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

Radiological diagnosis of arteriosclerotic abdominal aortic aneurysm is discussed. This review is based on the evaluation of 70 abdominal plain films and 58 aortograms. In addition, 11 aneurysms have been examined by ultrasound tomography (grey-scale technique). In 15% of patients referred with suspicion of aneurysm, the diagnosis could not be confirmed radiologically or operatively. The diagnosis of abdominal aortic aneurysm can be established in 80% of patients on the basis of the abdominal plain films. Ultrasonography gives better results as a screening method, since it renders a definite diagnosis possible in about 98% of cases and unnecessary arteriography can thus be avoided. However, preoperative abdominal aortography remains indispensable for demonstration of the exact anatomic details and pathologic changes in the large abdominal and pelvic arteries. The risk involved in this examination are minimal. Suprarenal or combined supra- and infrarenal aneurysm were found in 9% (5 patients), and renal artery stenosis or obstruction in 12% (7 cases). Obstruction or stenosis of the celiac artery and the superior mesenteric artery were present in only 2 patients with suprarenal expansion of the aneurysm. The angiographic-anatomic correlation is excellent, and only very infrequently is it impossible to determine exactly the distal extent of the aneurysm (2 patients).
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PMID:[Radiologic diagnosis of abdominal aortic aneurysm. Value of abdominal radiography, ultrasonic tomography and abdominal aortography]. 85 15

Thirty-four cases of combined abdominal aortic aneurysm (AAA) and renal artery stenosis (RAS) are reported. Hypertension was found at admission in 32 subjects, the other two being well responsive to drug therapy. Angiography and selective renal vein renin assay were always performed: renal artery stenosis was unilateral in 21 (61.7%) subjects and bilateral in 13 (38.3%). In 9 cases renal artery stenosis was not correlated to the hypertensive state. Mild chronic renal insufficiency was demonstrated preoperatively in 20 patients (58.8%). Simultaneous surgical treatment was carried out in 25 cases (73.5%). Mortality was 4% (one subject), severe renal insufficiency 8% (two subjects) and permanent renal failure 4% (one subject) All complications occurred among the group with bilateral RAS. While surgical repair of AAA is always mandatory, simultaneous surgical treatment of AAA and RAS should be carried out in carefully selected cases, due to elevated mortality rates reported in the literature, in order to cure renovascular hypertension, when it is demonstrated as related to RAS, or to preserve renal functionality, when RAS is contralateral to a functionally excluded or hypotrophic kidney or it exceeds 80% of the diameter of the artery.
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PMID:Surgical approach to combined abdominal aortic aneurysm and renal artery stenosis. 129 47

We present a surgical technique that we believe provides superior cerebral protection for simultaneous correction of carotid and cardiac pathology with low operative mortality and stroke rate. Our study population consists of 23 consecutive patients undergoing cardiac operation between August 1989 and April 1991 who also had associated critical (greater than 85%) carotid artery stenosis. Using 20 degrees C systemic hypothermia for cerebral protection, we performed simultaneous correction of both lesions during the aortic cross-clamp period, using continuous retrograde blood cardioplegia for myocardial protection. Mean patient age was 69.4 years; 83% were 65 years or older. Eighty-seven percent had angina, 35% had recent myocardial infarctions (within 30 days), and 52% had congestive heart failure. Asymptomatic bruit was found in 39%, and 61% had previous strokes, neurologic symptoms, or both. All had 85% or greater luminal narrowing on cerebral angiography, with 65% having severe or critical contralateral disease as well. Sixty-one percent had associated other vascular pathology, including peripheral vascular occlusive disease, renal artery stenosis, or abdominal aortic aneurysm. There were no postoperative strokes or neurologic events. One early vein graft occlusion resulted in postoperative myocardial infarction and subsequent death (4.3%).
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PMID:Combined cardiac operation and carotid endarterectomy during aortic cross-clamping. 843 Oct 83

To estimate its clinically unsuspected prevalence among patients with renal insufficiency, renal duplex sonography (RDS) was used to estimate the presence of critical renal artery stenosis (RAS) in that population. Patients, aged 45 to 75 years, with a serum creatinine of greater than or equal to 2.0 mg% but without dialysis dependence, prior renal transplantation, or prior renal artery surgery were considered for RDS. Fifty-three patients who met criteria for study were randomly selected from the Section of Nephrology clinic files and each patient was contacted both by mail and by telephone. Twenty-five patients agreed to RDS, and renal artery anatomy was determined in 21 patients using standardized RDS techniques. These techniques have demonstrated an overall accuracy of 96 and 97 per cent when compared prospectively to conventional angiography during validity analyses in the authors' center. Results of RDS revealed significant findings in 5 of 21 patients (24%). Three patients demonstrated criteria for ischemic nephropathy (IN): one patient had RAS with contralateral renal artery occlusion confirmed by angiography, while 2 patients demonstrated unilateral RAS. An abdominal aortic aneurysm and unilateral hydronephrosis were discovered in the fourth and fifth patients. Evaluation of patient demographic data and functional parameters as predictors of IN revealed that the duration of renal insufficiency at the time of RDS and extra-renal organ-specific atherosclerotic damage were significantly different between the groups with and without IN. The authors preliminary findings suggest that unsuspected ischemic nephropathy may exist in a significant minority of patients with renal insufficiency.
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PMID:Prevalence of ischemic nephropathy in patients with renal insufficiency. 164 86

