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

A 66-year-old man with the chief complaint of oliguria had been referred to our hospital under the diagnosis of bilateral hydronephrosis and abdominal aortic aneurysm by his family doctor. CT scan and digital subtraction angiography demonstrated an abdominal aortic aneurysm continuing to bilateral internal iliac arteries. The degree of right hydronephrosis was less advanced compared to the left side. Right percutaneous nephrostomy was performed because the retrograde stenting was unsuccessful. After the renal function improved, an operation for the aneurysm was undertaken in the surgical department. Although bilateral ureterolysis was possible, the resection of the aneurysm could not be done. After clamping the nephrostomy catheter, drainage of urine into the ureter was not seen one month after the operation. A double-J ureteral stent was inserted by the antegrade approach and the nephrostomy tube was removed. By exchanging the stent every 3 months, the renal function has been stable and the size of the aneurysm unchanged during the 25 months after the surgery.
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PMID:[Bilateral ureteral obstruction secondary to aneurysm of abdominal aorta: a case report]. 160 68

This report reviews the authors' experience in diagnosing and managing 17 consecutive patients with inflammatory abdominal aortic aneurysm (AAA). Among 491 patients undergoing repair for AAA during a 10-year period, 17 (3%) had evidence of associated periaortic fibrosis, which was confirmed histologically. No patient had acute rupture, and two patients (12%) had chronic contained rupture. Ureteral obstruction was evident in seven patients. In 41% of the patients, available surgical correlation demonstrated that computed tomographic (CT) scan accurately delineated the extent of the disease. Sixteen patients underwent aneurysm resection. Ureteral obstruction was relieved by ureterolysis in three patients treated early in this series. In the last period of the study, well-documented hydronephrosis spontaneously subsided in two patients without special treatment. Of these 17 patients, 15 (88%) were early (30-day) survivors. There were two late deaths at 2 months and 5 years; 12 (71%) patients are still alive and free of symptoms up to 10 years after operation. On the basis of our study, we conclude the following: (1) precise preoperative diagnosis and detailed anatomic information are widely available with CT; (2) aneurysm resection is the treatment of choice because the risk of rupture still exists, and this procedure seems to reverse the inflammatory process; (3) good early and late results can be expected with proper surgical technique; and (4) routine follow-up with CT is recommended to document resolution or progression of the fibrotic process after aneurysm resection.
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PMID:Diagnosis and management of 17 consecutive patients with inflammatory abdominal aortic aneurysm. 162 4

To estimate its clinically unsuspected prevalence among patients with renal insufficiency, renal duplex sonography (RDS) was used to estimate the presence of critical renal artery stenosis (RAS) in that population. Patients, aged 45 to 75 years, with a serum creatinine of greater than or equal to 2.0 mg% but without dialysis dependence, prior renal transplantation, or prior renal artery surgery were considered for RDS. Fifty-three patients who met criteria for study were randomly selected from the Section of Nephrology clinic files and each patient was contacted both by mail and by telephone. Twenty-five patients agreed to RDS, and renal artery anatomy was determined in 21 patients using standardized RDS techniques. These techniques have demonstrated an overall accuracy of 96 and 97 per cent when compared prospectively to conventional angiography during validity analyses in the authors' center. Results of RDS revealed significant findings in 5 of 21 patients (24%). Three patients demonstrated criteria for ischemic nephropathy (IN): one patient had RAS with contralateral renal artery occlusion confirmed by angiography, while 2 patients demonstrated unilateral RAS. An abdominal aortic aneurysm and unilateral hydronephrosis were discovered in the fourth and fifth patients. Evaluation of patient demographic data and functional parameters as predictors of IN revealed that the duration of renal insufficiency at the time of RDS and extra-renal organ-specific atherosclerotic damage were significantly different between the groups with and without IN. The authors preliminary findings suggest that unsuspected ischemic nephropathy may exist in a significant minority of patients with renal insufficiency.
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PMID:Prevalence of ischemic nephropathy in patients with renal insufficiency. 164 86

A 54-year-old man with hepatitis B virus-related periarteritis nodosa developed retroperitoneal fibrosis with bilateral hydronephrosis 2.5 months after placement of an aortobifemoral prosthesis for abdominal aortic aneurysm. Retroperitoneal fibrosis disappeared after treatment with corticosteroids. This observation is interesting in the light of the hypothesis that retroperitoneal fibrosis is caused by vasculitis.
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PMID:Retroperitoneal fibrosis after surgery for aortic aneurysm in a patient with periarteritis nodosa: successful treatment with corticosteroids. 197 43

In a series of 517 operations for abdominal aortic aneurysm from 1971 to 1988 there were 45 cases (8.7%) with an inflammatory aneurysm with a typical thick glistening whitish fibrous layer. Almost two-third of the patients had rather severe chronic or acute progressive pain in the abdomen, the back or the flank. Unilateral (7) or bilateral (2) hydronephrosis due to ureteral compression occurred in 9 patients (20%). A diagnosis of inflammatory aneurysm was made preoperatively only in 10 patients. In 8 of the 9 patients with hydronephrosis ureterolysis was done, unilaterally (6) or bilaterally (2). After ureterolysis all had complete resolution of the hydronephrosis. Preoperative diagnostic methods are excretory urography, showing medial deviation, ultrasonography and CT-scanning of the abdominal aorta. All patients with an inflammatory aneurysm should undergo aortic replacement to prevent rupture and achieve pain relief. Ureterolysis in cases of hydronephrosis is strongly recommended and may be performed safely and with excellent results.
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PMID:Inflammatory abdominal aortic aneurysms. 222 60

