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

To delineate the role of routine preoperative coronary angiography in patients undergoing elective abdominal aortic aneurysm resection, we reviewed the records of 422 such patients at the Mayo Clinic, Rochester, Minn. One hundred seventy-three patients (41%) had a history of either myocardial infarction or angina pectoris; 146 (35%) had a previous myocardial infarction; 111 (26%) had a history of stable angina. Six patients underwent coronary artery bypass grafting prior to aneurysmorrhaphy. Ten patients (2.4%) died within the first 30 postoperative days. Seven deaths (1.7%) were secondary to myocardial infarction. Mortality from myocardial infarction was 0.8% in patients who had no history of coronary artery disease and 2.9% in patients with a history. Mortality was not increased in elderly patients. Coronary angiography should be selectively obtained prior to elective aneurysmorrhaphy. A 0.8% mortality from myocardial infarction in patients without a history of coronary artery disease and an overall mortality of 1.7% do not justify routine coronary angiography prior to elective resection of an abdominal aortic aneurysm.
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PMID:Abdominal aortic aneurysm and coronary artery disease. 730 62

Routine preoperative coronary angiography has been recommended to all patients scheduled for elective abdominal aortic aneurysm resection at the Cleveland Clinic since 1978. Patients found to have severe, correctable coronary artery disease (CAD) have been advised to undergo myocardial revascularization prior to aneurysm resection in an attempt to reduce the incidence of fatal postoperative myocardial infarction. In order to provide an historic standard with which the results of this approach may eventually be compared, complete follow-up information has been obtained for 96% of 343 consecutive patients who underwent abdominal aortic aneurysm resection between 1969 and 1973. Fatal myocardial infraction accounted for 37% of early postoperative deaths and occurred in 6% of the entire series. Among the patients who survived operation, the five-year mortality rate was 31% and the 11-year mortality rate was 52%. Complications of CAD caused 39% of the deaths that occurred within five years after operation and 41% of the deaths that occurred within 11 years. The late incidence of fatal myocardial infarction among patients who had preoperative evidence of CAD was statistically significant (p < 0.05).
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PMID:Fatal myocardial infarction following abdominal aortic aneurysm resection. Three hundred forty-three patients followed 6--11 years postoperatively. 743 94

Between December 1991 and January 1994 fifteen patients with a ruptured abdominal aortic aneurysm and seven patients with a dissecting aortic aneurysm were treated in our emergency department. Dissection/rupture of an aortic aneurysm is still a dramatic event with poor outcome, whereby survival depends largely on early diagnosis. In most cases the diagnosis can be made with reasonable assurance by history taking and physical examination. The most frequent differential diagnoses are pulmonary embolism and myocardial infarction (thoracic aneurysms) and renal or biliary colic and lumbago (abdominal aneurysms). The largest delay in commencing therapy is caused by patients' hesitation to call the Emergency Medical Service. Chest X-ray, echocardiography and abdominal sonography are of high diagnostic value, computed tomography confirms the diagnosis in most cases. Our Emergency Department provides the facilities for rapid diagnosis and interdisciplinary preoperative management of dissecting/ruptured aortic aneurysms.
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PMID:[Emergency management of ruptured/dissecting aortic aneurysm--diagnosis and therapeutic strategies]. 781 Jan 45

Between 1988 and 1993, 17 (3%) out of a total 654 patients underwent reoperation for control of haemorrhage following repair of abdominal aortic aneurysm in a vascular surgery unit. The first operation was performed for rupture in 12 cases and electively in five. The incidence of reoperation for postoperative bleeding was 1.7% following elective operation and 3.3% following emergency operation. Case-controls, matched for sex and primary operation, were identified. The mortality rate in those requiring reoperation was 58% compared with 23% in the control group (p = 0.037). Seven patients suffered progressive deterioration and died in the early postoperative period. Of the remaining ten patients, four suffered unexpected serious complications; two a fatal cerebro-vascular accident (CVA), one a fatal myocardial infarction (MI) and the fourth a non-fatal CVA. The patients requiring reoperation had greater blood loss (p < 0.05), greater transfusion requirements and lower core temperatures (p < 0.05) at the end of their first operation than the control group. All except one of the patients who bled had evidence of coagulopathy and had lower platelet counts than the control group both before and after the first operation. At reoperation there were multiple minor bleeding points in 11 patients, no active bleeding points in two patients and a discrete bleeding point in four patients. In conclusion, re-operation for control of postoperative haemorrhage is an uncommon complication which is strongly associated with coagulopathy, may predispose to "rebound" postoperative thrombotic episodes, and carries a poor prognosis.
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PMID:Postoperative haemorrhage following aortic aneurysm repair. 781 32

The risks associated with elective repair of an abdominal aortic aneurysm have been reduced in recent years, but occasionally the extent of the aneurysm and the severity of the atherosclerotic process lead to life-threatening complications. The complications of myocardial infarction, acute renal failure, bleeding, and ischemia are examined in this article. To illustrate the complexities of nursing care when patients experience complications, the case of Mr. S is presented. Assessment and monitoring are considered as key components of nursing care, and ways to help patients and their families cope with unanticipated complications are outlined.
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PMID:Caring for patients with complications after elective abdominal aortic aneurysm surgery: a case study. 784 66

A leak from an abdominal aortic aneurysm following the administration of streptokinase treatment for myocardial infarction is reported. It is important to assess candidates for cardiac thrombolytic therapy for aortic pathology and give such treatment with extreme caution in those patients with abdominal aortic aneurysms.
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PMID:Aortic aneurysm leak after streptokinase treatment for myocardial infarction. 766 3