This study analyzed 33 variables that might potentially affect outcome in a series of 332 consecutive elective abdominal aortic aneurysm repairs in a southern West Virginia community. One of the interesting features of this series was that the repairs were done by 22 surgeons with varying degrees of experience. The mortality and complication rates were compared for various potential risk factors by both univariant methods (chi 2, Fisher's exact, and Student t tests) and multivariant methods of analysis. Our early mortality (2.1%) and postoperative complication rates were consistent with those of other series. With multiple linear regression models, five factors were selected as significant independent risk factors associated with an increasing number of postoperative complications: the number of blood transfusions (p less than 0.0001), left renal vein ligation (p less than 0.0001), the presence of greater than 50% renal artery stenosis (p = 0.0012), the lesser experience of the surgeon (p = 0.0203), and the history of prior cardiac catheterization (p = 0.0245). The only factor statistically correlated with mortality rate was an increased number of postoperative complications (p less than 0.0001). Neither postoperative complications nor mortality rate was found to be significant and independently influenced by other demographic, clinical, or operative factors. It is tempting to speculate that surgeons with less experience might be well served to refer patients with significant renal artery stenosis and coronary artery disease. Our mortality and complication rates were not increased by performing preoperative angiography and therefore prudent surgeons may find this helpful in selecting patients for safer repair.
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PMID:Elective resection of 332 abdominal aortic aneurysms in a southern West Virginia community during a recent five-year period. 200 May 55

Thirty five patients who underwent simultaneous aortic and renal artery reconstruction are reviewed, to determine the value of the combined approach. The risk factors determining operative morbidity and mortality are discussed, on the basis of a long term follow-up of more than sixteen years. All patients had a significant renal artery stenosis, in addition to either severe aorto-iliac occlusive disease or an abdominal aortic aneurysm. Twenty seven patients were hypertensive, and eight patients normotensive. Combined aorto-renal reconstruction was carried out prophylactically in eight instances. There were two operative deaths (5.7%). Factors found to be associated with an increased operative risk were advanced age (over 65 years), heart disease with ECG changes, severe hypertension and diabetes. Renal insufficiency with azothaemia and high levels of creatinine, represented a major risk factor. Post operatively, six individuals (24%) were classified as "cured" and thirteen (523) were "improved". Patients with bilateral renal artery stenosis, mild azothemia and moderately elevated creatinine, were found to improve significantly their renal function post operatively. No patient required hemodialysis. Simultaneous aorto-renal reconstruction may be performed with a low mortality and gratifying improvement in hypertensive patients, without evidence of adverse features.
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PMID:Simultaneous aorto-renal reconstruction and consideration to the value of combined approach. A 2-16 years follow-up study, with review of the literature. 331 23

A case is described of the onset of acute renal failure due to renal artery occlusion in a solitary kidney of a sixty-six-year-old woman. She had been treated for severe hypertension due to renal artery stenosis. An aortorenal bypass to revascularized the kidney was combined with repair of an abdominal aortic aneurysm. There was early and full recovery of renal function in the single kidney, and the patient was completely rehabilitated. Review of the literature shows that an aggressive surgical approach to the management of renal artery occlusion is usually followed by excellent results. The pre-existence of renal artery stenosis encourages the formation of a collateral arterial supply which maintains the nutrition of the kidney almost indefinitely, after renal artery occlusion. Revascularization will result in prompt recovery of renal function.
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PMID:Simultaneous aortic and renal artery reconstruction for acute arterial occlusion in solitary kidney. 333 30

A thorough investigation of a hypertensive 25 year old male was undertaken due to the finding of an absent right radial pulse. This work-up revealed widespread, largely asymptomatic arterial disease characterised by a combination of multiple sites of stenosis and occlusion, aneurysmal dilatation and extensive vessel wall calcification. The findings included a right renal artery stenosis, an abdominal aortic aneurysm and a splanchnic vasculature completely supplied by the inferior mesenteric artery. Consequently it was thought that a prolonged clamping time during the aortic repair would possibly result in ischemic injury. Therefore, the splanchnic organs were perfused by a paediatric oxygenator and pump during the aortic cross-clamping. This case report discusses the etiology of the disease and the technical aspects of splanchnic perfusion.
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PMID:Temporary extracorporeal perfusion of the splanchnic circulation dependent on the Riolan anastomosis. 358 23

Evaluation of intravenous digital subtraction angiography (IV DSA) in patients with abdominal aortic aneurysm was performed by obtaining catheter aortograms immediately before DSA studies in ten patients. Diagnostic images were obtained in nine of ten digital subtraction examinations. Although repeat injections were necessary in six DSA and three conventional aortography cases for adequate imaging of both cephalad and caudal extension of the aneurysm, average contrast dose was 53 cc (62 cc in standard catheter studies). Renal artery stenosis was diagnosed by DSA in two of three vessels, multiple renal arteries were demonstrated by both modalities in two cases. Digital subtraction and conventional aortographic findings were proved at surgery. Intravenous DSA was shown to be useful in the preoperative evaluation of patients with abdominal aortic aneurysm.
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PMID:Comparison of intravenous digital subtraction angiography to conventional aortography in patients with abdominal aortic aneurysm. 391 Feb 50

Twenty-eight patients with abdominal aortic aneurysm were examined by computed tomography (CT) and aortography. They subsequently underwent aneurysmectomy and reconstruction of the aorta. CT provided in most of the cases the same or more accurate preoperative information than aortography. CT is comfortable for the patient, less invasive and faster than aortography and can be done as an outpatient procedure. Thus, we recommend CT to be the primary method for preoperative evaluation of abdominal aortic aneurysm. In selected cases aortography gives additional information regarding the relationship to the renal arteries (when the aorta is very tortuous), the occurrence of renal artery stenosis, and peripheral vascular disease.
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PMID:Computed tomography versus aortography for preoperative evaluation of abdominal aortic aneurysm. 673 Oct 24


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