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

O2 and CO2 tensions were measured in the gastrocnemius muscles of patients submitted for reconstructive arterial surgery due to obstructive arteriosclerosis (37) or abdominal aortic aneurysm (5). Four patients without signs of arterial ischaemia served as controls. Measurements were carried out by means of implanted silastic tonometers during breathing of air and 100% O2 and immediately after walking on a treadmill. Peripheral blood pressures in the ankles were recorded with a Doppler apparatus. Baseline tissue gas tensions showed no essential differences between the various groups of patients: intermittent claudication, pain at rest, praegangrene, abdominal aortic aneurysm and controls. In contrast, baseline ankle pressures correlated well with the severity of the disease. During breathing of oxygen, the smallest increases of muscle PO2 were observed in extremities with pain at rest or praegangrene and the highest responses were recorded in controls and aneurysm patients. Muscle PCO2 values showed no alterations during oxygen breathing. In physical exercise, muscle PO2 and PCO2 levels as well as ankle blood pressures remained unchanged in controls and patients with aneurysm but no claudication. However, in all groups with arterial ischaemia, the exercise test resulted in a profound fall of muscle PO2 and ankle blood pressure and an increase of muscle PCO2.
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PMID:Tissue gas tensions in the calf muscles of patients with lower limb arterial ischaemia. 43 76

A 45-year-old man presented with bilateral lower extremity claudication due to aortitis and periaortic fibrosis. This variety of aortitis has been described in the pathologic literature as chronic periaortitis, a subset of idiopathic retroperitoneal fibrosis. The association of this aortitis with abdominal aortic aneurysm has been described in the surgical literature as inflammatory abdominal aortic aneurysms. These entities are thought to be secondary to the same disease process. We review the possible etiology, diagnostic considerations, and management of these aortidites.
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PMID:Aortitis and periaortic fibrosis. 192 Mar 15

Over a 1-year period, 242 patients with peripheral vascular disease underwent abdominal ultrasonography to detect the presence of an abdominal aortic aneurysm. In 34 (14 per cent) an abdominal aortic aneurysm was found; half of these aneurysms were greater than 4 cm in diameter. In addition, 16 patients had ectatic aortas. Abdominal aortic aneurysms were more common in men than in women (17 versus 8 per cent). Patients with claudication were as likely to have an abdominal aortic aneurysm as those with rest pain or gangrene. The presence of aortoiliac occlusive disease increased the chance of an aneurysm being present (P less than 0.02). Patients with occlusive peripheral vascular disease are a high-risk group with regard to the development of an abdominal aortic aneurysm. Patients with proximal occlusive disease represent a subgroup at even higher risk.
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PMID:Prevalence of abdominal aortic aneurysm in patients with occlusive peripheral vascular disease. 195 1

The proximal anastomosis is still a controversial issue in vascular surgery. To compare end-to-end (EE) and end-to-side (ES) proximal anastomoses, the authors undertook a prospective study with 3 years' follow-up involving 120 patients, all of whom had aortobifemoral bypass. Fifty-one (42.5%) patients received the EE and 69 (57.5%) the ES anastomosis. The indications for surgery were abdominal aortic aneurysm (EE 51%, ES 0%; p less than 0.05), claudication (EE 33.3%, ES 53.6%; p less than 0.05) and critical ischemia (EE 15.7%, ES 46.4%; p less than 0.05). Patients in the EE group were older (mean age: EE 66.1 +/- 2.8 years, ES 60.9 +/- 1.1 years; p less than 0.05) and had more ischemic heart disease (EE 39.2%, ES 27.5%; p less than 0.05). Postoperative mean increases in transcutaneous oximetry (EE 15.5 +/- 3.9 mm Hg, ES 12.6 +/- 2.3 mm Hg) and the ankle-brachial pressure index (EE 0.34 +/- 0.05, ES 0.30 +/- 0.03) were not significantly different in the two groups. The operative death rate was higher for the EE group (EE 11.8%, ES 1.4%; p less than 0.05). Early thrombosis occurred in six patients, two in the EE group and four in the ES group. Computed tomography, done 1 year postoperatively in 95 patients, revealed two small (less than 3 cm) distal anastomotic dilatations, one in each group. At 3 years, cumulative survival and patency were similar in both groups. The authors conclude that the two anastomotic groups had very similar short- and long-term results, except for the operative death rate which was higher in the EE group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:End-to-end versus end-to-side proximal anastomosis in aortobifemoral bypass surgery: does it matter? 205 57

Cigarette smoking is associated with an increased risk and extent of advanced atherosclerotic vascular disease in peripheral as well as coronary arteries. The likelihood of claudication, amputation, stroke, abdominal aortic aneurysm, and failure of vascular reconstruction is higher in smokers than nonsmokers. Smoking exerts its deleterious effects through many interactive mechanisms. Nicotine and carbon monoxide produce acute cardiovascular consequences, including altered myocardial performance, tachycardia, hypertension, and vasoconstriction. Smoking injures blood vessel walls by damaging endothelial cells, thus increasing permeability to lipids and other blood components. Among metabolic and biochemical changes induced by smoking are elevated plasma, free fatty acids, elevated vasopressin, and a thrombogenic balance of prostacyclin and thromboxane A2. Chronic smoking is associated with a tendency for increased serum cholesterol, reduced high density lipoprotein, and other lipid effects that contribute to atherosclerosis. In addition to rheologic and hematologic changes from increased erythrocytes, leukocytes, and fibrinogen, smokers have alterations in platelet aggregation and survival that produce thrombosis. Considering the ubiquitous repercussions of this menace, vascular surgeons should play an active role in motivating their patients to quit smoking.
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PMID:The peripheral vascular consequences of smoking. 206 25

