarding sheath size, number of components, operative time, blood loss, and length of stay. Significantly more O-EVAR subjects suffered groin complications (p=0.02), including five hematomas, two wound infections, two femoral thromboses, and one vessel which required patch repair. In the P-EVAR group there was only one hematoma, which was managed conservatively. There was no difference between the P-EVAR and O-EVAR groups with respect to femoral artery calcification (Agatston scores 667+/-719 vs. 945+/-1,248, p=0.37). Obesity (body mass index >30) was documented in six (27%) of both the P-EVAR and O-EVAR groups (p=nonsignificant). Pre- and postoperative CT-derived anatomic data showed a significant decrease in the minimal vessel area with O-EVAR compared to P-EVAR (p=0.02). This study demonstrates that patients with obesity or severely calcified femoral arteries can be successfully treated percutaneously with fewer minor groin complications.
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PMID:Percutaneous access for endovascular abdominal aortic aneurysm repair: can selection criteria be expanded? 1895 64


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