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

From January 1982 to June 1986 475 patients underwent operation for abdominal aortic aneurysm (AAA) with reconstruction by tube graft or bifurcation graft. Patients were subdivided into 2 groups, those operated upon either electively or those operated upon urgently. The overall hospital mortality following elective intervention was 4.9%, following emergency intervention 36.5%. In patients operated upon electively preoperative risk factors such as history of myocardial infarction or coronary artery disease did not influence mortality. In patients operated upon urgently, however, the postoperative mortality was significantly higher (p less than 0.005) in those with a history of myocardial infarction or coronary artery disease. Postoperative morbidity in the emergency group (2.7 complications per patient) was significantly higher than in the elective group (0.94 complications per patient). These results show that early elective operation on asymptomatic aneurysms and younger patients with few risk factors can prevent rupture and reduce postoperative mortality to an acceptable level.
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PMID:Abdominal aortic aneurysms. Risk factors and complications and their influence on indication for operation. 277 64

The perioperative and long-term survival of patients who undergo resection of abdominal aortic aneurysm is often determined by coexisting cardiac disease. This study evaluates the influence of left ventricular ejection fraction on both perioperative and long-term morbidity and mortality. Preoperative ejection fraction was measured in 104 of 208 patients undergoing elective abdominal aortic aneurysm resection. Nineteen patients were found to have ejection fractions less than 0.35, and this group was compared to 85 patients with ejection fractions greater than 0.35. The two groups did not differ significantly in terms of age, sex, preoperative renal function, or smoking status. The groups were significantly different with respect to the prevalence of prior myocardial infarction (79% of the low ejection fraction group vs 31% of the high ejection fraction group) and symptoms equivalent to New York Heart Association class II or greater (47% of the low ejection fraction group vs 24% of the high ejection fraction group) but not prior myocardial revascularization procedure (42% of the low ejection fraction group vs 31% of the high ejection fraction group). Surgical factors including aneurysm size, duration of aortic cross-clamping, and extent of arterial replacement did not differ significantly between the two groups. The perioperative mortality was not significantly different (low ejection fraction, 5%; high ejection fraction, 2%). The cumulative life-table survival of the two groups was not statistically different. Two patients in the low ejection fraction group died in the follow-up period, yielding a 4-year actuarial survival of 0.74. This is compared to 10 deaths and actuarial survival of 0.63 (p = NS) in the high ejection fraction group. We conclude that patients should not be denied aneurysm resection solely on the basis of left ventricular ejection fraction.
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PMID:Resection of abdominal aortic aneurysm in patients with low ejection fractions. 235

By the method of radionuclide ventriculography on the nuclear stethoscope, 106 patients at the age of 60-84 years with occlusive lesions (64) and abdominal aortic aneurysm (42) were examined. After preoperative therapy, 48 patients underwent resection of the abdominal aortic aneurysm with grafting, 41--aortofemoral shunting. Three (7.5%) patients developed myocardial infarction after the operation, one patient died.
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PMID:[Evaluation of reserve potentials of the heart in diseases of the abdominal aorta in middle aged and elderly patients]. 279 33

Patients with coronary artery atherosclerosis usually have concomitant peripheral vascular lesions. The authors describe the case of a 65-year-old woman who had multiple symptomatic lesions: severe stenosis of the left main coronary artery and the carotid arteries, a large abdominal aortic aneurysm and bilateral renal artery occlusion. To manage these and to avoid myocardial infarction and cerebrovascular accident at operation, concomitant procedures were performed as follows: coronary artery bypass grafting, aneurysm resection, carotid endarterectomy and revascularization of the larger kidney. Although the patient's hospital stay was prolonged, there was no major morbidity and her recovery was good. She returned to a normal life-style, requiring only hemodialysis on an outpatient basis.
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PMID:Concomitant vascular procedures in conjunction with myocardial revascularization: all or none? A report of a case. 281 22