Decisions to resect small aortic aneurysms or employ non-operative treatment for aorto-iliac occlusive disease must depend on current rather than historical surgical results. To assess current morbidity and mortality, we reviewed 200 consecutive aortic resections in two groups of patients treated from 1981 to 1989: those undergoing elective aortofemoral bypass for occlusive disease (AFB, no. 100) or resection of infrarenal abdominal aortic aneurysms (AAA, no. 100). Indications for AFB included claudication (54%), rest pain (32%), and gangrene (13%). AAA size ranged from 3 to 14 cm (mean 6.5 +/- 2.4 cm); 45% presented with abdominal or back pain. Patients undergoing AFB were younger (AFB 61.5 +/- 10 years vs AAA 68.7 +/- 8.9 years) with a higher incidence of some atherosclerotic risk factors, diabetes mellitus 30% vs 10%, tobacco use 77% vs 49%, hyperlipidemia 21% vs 7%; p less than 0.001). Coronary artery disease (CAD) was more prevalent in AAA patients (49% vs 34%; p less than 0.001). Postoperative mortality was not different in occlusive or aneurysmal disease (3% AFB vs 2% AAA), nor was the occurrence of serious complications such as myocardial infarction (2% vs 1%) or pulmonary embolism (2% vs 3%). Improvements in patient selection, perioperative care and surgical technique have lowered the mortality of elective aortic surgery. Given the current standard of care, an aggressive approach to AAA even in high risk patients is appropriate. The low morbidity of AFB for occlusive disease mandates a critical appraisal of less effective nonoperative therapies.
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PMID:Current results of elective aortic reconstruction for aneurysmal and occlusive disease. 221 95

Routine preoperative arteriography is advocated by many vascular surgeons before abdominal aortic aneurysm repair. We have used a selective approach based on the facts that arteriography is expensive, time-consuming, potentially hazardous, and often unwarranted. Based on preoperative indications, arteriography was used selectively in 41 of 100 consecutive patients prior to abdominal aortic aneurysmectomy. Many patients had more than one indication. A total of 82 specific indications were recognized. The most frequent indications were diminished lower extremity pulses (24), claudication (20), severe coronary artery disease (11), cerebrovascular disease (7), prior arterial reconstruction (8), hypertension in patients 60 years of age or less (5), evidence of other aneurysms (4), major renal anomaly (1), blue toe syndrome (1), and thoracic aneurysm (1). The 41 arteriograms produced 125 specific arteriographic abnormalities with an average of three per study. The most arteriographic abnormalities were in those patients with claudication and the least for those with hypertension. The arteriogram revealed information that would not have been obvious at operation, nor would it have led to operative procedure modification in only 10 patients. In the 59 patients not having arteriography, three had intraoperative findings which demanded a modification of the operative procedure. Thus, in only 13 patients was arteriography definitely useful. Presumably it was not indicated in the other 87. By comparing the cases in which the operation was modified with the presence of a specific indication, we have developed a predictability index as a guide for performing arteriography. Multiple indications increased the likelihood of operation modification only if four or more indications were present.
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PMID:Selective use of arteriography in the assessment of aortic aneurysm repair. 222 39

In a consecutive series of 640 surgically treated abdominal aortic aneurysms, 4 patients affected by thrombosis of the abdominal aortic aneurysm were observed. All aneurysms were five centimeters in diameter or smaller and all the patients complained of chronic claudication. In spite of the old opinion that considered abdominal aneurysmal thrombosis an useful event, we believe that the angiographic and clinical picture of juxta-renal aortic occlusion points to surgical treatment.
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PMID:[Clinical aspects, diagnosis and therapy of thrombosis of an abdominal aortic aneurysm]. 262 53

Intermittent claudication from peripheral vascular disease is sometimes difficult to distinguish from neurogenic claudication secondary to lumbar spinal stenosis. Of 172 patients with symptoms of claudication and lumbar spinal stenosis proved by myelography or computed tomography (CT), nine had peripheral vascular disease identified with ultrasonography and arteriography. All of the nine patients had a laminectomy performed to decompress the narrow spinal canal, and two had an additional posterolateral fusion. Two patients were treated with an excision of their abdominal aortic aneurysm, while one of those patients later required a bypass graft for iliac stenosis. One patient had had an aortofemoral bypass graft, one a femoropopliteal graft, and one a lumbar sympathectomy. Follow-up study ranged from three to eight years, with an average of five years after their last surgical procedure. Paresthesias generally dissipated after the spinal surgery. The cramping-type discomfort associated with walking was not easily attributed either to vascular or a neurogenic etiology. Five patients had initial weakness, which invariably improved. A secondary etiology contributing to claudication must be excluded in those patients with persistent discomfort following previous lumbar spinal or vascular surgery for arterial insufficiency.
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PMID:Concurrent lumbar spinal stenosis and peripheral vascular disease. A report of nine patients. 336 86

Magnetic resonance is a cost-effective imaging tool in the preoperative evaluation of abdominal aortic aneurysm, and yields more clinically relevant information than ultrasonography and computerized tomography. Magnetic resonance imaging has advantages over angiography in that is costs substantially less, is noninvasive, and reconstructs images in multiple planes. By utilizing multiplanar imaging, magnetic resonance imaging yields more information than angiography. The position of the left renal vein is imaged only by magnetic resonance, as is the origin of the superior mesenteric artery. Angiography remains important in patients with associated occlusive disease and claudication. The use of magnetic resonance in the emergent setting is limited at this time.
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PMID:Magnetic resonance imaging versus angiography in the preoperative assessment of abdominal aortic aneurysms. 336 19


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