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

Renal artery perfusion is usually unnecessary during resection of an abdominal aortic aneurysm, because most of these aneurysms are situated below the renal arteries. The authors report the interesting case of a patient with a solitary functioning kidney, who had undergone previous bypass grafting from the right iliac artery to the right renal artery and in whom the kidney was perfused with the Biomedicus pump during the repair of an abdominal aortic aneurysm. This technique may be useful in special situations in which any period of renal ischemia might be hazardous to renal function.
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PMID:Renal perfusion with the Biomedicus pump during resection of an abdominal aortic aneurysm. 145 90

The purpose of our article is to describe a patient with severe hypertension and moderate renal insufficiency, unstable angina, and a 6 cm abdominal aortic aneurysm. A previous aortogram had demonstrated severe bilateral renal artery stenoses. Cardiac catheterization demonstrated severe coronary disease. After cardiac catheterization acute renal failure and pulmonary edema requiring dialysis developed in the patient. In addition, evidence of impending myocardial necrosis developed. Because of the critical nature of the myocardial and renal ischemia it was necessary to perform combined myocardial and renal revascularization rather than staged procedures. At the time of coronary artery bypass grafting, a vein graft was anastomosed to the right coronary artery vein graft and tunneled through the diaphragm into the abdomen to revascularize both renal arteries. After surgery renal function gradually improved, and no further dialysis was required. The abdominal aortic aneurysm was repaired at a subsequent operation. At 2-year follow-up all grafts remained patent. The serum creatinine is 1.2 mg/dl. Although most patients with combined coronary artery disease and renal artery disease can be treated with staged operations, our procedure may be of value in patients in whom staged procedure are not feasible and in whom the infrarenal aorta is severely diseased or aneurysmal.
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PMID:Combined coronary artery bypass grafting and bilateral renal revascularization for unstable angina and impeding renal failure. 199 71

A persisting incidence of acute renal failure has been observed after operative treatment of thoracoabdominal aortic aneurysm, ruptured abdominal aortic aneurysm and renal artery occlusive disease in patients with preoperative impairment of renal function. Because preservation of kidney function can play an important role in the outcome of these patients, the effects of prostaglandin E1 (PGE1) to prevent ischaemic renal failure were studied in an experimental model. Twenty dogs were exposed to 3 h warm ischaemia by clamping of the supra- and infrarenal aorta and both renal arteries. In 10 dogs PGE1 was given intravenously (100 ng/kg/min) for 15 min before clamping. Ten dogs treated with normal saline served as controls. Glomerular filtration rate, renal plasma flow, plasma creatinine, blood urea nitrogen, urine volume, free water clearance and renovascular resistance were calculated before and after renal ischaemia for both groups. The dogs were followed-up for 2 weeks and radionuclide studies with Tc-99m-MAG3, I-131-OIH and In-113m-DTPA were performed on the third postoperative day to calculate global and split renal clearance, tracer extraction fraction and mean transport time. After renal ischemia 9 dogs of the control group and 3 dogs of the PGE1-group developed acute renal failure (P less than 0.05 due to Fisher's exact text). PGE1 infusion significantly attenuated the postischaemic fall in glomerular filtration rate and renal concentrating ability as well as the postischaemic increase of plasma creatinine and blood urea nitrogen induced by 3 h warm renal ischaemia (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Winner of the ESVS Prize 1988. Effects of prostaglandin E1 (PGE1) on experimental renal ischaemia. 265 70

Abdominal aortic aneurysm associated with a pelvic kidney was recognized and treated successfully in a 66-year-old male by keeping renal ischemia time to less than 40 minutes and implanting the renal arterial supply as a cuff with common iliac arterial anastomoses to each Dacron limb of the graft.
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PMID:Abdominal aortic aneurysm and pelvic kidney. 672 90

The case is presented of a 38-year-old male who presented with a large 10 cm x 8 cm pulsatile swelling in his abdomen. Thirteen years before, internal iliac arteries had been used to treat long segment occlusions and diseased state of both renal arteries. At the same time both kidneys had been transplanted to the iliac fossae. Digital subtraction angiography revealed a huge abdominal aortic aneurysm. Both kidneys were fully functional. As the renal transplants had been done extraperitoneally an easy transperitoneal approach was now possible. The maximum diameter of the aneurysm was 12 cm. An inclusion graft repair was carried out using a 16-mm woven Dacron graft. In the light of the favourable circumstances it was decided not to take any special protective measures against renal ischemia apart from keeping the aortic cross-clamp time short. The patient could be discharged with patent and normally functioning kidneys 10 days after surgery.
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PMID:Abdominal aortic aneurysm repair in a patient with bilateral autotransplanted kidneys. 801 29

Magnetic resonance angiography (MRA) and magnetic resonance imaging (MRI) are noninvasive techniques of visualizing blood vessels without the use of intravenous contrast or ionizing radiation. This prospective study assessed preoperative MRA and MRI in the evaluation of 28 patients with abdominal aortic aneurysm (AAA). MRI and MRA accurately predicted the extent of cephalad AAA, the patency of the superior mesenteric artery, and the course of the left renal vein, but were less accurate in defining the extent of caudal AAA, flow of the inferior mesenteric artery, and multiple renal arteries. This study suggests that MRI and MRA are alternatives to the combination of angiography and computed tomographic scan in the preoperative evaluation of patients with suspected AAA and no evidence of mesenteric or renal ischemia. When combined with preoperative segmental Doppler arterial studies, an accurate surgical plan may be formulated. Further refinements in image acquisition and postprocessing software analysis will advance the use of MRI and MRA for complete evaluation prior to elective AAA repair.
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PMID:Magnetic resonance angiography in the preoperative evaluation of abdominal aortic aneurysms. 835 11

