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

One hundred and two patients undergoing elective abdominal aortic aneurysm repair and admitted to ICU at RPAH in 1989/90 were studied. In forty patients a cell saver was used during the operative procedure (Group CS) while in the remaining sixty-two patients intraoperative blood loss was drained and discarded conventionally (Group NCS). Preoperative ASA grade and postoperative APACHE score were similar in these two groups. The amount of bank blood transfused intraoperatively was less in Group CS than in Group NCS (0.6 +/- 0.2 vs 3.3 +/- 0.3 units) (mean +/- SEM) (P less than 0.0001). The total amount of bank blood transfused during hospital admission was also less in Group CS (1.5 +/- 0.4 vs 4.8 +/- 0.4 units, P less than 0.0001). Of Group CS, 22 patients (55%) received no bank blood compared to two patients (3%) in Group NCS. There was no difference between the groups with respect to postoperative haemoglobin and creatinine levels. ICU stay was similar in both groups. We conclude that use of the cell saver reduces perioperative bank blood transfusion in elective abdominal aortic surgery.
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PMID:Use of the cell saver during elective abdominal aortic aneurysm surgery--influence on transfusion with bank blood. A retrospective survey. 175 Jun 36

The aim of this report is to review the single center, clinical experience with the Endovascular Grafting System (EGS/Ancure Endovascular Technologies, Menlo Park, Calif, USA) in the Netherlands. The program was started in January 1994 and at the moment of writing consists of 35 patients on an intention-to-treat basis. From January 1994 through January 1995, 11 patients (Group I) were treated. In January 1995, hook breaks of the attachments system were reported and consequently the EVT program was discontinued from January 1995 through January 1996, pending renewal of FDA approval. From January 1996 through October 1997, another 24 patients were treated with the redesigned EGS-II (group II). Patient and aneurysm characteristics are summarized in the table I. All patients were ASA class I-III and were scheduled for elective repair of asymptomatic infrarenal AAA. No compassionate cases or high-risk patients were included in this study. All patients were entered into a prospective follow-up program, including the following studies postoperatively, at 6 weeks, 6 and 12 months, and yearly thereafter. Duplex, plain X-rays and CT-angiography (CTA) with cine-mode post-processing. In Group I, there were 10 tubes and 1 one bifurcated system. The bifurcated EGS was explanted on the 1st postoperative day due to a significant proximal leak and lower back pain. Of the 10 tube grafts, 3 have been explanted. In one case (day 2) due to a proximal endoleak, in another case (at 12 months) due to persistent aneurysm growth with a distal endoleak and in the third case (at 3 years) due to a recurrent endoleak with aneurysm growth after initial spontaneous closure and shrinkage. These conversions and their postoperative courses were uneventful. In two cases, proximal hook breaks were detected after 6 and 15 months, but in both patients the aneurysm diameter has decreased and follow-up exceeds 3 years. Another 2 patients are alive more than 3 years after the procedure without signs of endoleak, but in one the aneurysm failed to shrink, probably due to complete circular calcification. The other 3 patients have died during follow-up (6, 11, and 20 months) from diseases unrelated to the aneurysm: one pancreatic carcinoma that had been missed on CT angiography, one respiratory failure and one myocardia infarction. Overall, at three years 4 out of 11 Group I patients are alive and well, with an excluded aneurysm. In Group II, there were 17 bifurcated grafts, 5 tubes, and 2 patients in whom a tube graft could not be placed because the introduction sheath could not pass the iliac artery. In one case, this was complicated by a tear in the external iliac artery. At conversion, both patients needed a conventional bifurcated graft, one extending into the groin to bypass the damaged external iliac artery. In a third patient, a tear in the distal aortic neck was detected intraoperatively after tube endograft placement. Conversion was performed in the same session. Of the 21 endografts that left the operating room, 2 have been explanted. In one case (day 5) a tear of the proximal neck was detected. Conversion to conventional repair involved suprarenal clamping which led to multiple organ failure in this 82-y/o patient who ultimately died. In the other the bifurcated endograft showed a distal endoleak on one side, which was locally repaired by an iliac interposition graft. Three months later a proximal and left distal endoleak was diagnosed, his aneurysm had not decreased in size, and his iliac interposition graft had occluded. He was then successfully converted to a conventional bifurcated graft. In 9 of the remaining 15 bifurcated and 4 tube grafts, endoleak was detected on the postoperative CTA. Five appeared to have closed spontaneously at 6 weeks, conversion has been scheduled in one, and 3 small endoleaks are being observed (2 weeks, 6 and 12 months). In all 35 attempts, there were four cases of injury to the common femoral artery at the introduction site, wh
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PMID:The Utrecht endovascular technologies (EVT) experience. 989 95

