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

The risk of rupture of an abdominal aortic aneurysm increases with size. It has thus been recommended that small aneurysms be continuously followed with some type of imaging technique to detect when aneurysm size constitutes an indication for surgery. The present study focuses on the growth rate of abdominal aortic aneurysms in 35 patients who were subjected to repeated computerized tomographic examinations of their abdominal aortic aneurysms. Several aneurysms were measured more than twice resulting in 57 different examinations. The mean growth rate of the transverse diameter was 0.52 cm/year. The individual growth rates were, however, variable. Aneurysms with an initial transverse diameter exceeding 6 cm showed a slightly but not significantly faster increase in size compared with smaller aneurysms. No correlation between initial size and growth rate could be established. Six patients died during the study period, two from myocardial infarction, three after elective aneurysm operations and one, refused for elective operation, died after rupture. It is concluded that the growth rate measured with computed tomography agrees well with previously reported estimates obtained with ultrasonography. It is recommended that small aneurysms particularly in patients with relative contraindications to surgery be followed with repeated examinations of size.
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PMID:Growth rate of abdominal aortic aneurysms as measured by computed tomography. 401 32

The operative mortality in abdominal aortic aneurysm repair is in large part attributable to a high incidence of myocardial infarction. This is a result of cardiovascular instability during aortic cross-clamping and declamping in patients with coexistent coronary artery disease. Therefore cardiodynamics (pulmonary arterial wedge pressure, PAWP; cardiac index, CJ) were studied in 31 patients during abdominal aortic aneurysm surgery. 12 patients (control) with a PAWP mean of 8 mmHg preoperatively showed impaired cardiac function after declamping and a significant fall in arterial pressure. 19 patients were volume loaded to a PAWP greater than 12 mmHg and the cyclo-oxygenase inhibitor Aspirin was given preoperatively. This resulted in improved cardiac performance with no fall in arterial pressure after declamping. Optimal volume loading and cyclo-oxygenase inhibition have the ability to prevent adverse hemodynamic responses to aortic clamping and declamping. Maintenance of optimal cardiac performance will reduce cardiovascular complications and postoperative mortality in abdominal aortic aneurysm repair.
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PMID:[Significance of hemodynamic sequelae of aortic ligation in infrarenal aneurysms of the abdominal aorta]. 404 69

Since atherosclerotic heart disease results in more than half of the perioperative deaths that follow abdominal aortic surgery, a prospective protocol was designed for preoperative evaluation and intraoperative hemodynamic monitoring. Twenty men who were prepared to undergo elective operation for aortoiliac occlusive disease (12 patients) and abdominal aortic aneurysm (eight patients) were evaluated with a cardiac scan and right heart catheterization. The night prior to operation, each patient received volume loading with crystalloid based upon ventricular performance curves. At the time of the operation, all patients were anesthetized with narcotics and nitrous oxide, and hemodynamic parameters were recorded throughout the operation. Aortic crossclamping resulted in a marked depression in CI in all patients. CI remained depressed P less than 0.05 after unclamping in the majority of patients. There were two perioperative deaths, both from myocardial infarction or failure. Both patients had ejection fractions less than 30% and initial CIs less than 2 L/M2, while the survivors' mean ejection fraction was 63% +/- 1 and their mean CI was 3.2 L/M2 +/- 0.6. We conclude that preoperative evaluation of ejection fraction can select those patients at a high risk of cardiac death from abdominal aortic operation. These patients should receive intensive preoperative monitoring with enhancement of ventricular performance.
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PMID:Nuclear cardiac ejection fraction and cardiac index in abdominal aortic surgery. 631 74

