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Sample records for aortic aneurysm surgery

  1. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B;

    1994-01-01

    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems....

  2. Fenestrated endografting of juxtarenal aneurysms after open aortic surgery

    NARCIS (Netherlands)

    Oikonomou, Kyriakos; Katsargyris, Athanasios; Bekkema, Foppe; Tielliu, Ignace; Verhoeven, Eric L. G.

    2014-01-01

    Introduction: Juxtarenal aneurysms after previous surgical aortic reconstruction constitute a complex clinical scenario. Open redo surgery is technically demanding and usually requires suprarenal or supraceliac clamping. Standard endovascular repair is prohibited due to the lack of a proximal landin

  3. Impact of smoking on endovascular abdominal aortic aneurysm surgery outcome.

    NARCIS (Netherlands)

    Lottman, P.E.M.; Marrewijk, C.J. van; Fransen, G.A.J.; Laheij, R.J.F.; Buth, J.

    2004-01-01

    OBJECTIVE: Smoking plays a major role in deficiencies of the vascular system, and seems to have consequences for the treatment of cardiovascular diseases. We hypothesized that smokers have a higher mortality and more complications after endovascular abdominal aortic aneurysm surgery than non-smokers

  4. Aortic Aneurysm

    Science.gov (United States)

    ... Most aneurysms are in the aorta, the main artery that runs from the heart through the chest and abdomen. There are two types of aortic aneurysm: Thoracic aortic aneurysms (TAA) - these occur in the part of the aorta running through the chest Abdominal aortic aneurysms (AAA) - these occur in the part ...

  5. Aneurysms: thoracic aortic aneurysms.

    Science.gov (United States)

    Chun, Kevin C; Lee, Eugene S

    2015-04-01

    Thoracic aortic aneurysms (TAAs) have many possible etiologies, including congenital heart defects (eg, bicuspid aortic valves, coarctation of the aorta), inherited connective tissue disorders (eg, Marfan, Ehlers-Danlos, Loeys-Dietz syndromes), and degenerative conditions (eg, medial necrosis, atherosclerosis of the aortic wall). Symptoms of rupture include a severe tearing pain in the chest, back, or neck, sometimes associated with cardiovascular collapse. Before rupture, TAAs may exert pressure on other thoracic structures, leading to a variety of symptoms. However, most TAAs are asymptomatic and are found incidentally during imaging for other conditions. Diagnosis is confirmed with computed tomography scan or echocardiography. Asymptomatic TAAs should be monitored with imaging at specified intervals and patients referred for repair if the TAAs are enlarging rapidly (greater than 0.5 cm in diameter over 6 months for heritable etiologies; greater than 0.5 cm over 1 year for degenerative etiologies) or reach a critical aortic diameter threshold for elective surgery (5.5 cm for TAAs due to degenerative etiologies, 5.0 cm when associated with inherited syndromes). Open surgery is used most often to treat asymptomatic TAAs in the ascending aorta and aortic arch. Asymptomatic TAAs in the descending aorta often are treated medically with aggressive blood pressure control, though recent data suggest that endovascular procedures may result in better long-term survival rates. PMID:25860136

  6. [Mortality and morbidity in surgery for abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Banke, A.B.; Andersen, Jakob Steen; Heslet, L.;

    2008-01-01

    INTRODUCTION: Patients undergoing surgery for ruptured abdominal aortic aneurysm (rAAA) have a mortality of 40-50%. The purpose of the present investigation is to document the mortality and morbidity of such patients at Rigshospitalet (RH) in 2005. The results are compared with the best results...... published internationally (benchmark) and with predicted mortality. Factors in postoperative intensive therapy that can improve morbidity and mortality are identified. MATERIAL AND METHODS: This is a retrospective calculation and analysis of mortality and morbidity. Data were collected from an Intensive...... was significantly higher than the overall ICU mortality. The ICU mortality and morbidity increased with the amount of postoperative blood loss. Patients with an initial serum creatinine concentration of mortality that was lower than that of patients with a higher initial serum creatinine...

