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

Acute thrombosis of an abdominal aneurysm is a catastrophic complication which is little known. It presents as a sudden event, characteristically with lower abdominal pain, signs of profound lower extremity ischemia and pronounced bilateral lower extremity neuromuscular dysfunction. While the mechanism of thrombosis is not understood and is unpredictable, it is certain that the condition is rapidly fatal if uncorrected. The mortality of acute thrombosis is very high, similar to rupture, which is the most common complication of an abdominal aortic aneurysm. Diagnosis is not difficult, and must be followed by prompt surgical restoration of circulation of the lower half of the body, if death is to be prevented. This can be accomplished by aneurysm resection and graft replacement. Retrograde transfemoral thromboembolectomy should not be done. This report describes two successfully operated cases which dramatize the symptomatology of the condition and show the gratifying results of immediate surgical intervention. Only 30 cases (15 fatal) have been reported in the literature.
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PMID:Acute thrombosis of abdominal aortic aneurysm. An uncommon entity. 406 45

The effects on central hemodynamics and skeletal muscle metabolism during surgery for abdominal aortic aneurysm were compared in 6 patients given a preoperative adrenergic block (group B) and in 6 patients who additionally had a temporary brachio-femoro-femoral by-pass during the aortic clamping (group B + S). The cardiac output, heart rate, arterial and pulmonary artery pressures and the cardiac filling pressure were studied. Biopsy specimens from the lateral vastus muscle and blood samples from the radial artery and the iliac vein were taken before aortic clamping and also before and 30 minutes, 4 and 16 hours after the aortic declamping. Intramuscular temperature and pH were measured. The glycogen, glucose, lactate, pyruvate, ATP, ADP, AMP, phosphocreatine (PCr) and creatine (Cr) contents of the muscle and the lactate and pyruvate concentration in iliac venous and radial arterial blood were determined, using enzymatic fluorometric techniques. In group B, aortic clamping induced severe temporary incomplete ischemia with a 300% increase in lactate/pyruvate (L/P) ratio and a fall in intramuscular pH (pHm). The adenylate energy charge (EC) decreased, but the creatine (PCr + CR) and the adenylate (ATP + ADP + AMP) pool remained unchanged. After aortic declamping, the L/P ratio, EC and pHm regained their preclamping values, but the pools of energy phosphate compounds were reduced, indicating dysfunction or damage of the muscle cells. In group B + S there were no major muscle metabolic changes during clamping or after declamping of the aorta. In group B the systemic vascular resistance (SVR), mean arterial blood pressure (MAP) and left ventricular stroke work (LVSW) increased during the occlusion. On release of the clamp, cardiac output rose, possibly due to the sudden reduction of SVR. A temporary marked fall of MAP occurred. In group B + S, no increase of SVR, MAP or LVSW was observed during aortic clamping. After the declamping, only a minor MAP drop was observed. In both groups, a brief rise in pulmonary vascular resistance after the aortic declamping suggested transient pulmonary microembolism. If a high-risk patient is to undergo reconstructive surgery of the abdominal aorta and/or technical difficulties can be expected to necessitate prolonged cross-clamping during the operation, a temporary extracorporeal by-pass may be a favorable adjuvant, improving cardiac performance and preventing derangement of muscle metabolism.
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PMID:Temporary incomplete ischemia of the legs induced by aortic clamping in man. Metabolic and hemodynamic effects of temporary extracorporeal by-pass. 613 73

We analyzed 110 patients who underwent abdominal aortography as a routine preliminary to abdominal aortic aneurysm resection. In 11 of the 15 patients for whom the procedures were useful in planning the operative tactics, the aortograms would have been performed anyway on clinical indications. In two patients, the changes in surgical maneuvers would not have been made through anatomic inspection at the time of the operations, but the lesions were asymptomatic. Biplane views and views of the femoropopliteal systems were rarely influential. Morbidity from the angiography was minimal and mortality was zero, but about seven aortograms were performed for each one that effected a change in procedure. We concluded that abdominal aortography as a preliminary to aneurysmectomy could be reasonably limited to patients in whom it was indicated by clinical features, including important hypertension, impaired renal function, diminished or absent femoral pulses, suspected mesenteric ischemia, suspected suprarenal extension of the aneurysm, or suspected (from the chest roentgenograms) thoracic aneurysm.
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PMID:The place of abdominal aortography in abdominal aortic aneurysm resection. 661 10

A 78-year-old man had complete dehiscence of the suture line of the aorta to a prosthesis, 8 years after standard repair of an abdominal aortic aneurysm. For 6 months, until the aortic was reconstructed, the patient had no hemorrhage or limb ischemia because a conduit was maintained by the original aneurysm wall which had been wrapped around the prosthesis. The authors believe this is the first report of survival following such dehiscence. They advocate the use of non-absorbable sutures when anastomosing the graft to the aorta and repair rather than resection of abdominal aortic aneurysms.
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PMID:Survival following complete detachment of an end-to-end aortic anastomosis. 662 54