Operative intervention causes a necessary biologic response known as the hypermetabolic stress response. Less invasive operative procedures may cause fewer metabolic and endocrine derangements. To evaluate the metabolic and endocrine differences between endovascular and transperitoneal abdominal aortic aneurysm (AAA) repair, 10 patients underwent standard open repair (open group) and 10 patients underwent endovascular repair of AAA (endovascular group) with a modular bifurcated endograft. Blood samples were obtained prior to general anesthesia (baseline) and every 6 hr for a 24-hr period. Assays for hormones related to the postoperative stress response as well as retinol-binding protein were performed. Peak hormonal values are presented in relation to the baseline. Demographic analysis of the two groups showed that there were no significant differences in age or ASA classification. The open group had a 9.6-fold increase in epinephrine release, which was significantly higher than the 1.6-fold increase in the endovascular group (p < 0.05). Elevations in cortisol were also significantly higher in the open group. Early postoperative nutritional derangements, as reflected by the levels of retinol-binding protein, were far less in the endovascular group than in the open group. Endovascular AAA repair appears to be associated with a marked reduction in the hypermetabolic stress response and nutritional deterioration, compared to traditional open repair. This reduction in physiologic stress may have salutary effects on the incidence of postoperative medical morbidity.
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PMID:Comparison of open transabdominal AAA repair with endovascular AAA repair in reduction of postoperative stress response. 1122 45

A 65-year-old man presented with an asymptomatic infrarenal abdominal aortic aneurysm of 6 cm in transverse diameter. Five years before he received a cadaveric renal transplant. The patient also had the following risk factors and associated diseases: arterial hypertension, coronary artery disease, previous myocardial infarction, coronary angioplasty and stent, ileal resection secondary to Chron disease, hepatopathy, hyperlipidemia and hepato-renal cystic disease. The ASA classification was III, IV. Considering previous abdominal operations and risk factors, we decided to repair the aneurysm with a minimal aggression. The aneurysm was successfully approached by an endovascular route implanting a 22x10 bifurcated aorto-iliac endovascular prosthesis. The patient died 13 months later after being diagnosed of enterocolitis by cytomegalovirus complicated with sepsis and lung infection. We consider this less invasive modality of treatment a valid and useful alternative in this high-risk group of patients.
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PMID:Endovascular repair of abdominal aortic aneurysm in a renal transplant patient. 1123 76

Mesenteric traction syndrome occurs during abdominal surgery and is described as sudden tachycardia, hypotension and flush. Among other etiological factors, eventeration or mesenteric traction of the small intestine may cause histamine release from mesenteric mast cells. Therefore, our hypothesis was that mesenteric traction syndrome could be positively influenced by prophylactic administration of H1- and and H2-antihistamines. Seventeen male patients (ASA groups III-V, 48-78 years old) were investigated in a randomised double blind study during elective abdominal aortic aneurysm (AAA) repair; which, in our opinion, is one of the most standardised surgical procedures. Eight patients had pre-anaesthetic prophylaxis with 0.1 mg/kg BW dimetindene (H1-receptor antagonist) plus 5 mg/kg BW cimetidine (H2-receptor antagonist) diluted with 100 ml 0.9% NaCl, while 9 patients received a placebo (100 ml 0.9% NaCl). Anaesthesia and invasive haemodynamic monitoring were standardised in all patients. Haemodynamic parameters, plasma histamine concentrations and clinical symptoms were determined one min after skin incision (HS), and 5 and 20 min after mesenteric traction (5' EV and 20' EV). Statistical analyses were performed using the Student's t-test, the Mann-Whitney-U-test for continuous data and Chi2-test for incidences. The incidence of histamine release was 55.5% (5/9) in the placebo group vs. 37.5% (3/8) in the antihistamine group (p > 0.05, Chi2-test). Plasma histamine levels (mean +/- SD) were higher in the placebo group than in the antihistamine group at 5 and 20 min after mesenteric traction, but there was no statistical significance. Arrhythmias were significantly more frequent in the placebo group (6 times) than in the antihistamine group (none) (p = 0.005 Chi2-test). Systolic blood pressure was not statistically different between the groups (e.g. 5 min after mesenteric traction, mean +/- SD; placebo 111 +/- 20 mm Hg vs. antihistamines 119 +/- 35 mm Hg). In the placebo group, however, the haemodynamics only stabilised 5 min after mesenteric traction when anaesthetic gas concentration was repeatedly reduced and vasopressor/volume administration was increased (placebo group = 20 times vs. antihistamine group = 8 times (p = 0.001, Chi2-test). From these results we conclude that prophylactic administration of antihistamines reduces in particular the incidence of arrhythmias and the number of stabilising measures during mesenteric traction. Prophylaxis with H1- and H2-antihistamines may therefore be of perioperative benefit and should be considered in AAA surgery.
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PMID:[Mesenteric traction syndrome during the operation of aneurysms of the abdominal aorta--histamine release and prophylaxis with antihistaminics]. 1452 56

