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

This study was undertaken to examine the community hospital experience in managing ruptured abdominal aortic aneurysm, and to assess the quality of life in survivors of the abdominal aortic aneurysm procedure. Study parameters included a retrospective chart review with prospective follow-up at a 369-bed, university-affiliated, community teaching hospital. Eighty-one consecutive patients undergoing surgery for ruptured abdominal aortic aneurysm between 1991 and 2000 were included. Main outcome measures included mortality and quality of life, as assessed by the SF-36 health survey. The overall perioperative mortality rate was 34.6%, significantly less (p < 0.005) than the 50% mortality rate reported in the literature. Predictor variables significantly related to mortality were age (p < 0.002), preoperative creatinine (p < 0.026), use of suprarenal clamp (p < 0.0001), acute renal failure (p < 0.0001), myocardial infarction (p < 0.0001), respiratory failure (p < 0.0001), and tobacco use (p < 0.05). Multiple regression analysis found that three predictor variables--myocardial infarction, respiratory failure, and use of a suprarenal clamp--predicted 25% of the variability in mortality (p < 0.0001). The quality-of-life analyses showed that the majority of the patients for whom follow-up data could be obtained (n = 26), reported the same or better quality of life compared to SF-36 norms for age-matched individuals. Results from this community hospital sample suggest that ruptured abdominal aortic aneurysm repair can be accomplished in this setting with an acceptable survival rate, and subsequent quality of life that meets or exceeds that of an age-matched sample.
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PMID:Ruptured abdominal aortic aneurysm and quality of life. 1270 27

The aim of this study was to evaluate clinical sequelae of accessory renal artery exclusion during endo-AAA repair. Medical records and pre- and postoperative CT scans were reviewed from 114 AAA patients treated with the AneuRx stent graft between 1996-2001. Thirty-seven accessory renal arteries were identified in 32/114 patients (28%) with 19/32 patients having infrarenally located accessory renal arteries. In group I (11 patients), the stent graft excluded 11 accessory renal arteries. In group II (8 patients), eight accessory renal arteries were not excluded. Average infrarenal neck length was 24.9 mm in group I vs. 30.7 mm in group II (p = 0.07). The average length of device seal was similar in both groups (19.4 vs. 18.5 mm, p = 0.67). There were no perioperative deaths, significant postoperative hypertension, rise in serum creatinine, or postoperative renal infarctions in either group. Three of eight patients (38%) in the non-excluded group developed type I proximal endoleaks whereas none in the excluded patient group did (p = 0.06). Accessory renal arteries may be safely excluded during endovascular AAA repair and may result in a more secure proximal device fixation.
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PMID:Endovascular abdominal aortic aneurysm repair using the AneuRx stent graft: impact of excluding accessory renal arteries. 1472 63

To evaluate the outcome of patients with renal insufficiency undergoing endovascular repair of abdominal aortic aneurysm (AAA), data were prospectively collected between 1998 and 2003 on patients undergoing elective repair of their AAA with a stent graft. The patients were divided into 2 groups: those with serum creatinine (Crs) concentrations <1.2 (Group A) and those with Crs > or =1.2 mg/dL not requiring hemodialysis (Group B). The outcomes of the procedure for these 2 groups were compared. Different variables that existed between the 2 groups and contributed to mortality included estimated blood loss (EBL), volume of contrast used in the operating room, incidence of diabetes (DM), tobacco use, and history of myocardial infarction (MI). In total, 213 patients underwent elective repair of their AAA with use of a stent graft: 61% who had a Crs <1.2 mg/dL (Group A) and 39% who had a Crs > or =1.2 mg/dL not requiring dialysis (Group B). Among 129 patients with normal renal function there was an 18.6% complication rate and 1.6% mortality rate. Of 83 patients with renal insufficiency not on hemodialysis 30.1% (Fisher's Exact Test = 0.076) had 1 or more complications and there was a 6% (Fisher's Exact Test = 0.166) mortality rate. One patient in Group A (0.8%) progressed to hemodialysis and 5 (6%) patients in Group B progressed to end-stage renal disease requiring hemodialysis (p=0.068). A statistically significant higher proportion of the patients in Group B had a history of MI (p<0.001). There was no difference in the amount of EBL between the 2 groups, but a significantly lower amount of contrast (p<0.05) was used in patients with renal insufficiency.
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PMID:Morbidity and mortality associated with renal insufficiency and endovascular repair of abdominal aortic aneurysms: a 5-year experience. 1506 45

