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

Thirty five patients who underwent simultaneous aortic and renal artery reconstruction are reviewed, to determine the value of the combined approach. The risk factors determining operative morbidity and mortality are discussed, on the basis of a long term follow-up of more than sixteen years. All patients had a significant renal artery stenosis, in addition to either severe aorto-iliac occlusive disease or an abdominal aortic aneurysm. Twenty seven patients were hypertensive, and eight patients normotensive. Combined aorto-renal reconstruction was carried out prophylactically in eight instances. There were two operative deaths (5.7%). Factors found to be associated with an increased operative risk were advanced age (over 65 years), heart disease with ECG changes, severe hypertension and diabetes. Renal insufficiency with azothaemia and high levels of creatinine, represented a major risk factor. Post operatively, six individuals (24%) were classified as "cured" and thirteen (523) were "improved". Patients with bilateral renal artery stenosis, mild azothemia and moderately elevated creatinine, were found to improve significantly their renal function post operatively. No patient required hemodialysis. Simultaneous aorto-renal reconstruction may be performed with a low mortality and gratifying improvement in hypertensive patients, without evidence of adverse features.
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PMID:Simultaneous aorto-renal reconstruction and consideration to the value of combined approach. A 2-16 years follow-up study, with review of the literature. 331 23

Life expectancy after aneurysm surgery was analyzed for male patients over the age of 60 years with known risk factors classified by the Goldman cardiac risk index, which has previously been utilized for prediction of immediate perioperative risks of surgery and anesthesia. The preoperative risk factors, Goldman cardiac risk index, and long-term survival rates were tabulated for each of 96 male patients over the age of 60 years who had elective repair of infrarenal abdominal aortic aneurysm. Follow-up data of up to 14 years (mean 4.2 years) was entered into a SurvPak-PC biostatistical software program for construction of Kaplan-Meier survival curves and actuarial life tables to measure differences in survival between groups and for performance of nonparametric analysis (by log rank test) of the influence of preoperative risk factors. The operative mortality rate was 3.1 percent and the 5 year survival rate for the whole group was 61 percent, with a median survival of 8.7 years. Five year survival rates for patients in three age groups (60 to 70 years, 71 to 80 years, and greater than 80 years), when compared with age-matched populations, were 67 percent versus 88 percent, 50 percent versus 73 percent, and 35 percent versus 39 percent, respectively. Patients in Goldman class 1, 2, and 3 or 4 had 5 year survival rates of 79 percent, 53 percent, and 41 percent, respectively. Factors that adversely affected long-term survival were Goldman classes 3 or 4 (median survival 2.1 +/- 0.4 years, p = 0.001), cerebrovascular disease (median survival 1.9 +/- 0.6 years, p = 0.004), history of cardiac disease (median survival 3.2 +/- 0.6 years, p = 0.012), and creatinine concentration greater than 3 mg/100 ml (median survival 3.1 +/- 1.6 years, p = 0.034), whereas Goldman class 2 or the presence of hypertension, pulmonary disease, diabetes mellitus, peripheral vascular disease, and size of the aneurysm, although associated with a shortened length of survival, as independent variables did not reach statistical significance. A combination of any three of these risk factors, however, shortened the survival time markedly (median 1.9 +/- 0.7 years, p = 0.003). We believe that the Goldman cardiac risk index classification correlates with long-term survival in patients undergoing elective aortic surgery.
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PMID:Cardiac risk index as a predictor of long-term survival after repair of abdominal aortic aneurysm. 340 Aug 5

Five patients who had undergone renal transplantation 3 months to 23 years ago were operated on successfully for an abdominal aortic aneurysm. In the first case, dating from 1973, the kidney was protected by general hypothermia. In the remaining patients, no measure was used to protect the kidney. Only one patient showed a moderate increase of blood creatinine in the postoperative period; renal function returned to normal in 15 days. All five patients have normal renal function 6 months to 11 years after aortic repair. Results obtained in this series show that protection of the transplant during aortic surgery is not necessary, provided adequate surgical technique is used. Such a technique is described in detail. Its use simplifies surgical treatment of such lesions and avoids the complex procedures employed in the seven previously published cases.
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PMID:Abdominal aortic aneurysmectomy in renal transplant patients. 351 May 92

