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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 review of the literature shows a very variable mortality, especially after emergency operations for abdominal aortic aneurysm (AAA) (14-70%). We therefore analyzed the mortality of our patients in different subgroups. The hospital data of 82 patients operated on for abdominal aortic aneurysm were analyzed retrospectively. 42 patients underwent emergency operations and 40 patients elective surgery. The mean age was 67.5 +/- 9.4 and 70.7 +/- 7.3 years respectively. The overall 30-day mortality in elective cases was 5% (2/40); elective patients under the age of 75 years had a mortality of 0%. 33% of the emergency cases died within 30 days. The mortality in various subgroups was as follows: "asymptomatic AAA" 5.4% (2/37), "symptomatic AAA" 10% (1/10), "retroperitoneal rupture" 34% (11/32) and "intraperitoneal rupture" 66.6% (2/3). Preoperatively 21/42 patients who underwent emergency surgery were in hypovolemic shock (systolic blood pressure < or = 90 mm Hg). The mortality of these patients was 52% (11/21) compared to 9.5% (2/21), (p < 0.01), in emergency patients without preoperative shock. The causes of death after emergency procedures were hypovolemic shock in 6, heart failure in 4, and multi-organ failure, respiratory insufficiency, unknown and pulmonary embolism in 1 each. 5/14 patients died in theatre. Two patients died after elective procedures: one 9 days postoperatively from myocardial infarction and the second 23 days after the operation from an unknown cause. Reoperation rate after elective and emergency procedures was 7.5% and 16.6% respectively. Mortality after reoperation was 40%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Abdominal aortic aneurysm. Risks and early postoperative course]. 144 85

Case of sixty-six year old male with abdominal aortic aneurysm rupturing into the retroperitoneal space and inferior vena cava is presented because of its rarity. Patient was operated upon with initial success but died probably due to pulmonary embolism with thrombus originating from the inferior vena cava narrowed at surgery.
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PMID:Aneurysm of the abdominal aorta ruptured to the retroperitoneal space and inferior vena cava. Case report. 184 5

Decisions to resect small aortic aneurysms or employ non-operative treatment for aorto-iliac occlusive disease must depend on current rather than historical surgical results. To assess current morbidity and mortality, we reviewed 200 consecutive aortic resections in two groups of patients treated from 1981 to 1989: those undergoing elective aortofemoral bypass for occlusive disease (AFB, no. 100) or resection of infrarenal abdominal aortic aneurysms (AAA, no. 100). Indications for AFB included claudication (54%), rest pain (32%), and gangrene (13%). AAA size ranged from 3 to 14 cm (mean 6.5 +/- 2.4 cm); 45% presented with abdominal or back pain. Patients undergoing AFB were younger (AFB 61.5 +/- 10 years vs AAA 68.7 +/- 8.9 years) with a higher incidence of some atherosclerotic risk factors, diabetes mellitus 30% vs 10%, tobacco use 77% vs 49%, hyperlipidemia 21% vs 7%; p less than 0.001). Coronary artery disease (CAD) was more prevalent in AAA patients (49% vs 34%; p less than 0.001). Postoperative mortality was not different in occlusive or aneurysmal disease (3% AFB vs 2% AAA), nor was the occurrence of serious complications such as myocardial infarction (2% vs 1%) or pulmonary embolism (2% vs 3%). Improvements in patient selection, perioperative care and surgical technique have lowered the mortality of elective aortic surgery. Given the current standard of care, an aggressive approach to AAA even in high risk patients is appropriate. The low morbidity of AFB for occlusive disease mandates a critical appraisal of less effective nonoperative therapies.
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PMID:Current results of elective aortic reconstruction for aneurysmal and occlusive disease. 221 95

A 59 years old male with abdominal aortic aneurysm ruptured into the left common iliac vein was transferred to us with symptoms resembling deep vein thrombosis of the left lower extremity, such as leg pain, swelling and dilatation of the superficial veins. At operation, a Fogarty's occlusion catheter was inserted through the right greater saphenous vein into the inferior vena cava and inflated concomitantly during aortic clamp to prevent pulmonary embolism which may be caused by the dislodged thrombi from the aneurysm, and as well as to control back-flow-bleeding from the central. The fistula (3.0 X 1.0cm) was closed from inside of the aneurysm using the inferior wall of the aneurysm. The blood from the fistula was collected by the Cell Saver and re-transfused to the patient. The abdominal aorta was replaced with a Dacron Y-shaped prosthesis. The postoperative course was uneventful. CTR on chest X-ray subsided from 51% to 42%, cardiac output normalized from 11l/min to 6l/min, and symptoms resembling the deep vein thrombosis disappeared.
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PMID:[A case of abdominal aortic aneurysm ruptured into the left common iliac vein with symptoms resembling deep vein thrombosis]. 398 87