There is still controversy as to which surgical method is the most suitable for repair of abdominal aortic aneurysm with concomitant horseshoe kidney (AAA-HSK). We report three cases of AAA-HSK treated with endovascular aneurysm repair. In one of these patients we sacrificed the accessory renal artery by applying coils before the operation. Renal infarction, hypertension, or elevated serum creatinine level was not observed in any of our patients. If the blood supply to the kidneys is taken into consideration, endovascular aneurysm repair is our preferred surgical method for repair of AAA-HSK when anatomic conditions are suitable for stent-graft application and kidney function is normal.
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PMID:Endovascular aneurysm repair: Treatment of choice for abdominal aortic aneurysm coincident with horseshoe kidney? Three case reports and review of literature. 1529 35

Aortic stent grafting may be an alternative to surgery for patients with an abdominal aortic aneurysm and coexistent horseshoe kidney but is not without difficulties. This study examines the renal consequences of aortic stent grafting in such patients. This is a retrospective review of patients with horseshoe kidney in whom aortic stent grafting was performed between December 1995 and August 2000. Follow-up occurred within the EUROSTAR protocol and included measurement of serum creatinine. Of 130 patients in whom aortic stent grafting was performed, 4 had coexistent horseshoe kidney. In all patients the aneurysm was successfully excluded with the occlusion of between one and four anomalous renal arteries. At follow-up, no clinically significant renal impairment was detected. Endovascular aneurysm repair is an attractive option for patients with a horseshoe kidney and normal preoperative creatinine levels.
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PMID:The renal impact of aortic stent-grafting in patients with a horseshoe kidney. 1557 40

In this study we aimed to define relevant prognostic predictors for the outcome of surgical treatment of ruptured abdominal aortic aneurysms. The study included 406 consecutive patients treated between January 1991 and December 2003. There were 337 (83%) male and 69 (17%) female patients aged 67 +/- 7.5 years. Fourteen (3.5%) patients had aortocaval fistula whereas 4 (0.98%) had primary aortorenteric fistula caused by aneurysm rupture into the inferior vena cava or duodenum. Reconstruction included interposition of a tube graft (215-53%), aortobiiliac bypass (134-33%), and aortobifemoral bypass (58-14.3%). Findings on admission that significantly correlated with both intraoperative (13.5%) and total operative mortality (48.3%) were systolic blood pressure <95 mmHg, low diuresis, unconsciousness, cardiac arrest, leukocytes >14 x 10(9)/L, hematocrit <0.29%, hemoglobin <100 g/L, urea> 11 mmol/L, and creatinine >180 micromol/L. Intraoperative determinants of increased mortality were aortic cross-clamping time >47 min, duration of surgery >200 min, intraoperative blood loss >3500 mL, diuresis <400 mL, arterial systolic pressure <97.5 mmHg, and the need for aortobifemoral bypass. Respiratory complications and multisystem organ failure were significantly associated with lethal outcome in the postoperative period. Surgical treatment of ruptured abdominal aortic aneurysm was life-saving in 51.7% of patients. Variables significantly associated with mortality were unconsciousness, low systolic blood pressure, cardiac arrest, low diuresis, high urea and creatinine levels, signs of blood loss, and the need for aortobifemoral reconstruction. Short aortic cross-clamping and the total operation time, low intraoperative blood loss, and well-controlled diuresis and arterial pressure during surgery have improved survival. Therapeutic efforts should concentrate on intraoperative factors that are possible to correct, leading to better survival of these patients.
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PMID:Ruptured abdominal aortic aneurysms: factors influencing early survival. 1571 64

