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

Survival following emergency surgery for ruptured abdominal aortic aneurysm remains poor and is in stark contrast to that for elective repair. We have carried out a 5-year retrospective observational study to determine the long-term (5-year) survival of patients following emergency surgery for ruptured abdominal aortic aneurysm at a district general hospital in East Anglia. A total of 99 patients presented to the operating theatre for emergency repair of ruptured abdominal aortic aneurysm in this 5-year study period. In-hospital mortality was 70% and was unchanged over the 5 years. Overall long-term survival in those patients discharged from hospital was good. The ICU cost per long-term survivor was calculated to be pound sterling 36750.
Anaesthesia 2000 May
PMID:Long-term survival following emergency abdominal aortic aneurysm repair. 1101 18

The standard surgical approach to nonleaking iliac aneurysms found at repair of a leaking abdominal aortic aneurysm is to minimize the operative risk by repairing the abdominal aorta only. This means that the bypassed iliac aneurysms may have to be repaired later. As this population of patients are usually elderly with coexisting medical problems, interventional radiology is being used to embolize these aneurysms, thus avoiding the morbidity and mortality associated with further general anesthesia and surgery. Various materials and stents have been reported to be effective in the treatment of iliac aneurysms. We report the successful use of endoluminal fibrin tissue glue (Beriplast) to treat two large iliac aneurysms in a patient who had had a previous abdominal aortic aneurysm repair. We discuss the technique involved and the reasons why we used tissue glue in this patient.
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PMID:Endoluminal embolization of bilateral atherosclerotic common iliac aneurysms with fibrin tissue glue (Beriplast). 1082 5

Endovascular aneurysm repair is useful for patients who are judged unfit for surgery. We investigated the outcome of endovascular repair of abdominal aortic aneurysm in patients fit and unfit for surgery. The 1-year cumulative survival for patients unfit for surgery and patients unfit for general anaesthesia was 20% and 23%, respectively. The overall health status of patients was an important predictor of survival after endovascular repair. The risks of endovascular aneurysm repair might, therefore, exceed that of non-operative management. Caution should be used when advising these patients about endovascular repair.
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PMID:Endovascular stenting of abdominal aortic aneurysm in patients unfit for elective open surgery. Eurostar group. EUROpean collaborators registry on Stent-graft Techniques for abdominal aortic Aneurysm Repair. 1102 35

Although the operative mortality following elective aneurysmectomy has achieved satisfactory results, that following surgery for ruptured abdominal aortic aneurysms (AAAs) remains high. The purpose of this study was to identify the factors affecting the mortality rate associated with the treatment of ruptured AAAs. Between 1978 and 1999, 33 patients underwent emergency surgery for a ruptured AAA. The operative mortality was 33.3% and in-hospital mortality was 6.0%. Hypotension, defined as a systolic blood pressure <80 mmHg, was seen in 19 patients at the time of presentation, 9 of whom underwent surgery in this state. In the remaining 10 patients, it was possible to increase the systolic blood pressure to > or =80 mmHg preoperatively. Of the 11 patients who died within 30 days of surgery, 9 had hypotension at the time of induction of anesthesia and only 2 had a systolic blood pressure of > or =80 mmHg. A satisfactory outcome was achieved in patients whose condition met the following criteria: a systolic blood pressure > or =80 mmHg at the time of operation, minimal aortic cross-clamping time, less blood loss and blood transfusions, and a shorter operation time to repair the ruptured AAA. Concomitant heart disease was also found to be an important prognostic factor.
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PMID:Prognostic factors in the surgical treatment of ruptured abdominal aortic aneurysms. 1103 5

Abdominal aortic reconstruction surgery in patients with arteriosclerosis obliterans usually has been carried out under standard intratracheal anaesthesia and only a some few centres have included continuous suprameningeal anaesthesia. On the basis of that scanty data it seems that combined intratracheal and suprameningeal anaesthesia might have some advantages over the standard anaesthesia owing to reducing general symptoms of perioperative stress. The aim of this study was to investigate the operative stress during abdominal aortic reconstruction in patients with arteriosclerosis obliterans as dependent on a type of anaesthesia: standard intratracheal and combined-intratracheal supported by suprameningeal doses of anaesthetics. The evaluation of a magnitude of perioperative stress was based on determinations standard markers of stress response in serum: cortisol, adrenaline, noradrenaline, somatotropic hormone and glucose as well. The assessment of the stress condition during abdominal aortic reconstruction in patients with arteriosclerosis obliterans might be of a great importance as most of the patients suffer from ischaemic heart disease. Thus, the choice of an optimal perioperative treatment might improve recovery process. Elective abdominal aortic reconstruction with prosthesis implantation were performed in the year 1995 in 42 patients--8 with abdominal aortic aneurysm (AAA) and 34 with aorto-iliac occlusion (AIO) divided at random in 2 comparable groups according to a type of anaesthesia: I--standard, general anaesthesia supported by myorelaxants and by analgetic drugs given intravenously in a postoperative period, II--combined anaesthesia with a standard general anaesthesia fortified by subarachnoid anaesthesia (0.5% bupivacaine with morphine) reaching the T4-T5 dermatome. The case protocol included: duration of surgery, duration of aorta clamping, type of prosthesis, blood loss, fluid balance, serum level of cortisol, adrenaline, noradrenaline, human growth hormone, glucose, blood morphology, and total creatine kinase activity. Analysing of mean levels of stress markers has shown that they have been lower in combined anaesthesia. It seems that combined anaesthesia is better than the standard anaesthesia owing to reducing general symptoms of perioperative stress.
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PMID:[Operative stress during aorto-bifemoral reconstruction as dependent on a type of anesthesia]. 1107 Jul 62

