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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 62-years old man had plural aneurysms from the aortic arch to the descending aorta. Y-grafting had been performed twice for an abdominal aortic aneurysm. We performed the first operation which involved aortic valve and arch replacement under deep hypothermia with selective cerebral perfusion. During the operation, hemodynamics was stable, but after the operation he developed paraplegia due to ischemic change in the spinal cord. It was considered that the cause of the ischemia might have been the changing of the blood supply to the spinal cord. In patients with severe atherosclerosis, the blood supply for the spinal cord needs to be very strictly determined.
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PMID:[Spinal cord ischemia after surgery for arch and aortic valve replacement with elephant trunk for plural thoracic aneurysms]. 1507 68

The treatment of abdominal aortic aneurysms (AAAs) has changed over the past 12 years, with increased numbers of endovascular procedures being performed. Early morbidity is decreased following endovascular abdominal aortic aneurysm repair (EVAR) compared with open repair, and long-term studies of EVAR have focused on freedom from death, rupture, and conversion to open repair. Other less commonly encountered complications of EVAR are rarely reported. For instance, spinal cord ischemia (SCI) is a devastating complication infrequently seen after open AAA repair. This report discusses a case of delayed paraplegia after EVAR and reviews the pertinent literature. The incidence of SCI after EVAR is similar to open repair, but the mechanisms may be different. Atheroembolization and occlusion of pelvic inflow appear to be the predominant etiologies for SCI after EVAR. Careful consideration of the potential for SCI should be made in elderly patients undergoing EVAR, particularly if difficult arterial anatomy is present.
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PMID:Delayed paraplegia following infrarenal abdominal aortic endograft placement: case report and literature review. 1524 44

Atheromatous disease and invasive intervention of the aortoiliac and distal arteries are common. Morbidity and mortality have been reduced through understanding and management of patient risk factors. Complications of this form of treatment affect all organ systems; mortality is most frequently caused by a cardiovascular complication (eg, myocardial infarction). Infection, leading to aortoenteric fistula is a dreaded complication, and paraplegia, though rare, is a devastating outcome. Multiorgan failure and death may result from a systemic inflammatory response syndrome. Vascular surgery for infrainguinal disease also has a significant cardiovascular complication rate. Resulting complications may affect all organs; loss of an extremity may occur. The first part of this article reviews perioperative and postoperative complications of open aortic repair and lower-extremity revascularization and addresses the issue of regional anesthesia for major vascular surgery. The second part reviews endovascular aortic repair (EVAR). EVAR is a new intervention that combines surgery and radiology. Complications of EVAR are similar to open repair, but early results suggest they may be less frequent. New technology leads to new complications; endoleaks, migration of the endoprosthesis, and surgical conversion are unique to EVAR. The benefits of EVAR may be less blood loss, shorter hospitalization, and less cardiovascular stress; the risks may be aneurysm recurrence, prolonged surveillance and repeated secondary procedures. The development of EVAR, the complications, and the anesthesia-related concerns of EVAR, including its use in management of acute abdominal aortic aneurysm are reviewed.
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PMID:Complications of major aortic and lower extremity vascular surgery. 1558 93

To protect the spinal cord during thoracoabdominal aortic aneurysm repair, motor evoked potentials (MEP) monitoring and cerebrospinal fluid drainage are often employed. Herein, we report a case, where intraoperative diminishment of motor evoked potentials was accompanied by multiple cerebral infarction. A 63-year-old man underwent elective surgery for both thoracoabdominal aortic aneurysm and abdominal aortic aneurysm. He had a past history of cerebral infarction, resulting in Wernicke aphasia but no paralysis. Preoperative magnetic resonance angiography and echocardiography revealed occlusion of the intercostal and lumbar arteries, mild aortic regurgitation, and atherosclerotic lesions at the aortic arch as well as descending aorta. Anesthesia and muscular relaxation were maintained with fentanyl, propofol, and continuous administration of vecuronium at 0.5 mg x kg(-1) x h(-1). The thoracoabdominal aortic aneurysm was repaired under distal aortic perfusion with femorofemoral bypass. After terminating the bypass, we found that the MEP at the lower limb had disappeared. Although we reconstructed intercostal arteries under mild hypothermia and partial bypass, the amplitude of MEP remained very low. Suspecting spinal cord ischemia, we performed cerebrospinal fluid drainage immediately after the operation. On the postoperative day 4, when we stopped the cerebrospinal fluid drainage and propofol administration, his level of consciousness was poor and brain CT revealed multiple cerebral infarction. On the postoperative day 30, he was discharged from an intensive care unit with complications of hemiplagia and paraplegia. Although cerebrospinal fluid drainage may be recommended to protect spinal cord during thoracoabdominal aortic aneurysm repair, we should consider performing brain CT to exclude a risk of brain herniation secondary to cerebrospinal fluid drainage if there is a possibility of cerebral incidents.
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PMID:[A case report of a patient who developed hemiparaplegia with multiple cerebral infarction during thoracoabdominal aortic aneurysm repair]. 1574 19

