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

Ischaemia of the large bowel occasionally occurs following abdominal aortic aneurysm repair and may lead to multiple system organ failure (MSOF). Intramucosal acidosis of the sigmoid colon is a good indicator of sigmoid colonic ischaemia. Intramucosal pH of the sigmoid colon was measured using the silicone tonometer in 21 patients undergoing abdominal aortic aneurysmectomy. Samples were taken for plasma endotoxin, tumour necrosis factor (TNF) and interleukin-6 (IL-6) measurements preoperatively, half-hourly during the operation, 2-hourly for the next 12 h, 4-hourly for a further 48 h and 8-hourly thereafter until the fifth day. The intramucosal pH of the sigmoid colon fell to less than 7.00 peri-operatively in 10 patients, four of whom developed diarrhoea; in comparison, this did not occur in any of the 11 whose pH remained greater than 7.00 (p = 0.036). Higher peak concentrations of endotoxin, TNF and IL-6 were found in those patients whose intramucosal pH fell to less than 7.00 compared to those whose pH remained greater than 7.00 (mean +/- S.E.M. pg/ml, endotoxin = 112 +/- 24 vs. 58 +/- 6, p < 0.05; TNF = 26 +/- 8 vs. 7 +/- 2, p < 0.05; IL-6 = 213 +/- 59 vs. 87 +/- 12, p = 0.09). In the two patients who died, both from the group with pH level less than 7.00, concentrations of IL-6 were considerably higher than that in most of the other patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Endotoxaemia, the generation of the cytokines and their relationship to intramucosal acidosis of the sigmoid colon in elective abdominal aortic aneurysm repair. 840 98

A patient with a large abdominal aortic aneurysm was noted to have a congenital pelvic kidney. The patient also had bilateral iliac aneurysms that required repair. The blood supply of the congenital pelvic kidney was not apparent from preoperative studies but was found at the time of surgery to be from the area of the aortic bifurcation. Pelvic renal ischemia was limited by a "double proximal clamping" technique and by placement of a temporary shunt from the body of the aortic graft into the pelvic renal artery during completion of two distal anastomoses. The patient's renal function remained normal during the perioperative period, and the reconstruction was demonstrated to be patent more than one year after surgery. Although simple clamping and expeditious reconstruction are appropriate in most cases of aortic surgery in the presence of congenital or transplant pelvic kidney, more complex anatomy, including iliac aneurysms, may require longer periods of ischemia. Pelvic renal ischemia may be limited with the technique described.
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PMID:Temporary perfusion of a congenital pelvic kidney during abdominal aortic aneurysm repair. 844 61

Both dipyridamole myocardial perfusion imaging (cardiolite) and ambulatory ECG monitoring (Holter) for silent ischaemia have been found to be useful for stratification of cardiac risk in patients undergoing vascular surgery. The purpose of this study was to compare the diagnostic accuracy of these two non-invasive tests for prediction of perioperative cardiac events. One hundred patients (86 males, 14 females; mean age 67 +/- 8 years) underwent out-patient 48 h Holter monitoring and cardiolite imaging prior to vascular surgery (70 abdominal aortic aneurysm, 21 aortobifemoral, nine femoralpopliteal grafts). Ischaemia on Holter was defined as one or more episodes of ST segment depression 1 mm or greater, lasting 1 min or longer. Myocardial perfusion imaging was carried out with the high dose dipyridamole protocol (0.84 mg/kg), cardiolite and planar imaging. Ischaemia was defined as a segmental perfusion abnormality following dipyridamole with improved perfusion on rest imaging. Holter was positive for ischaemia in 34/100 patients (34%). Cardiolite scans were positive for ischaemia in 30/100 patients (30%). Perioperative myocardial infarction occurred in nine patients (two cardiac deaths). [table: see text] The diagnostic accuracy of the two tests was similar, with a low positive predictive value of 15-20%, and an extremely high negative predictive value of 94-96%. The event rate in patients with both tests negative was 2/48 (4.2%), with only one test positive 3/40 (7.5%) and with both tests positive 4/12 (33%). A reasonable approach to risk stratification would be to obtain either a Holter or cardiolite scan initially.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cardiac risk stratification using dipyridamole myocardial perfusion imaging and ambulatory ECG monitoring prior to vascular surgery. 846 3