A preoperative and postoperative hemodynamic study was performed in 20 consecutive patients undergoing elective resection of abdominal aortic aneurysm. Screening for venous thrombosis and pulmonary embolism with 125I uptake test, measurements of maximal venous emptying and pulmonary perfusion scintigraphy were also done before and after the operation. Only five patients complained of intermittent claudication preoperatively, but the laboratory investigations revealed signs of peripheral arterial insufficiency in 15 cases. Maximal venous emptying from the legs was markedly decreased on the first postoperative day and remained significantly below normal on the sixth day. Signs of postoperative thromboembolism appeared in eight patients. These patients did not differ from the others in regard to the pattern of maximal venous emptying. In the three-year follow-up period, the calf blood flow and the ratio of systolic toe pressure to systemic systolic blood pressure were further decreased, despite significant rise in systemic blood pressure.
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PMID:Hemodynamic findings before and after resection of abdominal aortic aneurysm. 649 75

Four cases of rupture of an abdominal aortic aneurysm into the inferior vena cava are presented. Clinical diagnosis may be difficult because characteristic symptoms are not always present. It is important to recognize the symptoms of an aortocaval fistula as it is usually rapidly fatal. Recognition must lead to immediate surgical intervention. Special attention must be paid to prevent the serious complications inherent in this syndrome such as copious venous bleeding. Preoperatively, strict monitoring of intravenous transfusion is essential. During the operation care in handling the aneurysm is necessary to avoid pulmonary embolism. Surgical closure of the fistula is easy from within the aneurysm.
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PMID:Aortocaval fistula: an easily missed diagnosis. 652 36

Massive pulmonary embolism associated with total cardiovascular collapse occurred during the surgical repair of a ruptured abdominal aortic aneurysm with an aortocaval fistula. Pulmonary artery pressure monitoring permitted immediate diagnosis whereas central venous pressures did not reflect the obstruction to right ventricular outflow. Pulmonary embolectomy without cardiopulmonary bypass was performed successfully.
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PMID:Intraoperative diagnosis and treatment of massive pulmonary embolism complicating surgery on the abdominal aorta. 687 Oct 62

A 66-year-old man with an abdominal aortic aneurysm confirmed by CT had bilateral swelling of the lower extremities with pain radiating to the back. Radionuclide venography and pulmonary scintigraphy demonstrated occlusion of the inferior vena cava and multiple pulmonary emboli, with a hot spot in the liver. Surgery revealed a ruptured abdominal aortic aneurysm that occluded the inferior vena cava, fistula formation, and extensive thrombosis of the inferior vena cava proximal to the occlusion site. Radionuclide venography was useful in detecting venous obstruction and the collateral formation represented by the hot spot in the liver as complications of the ruptured abdominal aortic aneurysm, and in assessing the improvement of pulmonary embolism by medical therapy.
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PMID:Inferior vena cava occlusion with pulmonary embolism because of complications due to ruptured abdominal aneurysm demonstrated by radionuclide venography. 762 49

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

Twenty-two spontaneous aortocaval fistulas between an abdominal aortic aneurysm and the inferior vena cava were surgically treated in 27 years at one surgical unit. The incidence was 5.9% of ruptured abdominal aneurysms; the operative mortality rate of 36.4% compared with an overall mortality rate for ruptured abdominal aortic aneurysms of 34.9%. Among 10 subjects in shock on admission the mortality rate was 50% compared with 25% in non-shocked patients. Of the 22 patients one died at laparotomy from irreversible cardiac arrest; in the other 21 the procedure consisted of endoaneurysmal repair of the fistula which involved replacement of the aneurysm by a Dacron prosthesis after control of venous bleeding was achieved. No occurrence of paradoxical pulmonary embolism was reported. Multiple organ failure caused death in six cases; of these, four died as a result of acute renal failure. Severe preoperative anuric shock was recorded in five instances, with a mortality rate of 80%, compared to 25% for non-shocked subjects. Mortality was not improved by intraoperative autotransfusion; however, the incidence of severe shock was 55.5% in those patients treated by autotransfusion, compared with 38.5% in the standard blood replacement group.
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PMID:Primary aortocaval fistula. 795 56


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