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

A 66-year-old man with the chief complaint of oliguria had been referred to our hospital under the diagnosis of bilateral hydronephrosis and abdominal aortic aneurysm by his family doctor. CT scan and digital subtraction angiography demonstrated an abdominal aortic aneurysm continuing to bilateral internal iliac arteries. The degree of right hydronephrosis was less advanced compared to the left side. Right percutaneous nephrostomy was performed because the retrograde stenting was unsuccessful. After the renal function improved, an operation for the aneurysm was undertaken in the surgical department. Although bilateral ureterolysis was possible, the resection of the aneurysm could not be done. After clamping the nephrostomy catheter, drainage of urine into the ureter was not seen one month after the operation. A double-J ureteral stent was inserted by the antegrade approach and the nephrostomy tube was removed. By exchanging the stent every 3 months, the renal function has been stable and the size of the aneurysm unchanged during the 25 months after the surgery.
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PMID:[Bilateral ureteral obstruction secondary to aneurysm of abdominal aorta: a case report]. 160 68

We administered general anesthesia for an emergency abdominal surgery due to duodenal ulcer hemorrhage. The patient was in postoperative state after femoral supracondylar fracture, in pre-shock state, of old age (97 y-o), with severe anemia, and hypoproteinemia, and complicated with a giant abdominal aneurysm and mild aortic regurgitation. Before the operation, the patient was transferred to ICU and had intravascular volume replaced (infused with blood 600 ml, crystalloid fluid 2000 ml, colloid fluid 500 ml) and received stomach lavage. Under monitoring of direct arterial pressure, after fully pre-oxygenation, fentanyl 0.1mg was administered slowly, and crush induction was performed by a small dose of thiopental and SCC. After induction of anesthesia systolic blood pressure decreased to 60 mmHg temporarily and it was maintained between 80 and 120 mmHg during the surgery, but tachycardia continued (90-110.min-1). In order to treat oliguria owing to pre-shock state, we administered dopamine and urinastatin continuously. The patient was transferred to ICU postoperatively and close attention was paid. Postoperative pain controlled was well by epidural morphine and bupivacaine. The postoperative course was uneventful without any complications. Twenty three days later, abdominal aortic aneurysm resection was performed uneventfully. In this paper, problems of preanesthetic and anesthetic management of emergency abdominal surgery for an aged patient were discussed.
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PMID:[Anesthetic experience in emergency abdominal surgery in a 97-year-old patient complicated with a giant abdominal aneurysm]. 258 3

In four patients with ruptured abdominal aortic aneurysms increased intra-abdominal pressure developed after repair. It was manifested by increased ventilatory pressure, increased central venous pressure, and decreased urinary output associated with massive abdominal distension not due to bleeding. This set of findings constitutes an intra-abdominal compartment syndrome caused by massive interstitial and retroperitoneal swelling. The purpose of this report is to establish criteria for this syndrome and suggest a method of treatment. The syndrome developed within 24 hours; in one patient within 5 hours postoperatively. All four patients received more than 25 liters of fluid resuscitation (electrolyte and blood) during and within 16 hours after operation and had massive abdominal distension. Decompressive laparotomies were performed in the Intensive Care Unit with placement of Marlex (Bard Corp., Billerica, MA) mesh. In two additional patients, at the completion of the aneurysmectomy the abdominal incision was left open with interposition Marlex mesh. Opening the abdominal incision was associated with dramatic improvements in central venous pressure, urinary output, ventilatory pressure, arterial carbon dioxide tension, and oxygenation. The authors conclude that some patients with ruptured abdominal aortic aneurysm do not tolerate the closure of the abdominal wall, as manifested by increased ventilatory pressures, decreased oxygenation, and decreased urinary output. Opening the abdominal wound or delayed closure may reverse the oliguria and improve oxygenation. Recognition and treatment of this condition by opening the abdominal wound or delayed closure may affect outcome in some cases.
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PMID:Intra-abdominal compartment syndrome as a complication of ruptured abdominal aortic aneurysm repair. 272 80