A patient with a large abdominal aortic aneurysm was noted to have a congenital pelvic kidney. The patient also had bilateral iliac aneurysms that required repair. The blood supply of the congenital pelvic kidney was not apparent from preoperative studies but was found at the time of surgery to be from the area of the aortic bifurcation. Pelvic renal ischemia was limited by a "double proximal clamping" technique and by placement of a temporary shunt from the body of the aortic graft into the pelvic renal artery during completion of two distal anastomoses. The patient's renal function remained normal during the perioperative period, and the reconstruction was demonstrated to be patent more than one year after surgery. Although simple clamping and expeditious reconstruction are appropriate in most cases of aortic surgery in the presence of congenital or transplant pelvic kidney, more complex anatomy, including iliac aneurysms, may require longer periods of ischemia. Pelvic renal ischemia may be limited with the technique described.
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PMID:Temporary perfusion of a congenital pelvic kidney during abdominal aortic aneurysm repair. 844 61

Between June 1992 and May 1996, five patients underwent an abdominal aortic aneurysm (AAA) repair with concomitant arterial branch reconstruction. All of the patients were males ranging in age from 55 to 66 years (mean: 61.6 years). The operations were performed for a localized abdominal aortic dissection, a pseudoaneurysm after patch angioplasty of a supraceliac AAA, a pararenal AAA, a total AAA with retrograde descending thoracic aortic dissection, and a supraceliac AAA after an infrarenal AAA repair. All patients underwent bilateral renal artery (RA) reconstruction. Three patients also had a concomitant reconstruction of the superior mesenteric artery ad celiac axis. The renal arteries were preferentially reconstructed. Visceral circulation during aortic cross-clamping was maintained via a temporary bypass circuit. A temporary division of the left renal vein was necessary in two patients. Overall, the mean renal ischemia time was 17.2min (range: 10 to 32 min). There was one perioperative death due to sepsis from a graft infection. Another patient died 6 months postoperatively due to pyothorax. One patient required postoperative hemodialysis for 1 month. Based on the above findings, the temporary bypass technique is thus considered to be useful for maintaining physiologic organ perfusion during aortic clamping without the need to use any complicated devices.
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PMID:Abdominal aortic aneurysm repair with arterial branch reconstruction: utility of the temporary bypass technique. 960 1

The coexistence of an abdominal aortic aneurysm (AAA) and a pelvic renal allograft is a unique clinical situation. Because of the increased susceptibility of the transplant kidney to ischemic injury, various approaches have been developed to minimize allograft ischemia during open aneurysm repair. Endovascular techniques have the potential advantage in this situation of greatly diminishing renal ischemia time. To our knowledge, this approach has not been reported in this situation. We report a case of a 61-year-old male with a 7.0-cm AAA and a functioning right pelvic transplant kidney. There was an adequate aneurysm neck below the level of the superior mesenteric artery with occluded renal arteries. Successful endovascular repair of the aneurysm was achieved using a bifurcated graft and bilateral iliac extensions. Perfusion to the renal allograft was maintained throughout the procedure except for short periods when the graft was expanded with a balloon. Short-term follow-up reveals successful aneurysm exclusion and no deterioration in renal function. This exciting new approach to this challenging clinical problem is reviewed along with other methods of minimizing renal allograft ischemia.
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PMID:Endovascular repair of abdominal aortic aneurysm with coexisting renal allograft: case report and literature review. 1166 48

In an effort to identify preoperative and perioperative factors impacting outcome in repair of juxtarenal abdominal aortic aneurysm (JRAAA), hospital records and CT scans (for calcification, intraluminal thrombus, and aortic diameter) of all patients undergoing JRAAA repair over the past 10 years were reviewed. The 87 men and 25 women had a mean age of 72, and a mean maximal aortic diameter of 6.2 cm. Renal artery stenosis (RAS) and iliac disease were present in 13 (11%) and 40 patients (35%), respectively. Comorbidities included coronary artery disease (n = 49, 44%), COPD (n = 28, 25%), diabetes mellitus (n = 10, 9%), and preoperative renal insufficiency (PRI; Cr >1.4 mg/dL; n = 14, 12%). A midline incision was used in most of the patients (n = 98, 88%). The proximal aortic clamp was placed in the supraceliac (SC) position in 92 (82%) patients, and directly above one or both renal arteries in 20 (18%) patients. The overall mortality was 6% (n = 7). Cardiac complications occurred in 26 patients (23%); pulmonary, in 22 (20%); renal, in 14 (12%); and gastrointestinal, in 10 (9%). No patient experienced mesenteric ischemia. Mean elevation in creatinine was greater in patients with PRI (1.8 mg/dL vs. 0.13 mg/dL, p = 0.04). Mean blood loss (EBL) was 2701 +/- 189 cc, and mean LOS was 16.1 +/- 1.7 days. Age >70 was associated with increased length of stay (LOS) (12.1 days vs. 18.6 days, p = 0.05) and higher mortality (0 vs. 10%, p = 0.02); otherwise there were no significant relationships between pre- and perioperative parameters and any of the measured outcomes including death, postoperative RI, and LOS. Preferential SC clamping may substantially reduce complications of JRAAA repair (such as mesenteric and renal ischemia) related to proximal cuff disease, but cannot overcome the deleterious affects of advanced age and PRI.
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PMID:Optimal operative strategies in repair of juxtarenal abdominal aortic aneurysms. 1252


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