Aortitis as a feature of rheumatoid arthritis is considered rare. We have, however, identified 10 patients with aortitis from among 188 consecutive autopsy cases of rheumatoid arthritis. There were 5 men and 5 women with a mean duration of rheumatoid arthritis of 9.6 years. Nine were rheumatoid factor positive and had associated nodules. In addition to standard treatment regimens, 9 patients received corticosteroids. Although involvement of the thoracic aorta was most common, involvement of both the thoracic and abdominal aorta was present in 4 cases. Two patients had aneurysmal dilatation of the thoracic aorta and 1 of the abdominal aorta. Microscopic features of aortitis included necrosis of medial smooth muscle and elastica, with an inflammatory infiltrate comprising primarily lymphocytes and plasma cells. A panmural aortitis was seen in 3 cases. Rheumatoid granulomas were noted in the aortic wall in 5. The diagnosis of aortitis was not made until autopsy in any case. Aortitis was hemodynamically significant in 3 patients. Two had congestive heart failure secondary to thoracic aortitis and aortic valvulitis, and 1 had rupture of an abdominal aortic aneurysm at a site involved by aortitis. Seven patients had rheumatoid vasculitis with a mean of 10 organs involved. Six of these died of complications directly related to vasculitis, including 4 patients with coronary arteritis and associated myocardial infarction. Aortitis can be a feature of severe rheumatoid arthritis and is often associated with rheumatoid vasculitis. Hemodynamic compromise does occur and may be fatal.
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PMID:Rheumatoid aortitis: a rarely recognized but clinically significant entity. 292 41

Surgical repair of abdominal aortic aneurysm (AAA) is frequently associated with DIC. 15 patients affected by AAA were studied to evaluate the risk of consumption coagulopathy and the efficacy of daily low-dose calcium heparin prophylaxis. The coagulation parameters investigated showed a postoperative decrease of AT III activity levels and platelet count the other laboratory tests did not show any significant modifications. Low dose heparin was effective in preventing coagulation activity or thrombotic episodes. No thromboembolic complications were observed, except nonfatal myocardial infarction.
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PMID:Consumption coagulopathy and low-dose heparin in the surgical repair of abdominal aortic aneurysm: a study of fifteen cases. 322 79

This article describes the patient population and operative management of 666 patients with nonruptured aneurysms of the abdominal aorta. Statistical significance of variables was determined by the chi-square test and logistic regression analysis. There were no statistically significant differences (p greater than 0.05) in mortality rate for abdominal aortic aneurysm (AAA) on the basis of indication for surgery (asymptomatic, 3.9%; asymptomatic but with evidence of enlargement, 4.9%; and symptomatic, 7.2%) or the urgency of operation (elective operation, 4.5%; and urgent operation, 7.1%). Characteristics of the 72 participating surgeons did not influence the operative mortality rate. A family history of AAA was documented in 6.1% of cases and was more common if the patient was female (p = 0.03) and less than 65 years of age (p = 0.04). Patients without clinical evidence of coronary artery disease had a 0.8% mortality rate from cardiac disease compared with 6.2% if any stigmata of coronary disease were present. Prior aortocoronary bypass surgery did not reduce the incidence of postoperative cardiac events or operative mortality rate. Patients having "routine" angiography did not have a less complicated operative course, fewer thrombotic complications, or lower mortality rate than those not having it. Those patients with an inflammatory AAA (4.5%) did not have a significantly higher incidence of pain. Heparin administration (84.8%) did not reduce the complications of graft thrombosis, "trash," distal thrombosis, and/or amputation. The 6.8% of patients requiring suprarenal aortic cross-clamping had a higher incidence of postoperative renal dysfunction (p = 0.02) and intraoperative blood loss (p less than 0.001), but cardiac events were not more frequent. When the aortic cross-clamping time was prolonged (more than 70 minutes), the requirement for crystalloid fluid administration increased (p less than 0.001) and postoperative myocardial infarction was more common (p = 0.004). After ligation of the left renal vein in 7.9%, renal damage or dialysis was more frequent (p = 0.01). Patients having an intra-abdominal graft (tube, 38.5% and biiliac, 30.7%) had fewer wound infections (p = 0.02) and graft thromboses (p less than 0.001) than the patients with a femoral anastomosis. When the internal iliac artery flow was interrupted bilaterally (12%), diarrhea (p = 0.03) and ischemic colitis (p = 0.03) were more frequent complications. Reimplantation of the inferior mesenteric artery was carried out in 4.8%. After renal artery bypass in 2.1%, the mortality rate was not increased, but the incidence of transient renal dysfunction was increased (p = 0.03).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Multicenter prospective study of nonruptured abdominal aortic aneurysms. I. Population and operative management. 327 8

