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

Chronic renal insufficiency is one of the most important factors governing the immediate and long-term outcome after aneurysm repair. A total of 484 patients with abdominal aortic aneurysm (A.A.A.) have undergone elective surgical treatment in our Institution during the last 5 years. Of these, we selected 60 patients; 30 with a normal serum creatinine concentration and 30 with preoperative renal insufficiency (serum creatinine concentration greater than 2 mg/dl). In this second group, 23 patients (76.6%) were affected by slight or median renal insufficiency, 5 patients (16.6%) were affected by severe renal insufficiency (creatinine concentration greater than 4.5 mg/dl), and 2 patients (6.6%) had complete renal failure with dialytic treatment from 1.5 and 2 years respectively. We analyzed postoperative renal function in all 60 patients. In the first group, only 6 patients (20%) showed a transient renal insufficiency, without mortality and morbidity. In the second group, postoperative complications and mortality tended to occur more frequently in patients with a severe renal insufficiency than in patients with slight or median insufficiency or complete renal failure. The present data suggest that dialytic treatment might be necessary in patients with severe renal insufficiency before aneurysm repair.
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PMID:[The role of chronic renal insufficiency in the prognosis of surgical interventions in subrenal abdominal aortic aneurysm]. 823 15

Renovascular hypertension in subjects with a solitary kidney, though an infrequent condition, requires surgical direct revascularization procedures either to reduce the hypertensive state and, more important, to preserve renal function. This paper reports a series of six surgically treated cases between 1982 and 1990, with at least two years follow-up. Preoperative renal function, as evaluated by BUN and blood creatinine, was reduced in 5 cases, the remaining one being normal. All subjects were hypertensive at admission: in four cases drug therapy was ineffective for restoring normal pressure values. All subjects had previously undergone surgical nephrectomy: in 3 cases for shrunk kidney, in 2 for failure of a previous attempt of renal revascularization, and one for renal tuberculosis. 3 subjects were concomitantly affected with abdominal aortic aneurysm, and one had previously undergone aortobifemoral bypass. Treatment of the concomitant aortic lesion and renal artery revascularization were carried out at the same operation. Operations performed were TEA of residual renal artery in 3 cases, prosthetic reconstruction in 2 and intraoperative transluminal angioplasty by Gruentzig balloon catheter in one. Over a two-year follow-up renal function remained good in 4 cases, while one subject required a second surgical revascularization due to late acute thrombosis of a previous aortorenal saphenous vein graft. Acute early postoperative renal failure occurred in one case and permanent haemodialysis was instituted. No deaths were recorded in this series.
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PMID:[The surgical treatment of renovascular hypertension in subjects with a single kidney]. 835 75

B-mode ultrasound examinations of the abdominal aorta were performed from 1990 to 1992 to evaluate the prevalence of abdominal aortic aneurysm (AAA) in a subgroup of the Pittsburgh cohort (656 participants, aged 65 to 90 years) of the Cardiovascular Health Study (CHS). In this pilot study, we evaluated various definitions of aneurysm and the reproducibility of the measurements. In year 5 (1992 to 1993) of the CHS, the entire cohort (4741 participants) was examined. AAA was defined as an infrarenal aortic diameter of > or= 3.0 cm, or a ratio of infrarenal to suprarenal diameter of > or= 1.2, or a history of AAA repair. For the entire CHS cohort, prevalence of aneurysms was 9.5% (451/4741) overall, with a prevalence among men of 14.2% (278/1956) and prevalence among women of 6.2% (173/2785). Variables significantly related to AAA were older age; male sex; history of angina, coronary heart disease, and myocardial infarction; lower ankle-arm blood pressure ratio; higher maximum carotid stenosis; greater intima-media thickness of the internal carotid artery; higher creatinine; lower HDL levels and higher LDL levels; and cigarette smoking. The study has documented the strong association of cardiovascular risk factors and measures of clinical and subclinical atherosclerosis and cardiovascular disease and prevalence of aneurysms. We used a definition that is more sensitive than previously reported (diameter or ratio), which allowed the detection of smaller aneurysms and possibly those at an earlier stage of development. Follow-up of this cohort may lead to new criteria for determining the risk factors for progression of aneurysms.
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PMID:Risk factors for abdominal aortic aneurysms in older adults enrolled in The Cardiovascular Health Study. 869 60