The incidence of inflammatory abdominal aortic aneurysm (IAAA) is reported in between 5 and 15% of all cases of abdominal aortic aneurysms (AAA). As a diagnostic hint the CT- or MRI-scan shows the ureters typically displaced medially, caused by a simultaneously visible retroperitoneal perianeurysmal fibrosis. In IAAA, one has to expect about 25% ureteral congestion, uni- or bilateral. Since the probability of rupture of IAAA--in the natural course between 15 and 25% of the cases--does not apparently differ much from the arteriosclerotic AAA, the operative aorto-iliac reconstruction with bypass grafting is the only solution and procedure of choice. Postoperatively, renal insufficiency caused by congestion normalizes: long-term follow-up by CT-scanning demonstrates the regression of both retroperitoneal fibrotic process and ureteral entrapment. Therefore, the dangerous ureterolysis results to be unnecessary. Hydronephrosis due to ureteral obstruction following aorto-iliac bypass grafting, if progressive or symptomatic, should be treated first non-operatively by ureteral splint.
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PMID:[Inflammatory aneurysm of the abdominal aorta and ureteral obstruction]. 263 97

Abdominal aortic aneurysms are rare causes of ureteric obstruction. We report three cases of inflammatory abdominal aortic aneurysm producing hydronephrosis. In two patients acute renal failure preceded this presentation. The diagnosis can be established by computed tomography when mural thrombus, wall calcification, and an enhancing periaortic soft-tissue mantle are present. It is important to recognize this disease preoperatively.
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PMID:Inflammatory abdominal aortic aneurysm: a cause of urinary obstruction and acute renal failure. 273 13

348 cases of abdominal aortic aneurysm were reviewed for typical features of inflammatory aneurysm (IAAA) (marked thickening of aneurysm wall, retroperitoneal fibrosis and rigid adherence of adjacent structures). IAAA was present in 15 cases (14 male, 1 female). When compared with patients who had ordinary aneurysms, significantly more patients complained of back or abdominal pain (p less than 0.01). Erythrocyte sedimentation rate was highly elevated. Diagnosis was established in 7 of 10 computed tomographies. 2 patients underwent emergency repair for ruptured aneurysm. Unilateral ureteral obstruction was present in 4 cases and bilateral in 1. Repair of IAAA was performed by a modified technique. Histological examination revealed thickening of the aortic wall, mainly of the adventitial layer, infiltrated by plasma cells and lymphocytes. One 71-year-old patient operated on for rupture of IAAA died early, and another 78-year-old patient after 5 1/2 months. Control computed tomographies revealed spontaneous regression of inflammatory infiltration after repair. Equally, hydronephrosis due to ureteral obstruction could be shown to disappear or at least to decrease. IAAA can be diagnosed by computed tomography with high sensitivity. Repair involves low risk, but modification of technique is necessary. The etiology of IAAA remains unclear.
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PMID:[Inflammatory abdominal aortic aneurysm]. 339 98

In a prospectively designed study of 13 consecutive patients with proven abdominal aortic aneurysm, the diagnostic accuracy of computed tomography (CT) was compared with aortography. Computed tomography was found to be a highly informative diagnostic test providing clear delineation of lesions and extent of aneurysm and its relationship to renal and iliac arteries. Furthermore one case of retroperitoneal fibrosis and one case of hydronephrosis were demonstrated by CT. The diagnosis of aneurysm by aortography was uncertain in six cases and in another three cases the relation of the aneurysm to the renal arteries was uncertain. Thus CT was found superior to aortography in examining patients for abdominal aortic aneurysm.
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PMID:Comparison of computed tomography and aortography in abdominal aortic aneurysms. 686 68

The records of 16 patients with 44 aneurysms of the iliac artery during a 12-year period (1981 to 1992) were retrospectively reviewed. The mean age was 71.2 (range 53-81) years; the male/female ratio was 7:1. An extremely high incidence of isolated iliac artery aneurysm was noted relative to abdominal aortic aneurysm (11.7%) during the same period. Aneurysms ranged in size from 2 to 12 cm. Rupture occurred in four patients (25%). Six patients presented urologic complications of ureteral stenosis, with hydronephrosis caused by perianeurysmal fibrosis in five. Thirteen patients underwent surgical treatment with emergency operation performed in four with rupture and one with impending rupture. The mortality rate for ruptured aneurysm was high (50%). The operative procedures for common iliac aneurysms were open resection in 18, aneurysmectomy in two, and thromboexclusion in three. For internal iliac aneurysms, the procedures were aneurysmorrhaphy (partial resection) in five, obliterative endoaneurysmorrhaphy in seven, aneurysmectomy in two, and thromboexclusion in two, with appropriate graft replacement. Endarterectomy and reimplantation of the inferior mesenteric artery, and internal iliac artery graft interposition were performed to prevent colon ischaemia in three and two patients, respectively. Ureterolysis was performed in three patients with ureteral stenosis caused by perianeurysmal fibrosis, which improved hydronephrosis and renal function in two. Early diagnosis and elective surgery before rupture is the treatment of choice for saving the patient's life. The importance of preventing colon ischaemia for bilateral internal iliac aneurysms and ureterolysis for ureter entrapped within perianeurysmal fibrosis is emphasized.
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PMID:Isolated iliac artery aneurysm and its management. 795 55


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