Conventional surgical treatment of anastomotic false abdominal aortic aneurysms (AFAA) is technically difficult. Morbidity-mortality rates are higher than those for surgery of infrarenal abdominal aortic aneurysm (AAA). Endovascular management without laparotomy or aortic clamping represents an attractive alternative. The purpose of this study was to determine the immediate and middle-term outcome of endovascular management of AFAA. Between 1998 and 2001, 10 patients were treated for AFAA by placement of an endograft. The initial procedure was aortobifemoral bypass for occlusive artery disease in eight cases and resection and grafting for AAA in two cases. Mean age was 70 years. Seven patients were classified ASA 3 or 4. Three patients presented cardiac insufficiency with left ventricular ejection fraction <40%. Eight patients were treated using an aortounilateral iliac artery endograft in association with crossover femorofemoral bypass (3 AneuRx, 2 Endologix, 1 Talent, 1 Zenith, 1 surgeon-made stent). Two patients were treated with an aortoaortic endograft (1 Talent, 1 surgeon-made stent). In two patients extraperitoneal exposure of the common iliac artery was required for introduction of the stent in one case and for surgical closure of the iliac artery in the other case. A total of nine patients underwent another surgical procedure in association with stenting. Four endografts were custom-made. Endograft deployment was successful in all cases. No patient died during the postoperative period. Postoperative computed tomography (CT) scan confirmed exclusion of the aneurysmal sac in all cases. The mean duration of hospitalization was 13 days (range, 5-28 days). During follow-up (mean duration, 17.7 months; range, 5-42 months), one patient died from heart-related causes. No direct or indirect endoleak was detected by CT scan follow-up and a significant reduction in AFAA diameter was noted in the eight patients with follow-up periods lasting 6 months or more. One patient developed occlusion of an aortounilateral iliac artery endograft and was treated by axillobifemoral bypass. In one patient stenosis of the distal end of an aortounilateral iliac endograft was discovered by duplex scan and successfully treated by dilatation. Endovascular treatment of AFAA is technically feasible but requires more complex procedures involving associated surgical procedures and use of custom-made endografts. The morbidity-mortality rate in this small series of high-risk patients was low. Immediate and middleterm exclusion of AFAA was good.
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PMID:Endovascular treatment of anastomotic false aneurysms of the abdominal aorta. 1467 14

We retrospectively analyzed the peri-operative outcome of 210 consecutive patients undergoing elective infrarenal abdominal aortic aneurysm (AAA) repair according to the surgical approach: transperitoneal (TP; 63 patients), retroperitoneal (RP; 81 patients) and endovascular (EV; 66 patients) repair. Concerning gender, AAA diameter and classification of the American Society of Anesthesiologists (ASA score) all groups were comparable; the median age in the EV group was significantly higher (78 years vs. 68 years and 67 years, respectively, P=0.001). Mortality rates were 0% for TP, 1.2% for RP and 3% for EV repair (n.s.). Morbidity rates did not significantly differ between the groups. In specialized centres mortality rates of elective infrarenal aneurysm repair are low - regardless of the surgical approach. In such centres the best treatment options for each patient as to the surgical approach as well as peri-operative management can be provided individually.
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PMID:Elective infrarenal abdominal aortic aneurysm repair--transperitoneal, retroperitoneal, endovascular? 1966 53