Preoperative radionuclide ventriculography was performed in 60 patients to assess whether such testing could define those at increased risk after direct abdominal aortic aneurysm (AAA) repair. None of the patients had prophylactic coronary artery reconstruction to reduce the risk of AAA repair despite angina in 27% and previous myocardial infarction (MI) in 42%. The mean ejection fraction (EF) was 52% +/- 15% (range 14% to 78%). Low EF (normal greater than 50%) was present in 40%, whereas ventricular wall motion abnormalities were present in 39% of patients. The overall perioperative (30-day) mortality rate was 5%. MI occurred in 7% within 30 postoperative days; none was fatal. Life-table analysis revealed that overall survival after AAA repair was significantly lower in patients with an EF of 50% or less (p less than 0.025, Mantel-Cox) during a follow-up of 20.1 +/- 11.9 months. Overall survival differences were even more striking for those with an EF of 35% or less (p = 0.003, Mantel-Cox). There was a marked difference in the cumulative mortality rate during follow-up, being 50% in those patients with an EF of 35% or less (n = 10) compared with 14% in those with an EF greater than 35% (n = 50, p = 0.036, Fisher exact test). There was no statistical difference in the incidence of perioperative MI or perioperative death for those with an EF of 35% or less vs EF greater than 35%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The role of preoperative radionuclide ejection fraction in direct abdominal aortic aneurysm repair. 329 49

To assess the value of exercise testing in the prediction of cardiac risk, 100 patients requiring arterial reconstructive surgery had either treadmill testing or arm ergometry before operation. Thirty-four patients then had abdominal aortic aneurysm repair, 48 had reconstructions for aortoiliac occlusive disease, and 18 had infrainguinal revascularization procedures. Cardiac complications included myocardial infarction in 10%, acute congestive failure in 5%, malignant ventricular arrhythmias in 7%, and cardiac death in 7%. Contingency table analysis showed that patients who achieved less than 85% of their predicted maximum heart rate (PMHR) during exercise testing had a complication rate of 24%, whereas patients who achieved more than 85% of PMHR had a 6% complication rate (p = 0.0396). The degree of ST segment depression during exercise testing was not a significant predictor of cardiac complications. However, patients who had a positive stress test (ST depression more than 1 mm) and achieved less than 85% of their PMHR had a complication rate of 33%, whereas patients with a positive stress test who achieved more than 85% of their PMHR had no complications (p = 0.048). Statistical analysis with a logistic regression model showed two factors to be significant. Patients who achieved a high maximum heart rate during exercise testing had a low probability of developing postoperative cardiac complications (p = 0.04), as did patients who achieved high cardiac work load maximal oxygen uptake (p = 0.03). We conclude that preoperative exercise testing is useful to predict cardiac complications after arterial reconstruction. Patients who are able to achieve more than 85% of their PMHR and a high maximal oxygen uptake represent a low-risk group.
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PMID:The use of preoperative exercise testing to predict cardiac complications after arterial reconstruction. 333 27

Of 15 patients having revascularization of the right renal artery with the use of the hepatic circulation from May 1984 through March 1987 at the Massachusetts General Hospital, eight patients had this accomplished with end-to-end anastomosis of the gastroduodenal artery and right renal artery. Operative indications were acute azotemic renal failure (three patients), poorly controlled renovascular hypertension (four patients), and staged repair of bilateral renal artery disease (one patient). All revascularizations were successful in restoring renal function or rendering hypertension manageable and were assessed by means of renal flow scans, celiac angiography, or return of function in those patients with a solitary, functioning kidney. All patients survived the operation with one late death caused by myocardial infarction after abdominal aortic aneurysm repair. The gastroduodenal artery may be used as the source for arterial inflow in revascularization of the right renal artery by end-to-end anastomosis in approximately 50% of instances, conferring the advantage of the use of only one anastomosis and obviating the long-term possibility of vein graft failure.
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PMID:Use of the gastroduodenal artery in right renal artery revascularization. 339 73


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