Between September 1996 and February 2000 five female and 62 male patients with an abdominal aortic aneurysm, requiring therapy, underwent endoluminal treatment. Their age ranged from 51 to 81 years (mean 72 years). Preoperative evaluation was done with spiral computed tomography (CT) and angiography. All procedures were performed under general anesthesia in a radiologically adapted operating room. Postoperative complications occurred in 28.4%. The total conversion rate was 13.4%, the 30-day lethality rate was 1.4%. During the mean follow-up of 15.1 months 19 secondary interventions were necessary in 13 patients. The results presented in this study do not justify the wide use of this method and indicate a stricter form of patient selection.
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PMID:Results and complications in endovascular treatment of abdominal aortic aneurysms--a single center experience. 1114 24

A 63-year-old male patient collapsed and died from a major subdural haemorrhage 5 days after elective repair of a Type III thoraco-abdominal aortic aneurysm. The anaesthetic technique had included the use of a lumbar cerebrospinal fluid drain. The management of the patient is described, and the association between subdural haemorrhage and cerebrospinal fluid drainage is discussed.
Anaesthesia 2001 Feb
PMID:Fatal subdural haemorrhage following lumbar spinal drainage during repair of thoraco-abdominal aneurysm. 1116 78

We evaluated how preoperative radionuclide ventriculography (RNV) influences the clinical management of 96 patients referred for elective infrarenal abdominal aortic surgery. Of these, 11 had aortoiliac occlusive disease and 85 an abdominal aortic aneurysm. In 89 patients (93%), there was a known history or clinical evidence of coronary artery disease prior to RNV. The scan was abnormal in half the patients. There were 56 patients with left ventricular ejection fraction (LVEF) > 50% and 40 with LVEF < or = 50%. The LVEF ranged between 10% and 88% with a mean of 52.8+/-14.1%. There was normal wall motion in 56 patients and wall abnormalities were present in 40, including four LV aneurysms. After initial assessment, 19 patients did not proceed to surgery for a variety of reasons. Cardiology consultation was requested in 11 patients, six of which were delayed or turned down for surgery mainly on cardiac grounds. Only one of these underwent cardiac catheterization. Of the remaining 77 patients who underwent surgery, 15 were seen by a cardiologist and one was delayed in order to optimize his cardiac status. No patient underwent prophylactic coronary angioplasty/stenting or revascularization preoperatively. In addition, based on the RNV results and in conjunction with the clinical findings, six patients had pulmonary artery catheters inserted either the night prior to operation (n = 3) or after induction to anaesthesia (n = 3). This is the largest reported British series of cardiac testing using RNV prior to abdominal aortic surgery. Coronaryartery disease is very common amongst such patients. RNV influences our decision-making and patientselection. An abnormal result may alter the clinical management, lead to a cardiology referral (26/96, 27% in this series) and have anaesthetic implications.
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PMID:Impact of radionuclide ventriculography prior to elective abdominal aortic reconstruction. 1119 6

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

Newer, minimally invasive catheter-based endovascular technology utilizing stent grafts are currently being evaluated for abdominal aortic aneurysm (AAA) repair. A retrospective review of all (3 years) consecutive, non-ruptured elective AAA repairs was undertaken to document the results of AAA surgical repair in a modern cohort of patients to allow a contemporary comparison with the evolving endoluminal data. One hundred twenty-one AAAs were identified in a male veteran population. Mean age was 68.5 +/-7.7 years. Medical history review showed hypertension in 55%, heart disease in 73.5%, peripheral vascular disease in 21%, stroke and transient ischemic attacks in 22%, diabetes mellitus in 7%, renal insufficiency in 10%, and smoking history in 80%. The AAA size was documented with ultrasound (5.2 +/-1.3 cm, n=40) and computed tomography (5.6 +/-1.3 cm, n=100). Fifty-nine percent had angiography. Intraoperative end points included an operative time of 165 +/-6.3 minutes from incision to dressing placement. A Dacron tube graft was used in 78%, the remaining were Dacron bifurcated grafts. A suprarenal clamp was used in 8% for proximal aortic control with juxtarenal aneurysms. A pulmonary-artery catheter was placed in 69%. A transverse incision was used in 69% of patients and a midline incision was used in the rest. Estimated blood loss was 1505 +/-103 mL; cell saver blood returned 754 +/-53 mL; crystalloid/Hespan 4771 +/-176 mL; banked packed red blood cells 0.75 +/-0.11 U. Time to extubation was, in the operating room (78.5%), on the day of the operation (5.0%), postoperative day (POD) 1 (12.4%), POD2 (1.7%), POD3 (0.8%), and one case was performed with epidural anesthesia only. Postoperative end points included a 30-day mortality rate of 1.6% (two patients). Postoperative morbidity included wound dehiscence 0.8%; sepsis, urinary tract infection, wound infection, leg ischemia, ischemic colitis, and stroke each had an incidence of 1.6%; myocardial infarction, congestive heart failure, pneumonia, re-operation for suspected bleeding, and ileus or bowel obstruction occurred with an incidence of 3.3%. No significant increase in serum creatinine levels was noted. Time to enteral fluids/nutrition was 3.5 +/-0.08 days. Patients were out of bed to a chair or walking by 1.3 +/-0.06 days postoperatively. The length of stay in the intensive care unit (ICU) was 2.0 +/-0.12 days and postoperative hospital stay was 6.6 +/- 0.33 days. Transfusion requirement for the hospital stay was 1.6 +/-0.2 U per patient. This review highlights a cohort of male veteran patients with significant cardiac co-morbidity who have undergone repair with a conventional open technique and low mortality and morbidity rates. This group had rapid extubation, time to oral intake, and ambulation. In addition, ICU and hospital stays were relatively short.
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PMID:Abdominal aortic aneurysm repair. 1156 37


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