  7. Aortic aneurysm disease vs. aortic occlusive disease - differences in outcome and intensive care resource utilisation after elective surgery

    DEFF Research Database (Denmark)

    Bisgaard, Jannie; Gilsaa, Torben; Rønholm, Ebbe;

    2013-01-01

    clamping is more pronounced in patients with aortic aneurysm disease, which may affect outcome. OBJECTIVES: The aim of this observational cohort study was to evaluate outcome after open elective abdominal aortic surgery, hypothesising a higher 30-day mortality, a higher incidence of postoperative organ...... dysfunction and a longer length of stay in patients with aortic aneurysm compared with aortic occlusive disease. DESIGN: Cohort observational study based on prospective registrations from national databases. SETTING: Eight Danish hospitals, including four university and four non-university centres, from 1...... or inotropes, ICU stay more than 24 h, hospital length of stay and mortality. RESULTS: Compared with aortic occlusive disease, more patients with aortic aneurysm disease had ICU stays more than 24 h (62 vs. 45%, P ...

  8. [Risk stratification in selective surgery of abdominal aortic aneurysm].

    Science.gov (United States)

    Iaitskiĭ, N A; Bedrov, A Ia; Moiseev, A A; Nesterova, I V

    2014-01-01

    A retrospective analysis of data of 188 patients, who underwent a selective surgery for abdominal aortic aneurism showed, that all the patients had a cardiac pathology. Ischemic heart disease and arterial hypertension had 175 (93.0%) and 177 (94.1%) of patients, respectively. Chronic nonspecific lung disease was noted in 65.4% patients and kidney disease--in 48.9%. Different complications developed in early postoperative period in 47 (25%) patients, that resulted in fatal outcome in 20(10,6%). The most frequent complication was an acute renal insufficiency, which led to fatal outcome in 40% patients. Myocardial infarction and pneumonia took the second place in the structure of postoperative complications, one half of the fatal cases was due to these. Retrospective risk stratification assessment of the development of early postoperative complications and lethality was made by Glasgow Aneurysm Score (GAS) and angiosurgical model scale V-POSSUM. It was stated, that score was up to 84 according to GAS scale and up to 28 (V-POSSUM). That fact is the evidence of high risk of the operation. On the basis of ROC curves building, the conclusion was made about greater predictive ability of V-POSSUM scoring system. PMID:25055502

  9. [Aortic aneurysm].

    Science.gov (United States)

    Villar, Fernando; Pedro-Botet, Juan; Vila, Ramón; Lahoz, Carlos

    2013-01-01

    Aortic aneurysm is one important cause of death in our country. The prevalence of abdominal aortic aneurism (AAA) is around 5% for men older than 50 years of age. Some factors are associated with increased risk for AAA: age, hypertension, hypercholesterolemia, cardiovascular disease and, in particular, smoking. The medical management of patients with an AAA includes cardiovascular risk treatment, particularly smoking cessation. Most of major societies guidelines recommend ultrasonography screening for AAA in men aged 65 to 75 years who have ever smoked because it leads to decreased AAA-specific mortality. PMID:24238836

  10. Surgery for abdominal aortic aneurysms. A survey of 656 patients

    DEFF Research Database (Denmark)

    Olsen, P S; Schroeder, T; Agerskov, Kim;

    1991-01-01

    Between 1979 and 1988, 656 patients were operated upon for abdominal aortic aneurysm. Elective operation was performed in 287 patients (44%) and acute operation in 369 patients. A ruptured aneurysm was found in 218 patients (33%). Patients with arteriosclerotic heart disease, hypertension, impaired...... renal function or chronic pulmonary disease showed an increased perioperative mortality. Development of postoperative cardiac and renal complications could not be related to previous cardiac or renal diseases. The major postoperative complications were renal failure in 81 patients (12%), pulmonary...... insufficiency in 77 patients (11%) and cardiac complications in 96 patients (13%). Failure of one or more organs occurred in 153 patients (23%) and the mortality rate for patients with multiorgan failure was 68%. Complications leading to reoperation occurred in 93 patients (14%). The perioperative mortality...