In patients with renal disease undergoing cardiovascular surgery, perioperative management continues to be a challenge. Traditional answers have turned into new questions with the introduction of new agents and the redesign of old techniques. For ARF prevention, early recognition of pending deleterious compensatory changes is critical. Theoretically, therapeutic intervention designed to prevent ischemic renal failure should be designed to preserve the balance between RBF and oxygen delivery on one hand and oxygen demand on the other. Maintenance of adequate cardiac output distribution to the kidney is determined by the relative ratio of renal artery vascular resistance to systemic vascular resistance. Indeed, it should not be surprising to learn that norepinephrine (despite its vasoconstricting effect) has been reported to have no deleterious renal effects in patients with low systemic vascular resistance. Until recently, strategies for the treatment of ARF have been directed to supportive care with dialysis (to allow tubular regeneration). Various therapeutic maneuvers have been introduced in an attempt to accelerate the recovery of glomerular filtration, including dialysis, nutritional regimens, and new pharmacologic agents. A recent small prospective trial of low-dose dopamine in the prophylaxis of ARF in patients undergoing abdominal aortic aneurysm repair showed no benefit in those patients receiving dopamine. Conversely, the effects of intravenous atrial natriuretic peptide in the treatment of patients with ARF appear to offer benefit in patients with oliguria. Among 121 patients with oliguric renal failure, 63% of those who received a 24-hour infusion of atrial natriuretic peptide required dialysis within 2 weeks compared with 87% who did not. Whether this effect will be borne out in the future remains to be determined. The administration of epidermal growth factor after induction of ischemic ARF in rats has been shown to enhance tubular regeneration and accelerate recovery of kidney function. Human growth factor administration has been shown to increase GFR 130% greater than baseline in patients with chronic renal failure, but no data for clinical ARF have been reported. In addition, there have been significant improvements in dialysis technology in the treatment of ARF. Modern dialysis uses bicarbonate as a buffer as opposed to acetate, which reduces cardiovascular instability, and has more precise regulation of volume removal. Dialysate profiles and temperatures improve hemodynamics and reduce intradialytic hypotension. Techniques of hemodialysis without anticoagulation have reduced bleeding complications. Finally, dialysis membranes activate neutrophils and complement less with the biocompatible membranes used today that reduce recovery time and dialysis treatment. Evidence indicates that activation of complement and neutrophils by older dialysis membranes caused a greater incidence of hypotension, adding to ischemic renal injury. It remains to be determined whether early and frequent dialysis with biocompatible membranes, as well as other therapeutic interventions, will increase the survival of patients with perioperative ARF.
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PMID:Perioperative renal dysfunction and cardiovascular anesthesia: concerns and controversies. 980 83

Aorto-caval fistula (ACF) is a rare complication of abdominal aortic aneurysm. It occurs in 1-6% of cases. The classic diagnostic signs of an ACF (pulsatile abdominal mass with bruit and right ventricular failure) are present only in a half of the patients. The most common diagnostic imaging procedures like ultrasound and computed tomography often are not sufficient enough. This leads to the delay in diagnosis, which has a great impact on the results of operation. We report a case of a patient, who was treated before admission to the Clinic because of azotemia and oliguria suggesting renal failure.
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PMID:[Aorto-caval fistula as a results of abdominal aortic aneurysm rupture imitating acute renal insufficiency]. 1271 63

In two patients, a man aged 67 and a woman aged 80, an abdominal compartment syndrome was diagnosed. The man had been treated surgically for an abdominal aortic aneurysm; he recovered after re-operation. The woman had been treated by sigmoidectomy because of ileus. A Bogota bag and a vacuum-assisted wound-closure system were applied to the abdominal wound. Her condition deteriorated, an intestinal perforation became apparent, of which she did not recover and died. An abdominal compartment syndrome should always be kept in mind when a patient at risk presents with increased intra-abdominal pressure and at least one of the following symptoms: oliguria, decreased cardiac output, increased pulmonary-artery pressure, hypotension and acidosis. Measurement of the bladder pressure remains the method of choice to establish the abdominal pressure level. However, there is a lack of correlation between the measured pressure and the clinical condition of the patient. Therefore, the combination of clinical findings and the observed trend in serial measurements of the bladder pressure is preferred to a single pressure measurement.
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PMID:[The abdominal compartment syndrome]. 1624 Aug 58

Heparin-induced thrombocytopenia (HIT) is still a relatively uncommon condition and it is not well known how to administer argatroban during continuous hemodiafiltration (CHDF). A 72-year-old man required CHDF with heparin because of the oliguria and hyperpotassemia directly after the open repair of a juxtarenal abdominal aortic aneurysm. As the postoperative blood platelet count dropped and there was a thrombus in the CHDF circuit, HIT was suspected and nafamostat mesilate, but not heparin, was immediately administered for CHDF. As heparin-platelet factor 4 complex was positive, we diagnosed him with HIT and started argatroban while monitoring the activated clotting time (ACT), resulting in no further obstruction of the CHDF and an increase in the platelets. There was no disadvantage for administering nafamostat mesilate which we have commonly used instead of heparin, we should have used argatroban once we suspected HIT. It may be important to consider the history of heparin especially in administering heparin and it may be useful to monitor the ACT when initially starting argatroban for patients with HIT.
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PMID:A Case of Heparin-Induced Thrombocytopenia Type 2 after Repair of Juxtarenal Abdominal Aortic Aneurysm. 2803 78

Aortocaval fistula (ACF) occurs in <1% of all abdominal aortic aneurysms (AAAs), and in 3% to 7% of all ruptured AAAs. The triad of clinical findings of AAA with ACF are abdominal pain, abdominal machinery bruit, and a pulsating abdominal mass. Other findings include pelvic venous hypertension (hematuria, oliguria, scrotal edema), lower-limb edema with or without arterial insufficiency or venous thrombus, shock, congestive heart failure, and cardiac arrest. Surgery is the main treatment modality. We report successful surgical treatment in a patient with a ruptured AAA with ACF who presented with cardiogenic shock.
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PMID:Surgical Repair of Aortocaval Fistula Presenting with Cardiogenic Shock. 3058 51