To evaluate long-term survival in relation to preoperative risk factors, we reviewed 1112 patients undergoing abdominal aortic aneurysm (AAA) repair from 1970 to 1975. A 6-to 12-year follow-up was obtained on 1087 patients (97.7%) by chart review, death certificates, autopsy reports, and questionnaires returned by patients and referring physicians. Preoperatively 24% of patients had a history of prior myocardial infarction, 19.9% had a history of angina, and 40.4% were hypertensive. Emergency operation for ruptured aneurysm was performed in 6.5% and for expanding aneurysm in 3.4% of patients. The survival rate at 5 years was 67.5% and at 10 years was 40.7%. Cardiac-related problems were the most frequent cause of death (38%); 23% died of myocardial infarction and 15% from other heart disease or sudden death. Other causes included neoplasm (14.6%), other ruptured aneurysm (8.2%), and stroke (6.8%). Cause of death was unknown in 19.6%. A significant correlation of reduced survival time was noted in patients with advanced age and those with evidence of heart disease or hypertension. For patients without preoperative evidence of heart disease or hypertension, the 5-year mortality rate from myocardial infarction was 3.7%, compared with 11.7% for those with a positive history of hypertension and heart disease (p = 0.0001). For patients with no preoperative evidence of hypertension or heart disease, the length of survival after AAA repair was the same as that expected for the general population with the same age and sex composition. This study supports the contention that coronary angiography and prophylactic coronary bypass grafting should be performed selectively. Decisions regarding the need for coronary revascularization should be based on symptoms, noninvasive testing, and selective coronary angiography because aneurysmal disease alone is not shown in this study to increase the risk of death from myocardial disease. For patients with clinical findings of coronary artery disease, an aggressive diagnostic approach appears to be justified.
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PMID:Late survival after abdominal aortic aneurysm repair: influence of coronary artery disease. 648 77

To define the group of patients at high risk for myocardial infarction (MI) and death associated with abdominal aortic aneurysm repair, resting gated blood pool studies were obtained on 50 such aneurysm patients preoperatively. The results indicated that three groups could be distinguished among these patients by cardiac ejection fraction. Group I (n = 25) had preoperative ejection fractions ranging from 56% to 85%. None of the patients in group I suffered an acute perioperative MI. Group II (n = 20) comprised patients with ejection fractions ranging from 36% to 55%. There was a 20% incidence of MI in group II but no cardiac deaths. Group III included five patients with ejection fractions ranging from 27% to 35%. There was an 80% incidence of perioperative MI in these patients, with one cardiac death and one cardiac arrest. All perioperative MIs occurred within the first 48 hours after surgery. In addition there was a 50% incidence of perioperative MI among all those patients who were 80 years of age or older. These results indicate guidelines for the management of patients undergoing abdominal aortic aneurysm repair based on their preoperative ejection fraction. The data further suggest that the noninvasive gated blood pool method of determining ejection fraction may serve a more broadly useful function in helping to determine which of those patients about to undergo major surgical procedures are at high risk for perioperative MI.
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PMID:The value of radionuclide angiography as a predictor of perioperative myocardial infarction in patients undergoing abdominal aortic aneurysm resection. 648 81

Two hundred and thirteen patients underwent surgical treatment for coronary artery disease from 1968, May to 1983, Feb. at our Department. Clinical diagnosis was stable angina in 55 patients, unstable angina in 47, angina with complication in 9, myocardial infarction in 54, and post-infarction complication in 48. Two hundred consecutive postoperative patients were evaluated. There were 11 late deaths occurred including 4 cardiac deaths in origin. Causes of late cardiac deaths were sudden death in 2 patients and cardiac decompensation in 2 patients. Reinfarction was seen in 1 out of 2 sudden deaths. This case underwent only left ventricular aneurysmectomy without A-C bypass grafting. Preoperatively, 49.2% of the patients were in NYHA 2, 34.8% in NYHA 3, and 15.9% in NYHA 4, but postoperatively 86.3% in NYHA 1 and 13.7% in NYHA 2. Reoperative surgical indications were native coronary progression in 1 patient, graft obstruction in 1, and ascending aortic aneurysm in 1. Surgical treatment of coronary arterial disease has still many problems to be solved, especially in patient with cardiogenic shock, multi-vessel disease, cerebral vascular disease, abdominal aortic aneurysm and patient of old age. But, we believe the surgical treatment will make much progress with development of myocardial preservation, assisted circulation, membrane oxygenator and simultaneous operative techniques including complete revascularization.
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PMID:[Survival and late results following surgical treatment of coronary artery disease]. 661 96