  11. Aortic aneurysm repair - endovascular

    Science.gov (United States)

    EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... Endovascular aortic repair is done because your aneurysm is very large, growing quickly, or is leaking or bleeding. You may have ...

  12. [Inflammatory abdominal aortic aneurysm].

    Science.gov (United States)

    Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T

    2000-01-01

    The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

  13. Abdominal Aortic Aneurysms: Treatments

    Science.gov (United States)

    ... access catheters Vertebroplasty Women and vascular disease Women's health Social Media Facebook Twitter ... Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists are vascular ...

  14. Aortic Aneurysm Statistics

    Science.gov (United States)

    ... connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, get thoracic aortic aneurysms. Signs and symptoms of thoracic aortic aneurysm can include Sharp, sudden pain in the chest or upper back. Shortness of ...

  15. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to become you to our live webcast. Today we’re going to repair an abdominal aortic aneurysm ... and together as a team of multidisciplinary physicians, we’re going to repair an abdominal aortic aneurysm ...

  16. Results of Castro Bernardes intraluminal ring in surgery for ascending aortic aneurysms and dissections

    Directory of Open Access Journals (Sweden)

    Fernando Rotatori Novaes

    2013-06-01

    Full Text Available OBJECTIVE: To demonstrate surgical results using Castro Bernardes intraluminal ring in ascending aorta surgery, instead of conventional suture. METHODS: 95 patients underwent ascending aorta surgery from December 2008 to April 2011 at Madre Tereza Hospital (Belo Horizonte, MG, Brazil, using Castro Bernardes intraluminal ring instead of conventional suture of the aorta. RESULTS: Ninety five patients underwent ascending aorta surgery with Castro-Bernardes intraluminal ring. Thirty patients presented acute dissection and 65 aneurism. Overall postoperative mortality was 15.78% (15/95. Nine patients in 15 (60% died due to acute type A dissection. For acute type A dissection, mortality was 30% and for aneurism mortality was 9.23%. The intraluminal ring was inserted in distal position in 89 patients and in proximal and distal position in 6 patients. Mortality was related to Bentall & De Bono or Cabrol associated techniques. Average extracorporeal circulation time was 57.4 minutes and average aortic cross-clamping time was 37 minutes. CONCLUSION: The use of Castro Bernardes intraluminal ring in ascending aortic surgery avoiding conventional suture reduces extracorporeal circulation time and aortic cross-clamping time, improving surgical results. This approach simplifies ascending aortic surgery whether the disease is type A dissection or aneurysm, and may be considered a good alternative technique.

  17. [Anesthesia and recovery of infrarenal abdominal aortic aneurysm surgery].

    Science.gov (United States)

    Beye, S A; Kane, O; Tchikangoua, T N; Ndiaye, A; Dieng, P A; Ciss, G; Ba, P S; Ndiaye, M