Abdominal aortic aneurysm (AAA) is rarely associated witha congenital pelvic kidney. To date only 11 cases have been reported in the literature in which a solitary pelvic' kidney was associated in only 1 patient. Repair of thesaneurysm is technically demanding because the abnormal origin of the renal arteries presents the problem of renal ischemia duringaortic cross-clamping. We report a case of a 77-year-old man who was found to have an AAA associated with a congenital solitary pelvic kidney. An abdominal aortography dearly showed 2 aberrant renal arteries, one of which originated from the aortic wall just above the aortic bifurcation and the other from the left common iliac artery. At surgery, we found other associated anomalies including malrotation of the gut and a left undescended testis. The surgical procedure consisted of an aneurysmorrhaphy followed by a tube graft replacement with therenal arteries being left intact to the distal aortic wall or below. Renal preservation during aortic cross-clamping was achieved by direct perfusion of the upper renal artery with cold lactated Ringer's solution together with topical cooling with ice slush. The patient's postoperative course was uneventful. Urinary output was satisfactory and serum creatinine level remained unchanged throughout his hospital stay. The renal preservation method used in this case was simple and effective.
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PMID:Abdominal aortic aneurysm repair in a patient with a congenital solitary pelvic kidney. A case report. 1573 73

Visceral (mesenteric and/or renal) ischemia/reperfusion phenomena likely contribute to the greater operative risk associated with pararenal and lower thoracoabdominal aortic aneurysm (TAA) repair. To differentiate the relative adverse effects of aortic clamp level, visceral ischemic duration, and various pre- and perioperative factors shared with infrarenal aneurysm patients, a comparative analysis of early and late outcomes after open repair of intact infrarenal and visceral aortic aneurysms was undertaken. A retrospective review of our university experience from 1993-1999/2002 revealed 549 patients (mean age 70 +/- 8 years, 11% female) undergoing open repair of intact, degenerative aneurysms of the infrarenal (n = 391, 71%), juxtarenal (n = 78, 14%), suprarenal (n = 35, 7%), and type IV (n = 40, 7%) and type III (n = 5, 1%) TAA segments. All pararenal aneurysms required suprarenal (SR) or supravisceral (SV, above celiac or superior mesenteric artery) clamp placement. Concomitant renal reconstruction was done in 30% of visceral aortic and 3% of open infrarenal aneurysm repairs. Thirty-day adverse outcomes [death, renal failure (creatinine 2 x baseline or new dialysis), visceral (bowel, hepatic, renal, spinal cord, multiple organ dysfunction), and nonvisceral (cardiac, pulmonary, procedural) complications] were analyzed relative to patient and operative factors using univariate comparisons and multivariate stepwise logistic regression. Perioperative mortality rates varied significantly between aneurysm locations (infrarenal 2.1%, juxtarenal 2.6%, suprarenal 11.4%, TAA 13.3%; p < 0.01) and for clamp locations (infrarenal 2.1%, SR 3.0%, SV 10.8 %; p < 0.01) but were not different between juxtarenal (1.8% vs. 4.4 %) and SR (9.1% vs. 12.5%) aneurysms requiring SR or SV clamping, respectively. Visceral ischemic time (VIT) during SR or SV clamping, and not clamp location, was the only independent predictor of operative mortality [odds ratio (OR) = 10.8, 95% confidence interval (CI) 4-29]. Sensitivity analyses revealed VIT > 32 min to be the strongest predictor of early death. Visceral complication or renal failure affected 34% and 23% of visceral aortic (5% dialysis) and 7% and 5% (1% dialysis) of infrarenal repairs, respectively. VIT > 32 min, SV clamp placement, diabetes, and inflammatory aneurysm repair were each predictive of visceral complications and/or renal failure. Five-year survival rate was similar after visceral aortic (70%) and infrarenal (75%) repairs but negatively impacted only in patients with prior infrarenal abdominal aortic aneurysm repair and recurrent aneurysms (OR = 2.8, 95% CI 1.2-6.9). The high incidence of early adverse outcomes following repair of pararenal and lower thoracoabdominal aneurysms is primarily associated with excessive periods of renal and/or gut ischemia during visceral aortic clamp placement. However, nearly equivalent early and late survival was seen for visceral aortic and infrarenal repairs when VIT < 32 min was achieved.
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PMID:Critical analysis of outcome determinants affecting repair of intact aneurysms involving the visceral aorta. 1605 85