The purpose of this study was to analyze outcomes of two different treatment strategies in patients treated for renal artery (RA) stenosis and a coincidental abdominal aortic aneurysm (AAA). A total of 50 patients were encountered who required treatment for concomitant RA stenosis and an AAA from 1980 to 1994. Simultaneous operative aortic and RA reconstruction was done in 32 patients, whereas 18 patients where treated with preoperative percutaneous transluminal renal artery angioplasty (PTRA). The two groups were well matched with respect to age, AAA size, incidence of hypertension, preoperative creatinine level, and creatinine clearance (all p values > 0.07). Aortorenal bypass (18 RAs), reimplantation (18 RAs), or endarterectomy (2 RAs) was performed to correct a mean RA stenosis of 88%, whereas 23 RAs (91% mean stenosis) were treated with preoperative PTRA. PTRA failed in four patients with RA stenosis, and they were successfully treated with surgery (3 bypasses and 1 reimplantation). Statistical analysis did not demonstrate a significant difference between these four failed PTRA patients, the 14 successful PTRA patients, and the 32 RA reconstruction patients in terms of operating time (p = 0.15), operative blood loss (p = 0.20), intensive care unit days (p = 0.71), or total hospital days (p = 0.94). Among the 40 patients available for follow-up, hypertension was cured in seven, improved in 10, unchanged in 15, and worse in eight with no difference demonstrated between the groups (p = 0.73). These data suggest that preoperative PTRA has no specific advantage over surgical RA reconstruction in patients with concomitant RA stenosis and AAA. Failed PTRA did not preclude or complicate subsequent operative RA revascularization.
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PMID:Combined renal artery stenosis and aortic aneurysm: treatment options. 887 91

In many reports, the prevalence of target organ damage in renovascular hypertension (RVH) appears to be higher than in essential hypertension (EH). Since in most studies the renal artery stenosis is part of a diffuse atherosclerotic disease, it is not known whether these complications are due to RVH itself or to the vascular disease. We have undertaken a case control study of 92 patients divided into two groups (46 in each), one with RVH and the other with EH and abdominal aortic aneurysm, with a comparable degree of diffuse atherosclerotic vascular disease. The vascular state of the extracranial carotid arteries and abdominal and inferior limb districts was investigated with angiography and sonography. The prevalence of left ventricular hypertrophy (LVH) and ischemic heart disease (IHD) were assessed by electrocardiography. Serum creatinine and urinary protein excretion were employed in the renal evaluation. While the analysis of the results confirmed an even diffusion of atherosclerotic vascular disease between the two groups, a significant difference was found in the prevalence of heart and renal damage. LVH was present in 32.6% of RVH patients versus 10.8% in EH (P = .02). Serum creatinine > 1.4 mg/dL was found in 50% of RVH and in 23.9% of EH, (P = .01). The prevalence of proteinuria in RVH was also higher although not reaching the statistical significance. The results suggest that, in patients with comparable degrees of atherosclerotic vascular disease, RVH is responsible for the higher prevalence of target organ damage in this condition compared to those with EH.
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PMID:Comparison of target organ damage in renovascular and essential hypertension. 893 30

In order to identify major risks for death and complications from elective repair of abdominal aortic aneurysm, the authors analyzed their experience with the last 1000 such repairs over a 15-year period. Of the patients, 772 were men and 228 were women; average age was 70 (range 37-92) years. Some 20% of the patients had severe chronic obstructive pulmonary disease and 33% had baseline creatinine level > 115 mumol/l. Fifteen patients were dialysis-dependent and 24% (242/1000) had significant cardiac disease. Operation used a retroperitoneal approach in 834 patients and a transperitoneal approach in 166. The perioperative mortality rate was 2.4%, but this did not change either chronologically or with technique: some 50% of the deaths were due to cardiac causes. Renal and pulmonary impairment did not affect mortality or complication; 64% of non-fatal complications were distributed in the renal (17%), pulmonary (19%) and cardiac groups (28%). The authors' experience showed that patients with cardiac disease remain at significant risk for post-abdominal aortic aneurysm repair complications in spite of selective preoperative cardiac evaluation. Renal and pulmonary risk factors did not cause additional mortality or morbidity. They suggest that elective abdominal aortic aneurysm repair can be performed with low mortality and morbidity, even in increasing numbers of high-risk patients.
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PMID:Results of 1000 consecutive elective abdominal aortic aneurysm repairs. 901 99

This study determines the early and late survival rates, the causes of death, and prognostic variables that are associated with early and late survival after for ruptured abdominal aortic aneurysm (AAA). These are based on the prospective analysis of 628 variables of data on 158 consecutive patients in 24 centers of our association in 1989. Patients were followed up for a mean of 42.1 +/- 21.0 months. Six patients were lost to follow-up. To identify the variables that were associated with early and late survival, statistical methods included logistic regression analysis, Kaplan-Meier analysis, and Cox regression analysis. The survival rate was 52.9% +/- 14.4% at 1 month, 48.8% +/- 15.8% at 1 year, 48.1% +/- 16.0 at 2 years, 40.3 +/- 19.2% at 3 years, and 35.0 +/- 21.8 at 4 years. The cause of the 73 (46.2%) early deaths were cardiac (33), hemorrhage (29), colonic necrosis (5), stroke (2), graft infection (2), pneumonia (1), and kidney failure (1). Significant predictors of early death were the presence of a common iliac aneurysm (p < 0.02), the age of the patient (p < 0.02), a previous history of stroke or transient ischemic attack (TIA) (p < 0.04), a bifurcated graft (p < 0.04), a saccular aneurysm (p < 0.06), the blood creatinine level (p < 0.06), and hypotension on admission (p < 0.06). The causes of the 28 (17.7%) late deaths were heart disease (11), cancer (8), stroke (3), another operation (3), graft infection (1), pneumonia (1), and Alzheimer disease (1). Significant predictors of late death were heavy smoking (p < 0.03) and chronic obstructive pulmonary disease (p < 0.07). Rupture of an abdominal aortic aneurysm remains a catastrophic event. Even after a successful cure of a ruptured AAA, cardiovascular causes of death are responsible for survival rates that are significantly lower than that in a matched nonaneurysmal population.
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PMID:Surgery for ruptured abdominal aortic aneurysm: early and late results of a prospective study by the AURC in 1989. 906 Nov 46