    2009-01-01

    The aim of this study was to evaluate the anaesthetic assumption of responsibility of the surgery of the aneurism of under renal abdominal aorta. It was a retrospective study over two years (April 2005 - April 2007). Seven patients were operated, the mean age was 69,4 years. An operational pre evaluation was carried out among all patients including/understanding an interrogation, a clinical examination and a clinical assessment. All the patients profited from a general anaesthesia with controlled ventilation. Arterial hypertension (5 cases) was the independent factor of risk followed by the nicotinism (2 cases) with a patient at the stage of obstructive chronic broncho-pneumonopathy (BPCO). A patient was allowed in a table of rupture with acute abdominal pain and a cardiovascular collapse. Electrocardioscopic anomalies were noted among three patients with type of: HVD+ HBAG; HVG; HAG. A patient presented a hypertrophy cardiopathy with deterioration of the function of the VG and an important pulmonary arterial hypertension. A tensionnelle fall was found among three patients after induction with the midazolam. The aortic time of clampage varied between 20 and 120 mn with an average of 57, 6 mn. The incidents at the time of the clampage were: a bradycardia, a hypertensive push and a hypotension. No incident was observed at the time of the declampage. The blood losses per operational were estimated on average at 1000 ml and the numbers of transfusion by patient was on average of 4 pockets. The post operative issue was simple among 5 patients. A surgical recovery was necessary in front of a case of thrombosis of prosthesis. An oligoanurie, an acute respiratory insufficiency was found at the patient admitted in a table of rupture. The intermediate duration of stay threw 11 days. The maintenance of a homodynamic stability per and post operational remainder a good strategy to prevent the operational complications post. PMID:19666389

  18. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... as atherosclerosis, high blood pressure, smokers, or a family history of abdominal aortic aneurysms. Today’s patient is ... be screened. In fact, patients who have a family history of aneurysm, men who are smoking over ...

  19. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... atherosclerosis, high blood pressure, smokers, or a family history of abdominal aortic aneurysms. Today’s patient is a ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the ...

  20. [A hybrid approach to surgery for thoracic aortic aneurysm

    DEFF Research Database (Denmark)

    L., de la Motte; Baekgaard, N.; Jensen, L.P.;

    2009-01-01

    A 57-year-old male, previously treated surgically with insertion of grafts for type A and B aortic dissection, presented with a pulsatile mass in the jugular fossa. Further examination verified a pseudoaneurysm the inlet of which was located at the proximal anastomotic site of the descending aort...

  1. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... wall will actually thin out. And the big risk here is that if this gets too big ... to the aging baby boomers. Next slide. The risk factors for abdominal aortic aneurysms are males over ...

  2. Health-related quality-of-life in patients after elective surgery for abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Ehlers, Lars Holger; Laursen, Kathrine Bang; Berg Jensen, Morten

    2011-01-01

    Purpose: The purpose of this study was to describe the health-related quality-of-life (QoL) in patients after elective surgery for abdominal aortic aneurysm (AAA) compared to a normal population and to study the association between QoL and number of years since surgery. Methods: All Danish men who...... underwent elective surgery for AAA at the age of 65 or more in the period from 1989–2007 in Denmark were invited to participate in the survey. Of 722 patients, 375 were alive and 328 (87%) responded. The nstruments EQ-5D (European Quality of life), EQ-VAS and SF-12 (Short Form Health Survey) were applied...... for measuring health-related QoL. Multiple regression analysis was used to study the association between QoL and number of years since AAA surgery. Results: A significantly poorer QoL was found in patients having had AAA surgery compared to the normal population as measured with the SF-12 and the EQ...

  3. Hybrid procedure for a descending thoracic and subclavian artery aneurysm in a patient with previous abdominal aortic surgery: Case report

    OpenAIRE

    Radak Đorđe; Tanasković Slobodan; Unić-Stojanović Dragana; Jović Miomir; Babić Srđan; Sagić Dragan

    2015-01-01

    Introduction. Hybrid procedures represent staged or simultaneous endovascular and open surgical techniques in the treatment of complex pathologies of the thoracic and abdominal aorta. We are presenting a patient with previous abdominal aortic surgery in whom hybrid vascular procedure for descending aorta and left subclavian artery aneurysm was performed. Case Outline. A 63-year-old female patient was admitted for computed tomography angiography. Descending ...