Recent reports in the literature have promulgated nonresective treatment of abdominal aortic aneurysm as a safer procedure than conventional aneurysmectomy with graft replacement in high-risk patients. This review of 106 high-risk patients who underwent conventional aneurysm repair between 1980 and 1985 was undertaken to compare the relative risks, perioperative morbidity, and operative mortality of these patients to that reported for patients treated by nonresective therapy. Excluded were those patients who had rupture initially or underwent a concomitant renovascular procedure. Patients were considered to be at high risk if they met one or more of the following criteria: age equal to or greater than 85 years; receiving oxygen at home, PO2 less than 50 torr, or forced midexpiratory flow less than 25% of predicted; serum creatinine equal to or greater than 3 mg/dl; biopsy-proven cirrhosis with ascites; retroperitoneal fibrosis; or New York Heart Association functional class III-IV angina, left ventricular ejection fraction less than 30%, recent congestive heart failure, complex ventricular ectopy, large left ventricular aneurysm, severe valvular disease, recurrent congestive heart failure or angina after coronary artery bypass grafting, or severe unreconstructed coronary artery disease confirmed by angiography. The mortality rate for conventional aneurysm repair in high-risk patients was 5.7%, compared with a reported 7% mortality rate for nonresective therapy. In those patients with severe cardiac dysfunction, intraoperative pharmacologic manipulation and the selective use of intra-aortic balloon counterpulsation appeared helpful in achieving survival.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Conventional repair of abdominal aortic aneurysm in the high-risk patient: a plea for abandonment of nonresective treatment. 370 38

The purpose of this study was to determine the effect of preoperative renal failure on the outcome of patients undergoing infrarenal abdominal aortic aneurysm (AAA) repair. Of 251 patients undergoing AAA repair from 1977 to 1984, 10% had evidence of preoperative chronic renal failure. These patients were classified according to their preoperative serum creatinine values; group I had preoperative creatinine levels of 2 to 4 mg/dl, group II had creatinine levels greater than 4 mg/dl but no history of hemodialysis, and group III consisted of patients on chronic hemodialysis before operation. One of 16 patients in group I developed transient high-output renal failure postoperatively. Four of the six patients in group II (67%) developed significant postoperative deterioration of renal function and required acute hemodialysis. Of the four patients in group III maintained on chronic hemodialysis preoperatively, one died of sepsis from an ischemic colon. This experience suggests that patients with mild renal dysfunction (serum creatine value less than 4 mg/dl) can undergo elective AAA repair without additional morbidity. Patients on hemodialysis before operation can also safely undergo surgical repair of their AAAs electively if dialyzed the day before operation. Patients with severe renal dysfunction (serum creatinine greater than 4 mg/dl) who are not on hemodialysis should be considered for dialysis preoperatively in an attempt to reduce the high incidence of serious postoperative renal functional deterioration and subsequent morbidity.
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PMID:Abdominal aortic aneurysm repair in patients with preoperative renal failure. 371 33

The aim of the study was to assess the early results of abdominal aortic aneurysm resection in relation to cardiac and other operative risk factors, assess the magnitude of the procedure, and evaluate longer-term postoperative rehabilitation; 176 patients (mean age 67,1 years) were assessed, of whom 160 (90,9%) had operations. Using the multifactorial index of cardiac risk in non-cardiac surgical procedures (Goldman) the majority fell into the low-risk category (groups I and II). Other risk factors evaluated were respiratory disease, renal insufficiency, hypertension and diabetes. The majority of these patients had creatinine clearance rates of less than 50% of the theoretical normal rate for age. Of 7 postoperative deaths (operative mortality rate 4,4%) 4 followed myocardial infarction, and all the latter patients fell into cardiac risk grade III. The other risk factors did not significantly influence the mortality or complication rates. The highest complication rate occurred in patients who underwent aortic bifurcation graft placement and the lowest in patients who underwent simple infrarenal tube grafting. Of 153 survivors, 10 have been lost to follow-up and 141 have returned to full activity. In conclusion, the cardiac risk index used is a valuable predictor of operative risk. If the patient survives surgery, excellent longer-term rehabilitation can be expected.
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PMID:Abdominal aortic aneurysm resection--operative risk and long-term results. 400 73

