Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0162871 (abdominal aortic aneurysm)
 8,664 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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.
 ...
PMID:Surgical approach to combined abdominal aortic aneurysm and renal artery stenosis. 129 47

The 10-year experience of a single community was reviewed and a multivariate analysis was performed to determine the relative importance of clinical and environmental factors in mortality after ruptured abdominal aortic aneurysm resection. Ruptured aneurysms were repaired in 243 patients in six area hospitals (one university, five community) by 25 surgeons (16 vascular, 9 general). Overall, 30-day mortality was 55% (133/243). Although the mortality by hospital ranged from 44% to 68%, these differences were not statistically significant. However, significant variations occurred in the mortality rates of individual surgeons, ranging from 44% to 73%. The mortality rate for the vascular surgeons was less than that of the general surgeons, 51% versus 69% (p less than 0.05). Clinical factors were evaluated, and the most significant parameters were systolic blood pressure, presence of chronic obstructive lung disease, and history of chronic renal insufficiency. These results support the implication that the degree of specialization of the surgeon and the preexisting health of the patient are the most important determinants of survival after ruptured abdominal aortic aneurysm. The size and sophistication of the hospital appear to be less influential factors.
 ...
PMID:Factors determining survival after ruptured aortic aneurysm: the hospital, the surgeon, and the patient. 232 10

Chronic renal insufficiency is one of the most important factors governing the immediate and long-term outcome after aneurysm repair. A total of 484 patients with abdominal aortic aneurysm (A.A.A.) have undergone elective surgical treatment in our Institution during the last 5 years. Of these, we selected 60 patients; 30 with a normal serum creatinine concentration and 30 with preoperative renal insufficiency (serum creatinine concentration greater than 2 mg/dl). In this second group, 23 patients (76.6%) were affected by slight or median renal insufficiency, 5 patients (16.6%) were affected by severe renal insufficiency (creatinine concentration greater than 4.5 mg/dl), and 2 patients (6.6%) had complete renal failure with dialytic treatment from 1.5 and 2 years respectively. We analyzed postoperative renal function in all 60 patients. In the first group, only 6 patients (20%) showed a transient renal insufficiency, without mortality and morbidity. In the second group, postoperative complications and mortality tended to occur more frequently in patients with a severe renal insufficiency than in patients with slight or median insufficiency or complete renal failure. The present data suggest that dialytic treatment might be necessary in patients with severe renal insufficiency before aneurysm repair.
 ...
PMID:[The role of chronic renal insufficiency in the prognosis of surgical interventions in subrenal abdominal aortic aneurysm]. 823 15

Among the indications for renal artery revascularization, either surgical or endovascular, in patients with renal artery stenosis are poorly controlled hypertension, ischemic nephropathy (preservation of renal function), or recurrent episodes of "flash" pulmonary edema and congestive heart failure. Pharmacologic treatment is the first-line therapy to control blood pressure. If the disease is unilateral, the blood pressure regimen should include an angiotensin-converting enzyme inhibitor. Guidelines published in the Sixth Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of high blood pressure should be followed. Revascularization is recommended if patients have at least 75% stenosis of one or both renal arteries, combined with resistant or poorly controlled hypertension; recurrent flash pulmonary edema; dialysis-dependent renal failure resulting from renal artery stenosis; chronic renal insufficiency and bilateral renal artery stenosis; or renal artery stenosis to a solitary functioning kidney. To treat fibromuscular disease of the renal arteries, percutaneous transluminal angioplasty is the revascularization procedure of choice. Ex vivo surgical repair of the renal artery may be required if there is significant branch renal artery stenosis. To treat atherosclerotic renal artery stenosis, the revascularization procedure of choice is percutaneous transluminal angioplasty and stent implantation, especially if there is concomitant ostial or proximal renal artery disease. Surgical revascularization is performed if concomitant aortic surgery is required, such as for abdominal aortic aneurysm.
 ...
PMID:Renal Artery Stenosis. 1109 69