The Stentor is a thermal memory Nitinol frame covered by an external permeable polyester fabric. The Mialhe Stentor bifurcation which is matted into the infra renal aorta is designed for the treatment of AAA extended to the bifurcation and the iliac arteries. The bifurcated device is comprised of two separately introduced segments: --the aortic part with a fixed iliac limb loaded into a 18 F delivery system is introduced into the common femoral artery by a cut down approach, --the contralateral iliac leg loaded into a 10 F introducer is inserted percutaneously. This preliminary series involves 84 Stentor procedures: 14 straight, 2 tapered, 21 single bifurcated and 50 bifurcated and extended devices. The per and post operative surgical complications are reported: 4 peripheral emboli, 1 partial left colon ischemia, 2 hematomas and 1 local infection at the access site. Post operative angio and CT scan are necessary to identify the remaining leakages and their origin. In this series two AAA remain injected because of a proximal leakage by mismatch which has to be treated by implanting a cuff. These preliminary results demonstrate the accuracy of the proximal positioning, the adaptability of the device according to the anatomical situation and its ability to be extended. A long term follow-up study is necessary to prove the long term effectiveness of the endovascular exclusion of AAA and to improve the selection criteria.
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PMID:[Endovascular treatment of aneurysms of the subrenal aorta using the Stentor endoprosthesis. Preliminary series]. 858 50

Colonic ischemia is an often fatal complication of abdominal aortic aneurysm (AAA) repair. In elective AAA repair, patency of the inferior mesenteric artery (IMA) has been shown to be an important contributing factor. The purpose of this study was to determine which clinical and operative factors are important in the development of colonic ischemia in ruptured AAA repair. A retrospective review of all patients treated for ruptured AAA over a 7-year period was performed. Of 101 patients who were treated for ruptured AAA, 71 (70 per cent) survived for longer than 24 hours postoperatively, and these patients are the basis for this study. Colonic ischemia, primarily left sided, was a common perioperative complication (n = 24; 35 per cent) requiring colectomy in 11 patients (44 per cent). It carried a 44 per cent mortality compared to 20 per cent in patients without this complication (P = 0.07). Colonic ischemia occurred more frequently in patients with preoperative shock (P = 0.01) and a greater intraoperative blood loss (P = 0.003), but showed no correlation with patient age, co-morbid medical conditions, laboratory values, time to operation, or treatment of the IMA. Most patients with postoperative bowel ischemia were found to have chronic IMA occlusion, including 8 of the 11 patients requiring colectomy. Revascularization would not be feasible in this group. Revascularization of patent IMAs had little effect on outcome. Of the 17 patent IMAs, 9 were reimplanted and 5 (55 per cent) developed bowel ischemia, two of which required colectomy. Eight were ligated and 3 (38 per cent) developed bowel ischemia, one requiring colectomy. The presence of preoperative shock is the most important factor predicting the development of colonic ischemia following ruptured AAA. The incidence of ischemia is not altered by the presence of a patent IMA or with attempts at IMA revascularization. Colonic ischemia remains a significant source of morbidity and mortality in these patients.
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PMID:Colonic ischemia: the Achilles heel of ruptured aortic aneurysm repair. 865 51

Ischaemia-reperfusion injury generates oxygen-derived free radicals leading to local and distant damage. A simple method of following oxidative activity is to measure the consumption of endogenous scavenging antioxidants; an enhanced chemiluminescent assay was used to study this phenomenon in 21 patients undergoing surgery for abdominal aortic aneurysm (AAA). Samples of peripheral venous blood were taken before induction of anaesthesia and then from a central venous line and the inferior mesenteric vein before, during, and after clamping of the aorta. Further specimens were taken from the central line at 2, 6 and 24 h after operation. Antioxidant concentration in the peripheral, central and inferior mesenteric blood were similar, indicating that anaesthesia and surgical dissection had no effect. Levels decreased significantly in central and inferior mesenteric blood during and after clamping, but returned to normal by 24 h. These results confirm ischaemia-reperfusion phenomena in AAA repair.
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PMID:Antioxidant depletion during aortic aneurysm repair. 866 7

Abdominal aortic aneurysm surgery has been widely performed for more than forty years. Indications, contraindications, mortality-morbidity are clearly known. Surgical results are grossly reproducible whatever the centre. This classical technique of graft inclusion is superior to recent endovascular technique in terms of practicability and reproducibility. Classical technique seems safer for prevention of secondary aneurysms, for simultaneous treatment of abdominal non vascular lesions, for assessment and cure of associated renovascular abnormalities, and for avoiding distal emboli and colorectal ischemia.
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PMID:[Infrarenal aneurysm: traditional surgery]. 871 71

The combination of abdominal aortic aneurysm (AAA) and necrosis of the lumbar vertebral bodies is often the consequence of ischemia of the lumbar arteries and local compression from the aneurysm. A patient with necrosis of lumbar vertebral bodies 2 to 4 was admitted for abdominal aneurysm repair. CT scanning revealed almost complete destruction of the second and fourth lumbar vertebral bodies. In a combined operation an orthopedic and a vascular surgical team implanted two carbonic cages with autogenous splinter of the pelvic bone and an aortic vascular graft, using a retroperitoneal approach. Three months after the operation the 61-year-old man is entirely well and without any signs of back pain. He could be fully mobilized within 3 weeks postoperatively. This case study depicts the surgical techniques and discusses the advantages of the simultaneous operation and retroperitoneal exposure.
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PMID:[Simultaneous retroperitoneal operation of juxtarenal abdominal aortic aneurysm and ischemic vertebral body necrosis]. 920 40

