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

Eleven cases of renal failure associated with resection of ruptured abdominal aortic aneurysm and requiring hemodialysis are reported. Previously described series have emphasized the extremely high mortality rate in such patients. In our clinical experience, however, 8 of 11 consecutively treated patients with this clinical problem survived and recovered adequate renal function. We believe that these favorable results can be largely explained by the low incidence of pulmonary infection in our patients as opposed to the frequent occurrence of pulmonary sepsis in other reported series. The reduction in the incidence of pulmonary infection can probably be attributed to the early discontinuance of artificial ventilation after prompt removal of pulmonary edema fluid by intensive hemodialysis ultrafiltration. These survival figures demonstrate that, with appropriate intensive management, full recovery is possible in the majority of patients with acute renal failure complicating ruptured aortic abdominal aneurysm. Our experience serves as a stimulus to render full intensive care support to such patients.
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PMID:Acute renal failure after ruptured abdominal aortic aneurysm: an improved clinical prognosis. 45

Acute aortic occlusion is most often seen in elderly patients with advanced cardiac disease. The management of these patients has been facilitated by the use of extraanatomic bypass. Over the past 2 years, six patients aged 55 to 87 years presented to our medical center with acute aortic occlusion, three after major operative procedures. One patient had a thrombosed abdominal aortic aneurysm; in the other five patients differentiation between saddle embolus and thrombosis of the distal aorta was impossible. There was one operative death. Four of the other five patients underwent axillobifemoral bypass and one underwent aortofemoral thrombectomy. All survived, and none required amputation. Two of the three patients who underwent preoperative aortography developed transient renal failure postoperatively. Aortography is of little value in diagnosis and is probably contraindicated in acute aortic occlusion. Our recommendation for operative management includes (1) preparation of the patient for possible axillobifemoral bypass, (2) angiography of distal runoff via both femoral arteries, (3) attempt at bilateral aortofemoral embolectomy with Fogarty catheters, and (4) axillobifemoral bypass if embolectomy fails to restore normal pulsatile flow.
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PMID:Management of acute aortic occlusion. 46 33

Ten patients have undergone surgical division of the left renal vein (LRV) during operations on the abdominal aorta. Nine were elective procedures performed during the resection of a complicated abdominal aortic aneurysm (six patients) or treatment of complete infrarenal aortic occlusion (three patients). The first patient in this series underwent emergency LRV ligation at the renal hilum for the control of hemorrhage incurred during an elective aneurysmectomy. This patient survived postoperative renal failure and myocardial infarction, but died 21 months later from another myocardial infarction. At the time of death, he had moderate renal insufficiency. None of the remaining nine patients undergoing elective LRV division experienced any apparent renal dysfunction, as measured by urine sediment, serum creatinine, blood urea nitrogen, and intravenous pyelography. Although not recommended as a routine maneuver, division of the LRV is advocated as a safe adjunct for surgical exposure in difficult aortic procedures.
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PMID:Division of the left renal vein: a safe surgical adjunct. 62 89

The first patient with an abdominal aortic aneurysm with rupture into the inferior vena cava associated with a horseshoe kidney is reported. Rupture of an aortic aneurysm into the inferior vena cava with formation of an aortocaval fistula has been reported in 100 patients. Aortic aneurysm in combination with horseshoe kidneys has been described in 34 patients. The diagnosis was made by an abdominal aortogram. The patient's preoperative condition was characterized by circulatory and renal failure subsequent to the development of a large aortocaval fistula. Operative repair was performed by dividing and rotating the kidney, dividing a renal polar artery, incising the aneurysm, and over-sewing the fistula from within. The patient's postoperative course was complicated by renal failure and sepsis and he died two months later. It is essential to preserve renal function in patients with this combination of anomalies.
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PMID:Abdominal aortic aneurysm with rupture into inferior vena cava associated with horseshoe kidney. 63 92