Cardiac disease continues to be the leading cause of morbidity and mortality following peripheral vascular surgical procedures. Although the mechanism of sudden myocardial infarction remains elusive, many possibilities exist. The role of catecholamines is intriguing in view of the evidence that beta-adrenergic blockers reduce cardiac morbidity and mortality in vascular surgical patients. To ascertain whether the plasma catecholamine levels rise significantly during abdominal aortic aneurysm repair, serial determinations of plasma epinephrine and norepinephrine levels were performed in 18 patients. Epinephrine levels rose significantly from preoperative baseline values both during the operation and postoperatively, and norepinephrine levels rose significantly at 24 hours postoperatively. Although only one patient studied developed a myocardial infarction, the finding that patients undergoing aortic surgery uniformly experienced abnormally high serum catecholamine levels supports other evidence that perioperative myocardial ischemic events have a hormonal component.
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PMID:Plasma catecholamine concentrations during abdominal aortic aneurysm surgery: the link to perioperative myocardial ischemia. 831 83

Percutaneous transluminal coronary angioplasty (PTCA) has assumed an increasing role in the preoperative preparation of patients with an abdominal aortic aneurysm (AAA). The influence of this modality on perioperative morbidity and long-term outcome has not been substantiated. To determine the effect of PTCA, we analyzed a cohort of 2,452 patients who underwent repair of an AAA between 1980 and 1990 at our institution. We compared the cardiac morbidity, mortality, and survival of patients who had preoperative coronary revascularization by PTCA or coronary artery bypass grafting (CABG). The overall perioperative mortality for the 2,452 patients was 2.9%. Preoperative coronary revascularization was necessary in 100 patients (4.1%)--86 had CABG and 14 had PTCA. Of these 100 patients, 95% had cardiac symptoms. Patients selected for PTCA, in comparison with CABG, had significantly less three-vessel disease but not significant differences in cardiac history or ejection fraction. During the study period, the use of PTCA increased significantly. The perioperative rate of myocardial infarction for patients with prior CABG was 5.8% in comparison with 0% for those with prior PTCA. No hospital deaths occurred in either group. The median interval between coronary revascularization and repair of an AAA was 10 days for PTCA and 68 days for CABG. The 3-year survival was not statistically different between CABG (82.8%) and PTCA (92.3%) groups. The rate of late cardiac events (at 3 years) was 56.5% in the PTCA group and 27.3% in the CABG group. We conclude that PTCA as part of a highly selective approach to coronary revascularization before repair of an AAA minimizes cardiac-related events and death.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Myocardial revascularization before abdominal aortic aneurysmorrhaphy: effect of coronary angioplasty. 835 Jun 48

To clarify the influence of clamping of aorta on ischemic heart, 235 patients who underwent abdominal aortic surgery from 1980 to 1989 were studied. One hundred and twenty patients underwent resection of abdominal aortic aneurysm, and 115 patients underwent operation for aortoiliac occlusive disease. Myocardial infarction occurred in 8 patients, and 4 patients died. The onsets of the myocardial infarction were later than the 3rd post operative day in every patient but one. There were no significant differences in the incidence of myocardial infarction between the patients of nonruptured abdominal aortic aneurysm and of aortoiliac occlusive disease. To clarify the hemodynamic changes during abdominal aortic procedure, following experiments were performed using dogs. The dogs were divided into 6 groups, Groups 1, 3, 5; normal control groups, Group 2, 4, 6; groups with coronary stenoses. The infrarenal aorta were cross-clamped in groups 1, 2, 3, 4. In groups 3 and 4, PGE1 were administrated continuously into the infrarenal aorta below the clamping sites. In groups 5 and 6, descending thoracic aorta were cross-clamped. In group 6, one dog developed ventricular fibrillation at 60 minutes after aortic cross-clamping. Moreover ECG of the other dog of group 6 demonstrated myocardial ischemia during aortic clamping. But there were no significant differences in hemodynamic variables between groups, 1, 3, 5 and 2, 4, 6. These results indicate that aortic clamping can induce the myocardial ischemia, but that ischemia is not the chief cause of postoperative myocardial infarction.
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PMID:[Clinical and experimental study of hemodynamic changes during aortic surgery]. 837 62

Long-term results of coronary artery bypass grafting (CABG) in consecutive 32 patients with familial hypercholesterolemia, 6 homozygotes and 26 heterozygotes between 1976 and 1990, were analyzed. Seventeen patients in the early series underwent CABG with vein grafts alone. Subsequently, 15 patients underwent CABG with internal mammary artery grafting to the left anterior descending artery and received intensive lipid-lowering treatments early after CABG. All homozygotes and 1 heterozygote received intermittent low-density lipoprotein apheresis after CABG. There was only one late noncardiac death (3%), and the actuarial rates of freedom from cardiac events (myocardial infarction, cardiac death, and angina pectoris) were 60% at 5 and 10 years for homozygotes, and 87% and 73% for heterozygotes. The cardiac event-free curve for the heterozygous familial hypercholesterolemia group was comparable with that for the random age-matched subset of patients without familial hypercholesterolemia who underwent CABG during the same period. Two of 3 homozygotes and 4 of 14 heterozygotes in the early series had one or more cardiac events, whereas no patients in the late period had cardiac events. The patency rate of internal mammary artery grafts to the left anterior descending artery from 1 to 3 years after CABG was significantly higher than that of vein grafts to the left anterior descending artery (92 versus 45%; p < 0.05). Abdominal aortic aneurysm developed postoperatively in 2 homozygotes and 2 heterozygotes without sufficient cholesterol reduction. In conclusion, internal mammary artery grafting in combination with postoperative intensive lipid-lowering treatments, including low-density lipoprotein apheresis, may provide acceptably good long-term results of coronary revascularization in patients with FH.
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PMID:Long-term appraisal of coronary bypass operations in familial hypercholesterolemia. 837 22


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