The outcome of conventional elective open repair for infrarenal abdominal aortic aneurysm (AAA) has improved mainly as a result of screening to detect coronary artery disease, the main risk factor for morbidity and mortality. Our group's policy is to perform routine coronary angiography in patients scheduled to undergo elective AAA repair. The purpose of this study was to evaluate morbidity and mortality in our department using this work-up strategy. From January 1990 to December 2000 we performed elective open repair on 632 patients, including 580 men (92%) and 52 women (8%). Preoperative coronary angiography performed in 607 cases (96%) revealed significant coronary disease in 53% of patients and led to the decision to propose prior myocardial revascularization in 12.5% of cases. Mortality and morbidity in the first 30 days after AAA repair were 1.4% and 15%, respectively. Analysis with the Cox model showed that the only risk factor for mortality was chronic renal insufficiency. Our data support routine use of coronary angiography prior to AAA repair. Screening and, if necessary, treatment of coronary artery disease that is commonly associated with AAA enhances the outcome of open AAA repair.
 ...
PMID:Current outcome of elective open repair for infrarenal abdominal aortic aneurysm. 1559 28

The successful endovascular repair of a type III thoracoabdominal aortic aneurysm (TAAA) with the use of a tube endograft is reported. A 56-year-old male with a 6.4-cm type III TAAA, a 4.2-cm infrarenal abdominal aortic aneurysm, and chronic renal insufficiency presented with flank pain, nausea, acute anuria, and serum creatinine of 6.1 mg/dl. Acute occlusion of the left solitary renal artery was diagnosed and emergent recanalization with percutaneous transluminal angioplasty and stenting was performed successfully, with reversal of the serum creatinine level at 1.6 mg/dl. Further imaging studies for TAAA management revealed ostial occlusion of both the celiac artery (CA) and the superior mesenteric artery (SMA) but a hypertrophic inferior mesenteric artery (IMA) providing retrograde flow to the aforementioned vessels. This rare anatomic serendipity allowed us to repair the TAAA simply by using a two-component tube endograft without fenestrations (Zenith; William Cook, Bjaeverskov, Denmark) that covered the entire length of the aneurysm, including the CA and SMA origins, since a natural arterial bypass from the IMA to the CA and SMA already existed, affording protection from gastrointestinal ischemic complications. The patient had a fast and uneventful recovery and is currently doing well 6 months after the procedure. To our knowledge, this is the first report in the English literature of successful endovascular repair of a TAAA involving visceral arteries with the simple use of a tube endograft.
 ...
PMID:Endovascular repair of a type III thoracoabdominal aortic aneurysm in a patient with occlusion of visceral arteries. 1745 Mar 97

(EVAR) Endovascular Aneurysm Repair of abdominal aortic aneurysms have mandated the need for surveillance imaging and other follow-up testing to minimize the complications of endograft failure and potential for abdominal aortic aneurysms rupture. The 2-dimensional and 3-dimensional contrast-enhanced computed tomography imaging currently serves as the gold standard for serial (EVAR) Endovascular Aneurysm Repair assessment, but this recommendation is being modified by successful clinical experience using duplex ultrasound, magnetic resonance imaging, and implantable wireless sac pressure sensors. Nearly all stent graft devices and abdominal aortic aneurysm-related complications after (EVAR) Endovascular Aneurysm Repair can be detected using available surveillance modalities assuming a compliant patient during follow-up. Alternating complementary surveillance techniques (contrast and noncontrast computed tomography, ultrasound, and pressure measures) can be used to reduce contrast dye and radiation exposure and can be tailored to patients with chronic renal insufficiency.
 ...
PMID:Surveillance after endovascular abdominal aortic aneurysm repair. 1828 50

Percutaneous renal artery revascularization for hypertension and renal dysfunction is now common, and there is an increasing realization that renal artery intervention can be associated with parenchymal injury. The frequency, cause, and outcomes of acute functional injury associated with renal intervention are poorly delineated. Our aim was to determine the frequency of acute functional renal injury 30 days after renal artery intervention, to identify factors associated with functional renal injury and determine whether functional renal injury related to renal intervention is associated with late adverse clinical events. A retrospective analysis of patients undergoing renal artery interventions for atherosclerotic renal artery disease between 1990 and 2007 was performed. No distal embolic protection devices were used. Acute functional parenchymal renal injury was defined as a persistent increase in serum creatinine of > or =0.5 mg/dL at 1 month after the procedure. Freedom from kidney-related morbidity (increase in persistent creatinine >20% of baseline, progression to hemodialysis, death from kidney-related causes) and patient survival were measured. There were 418 patients who underwent 581 renal artery interventions: 57% for hypertension, 23% for hypertension associated with chronic renal insufficiency, and 12% for renal insufficiency. Acute functional renal injury occurred in 20% of the patients. The occurrence of a functional injury was associated with a significant decrement in freedom from kidney-related morbidity (mean +/- SEM 80 +/- 2% vs. 55 +/- 10%, no injury vs. injury, p < 0.01) and markedly decreased survival at 5-year follow-up (71 +/- 4% vs. 41 +/- 10%, p < 0.01). At 5-year follow-up, three times as many patients with functional injury progressed to hemodialysis compared to those without injury (19% vs. 7%, p < 0.01). By multivariate analysis, the presence of an unrepaired abdominal aortic aneurysm (AAA), low estimated glomerular filtration rate, non-insulin-dependent diabetes mellitus, contralateral renal artery disease, and a solitary kidney were significantly associated with functional injury and poor long-term clinical benefit. Hypertension, hyperlipidemia, and contrast volume were determined to be not significant. Acute functional renal injury occurs in approximately 20% of patients undergoing percutaneous renal artery intervention and is more likely in the presence of an unrepaired AAA, non-insulin-dependent diabetes mellitus, and preexisting renal disease. Acute functional renal injury is a negative predictor of survival and is associated with subsequent renal failure, need for dialysis, and death. While this data set does not establish a causal relationship, patients who are predisposed to acute functional injury may have underlying factors that also lead to decreased long-term renal function and decreased survival.
 ...
PMID:Implications of acute functional injury following percutaneous renal artery intervention. 1869 90