For the endovascular therapy of abdominal aortic aneurysm an increasing number of publications deal with the subject of device-related outcome and aneurysm sac behaviour. The present study was designed to investigate whether, and to what extent, aneurysm sac behaviour of thoracic aortic aneurysms and perioperative outcome is influenced by the different types of stent grafts. Bibliographic search and analysis was performed. A systematic MEDLINE search on thoracic aortic aneurysms produced a total of 2,884 references with abstracts between 1990 and 2004. Restricted by using the additional terms of ''descending'' and ''stent graft'' the result condensed to 152 papers. Each reference was analyzed according to predetermined criteria. The majority of articles were published in the English language. Two publications summarized the results of nation-wide or continental registers of endoluminally treated patients with descending aortic dissections or thoracic aortic disease. Several series were partial and/or updated reports from the same authors and/or on the same patients. A total of 48 centres reported about the endovascular treatment of more than 3,000 patients with pathological thoracic aortic entities (Approximately 1,650 degenerative thoracic aortic aneurysms, Approximately 1,000 aortic dissections, Approximately 400 miscellaneous aortic pathologies). The heterogeneity among the series precluded any relevant comparison. Only 4 centres have presented study groups of more than 100 treated patients, but 3 series contained several treated aortic pathologies. Without a differentiation to the underlying pathology, the bibliographic research documented a rate of technical success in a range of 76% to 100%. Summarizing the data of par-procedural and in-hospital mortality the bibliographic research documented a mortality rate of 6.8% for all reported procedures. The rate of paraplegia for all procedures was 1.7%. In conclusion the presented bibliographic search and analysis demonstrated the technical feasibility of the endoluminal stent grafting of a great variety of thoracic aortic pathologies. The short-term results are promising, but data of mid-term results are rare and long-term results are missing. Moreover, the question about the influence of different types of stent grafts on the outcome can not be answered.
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PMID:Device-specific outcomes with endografts for thoracic aortic aneurysms. 1579 90

Endovascular therapy (EVT) of thoracic aortic pathologies meanwhile is an established procedure with favourable midterm results in high risk patients. Different stent fabrications are available with defined flexibility, radial attachment force, metallic stent components and membrane porosities. Recent approval of the TAG Excluder (Gore) by the Food and Drug Administration (FDA) was an important step. Endoleaks, paraplegia, stroke and retrograde dissections are the main specific complications. Type I endoleak incidence rates are related to morphological case complexity; primary frequency rates of 0-20% are reported in the literature with 0-5% secondary incidence. Creating an appropriate proximal neck -- if necessary by supra-aortic branch remodelling -- and deliberate left subclavian artery overstenting is the key mechanism to avoid proximal endoleaks. Paraplegia rates are reportedly low with EVT in the range of 0-5%. Risk situations are: cases of rupture with compromised blood pressure, cases with a history of abdominal aortic aneurysm (AAA) exclusion, cases who require total overstenting of the descending thoracic aorta. The role of cerebrospinal fluid (CSF) drainage in EVT is not defined. Stroke as consequence of embolizing material from central endoaortic manipulations is almost in the same range as paraplegia, when morphologies in the distal arch are attacked. Retrograde dissection is reported not only after treatment of type B dissection but also after aneurysms. Rigid bare springs and ballooning in cases of type B dissection seem to be involved. In recent reports mortality in elective cases varies between 1.5% and 6.5%. All these data are promising but the proof of longterm durability is still lacking. Further development will show whether or not these preliminary data will translate into longterm success.
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PMID:Stentgrafting of the thoracic aorta-complications. 1579 91

