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

In traumatized and septic patients, excessive cytokine production may lead to organ dysfunction and death. Current understanding of cytokine kinetics with regard to clinical scenarios, however, is still limited by a paucity of studies investigating the cytokine levels in humans with inflammation-reperfusion injury in the absence of infection. Our hypothesis was that endotoxin is introduced into circulation during and after abdominal aortic aneurysm (AAA) repair and is associated with pro- and anti-inflammatory cytokine-response. The purpose of this prospective pilot study in 10 patients who underwent elective AAA repair was to assess organ function and immune response to systemic endotoxemia after the operation by measuring endotoxin, endotoxin neutralizing capacity (ENC), tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-10, and TNF-RI and II. Blood samples were obtained from indwelling catheters or direct venipuncture preoperatively, perioperatively (8 time points) until the second postoperative day. Endotoxin and ENC were determined by a special kinetic Limulus amoebocyte lysate (LAL) assay and TNF-alpha, IL-6, IL-10, and TNF-RI and II by commercial ELISA. Endotoxin levels were significantly elevated after declamping and 90 min after clamping of the aorta (2.3 + .9 pg/mL; 5.4+/-3.6 pg/mL). ENC decreased to the lowest levels at 90 min after clamping. TNF-alpha levels were maximal, but not significantly elevated, 120 min after clamping. IL-6 increased significantly during the operation and reached maximum levels (189.8+/-47 pg/mL) at the first postoperative day. Anti-inflammatory IL-10 and TNF-RI and II were elevated early during the operation. The changes in cytokine levels were associated with mild organ dysfunction. We conclude that AAA repair is associated with endotoxin, proinflammatory, and an almost coincidental anti-inflammatory cytokine release, providing baseline data about what constitutes an appropriate immune response. Such responses to trauma and ischemia-reperfusion need to be further investigated before attempting immunomodulation.
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PMID:Pro- and anti-inflammatory cytokine-response in abdominal aortic aneurysm repair: a clinical model of ischemia-reperfusion. 1035 34

Aortic cross-clamping is the cornerstone of abdominal aortic aneurysm surgery. The transient ischemia of the inferior hemisoma, and mainly of the large bowel, is then a current condition, usually well tolerated. At the time of vascular clamps removal, the ischemia-reperfusion syndrome may take place, and evolution toward multiple organ failure is an actual risk. The large bowel has a crucial role in the sequence of events causing ischemia-reperfusion syndrome, even when intestinal ischemia is not evident during aneurysmectomy. In this paper, current concepts of ischemia-reperfusion syndrome are reviewed, and the role of the colon after abdominal aortic cross-clamping for aneurysmectomy is focused. Principles of prevention of MOF from ischemia-reperfusion syndrome are pointed out.
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PMID:[Ischemia-reperfusion of the colon following clamping of the abdominal aorta]. 1041 15

We report an unusual case of type IV Thoracoabdominal Aneurysm (TAA) with Superior Mesenteric Artery (SMA), celiac artery, and bilateral renal artery aneurysms in a patient who underwent an earlier repair of two infrarenal Abdominal Aortic Aneurysm (AAA) ruptures. Because of the presence of the visceral artery aneurysms and the earlier operation through the retroperitoneum, standard surgical treatment via a retroperitoneal approach with an inclusion grafting technique was considered difficult. A combined surgical approach achieving retrograde perfusion of all four visceral vessels and endovascular grafting allowing exclusion of the TAA was accomplished. Complete exclusion of the aneurysm and normal perfusion of the patient's viscera was documented by means of follow-up examinations at 3 and 6 months. The repair of a type IV TAA with a Combined Endovascular and Surgical Approach (CESA) allowed us to manage both the aortic and visceral aneurysms without thoracotomy or re-do retroperitoneal exposure and minimized visceral ischemia time. If the durability of this approach is confirmed, it may represent an attractive alternative in patients with aneurysmal involvement of the visceral segment of the aorta.
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PMID:Repair of type IV thoracoabdominal aneurysm with a combined endovascular and surgical approach. 1047 50

Paraplegia is a well known complication after surgery for thoracic and thoraco-abdominal aneurysm but is very rare when the level involved is lower than the renal arteries. It is seen most often after treatment of ruptured aneurysm and very few cases are found in the literature reporting spinal cord ischemia after elective repair of an infrarenal abdominal aortic aneurysm. A new case of transient paraplegia following elective repair of an infrarenal abdominal aortic aneurysm is reported and different aspects of this complication are discussed. In our case, probably the interruption of blood flow in lumbar arteries and the duration of crossclamping were likely contributive factors and it suggest that a failure to appreciate the significance of collateral sources of spinal cord blood flow may be responsible for at least some cases of postoperative paraplegia.
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PMID:Transient paraplegia following elective infrarenal aortic aneurysm repair. Case report. 1129 26