The purpose of this study was to examine the changing trends in surgical management of patients with abdominal aortic aneurysms at a tertiary care teaching hospital over the past 40 years, by analysis of demographic data, perioperative variables and outcomes on all patients having abdominal aortic aneurysm surgery between 1955 and 1993. Some 1604 abdominal aortic aneurysms were assessed. The annual rate of abdominal aortic aneurysm surgery increased from 17.6 to 67.8 cases per year. The non-ruptured to ruptured abdominal aortic aneurysm ratio increased from 2.4:1 in the first decade to 3.4:1 in the last 5 years. In non-ruptured abdominal aortic aneurysm repairs, the following variables changed over the four decades: patients age over 80 years increased (2.4% to 8.0%; P<0.04), concomitant lower-limb occlusive disease increased (12.2% to 23.7%; P<0.02), prevalence of smaller aneurysms (4-6 cm) increased (16.0% to 54.2%; P<0.0001); intraoperative hypotension decreased (9.0% to 0.7%; P<0.0001), postoperative hemorrhage decreased (8.2% to 0.0%, P<0.0001), postoperative leg ischemia decreased (5.7% to 1.1%; P<0.02) and postoperative amputation rate decreased (3.2% to 0.0%; P<0.03). There was a significant decrease in perioperative mortality (17.0% to 3.4%; P<0.0001). For ruptured aneurysms, early operation (within 1 h of admission) increased from 8.7% to 55.8% (P<0.0001), prevalence of intraoperative hypotension decreased (50.0% to 23.5%; P<0.001), and major venous injury decreased (18.0% to 5.2%; P<0.05). Mortality, however, did not decrease significantly (54.2% to 44.2%; P=0.32). In conclusion, there was a significant decrease in mortality and morbidity associated with non-ruptured abdominal aortic aneurysm repair over the four decades studied. In addition, older patients with smaller aneurysms and more co-morbid conditions were operated on during this period. Mortality for patients operated on for ruptured abdominal aortic aneurysm repair has not changed significantly.
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PMID:Progress in abdominal aortic aneurysm surgery: four decades of experience at a teaching center. 921

Repair of abdominal aortic aneurysms may require aortic occlusion above the renal arteries. Despite fears of renal, hepatic and intestinal ischemia, recent publications have suggested that when repair would be difficult or impossible with infrarenal aortic clamping, supraceliac clamping may not be associated with significantly increased morbidity. Between February 1985 and January 1994, 169 patients underwent elective or urgent (symptomatic but not ruptured) repair of infra- or juxtarenal abdominal aortic aneurysm. Twenty-three patients (14%) required supraceliac clamping for juxtarenal abdominal aortic aneurysm, inflammatory abdominal aortic aneurysm, or other difficult exposure problems. Supraceliac clamping and infrarenal aortic clamping patients were indistinguishable with respect to age, gender, abdominal aortic aneurysm diameter, and other co-morbidities. There was a trend toward more frequent use of supraceliac clamping in urgent operations. Preoperative angiography was used selectively and was obtained more often in supraceliac clamping patients, reflecting suspected juxtarenal or renal involvement based on computed tomography findings, but the decision to employ supraceliac clamping was made at surgery. Mean (s.d.) supraceliac clamping clamp time was 22(5) (range 12-30) min. Similar numbers of supraceliac clamping and infrarenal aortic clamping patients required bifurcated grafts, operative times were comparable, and numbers of early complications were similar in the two groups. Transfusion requirements were slightly greater and length of stay was insignificantly shorter in supraceliac clamping patients (due to a few prolonged hospital stays in infrarenal aortic clamping patients). No supraceliac clamping patient required dialysis or suffered clinically apparent hepatic failure, coagulopathy, or intestinal ischemia. There were no operative deaths and all patients were discharged from the hospital. Supraceliac clamping was not associated with greater perioperative morbidity and may have contributed to a lack of mortality by facilitating repair of difficult abdominal aortic aneurysm. Supraceliac clamping should be considered for elective and urgent abdominal aortic aneurysm repair when there is inadequate length or quality of infrarenal aorta for anastomosis, severe associated pararenal atherosclerosis, inflammatory aneurysm, or previous aortic surgery. It is concluded that selective supraceliac clamping is safe and facilitates repair of difficult aortic problems.
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PMID:Supraceliac versus infrarenal aortic cross-clamp for repair of non-ruptured infrarenal and juxtarenal abdominal aortic aneurysm. 929 62


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