A 2-year-old male castrated Cavalier King Charles Spaniel was presented with paraplegia, cold caudal extremities and lack of femoral pulses. A 2cm long thrombus occluding the aortic trifurcation and a 3cm long abdominal aortic aneurysm with a thrombus were detected by ultrasonographic examination. The clinical and ultrasonographic findings were consistent with aortic thromboembolism. Anti-thrombotic and vasodilative therapy was not helpful and the dog was euthanized 3 days after the onset of paraplegia. A thrombus in the aortic trifurcation, multiple thoracic and abdominal aneurysms and a distal mediastinal esophageal granuloma containing Spirocera lupi worms were found on necropsy. The abdominal aortic aneurysms formed by S. lupi larval migration are believed to be responsible for the formation of the thrombus that occluded the aortic trifurcation. This is the first report of aortic thromboembolism associated with S. lupi infection.
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PMID:Aortic thromboembolism associated with Spirocerca lupi infection. 1589 30

Endovascular stent grafting (EVSG) is a minimally invasive alternative to open repair of thoracic aortic aneurysms. It is useful in the treatment of thoracic aneurysms, dissections, and ruptures. Currently, the incidence of thoracic aortic aneurysms is 6:100,000 people. Comorbidities often include hypertension, coronary artery disease, chronic obstructive pulmonary disease, peripheral vascular disease, and cerebrovascular disease, and there often is a history of smoking. Without surgical intervention, a high risk of mortality exists, primarily due to aneurysm rupture. Due to the complexity of performing open surgical repair of the thoracic aorta and its associated morbidities such as paraplegia, renal failure, stroke, and prolonged ventilator support, new approaches to thoracic aneurysm repair are being investigated. When compared with open repair, stent grafting is a palliative rather than a curative treatment, and the risk of aneurysmal rupture still exists. This article describes a patient who underwent EVSG who had a history of abdominal aortic aneurysm repair and a known bovine arch.
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PMID:Thoracic endovascular stent graft placement: a case report. 1661 18

Endovascular stent-grafting holds great potential as a minimally invasive alternative to open surgery for thoracic aortic aneurysm. Although there have been several commercially available stent graft systems applied to abdominal aortic aneurysm in the United States, Gore TAG is the only device that is approved by Food and Drug Association (FDA) for thoracic aortic aneurysm repair. Experience of endovascular aneurysm repair by our homemade system and TAG device which is crafted particularly for the thoracic aorta is reported. TAG was successfully delivered to the target region in 137 patients (98%). The aneurysm was successfully excluded by our homemade system in 258 patients (94%). The mortality rates of TAG and our homemade device groups were 2.1 and 3.6% respectively. Postoperative stroke incidence was 1.8% and was more frequent in patients with stent-graft deployed in the region between the landing zone map of Z3 and Z4. The rate of paraplegia/paraparesis with delayed onset was 2.8% in TAG group, and was almost similar in the homemade group (2.6%). The event-free rate of patients treated with stent-graft was low as compared to that of open surgery in 1 and 3 year follow-up period. Endovascular stent-grafting is feasible as one treatment option for thoracic aortic aneurysm. Selection of proper indications, development of the better device and technical improvement are keys to successful stent-grafting.
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PMID:[Endovascular stent-graft repair for thoracic aortic aneurysm]. 1691 May 12

Paraplegia secondary to spinal cord ischaemia is a rare but devastating complication of abdominal aortic aneurysm repair. We report a case of paraplegia following elective endovascular repair of an infrarenal aortic aneurysm. A cerebrospinal fluid (CSF) drain was immediately inserted and resulted in full neurological recovery. This case highlights the fact that endovascular techniques are prone to similar complications as open surgery, and the importance of prompt cerebrospinal fluid drainage in cases of spinal cord ischaemia.
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PMID:Paraplegia following elective endovascular repair of abdominal aortic aneurysm: reversal with cerebrospinal fluid drainage. 1792 Mar 9


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