Resection of an abdominal aortic aneurysm was associated with intraoperative or postoperative leg ischemia in seven of 100 consecutive survivors of this procedure. Distal embolization of thrombus and debris is the apparent cause in the majority of cases (six). One case of stenosis at a graft-to-vessel anastomosis was identified. Early (intraoperative) thromboembolectomy averted tissue loss in four cases. The role of concurrent lumbar sympathectomy in ameliorating ischemic tissue loss is evaluated. Postaneurysmectomy leg ischemia may accompany other serious complications, particularly hypotension and renal failure.
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PMID:Leg ischemia following surgery for abdominal aortic aneurysm. 68 82

The effectiveness of an intravenous nutritional program plus aggressive dialysis was studied in 32 patients with renal failure following ruptured abdominal aortic aneurysm. Each patient was managed postoperatively with a renal failure fluid regimen, consisting of the eight essential amino acids plus dextrose in conjunction with peritoneal dialysis and hemodialysis. This regimen induced salutary metabolic effects temporarily improving the patient's condition in most instances. No technical or septic complications associated with the intravenous dietary therapy occurred. However, the incidence of recovery of renal function was low, and the overall patient survival was only 12.5%. The experience indicates that although this program has been shown to be efficacious in some patients with acute renal failure, it seems of little benefit in those whose renal failure follows ruptured aortic aneurysm.
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PMID:Renal failure after ruptured aneurysm. 80 97

Ruptured abdominal aortic aneurysm complicated by renal failure is associated with a mortality greater than 90%. Aggressive management, which included the early use of hemodialysis, was employed. Between 1970 and 1973, a total of 43 patients had surgery for proved ruptured abdominal aortic aneurysm. Fourteen patients developed acute and fixed renal failure. Nine of these 14 patients had undergone hemodialysis with treatments beginning as early as the second postoperative day and lasting as long as ten weeks. There were six survivors, with a hospital mortality of 33%. This represents an improvement in survival compared with our earlier experience where the mortality in this type of patient was 93%. Early use of hemodialysis in the postoperative management of patients with acute renal failure complicating ruptured abdominal aortic aneurysm is recommended.
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PMID:Acute renal failure complicating ruptured abdominal aortic aneurysm. 113 Sep 95

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

Eight patients underwent both cardiac operation and repair of abdominal aortic aneurysm. All had respiratory impairment and significant impairment of left ventricular function, whereas six patients had severe diffuse distal coronary disease. In all patients the cardiac procedure was performed first, and the patients continued to receive cardiopulmonary bypass. Rewarming was not commenced until the abdominal repair was well under way, to protect the vital organs. There were no problems in weaning the patients from bypass, and six of the patients were extubated within 24 hours; one required ventilation for 36 hours. One patient died of colonic infarction complicated by kidney failure without being extubated. Another patient who was initially extubated in 11 hours required reintubation because of poor lung function and eventually died of multisystem organ failure caused by bilateral lower limb ischemia that persisted despite embolectomies. All survivors are well and in New York Heart Association functional class I or II between 3 and 18 months postoperatively. We conclude that for patients considered unfit for abdominal aortic aneurysm operations because of the nature of the cardiac disease, the combined operation with cardiopulmonary bypass is both safe and effective.
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PMID:Combined cardiac and abdominal aortic aneurysm operations. The dual operation on cardiopulmonary bypass. 140 1

During 1979-1988 218 patients were operated on for ruptured abdominal aortic aneurysm. On admission 110 patients (50%) were in shock. Patients with a systolic blood pressure less than 100 mmHg, anuria on admission, peroperative bleeding of more than five litres and aged more than 70 years had an increased mortality. The intraoperative mortality was 15% and the postoperative mortality 21%. The perioperative mortality decreased from 45% in 1979 to 32% in 1988. The most frequent complications were renal failure and respiratory insufficiency, both were associated with a mortality of more than 50%. The five year survival was 48%. This study has revealed that patients with ruptured abdominal aortic aneurysm have an acceptable prognosis. The investigation emphasizes the importance of early diagnosis and elective operation to avoid rupture.
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PMID:[Surgery of ruptured abdominal aortic aneurysm. Are the results compatible with the effort?]. 192


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