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

A large end stage renal failure population treated by chronic ambulatory peritoneal dialysis (CAPD) was examined for rates of infection, CAPD modality failure and patient survival (N = 347). Nearly half were considered high risk for survival for reasons of age (39% older than 60 years), diabetes mellitus (33%), hemodialysis access failure (10%), poor cardiopulmonary reserve (16%) or technical challenges (30% had morbid obesity, history of abdominal aortic aneurysm repair or multiple abdominal surgeries). Hence, CAPD was often initiated by default rather than choice in the 347 patients studied (mean age: 51 +/- 17 years). Infections greatly outnumbered technical failures as grounds for cessation of CAPD. Over 5521 patient-months, 51% of patients developed infection with peritonitis predominating (80%) when compared to exit site infections (20%). The frequency of infections was 1.9 mean episodes per patient; however, 55% of these patients had only one episode of peritonitis. A rate of 0.75 infections per patient per year was seen with an average interval of 16 months between infections. Technique and patient survival rates at 4 years were 50% and 61% respectively. High risk status does not preclude successful CAPD and should not preclude its implementation.
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PMID:Single center success with a high risk peritoneal dialysis population. 136 61

The operative mortality rate for abdominal aortic aneurysm resection remains high (20% to 66%) for high-risk patients. The high-risk factors are severe cardiac, respiratory, and renal insufficiency and morbid obesity. Those advocating the alternative nonresective treatment of aneurysm thrombosis and axillofemoral bypass grafts have reduced the operative mortality rate to between 0% and 7%. However, in a collective series of 87 patients, there was a mortality rate of 10.3% in the patients with aortic aneurysms treated by the nonresective method and an incidence of reoperation for complications of axillofemoral graft of 31.0%. Many of these patients had subsequent operations and/or radiologic procedures to complete the process of aneurysm thrombosis (23.0%). Because there is an increasing trend toward this method of treatment, we reviewed our experience with the conventional aneurysm resection in a similar group of patients. Of 105 consecutive patients, 19 qualified as high risk. One patient died, resulting in an operative mortality rate of 5.2%. Cerebral, cardiac, and renal morbidity was transient and subsequent operations were not required. Eighteen patients were discharged as well. In the remaining 86 patients, one died, resulting in an operative mortality rate of 1.2%. The mortality rate for the entire series was 1.9%. Indications for the nonresective treatment appear to be increasing by the addition of other risk factors. This trend is of concern. We believe that there are limited indications for the treatment of aortic aneurysms without resection. However, the procedure should not be offered lightly as an alternative form of treatment.
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PMID:The contrary position to the nonresective treatment for abdominal aortic aneurysm. 396 58

Extracorporeal shock wave lithotripsy (ESWL) for urolithiasis may result in rupture of a coexistent abdominal aortic aneurysm (AAA). We report a patient who required ESWL and who had an AAA. Open surgery was precluded by morbid obesity and persisting incisional hernias after mesh repair. Endovascular AAA repair (EVAR) with bifurcated grafts was precluded by an 11-mm distal aorta. EVAR with stacked tubular AneuRx components was performed, followed by ESWL. The AAA was excluded, and the integrity and position of the endografts were not altered by ESWL.
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PMID:Endovascular abdominal aortic aneurysm repair to prevent rupture in a patient requiring lithotripsy. 1468 53

The aim of this study was to determine whether vascular patients are becoming progressively more obese and whether morbid obesity affects outcomes from vascular surgery. Data for the index vascular procedures of infrainguinal bypass, carotid endarterectomy, and abdominal aortic aneurysm (AAA) repair were collected in a computer database for 1996-2006. Body mass index (BMI) was stratified into <18.5 kg/m2 as underweight, >35 kg/m2 as morbidly obese, and other as control (18.5 < BMI < 35). The data were analyzed with respect to operation duration, length of stay, complication rates, and mortality rates. Results were adjusted for potential confounding variables, including mode of admission, diabetes, cardiac history, renal function, and smoking. A total of 1,317 patients were reviewed, and 1,105 cases were deemed suitable for analysis. The incidence of morbid obesity increased in a linear manner from 1.3% to 9% over the 10-year period. The operation duration was longer for morbidly obese subjects compared with normals. This was only statistically significant for AAA repair category, with a mean operating time of 158.4 +/- 65.5 min for patients with BMI <35 kg/m2 vs. 189.8 +/- 92.2 min for morbidly obese patients (p < 0.014). Infection rates were consistently higher in the morbidly obese group; however, this reached a statistically significant rate among AAA repair cases (43.5% [n = 16] vs. 34.8% [n = 159], p < 0.004). There were no significant differences in other complications, graft failure, length of stay, or mortality. Vascular patients are becoming progressively more obese. Procedures performed on morbidly obese subjects take longer, and these patients have higher rates of infectious complications. This is mainly attributable to AAA. This did not translate into poorer final outcomes in this study, although significant differences might emerge from a larger sample.
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PMID:The effects of increasing obesity on outcomes of vascular surgery. 1869 22