Asymptomatic cholelithiasis with abdominal aortic aneurysm (AAA) is one of few ideal fields for simultaneous "open" repair. In AAA cases with acute lithiasic cholecystitis, the simultaneous open repair is debatable due to increased possibility for prosthetic graft contamination. We report a case of a 78-year-old, ASA IV patient suffering from acute cholecystitis and concomitant (62 mm) AAA. The patient was treated by simultaneous endovascular AAA repair with a bifurcated prosthesis Endurant and laparoscopic cholecystectomy. Operative time was 165 minutes with total blood loss <100 mL. The patient fed and mobilized the second postoperative day, and the course until patients' discharge the sixth day was uneventful. Follow-up imaging at first month confirmed the successful aneurysm's exclusion without endoleak or migration. The simultaneous endovascular AAA repair and laparoscopic cholecystectomy seems to be simple, safe, and effective technique and minimized the possibility of local and systemic postoperative complications.
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PMID:Abdominal aortic aneurysm with symptomatic cholelithiasis: report of a case treated by simultaneous endovascular aneurysm repair and laparoscopic cholecystectomy. 2304 10

Innovations in thoracic endovascular aortic repair techniques have enabled its incorporation in open procedures, resulting in a hybrid approach to aortic arch repair. The present study reported our experience with the hybrid technique in managing arch pathologies. Fifty-one patients underwent a hybrid repair of arch pathologies. 10 patients had urgent or emergency surgery, and 8 had previous abdominal aortic aneurysm repair; all were classified as high risk (ASA grade III or IV). Overall 30-day mortality was 9.8% (5/51). Hospital mortality was 30% (3/10) in urgent/emergent surgery and 4.90% (2/41) in elective cases. Ischemic stroke occurred in 11.8% (6/51) of patients, while 5.9% (3/51) experienced paraplegia. Endoleaks occurred in 8 patients, 6 of which were Type 1. Long-term patency rate was 96%. The hybrid technique is a safe, effective and less invasive alternative to open repair of arch pathologies, with comparable outcomes in high-risk patient groups. Patency rates and durability demonstrate the long-term potential of this technique.
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PMID:Hybrid aortic arch repair. 2397 98

Main- and side-chain sequence-regulated vinyl copolymers were prepared by a combination of iterative atom transfer radical additions (ATRAs) of vinyl monomers for side-chain control and 1:1 or 2:1 alternating radical copolymerization of the obtained side-chain sequenced "oligomonomers" and vinyl comonomers for main-chain control. A complete set of sequence-regulated trimeric vinyl oligomers of styrene (S) and/or methyl acrylate (A) were first synthesized via iterative ATRAs of these monomers to a halide of monomeric S or A unit (X-S or X-A) under optimized conditions with appropriate ruthenium or copper catalysts, which were selected depending on the monomers and halides. The obtained halogen-capped oligomers were then converted into a series of maleimide (M)-ended oligomonomers with different monomer compositions and sequences (M-SSS, M-ASS, M-SAS, M-AAS, M-SSA, M-ASA, M-SAA, M-AAA) by a substitution reaction of the halide with furan-protected maleimide anion followed by deprotection of the furan units. These maleimide-ended oligomonomers were then radically copolymerized with styrene or limonene to enable the 1:1 or 2:1 monomer-sequence regulation in the main chain and finally result in the main- and side-chain sequence-regulated vinyl copolymers with high molecular weights in high yield. The properties of the sequence-regulated vinyl copolymers depended on not only the monomer compositions but also the monomer sequences. The solubility was highly affected by the outer monomer units in the side chains whereas the glass transition temperatures were primarily affected by the two successive monomer sequences.
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PMID:Main-Chain and Side-Chain Sequence-Regulated Vinyl Copolymers by Iterative Atom Transfer Radical Additions and 1:1 or 2:1 Alternating Radical Copolymerization. 2676 Nov 48


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