The purpose of this study was to determine the influence of preoperative renal dysfunction on the outcome of patients undergoing elective, infrarenal abdominal aortic aneurysm (AAA) repair. Patients undergoing AAA repair from 1984 to 1996 (n = 250) were divided into 2 groups, according to their preoperative serum creatinine levels: > or = 1.5 mg/dl (group A, n = 33) and < 1.5 mg/dl (group B, n = 217). There was no apparent difference in the incidences of preoperative risk factors, excluding ischemic heart disease, between the groups. The mortality rates of the 2 groups did not differ (9.9% vs 3.2% in groups A and B, respectively, p = 0.13), but the morbidity rate of group A (30.3%) was significantly higher than that of group B (12.9%, p = 0.0095). The 5-year cumulative survival rate of group A patients was 60%, which was significantly lower (p < 0.0001) than that of group B patients (84%). Five group A patients underwent simultaneous renal artery reconstruction, which relieved postoperative renal deterioration in 4, although 2 of them developed chronic renal failure requiring hemodialysis over 5 years after the operation. These findings suggest that morbidity and long-term survival in patients with renal dysfunction can be severe after AAA repair and that simultaneous renal artery reconstruction may delay renal function decline.
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PMID:Surgical results of abdominal aortic aneurysm repair in patients with chronic renal dysfunction. 929 6

BACKGROUND: Endovascular repair (EVR) of abdominal aortic aneurysm (AAA) is feasible for selected patients. Placing an uncovered stent across the origins of the renal arteries may improve fixation and seal of the proximal end of the stent-graft. However, this has potential for problems (e.g. renal artery stenosis or microembolization). This study aimed to evaluate the short-term effect of a suprarenal stent on the function of the individual kidney. METHODS: In 30 patients undergoing EVR for AAA, renal function was assessed before and after operation by 99mTc-radiolabelled diethylenetriamine penta-acetate radionuclide renography and daily measurement of serum creatinine levels. Eleven patients had infrarenal stent-grafts using an aorta uni-iliac system (group 1); 19 patients had the device with an uncovered suprarenal stent (modified Gianturco Z stent), ten of which were aorta uni-iliac and nine bifurcated systems (group 2). Individual kidney function was expressed as the whole kidney transit time (WKTT). In addition, glomerular filtration rate (GFR) was measured from serial blood samples following renography. RESULTS: [Table: see text] CONCLUSION: No result reached statistical significance. Placing an uncovered stent over the origins of the renal arteries does not appear to impair kidney function in the short term.
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PMID:Vascular surgical society of great britain and ireland: perioperative renal function following endovascular repair of abdominal aortic aneurysm with suprarenal and infrarenal stents 1036 24

This article summarizes considerations in screening for abdominal aortic aneurysm (AAA) and preoperative imaging before conventional surgical repair. Because death of this relatively common disease can be prevented by an effective treatment, there is great interest in early detection and elective repair. The prevalence of AAA in older adults (65 to 80 years of age) varies from 4% to 7%. Factors associated with AAA include smoking, age, coronary artery disease, high serum cholesterol level, family history, and hypertension. A higher prevalence of AAA has been found among first-degree relatives of AAA patients, particularly in men, and smoking is an important factor in the development and progression of AAA. Screening for AAA may be appropriate in male patients older than 65 years with a smoking history, particularly current smokers, who have carotid occlusive disease, coronary artery disease, or lower extremity occlusive disease. Ultrasound is the screening method of choice and has the benefit of being inexpensive and noninvasive. Preoperative imaging serves mainly to establish the indication for operation. The vascular surgeon comfortable with discovering potentially confusing anatomic configurations or adverse extensions of pathology at the time of operation may not require any imaging beyond ultrasound. Specific indications for arteriography include suggestion of juxtarenal aneurysm by ultrasound or physical examination, clinical evidence of lower extremity arterial occlusive disease, uncontrolled hypertension or unexplained creatinine elevation, or prior arterial reconstruction. Spiral computed tomography (CT) scan with 3-dimensional reconstruction and gadolinium magnetic resonance (MR) angiography are increasingly useful alternatives to contrast arteriography.
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PMID:Screening and preoperative imaging of candidates for conventional repair of abdominal aortic aneurysm. 1065 58


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