In 18 cases with unruptured abdominal aortic aneurysm, preoperative aortographic findings and the mean ratio of inferior mesenteric arterial stump blood pressure to systemic blood pressure (IMA/Syst. Pr. Ratio) were analyzed. In all cases IMA was ligated at operation because IMA/Syst. Pr. Ratio was more than 0.4, and one developed ischemic colitis. Preoperative aortogram was useful to identify meandering mesenteric artery and its flow direction to predict colon ischemia. IMA/Syst. Pr. Ratio following aortic reconstruction ranged from 0.41 to 1.0 with mean value of 0.70. In a case of ischemic colitis the ratio was the lowest value (0.5) except one case. Thus the ratio had diagnostic value to predict colon ischemia. Aortogram and IMA/Syst. Pr. Ratio were summed up to evaluate collateral circulation to colonic blood supply. Hypogastric arteries played an important role in some cases with intact IMA, and meandering mesenteric artery frequently in cases with occluded IMA. Consequently, it is important to preserve hypogastric arterial blood flow especially in the cases with intact IMA. In two cases whose internal iliac arteries were ligated bilaterally, IMA stump pressure was enough, and ischemic colitis was not encountered. The problems of peripheral vascular reconstruction in these two cases were also discussed.
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PMID:[Studies on inferior mesenteric arterial stump blood pressure and aortographic findings in surgical cases of abdominal aortic aneurysm: in relation to ischemic colitis]. 667 95

In an attempt to reduce early and late mortality caused by myocardial infarction, coronary angiography was performed in 1000 patients (mean age, 64 years) under consideration for elective peripheral vascular reconstruction since 1978. Those found to have severe, surgically correctable coronary artery disease (CAD) were advised to undergo myocardial revascularization (CABG), usually preceding other vascular procedures. The primary vascular diagnosis was abdominal aortic aneurysm (AAA) in 263 patients (mean age, 67 years), cerebrovascular disease (CVD) in 295 (mean age, 64 years), and lower extremity ischemia (ASO) in 381 (mean age, 61 years). Severe correctable CAD was identified in 25% of the entire series (AAA, 31%; CVD, 26%; and ASO, 21%). Surgical CAD was documented in 34% of patients suspected to have CAD by clinical criteria (AAA, 44%; CVD, 33%; and ASO, 30%) and in 14% of those without previous indications of CAD (AAA, 18%; CVD, 17%; and ASO, 8%). Cardiac procedures (216 CABG) were performed in 226 patients (AAA, 30%; CVD, 22%; and ASO, 19%), with 12 (5.3%) postoperative deaths. A total of 796 patients underwent 1066 peripheral vascular operations with an early mortality of 2.0% (AAA, 3.4%; ASO, 1.9%; and CVD, 0.3%), but only one death (0.8%) occurred in the group of 130 patients having preliminary CABG. The overall operative mortality for 1292 cardiac and peripheral vascular procedures was 2.6%.
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PMID:Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. 669 38

Protection of renal function during aortic surgery is of utmost importance. continuous profound hypothermic perfusion was utilized for the first time to protect a renal allograft from ischemia during resection of an abdominal aortic aneurysm. Ringer's lactate at 4 C was perfused directly into the iliac artery bearing the allograft. No significant corporeal hypothermia was induced.
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PMID:In situ hypothermic preservation of a renal allograft during resection of abdominal aortic aneurysm. 704 5

Five high-risk patients received nonresective treatment of abdominal aortic aneurysms (AAAs). This treatment included ligation of the iliac arteries to induce acute thrombosis of AAA and a simultaneous axillobifemoral bypass for restoration of arterial flow to the lower extremities. Of these five patients, lethal complications associated with this procedure developed in four. The complications included rupture, infection of the thrombotic aortic aneurysm, visceral ischemia, and consumptive coagulopathy. This high incidence of lethal complications and the unacceptably high patient mortality in these five patients indicates extreme precaution in the application of nonresective treatment for AAA.
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PMID:Lethal complications associated with nonrestrictive treatment of abdominal aortic aneurysms. 711 68

Acute lower extremity ischemia secondary to fecal impaction has not been previously reported. Herein, we report the case of an elderly man who was referred to our medical center with an acutely ischemic right lower extremity and a possible abdominal aortic aneurysm. The suspicious abdominal mass noted by his local physician was found to be a large fecal impaction of the rectosigmoid which, by direct pressure, was compressing and occluding the right common iliac artery. After disimpaction, there was complete resolution of the vascular symptoms and signs in the right lower extremity.
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PMID:Fecal impaction as a cause of acute lower limb ischemia. 748 25

This work was undertaken to assess the role of endothelial E-selectin in the development of neutrophil accumulation into the ischemic and reperfused human skeletal muscle and eventually in the genesis of ischemia-reperfusion syndrome. Twelve patients affected by abdominal aortic aneurysm who were undergoing reconstructive vascular surgery were studied. Muscle biopsies from the right femoral quadriceps were taken (1) immediately after anesthesia, as control samples, (2) before declamping the aorta, as ischemic samples, and (3) 30 minutes after reperfusion and then processed for immunohistochemical and ultrastructural analysis. Immunohistochemistry revealed a strong positive reaction for E-selectin on the venular endothelium during ischemia and reperfusion. Ultrastructural investigation showed that reactivity for E-selectin matched neutrophil accumulation of the skeletal muscle tissue. This phenomenon was dependent upon a complex series of events that included neutrophil adhesion to the inner surface of the postcapillary venules, passage through endothelial intercellular junctions, and migration distally into the interstitial spaces of the skeletal muscle tissue. Neutrophil tissue infiltration was also associated with ultrastructural signs of tissue damage at reperfusion. This is in agreement with accumulating evidence indicating a role for tissue infiltrating neutrophils in the genesis of toxic O2 free radicals. Our data suggest that E-selectin expression on the vascular endothelium of human skeletal muscle may represent a key regulatory point in the process of neutrophil tissue accumulation and indicate an active role for the venular endothelium in the development of human ischemia-reperfusion syndrome.
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PMID:Expression of E-selectin in ischemic and reperfused human skeletal muscle. 754 27


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