Acute vascular abdomen is a severe and life-threatening pathology due to arterial degeneration, leading to hemorrhage or arterial occlusion leading to ischemia. Differential diagnosis of patients with severe abdominal pain and/or shock include several vascular and traumatic diseases, the most common being rupture of abdominal aortic aneurysm (AAA), or less frequently rupture of visceral artery aneurysm. Also acute aortic dissection, iatrogenic injury and acute mesenteric ischemia may lead to acute vascular abdomen. Clinical evaluation of the haemodynamic status of the patient may be very difficult, and may require airway maintenance and ventilation with a rapid treatment of hemorrhagic shock. In the stable patient with an uncertain diagnosis, CT scan, NMR and selective angiography may be helpful in diagnosis before vascular repair. On the contrary, the unstable patient, after hemodynamic resuscitation, must be operated on expeditiously. We present our vascular algorithms, to assess timing of diagnosis and treatment of this severe acute disease.
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PMID:Acute vascular abdomen. General outlook and algorithms. 1063 67

We report a case in which posture change for radiography after induction of anesthesia caused free rupture of the abdominal aortic aneurysm (AAA) into the peritoneal cavity, resulting in shock, although in the patient an AAA had ruptured into only the retroperitoneal space and hemodynamics had been stable preoperatively. The massive bleeding was controlled with autotransfusion using a washing salvaging autotransfusion device and a roller pump for hemodialysis. In addition, international mild hypothermia was effective for protection of the brain from suspected ischemia during shock. Meticulous attention should be paid for anesthetic management of patients with ruptured AAA even if their hemodynamic status is stable.
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PMID:[A case of free rupture of abdominal aortic aneurysm into the peritoneal cavity during posture change after induction of anesthesia]. 1070 24

We report a case of combined surgical repair including lower limb revascularization (below-knee bypass) and abdominal aortic aneurysm repair using cryopreserved arterial homograft. The patient experienced lower limb ischemia due to repeated thrombosis of a long-infected polytetrafluoroethylene (PTFE) graft, and was also shown to have a complicating abdominal aortic aneurysm. Infection was eradicated with total graft excision and intravenous antibiotics. Two-year patency of the in situ arterial homograft revascularization was demonstrated with hemodynamic and tomographic controls; no degenerations have been found to date. Benefits of the use of in situ arterial homograft for arterial reconstruction may include improved hemodynamics and greater resistance to infection compared to when alloplastic materials are used. Because of the risk of allograft deterioration, close follow-up of the patient is required.
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PMID:Surgical repair of infected peripheral graft and abdominal aortic aneurysm using arterial homograft. 1074 35

Intraoperative administration of diuretics and renal hypothermia with cold (4 degrees C) heparinized Ringer's lactate were useful methods for preserving renal function during warm ischemia time. 54-year and 74-year-old men were diagnosed as abdominal aortic aneurysm. Their left renal and accessory left renal arteries originated from the border zone of the aneurysm. We reported two cases of reimplantation of the renal artery in abdominal aortic aneurysm without deterioration of renal function.
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PMID:Preservation of renal function in reimplantation of renal artery of abdominal aortic aneurysm. 1083 37

This study was designed to clarify and compare the clinical characteristics and prognoses of patients with closing and nonclosing dissection of the descending thoracic aorta. Between January 1991 and December 1994, 19 patients with closing dissection (Group A) and 20 with nonclosing dissection (Group B) underwent surgical repair or medical treatment at our institution. There were 29 men and 10 women, aged between 37 and 74 years, with a mean age of 62 years. There was a significant difference in age between the two groups, being 67 +/- 7 and 58 +/- 12 years for Groups A and B, respectively (P = 0.009). The presence of a concurrent abdominal aortic aneurysm was confirmed in 32% and 10% of Groups A and B, respectively (P = 0.095). A total of 15 patients experienced a variety of complications related to the dissection, but there were no significant differences in the morbidity rate between the two groups. Visceral ischemic disorders such as renal failure, leg ischemia, and ileus were the most common complications. The overall survival rate 4 years after the development of dissection was 80%, with no significant difference between the two groups. These findings led to the establishment of our policy to place all patients with dissection of the descending thoracic aorta on careful antihypertensive therapy and frequent follow-up imaging studies to assess the aorta, regardless of the condition of the false lumen.
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PMID:The management of patients with dissection of the descending thoracic aorta: a comparison between closing and nonclosing dissections. 1087 May 76

Acute thrombosis of an abdominal aortic aneurysm (AAA) is a surgical emergency. Only 44 cases have been reported in the literature. The mechanism of the thrombosis has not been delineated. The proposed etiologies include propagation of thrombus from distal artery occlusion, cardiac thromboembolism, and dislodgment of a mural thrombus. Patients often present bilateral lower extremity ischemia, mimicking a saddle embolism. Systemic heparinization immediately after diagnosis and prompt surgical revascularization can reduce the mortality rate. The authors present a patient with sudden thrombosis of an AAA who was successfully treated with an axillobifemoral bypass graft. All published cases of thrombosed AAAs are analyzed.
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PMID:Acute occlusion of an abdominal aortic aneurysm--case report and review of the literature. 1087 Aug 62


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