We examined the effect of left renal vein (LRV) division during abdominal aortic aneurysm operations on renal function during the recovery period. Fifteen patients with LRV division were compared with 26 patients in whom the LRV was not ligated. These two groups of patients did not differ significantly in any of their preoperative characteristics, operative management, or postoperative complications. Preoperative, highest postoperative, and predischarge levels of plasma urea and creatinine, as well as urinary sediment, were compared in both groups. Left renal vein division could not be implicated as a cause of renal function deterioration and was found to be a safe, useful adjunct to abdominal aortic aneurysm surgery.
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PMID:Left renal vein division in abdominal aortic aneurysm operations. Effect on renal function. 402 55

A retrospective case review of 34 men was undertaken to evaluate the relationship between preoperative volume loading and renal function before, during, and after abdominal aortic aneurysm surgery. Volume expansion was guided by either central venous pressure (CVP) in 12 patients or pulmonary artery wedge pressure (PAWP) measurements in 22 patients. Statistically significant differences (P less than .05) were noted between the two groups where greater preoperative volume loading and urine output were associated with lower postoperative serum creatinine and renal function indices in the PAWP group. The age range, vascular risk factors, aneurysm size, and preoperative renal function were similar. The data indicate that (1) PAWP is a more accurate monitor for volume expansion than CVP and (2) when volume replacement is optimal, abdominal aortic aneurysm surgery is not associated with postoperative renal insufficiency.
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PMID:Prevention of renal insufficiency after abdominal aortic aneurysm resection by optimal volume loading. 731 50

Previous reports have suggested the use of supraceliac aortic clamping in the surgical treatment of abdominal aortic aneurysm of difficult approach. The objective of the present report was to study the hepatic and renal metabolic changes of three groups of dogs submitted to temporary clamping (30 minutes) of the abdominal aorta at three different levels: below the renal arteries, infrarenal group (8 dogs); above the renal arteries, suprarenal group (9 dogs); above the celiac artery, supraceliac group (9 dogs). Blood bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea nitrogen, and creatinine levels were measured before clamping and 5 minutes and 24 hours after reperfusion of the aorta. Bilirubin levels remained unchanged 5 minutes and 24 hours after reperfusion in all three groups. Alkaline phosphatase levels were significantly increased in all three groups 24 hours after reperfusion. ALT levels increased significantly in the supraceliac group and AST levels increased significantly in the infrarenal and supraceliac groups 24 hours after reperfusion of the aorta. However, despite these significant increases after reperfusion, the levels of these hepatic enzymes were still within the normal range for dogs. Urea nitrogen and creatinine levels showed that renal function did not change in any of the three groups. We conclude that supraceliac, infrarenal or suprarenal aortic clamping for 30 minutes do not promote any important changes in the hepatic or renal function of dogs.
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PMID:Supraceliac clamping in the surgical treatment of abdominal aortic aneurysm. An experimental study in dogs. 761 Mar 26

The effect of low-dose dopamine administration on intramucosal pH (pHi) of the sigmoid colon and on postoperative function of various organs in patients undergoing elective abdominal aortic aneurysm repair was examined. Nineteen patients were randomized to two groups; nine received dopamine at a rate of 3 micrograms per kg per min for 24 h from induction of anaesthesia and ten control patients received fluids without dopamine. pHi was measured with a silicone tonometer and daily samples of blood were taken for measurement of liver transaminase activity, arterial oxygen saturation and creatinine concentration. Mean(s.e.m.) pHi fell to a significantly lower minimum value in those receiving dopamine compared with control patients (6.86(0.10) versus 7.11(0.08), P < 0.05). Five of the nine patients given dopamine developed intramucosal acidosis compared with only one of the ten control patients (P = 0.06). After operation the mean(s.e.m.) aspartate transaminase concentration in patients given dopamine rose from 33(2) to 80(17) units/l (P < 0.01); in control patients it rose from 32(3) to 59(16) units/l (P = 0.054). No differences between the groups was observed in the postoperative ratio of arterial oxygen saturation to inspired oxygen fraction or creatinine concentrations. These results indicate that dopamine has no beneficial effect on bowel mucosal oxygenation and function of the various organs in patients undergoing aortic aneurysm repair.
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PMID:Effect of low-dose dopamine on sigmoid colonic intramucosal pH in patients undergoing elective abdominal aortic aneurysm repair. 764 6


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