A transport request was received from a free-standing emergency facility to transport a morbidly obese man with a ruptured abdominal aortic aneurysm (AAA). Weather conditions at the time prohibited rotor-wing transfer, so ground transport was arranged. The patient was a 58-year-old man being worked up for a possible back injury. During the evaluation, the patient had an episode of supraventricular tachycardia (SVT) with associated hemodynamic instability. Although the SVT corrected without intervention, the patient remained hemodynamically unstable. An abdominal computed tomographic (CT) scan with intravenous (IV) contrast demonstrated a 10-cm leaking abdominal aortic aneurysm. The patient complained of severe heartburn and abdominal pain. He had a significant medical history, including a previous three-vessel coronary artery bypass graft surgery, non-insulin-dependent diabetes, and chronic renal insufficiency. Physical examination was significant for limited mouth opening, limited neck mobility, a previous median sternotomy scar on the chest, and a markedly distended abdomen. Vital signs demonstrated a heart rate of 138 beats/min, respiratory rate 28 breaths/min, blood pressure 103/47 mmHg, and an oxygen saturation of 93% on 15 L/min by a nonrebreather (NRB) mask. Sinus tachycardia was identified on the monitor. Vascular access included an 18-gauge IV line in the right hand, a 16-gauge IV line in the left antecubital fossa, and a 7.5-French triple-lumen catheter in the right subclavian vein. Dopamine was running at 10 mug/kg/min. A unit of packed red blood cells (PRBCs) was also noted to be infusing at a rate of 999 mL/hour by infusion pump. Blood transfusion continued, and the dopamine was decreased to 5 mug/kg/min and eventually able to be discontinued. Despite this, approximately 15 minutes into the transport, the patient had another episode of SVT.
 ...
PMID:Supraventricular tachycardia in a patient with a ruptured abdominal aortic aneurysm: conclusion. 1927 68

Presented in the article is a clinical example of surgical treatment of a patient with a severe course of type 2 diabetes mellitus, multiple lesions of coronary arteries, lower-limb arteries with the development of lower-limb ischaemia, bilateral lesions of renal arteries and chronic renal insufficiency, the presence of an aneurysm of the infrarenal portion of the aorta. The unique nature of the case report consists in joint work of endocrinologists, cardiologists, specialists in purulent surgery and reoentgenovascular surgeons, also in carrying out simultaneous endovascular reconstructive operation on various vascular basins: stenting of the right renal artery, balloon angioplasty and stenting of the left leg arteries and endovascular prosthetic repair of the abdominal aortic aneurysm. The comprehensive treatment of the patient resulted in safe performance of the endovascular intervention, saving the supporting function of the limb, improvement of glycemic control, decreasing the risk of sudden death on the background of abdominal aortic aneurysm rupture, decreased rate of progression of renal insufficiency, better control of symptoms of angina pectoris and cardiac failure. Also the article reflects importance of rendering medical care for patients with multifocal atherosclerosis and diabetes mellitus, also showing the necessity of creating multi-modality medical centres and working out of algorithms for treatment of this patient cohort.
 ...
PMID:[Single-step endovascular revascularization of the kidney, lower limb and endovascular reconstruction of abdominal aortic aneurysm in a patient with type 2 diabetic mellitus]. 2305 7


1 2 Next >>