Renal ischemia remains a vexing issue in the repair of suprarenal abdominal aortic aneurysms (SR-AAAs). Multiple reconstruction methods have been described, including fish-mouth anastomoses, renal artery reimplantation, and aortorenal interposition grafts. We present an alternative method of SR-AAA repair that minimizes renal ischemia time. We describe our approach in two patients with SR-AAAs. Both patients had normal preoperative renal function. Maximal aneurysm diameters were 6.0 and 7.4 cm. In each case, the abdominal aorta was exposed via the retroperitoneal approach and the supraceliac aorta was dissected from the surrounding tissue. A partially occluding side-biting aortic clamp was placed at this level to facilitate placement of a synthetic 6 mm interposition graft that was sewn in an end-to-side fashion to the suprarenal aorta first. These grafts were then sewn end-to-end to the left renal artery, completing the aorto-left renal bypass. Left renal ischemia times were 12 and 14 min. The aneurysm was then repaired with a beveled proximal anastomosis, accommodating the right renal artery orifice. Both patients had minimal postoperative renal dysfunction, with peak creatinine levels of 1.9 and 1.4 mg/dl. At discharge, both patients had a creatinine level of 1.1 mg/dl. Urinary output remained normal throughout the hospital stays, and neither patient required dialysis. Retroperitoneal aortic exposure with preliminary aorto-left renal artery bypass is an effective method of treating SR-AAAs. Proximal anastomosis can be done with less urgency and minimal right renal ischemia, by revascularizing the left kidney first.
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PMID:Aorto-left renal artery bypass as an adjunct to suprarenal abdominal aortic aneurysm repair. 1605 90

Cardiopulmonary complication after ruptured abdominal aortic aneurysm (rAAA) repair is an important cause of mortality. Early tracheostomy promotes patient recovery from respiratory morbidities. A policy of routine immediate tracheostomy was adopted in 1999 at our institution. This study investigates the trend of hospital mortality of rAAA patients over 12 years with particular reference to immediate tracheostomy. Consecutive rAAA patients operated during 1993-2004 were divided into two groups (first group, 1993-1998; second group, 1999-2002). Intra- and postoperative care was the same for all patients except that immediate tracheostomy was performed routinely in the second group and only selectively in the first. Hospital mortality of the two groups was examined. Patient characteristics, biochemical parameters, aneurysm feature, operative details, and clinical outcomes of the two groups (excluding 48 hr perioperative mortalities) were compared to identify prognostic factors of hospital mortality. Sixty-three patients were operated during the study period. The overall hospital mortality for the first and second groups was 62.5% (20/32) and 22.6% (7/31) (p=0.001), respectively. Excluding the 48 hr mortalities, 57.1% (12, n=21) of patients in the first group and 85.7% (24, n=28) of those in the second group survived to be discharged from hospital (p=0.048). The pre-, intra-, and postoperative parameters were comparable between the two groups. Immediate tracheostomy was performed for all patients in the second group and only 52.4% (11) in the first group. Male gender, high creatinine level on presentation, postoperation cardiac morbidity, renal failure, and bowel ischemia were found to be associated with a higher mortality. Immediate tracheostomy is a significant factor associated with improved survival. In conclusion, a significant improvement of rAAA patients' in-hospital mortality was achieved during the study period. Tracheostomy performed immediately following rAAA repair is associated with better hospital survival.
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PMID:Improvement of mortality of ruptured abdominal aortic aneurysm patients over 12 years and its relationship with tracheostomy. 1655 27


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