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Query: UMLS:C0162871 (abdominal aortic aneurysm)
 8,664 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Anasarca and intractable congestive heart failure were the presenting signs of an abdominal aortic aneurysm with aortocaval fistula. Management with careful monitoring of cardiovascular function using a Swan-Ganz catheter before, during, and after surgery resulted in an uneventful recovery.
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PMID:Management of aortocaval fistula due to abdominal aortic aneurysm. 45 77

An aorto-caval fistula is a rare complication of an abdominal aortic aneurysm (AAA). Typical features, including congestive heart failure and a loud abdominal bruit, may be present and allow prompt diagnosis, but not infrequently they are absent or overlooked and the diagnosis not made preoperatively. Four patients with an AAA and an aorto-caval fistula are described, each of whom presented with hematuria. We believe the presence of hematuria in a patient with a symptomatic AAA should suggest the diagnosis of an aorto-caval fistula. A correct preoperative diagnosis may contribute to better planning of the operative procedure, reduced blood loss, and avoidance of possible pulmonary embolization.
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PMID:Hematuria as a sign of aorto-caval fistula. 60 81

The placement of a Swan-Ganz catheter into the abdominal vena cava by the femoral route is recommended for all patients presenting with severe congestive heart failure and an abdominal aortic aneurysm. If an aortocaval fistula exists, its presence can be determined immediately by noting increased vena caval pressure and higher than normal oxygen content. Immediate recognition of this condition is essential. Fluid overloading is avoided, immediate surgical treatment is instituted and the defect is closed. Minimal manipulation is done in an effort to prevent pulmonary embolization. If the results of catheter studies show no evidence of an aortocaval communication, it may be advisable to make an effort to correct the congestive heart failure before surgically correcting the aneurysm.
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PMID:Aortocaval fistula detection using a Swan-Ganz catheter. 87 Oct 3

The records of 111 patients, 80 years of age or older, with a primary diagnosis of abdominal aortic aneurysm(AAA) showed that 86 patients underwent aneurysm resection and grafting. Ruptured AAAs (n=30) were associated with an operative mortality of 74%. By contrast, AAA resection in the expanding aneurysm group (n=19) and in the elective surgery group (n=44) was associated with a 10% and 2% mortality, respectively. Thus, resection of a nonruptured AAA in 63 octogenarians was carried out with an overall mortality of 4.7%. While nearly half of the patients had cardiac disease detected preoperatively, the elective group demonstrated a low incidence of previous myocardial infarction (7%) and congestive heart failure (8%). Concomitantly, the incidence of myocardial infarction (6%) and congestive heart failure was relatively low after AAA resection. Significant postoperative oliguric azotemia was observed in only 5% of the nonruptured patients. Long-term survival was comparable to that of the general population over the age of 80 years. The quality of life enjoyed by these patients was not adversely affected by AAA resection. By contrast, 50% of patients treated conservatively died of ruptured AAA. Physiologic rather than chronologic age should determine selection for AAA resection in the octogenarian.
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PMID:Is 80 years too old for aneurysmectomy? 98 73

We retrospectively reviewed the records of 88 patients who underwent a total of 95 in-situ bypass operations. Seventy-eight percent were diabetics, 56% hypertensives, 23% had a history of a myocardial infarction, 18% a previous stroke or transient ischemic attack, and 19% a renal transplant. Eighty-eight percent had general anesthesia. Eighty-four percent of the operations extended distal to the popliteal trifurcation, with an average operating time of 5.12 +/- 1.25 hours and blood loss of 354 +/- 239 ml. The overall mortality was 4.2%, with two deaths due to wound sepsis and two deaths due to congestive heart failure. The perioperative myocardial infarction rate was 6.3%. The average age of the patients who died was significantly greater than the age of those who survived (78.2 +/- 17.7 years vs. 59.9 +/- 14.8 years, p less than 0.05). The Goldman risk index was not helpful in predicting cardiac complications. The results show that patients undergoing in-situ bypass operations are at high risk for cardiovascular complications. Aggressive perioperative evaluation and management similar to that shown to reduce such complications in abdominal aortic aneurysm surgery should be helpful.
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PMID:Complications and mortality of the in-situ saphenous vein bypass for lower extremity ischemia. 153 65

Spontaneous aortocaval fistula is a rare but documented complication of arteriosclerotic abdominal aortic aneurysm. Most cases reported have presented clinically with a palpable aneurysm, abdominal bruit, and high output congestive heart failure. A diagnosis in such cases requires active demonstration of findings secondary to arteriovenous shunting, which can be optimized utilizing proper CT bolus technique and dynamic scanning. We describe several CT findings--all of which may be typical for and support the diagnosis of this potentially lethal complication of abdominal aortic aneurysm.
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PMID:Computed tomography of primary aortocaval fistula. 156 99