The usefulness of two dimensional echocardiography (2-D echocardiography) and x-ray computed tomography (CT) for the diagnosis of thrombi in the cardiac cavity and large vessels was studied by comparing them with the findings of invasive methods. Among 56 subjects with mitral stenosis, left atrial thrombi were noted in 12 cases (16 regions) by CT and 8 cases (9 regions) by 2-D echocardiography. In 16 subjects who underwent operations, one false negative case by CT and 3 false negative and one false positive cases by 2-D echocardiography were found. In 80 subjects with myocardial infarction 2-D echocardiography, CT and left ventriculography (LVG) were performed at approximately the same time. Thrombi were detected in 10 subjects (12.5%) by 2-D echocardiography, in 15 (18.8%) by CT and in 14 (17.5%) by LVG. Although mural thrombi in abdominal aortic aneurysm were detected very easily, thin thrombi surrounding the false lumen of the dissecting aneurysm were not detected ultrasonographically. These thrombi were only detected by the enhanced CT. Our results show the usefulness of both methods for detecting thrombi in the heart and large vessels. CT can distinguish the thrombi more clearly than 2-D echocardiography, but 2-D echocardiography is performed more easily, safely and economically than CT.
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PMID:Noninvasive diagnosis of thrombus in the heart and large vessels--usefulness of two-dimensional echocardiography and X-ray CT. 669 35

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

Some patients who undergo repair of an abdominal aortic aneurysm require a concomitant procedure. This study compares the morbidity and mortality rates of patients who undergo combined procedures with those who undergo aneurysmorrhaphy alone. Five hundred sixty-three elective aneurysmorrhaphies were performed in the years 1971, 1976, and 1980. Three hundred thirty-five individuals underwent aneurysm repair alone (group I), while 115 underwent at least one additional vascular procedure (group II), and 113 underwent one or more nonvascular procedures (group III) concomitant with aneurysmorrhaphy. Mortality rates for the three groups were 2.6%, 3.5%, and 6.0%. Morbidity rates were 12.8%, 26.1%, and 18.5%. The differences in rates do not achieve statistical significance, but causes of death and complications varied slightly in each group. Deaths in group I were largely due to myocardial infarction, while deaths in groups II and III were largely due to complications of operation or underlying disease. Patients who required concomitant renal artery revascularizations had the greatest number of serious complications in group II. Patients with concomitant cholecystectomy appeared to have an increase in serious complications, but concomitant herniorrhaphy or lumber sympathectomy appeared to be free of any additional morbidity.
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PMID:Abdominal aortic aneurysm repair combined with a second surgical procedure--morbidity and mortality. 671 Mar 43

The association of coronary artery disease and peripheral vascular disease was studied to determine the influence of coronary artery disease on early and late mortality rates after surgical reconstruction for peripheral occlusive vascular disease and abdominal aortic aneurysm. Between January 1976 and December 1978, 161 consecutive patients underwent surgery for peripheral occlusive vascular disease or abdominal aortic aneurysm. The patients were 35-86 years old (mean 63.3 years). Thirty patients (18.6%) had abdominal aortic aneurysmectomies, 59 (36.7%) had aortoiliac reconstruction with or without femoropopliteal bypass and 72 (44.7%) had procedures for femoropopliteal disease. The 30-day hospital mortality rate was 6.7% for abdominal aortic aneurysm (n = 2), 3.4% for aortoiliac reconstruction (n = 2) and 1.4% for femoropopliteal procedures (n = 1). Myocardial infarction was the cause of 40% (n = 2) of the early postoperative deaths. The early mortality rate of patients with a history of angina or myocardial infarction was 5.4% (two of 37), while the early mortality rate among patients without such a history was 2.4% (three of 124). The mortality rate from myocardial infarction during the late observation period was 65% (15 of 23). The freedom from myocardial infarction was 90% at 30 months and 75% at 60 months. The overall survival rate was 87% at 30 months and 71% at 60 months. The late mortality rate was assessed with respect to various risk factors: coronary artery disease (n = 31), previous vascular surgery (n = 19) and diabetes mellitus (n = 7). Among the 63 patients who had one or more of the risk factors, the late cardiac mortality rate was 20.6% (n = 13). The late cardiac mortality rate for for the 78 patients with no risk factors was 3.8% (n = 3). An additional 10 patients with previous coronary artery bypass (n = 9) or angiography (n = 1) experienced no early or late mortality. The freedom from late cardiac death at 60 months was 71% for the high-risk group (63% patients) and 96% for the low-risk group. The study shows that coronary artery disease is a major determinant of both early and late mortality after arterial reconstruction. The status of the myocardium should be assessed before peripheral vascular surgery, as selective myocardial revascularization may improve survival in these patients.
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PMID:Influence of ischemic heart disease on early and late mortality after surgery for peripheral occlusive vascular disease. 708 52


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