We present a surgical technique that we believe provides superior cerebral protection for simultaneous correction of carotid and cardiac pathology with low operative mortality and stroke rate. Our study population consists of 23 consecutive patients undergoing cardiac operation between August 1989 and April 1991 who also had associated critical (greater than 85%) carotid artery stenosis. Using 20 degrees C systemic hypothermia for cerebral protection, we performed simultaneous correction of both lesions during the aortic cross-clamp period, using continuous retrograde blood cardioplegia for myocardial protection. Mean patient age was 69.4 years; 83% were 65 years or older. Eighty-seven percent had angina, 35% had recent myocardial infarctions (within 30 days), and 52% had congestive heart failure. Asymptomatic bruit was found in 39%, and 61% had previous strokes, neurologic symptoms, or both. All had 85% or greater luminal narrowing on cerebral angiography, with 65% having severe or critical contralateral disease as well. Sixty-one percent had associated other vascular pathology, including peripheral vascular occlusive disease, renal artery stenosis, or abdominal aortic aneurysm. There were no postoperative strokes or neurologic events. One early vein graft occlusion resulted in postoperative myocardial infarction and subsequent death (4.3%).
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PMID:Combined cardiac operation and carotid endarterectomy during aortic cross-clamping. 843 Oct 83

A cost-effective method to reduce mortality rates after abdominal aortic aneurysm repair centers on selecting and investigating only those patients at risk for cardiac-related death. All 146 patients undergoing asymptomatic abdominal aortic aneurysm repair over a 5-year period (1986 to 1990) were retrospectively placed into one of the three following groups on the basis of a clinical evaluation. Group I: no history of myocardial infarction or angina, no congestive heart failure, and no ischemic changes on electrocardiogram (ECG). Group II: history of myocardial infarction or class I-II angina or ischemic changes on ECG. Group III: presence of congestive heart failure or class III-IV angina. Patients in group I had no further cardiac work-up; patients in group II with angina had left ventricular ejection fraction assessment by multiple gated acquisition (all greater than 37%) and were cleared for operation by a cardiologist; patients in group II without angina had no further cardiac work-up; patients in group III had coronary angiography and then coronary revascularization. The overall mortality rate was 4.8%, with a cardiac mortality rate of 3.4%. The mortality rate in group I (n = 64) was 1.8%, with no cardiac-related deaths; the mortality rate in group II (n = 63) was 9.5% (8% cardiac-related deaths). No deaths occurred in group III (n = 19). The difference between the cardiac mortality rates in groups I and II was significant (p = 0.02) as was the postoperative cardiac morbidity: total myocardial infarctions (p less than 0.001); congestive heart failure (p = 0.02); tachyarrhythmias (p = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Does the clinical evaluation of the cardiac status predict outcome in patients with abdominal aortic aneurysms? 159 94

The purpose of this study was to evaluate the ability of dipyridamole-thallium scintigraphy to predict perioperative and late cardiac events after peripheral vascular operations. A total of 262 patients had dipyridamole-thallium scintigraphy before 87 infrainguinal reconstructions, 108 abdominal aortic aneurysm operations, and 67 aortobifemoral bypass grafts that were placed for occlusive disease. Follow-up extended to 5 years (mean, 31.1 months). Logistic regression analysis selected dipyridamole-thallium scintigraphy redistribution as the best predictor of perioperative events. Fixed defects were not predictive. A Cox proportional hazards model for a variety of clinical risk factors and scan parameters identified fixed defects and a history of congestive heart failure as the strongest predictors of late cardiac events. The presence of greater than 1 or 2 fixed segments were the best predictors in patients with an abnormal scan; redistribution did not predict late events. The risk of combined perioperative or late cardiac events was 29% for infrainguinal, 19% for abdominal aortic aneurysm, and 7.5% for aortobifemoral operations. Life-table analysis showed that after a cluster of perioperative events that occurred primarily in patients with dipyridamole-thallium scintigraphy redistribution, most of the late cardiac morbidity and deaths occurred in patients with fixed defects.
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PMID:Dipyridamole-thallium scintigraphy predicts perioperative and long-term survival after major vascular surgery. 159 95

The authors report 56 patients. 80 years of age or older who had an abdominal aortic aneurysm (AAA): twenty seven were operated upon as emergencies, 7 with intra-peritoneal (Group I) and 20 with retro-peritoneal rupture (Group II). Twenty nine underwent elective surgery (Group III). Renal pulmonary and cardiac disease are frequent in octogenarian patients. The surgical repair consisted of 40 knitted bifurcated grafts and 16 aorto-aortic woven grafts. The overall in-hospital mortality rate is high (28.5%: 16 patients) essentially in "emergency" surgery: 71% for the seven Group I patients and 45% for the twenty Group II patients. The in-hospital mortality rate of 6.9% for the Group III of "elective" procedure is higher than the mortality rate of patients of all ages operated on for asymptomatic AAA in our institution which is 4.3%. Once a patient has been operated on successfully his life expectancy tends to parallel that of a normal population for his age group. These results can be improved with preventive measures such as elective surgery for asymptomatic AAA with a diameter of 6 cm or more. Operative contraindications are severe congestive heart failure, advanced pulmonary disease or neoplastic disease. The age "per se" is not a contraindication to aneurysmectomy. Physiologic rather than chronologic age should determine the selection for AAA in the over-80 age group. CT scans and MR are safe fast and non-invasive preoperative examinations for AAA.
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PMID:Abdominal aortic aneurysmectomy in octogenarian patients. 232 87


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