  4. Hybrid procedure for a descending thoracic and subclavian artery aneurysm in a patient with previous abdominal aortic surgery: Case report

    Directory of Open Access Journals (Sweden)

    Radak Đorđe

    2015-01-01

    Full Text Available Introduction. Hybrid procedures represent staged or simultaneous endovascular and open surgical techniques in the treatment of complex pathologies of the thoracic and abdominal aorta. We are presenting a patient with previous abdominal aortic surgery in whom hybrid vascular procedure for descending aorta and left subclavian artery aneurysm was performed. Case Outline. A 63-year-old female patient was admitted for computed tomography angiography. Descending aorta aneurysm (7.6 cm as well as aneurysm of the left subclavian artery (LSA was noted. Eight years ago she underwent abdominal aortic aneurysm resection and aortoiliac bypass. Standard TEVAR (thoracic endovascular aortic repair procedure couldn’t be done due to small dimensions of previous “Y” graft (12.6 mm, so first we did LSA transposition and after three days hybrid procedure. After “Y” graft exposure, anastomosis between the corps of “Y” graft and tubular graft 10 mm was created and through this conduit thoracic stent-graft was placed followed by complete “Y” graft replacement. After 6 months angiography showed regular postoperative findings. Conclusion. Combined surgical and endovascular procedures in thoracic aorta pathology treatment could be useful solutions with favorable outcome. [Projekat Ministarstva nauke Republike Srbije, br. 41002

  5. Inflammatory aortic aneurysms

    DEFF Research Database (Denmark)

    Bitsch, M; Nørgaard, H H; Røder, O;

    1997-01-01

    operated on for abdominal aortic aneurysms without PF in the same period, served as reference group. RESULTS: Preoperative thickness of PF was assessed as > 1 cm in 11 and cm in 10 patients. Ureterolysis was performed in seven patients where the fibrosis caused ureteral obstruction. Postoperative CT...

  6. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to repair an abdominal aortic aneurysm using a technology called an “endograft,” which is sometimes called the “ ... separate area, and it’s because of this small technology that allows you to do this. Exactly. So ...

  7. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... an abdominal aortic aneurysm. Normally this procedure takes us about 45 minutes to an hour of doctor work time, which is, I think, a fairly quick procedure to replace a major life-threatening problem in the patient’s abdomen. So you can see ...

  8. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... moving inside in the aneurysm sack with the spine projected in the background. So how long have ... have a much more rapid recovery than open surgery. What do you think about that, Ignacio, compared ...

  9. Distal small bowel motility and lipid absorption in patients following abdominal aortic aneurysm repair surgery

    Institute of Scientific and Technical Information of China (English)

    Robert J Fraser; Paul Jury; John Dent; Marc Ritz; Addolorata C Di Matteo; Rosalie Vozzo; Monika Kwiatek; Robert Foreman; Brendan Stanley; Jack Walsh; Jim Burnett

    2006-01-01

    AIM: To investigate distal small bowel motility and lipid absorption in patients following elective abdominal aortic aneurysm (AAA) repair surgery.METHODS: Nine patients (aged 35-78 years; body mass index (BMI) range: 23-36 kg/m2) post-surgery for AAA repair, and seven healthy control subjects (20-50 years;BMI range: 21-29 kg/m2) were studied. Continuous distal small bowel manometry was performed for up to 72 h, during periods of fasting and enteral feeding (Nutrison(R)). Recordings were analyzed for the frequency,origin, length of migration, and direction of small intestinal burst activity. Lipid absorption was assessed on the first day and the third day post surgery in a subset of patients using the 13C-triolein-breath test, and compared with healthy controls. Subjects received a 20-min intraduodenal infusion of 50 mL liquid feed mixed with 200 μL 13C-triolein. End-expiratory breath samples were collected for 6 h and analyzed for 13CO2 concentration.RESULTS: The frequency of burst activity in the proximal and distal small intestine was higher in patients than in healthy subjects, under both fasting and fed conditions (P<0.005). In patients there was a higher proportion of abnormally propagated bursts (71% abnormal), which began to normalize by d 3 (25% abnormal) post-surgery.Lipid absorption data was available for seven patients on d 1 and four patients on d 3 post surgery. In patients,absorption on d 1 post-surgery was half that of healthy control subjects (AUC 13CO2 1323 ± 244 vs 2 646 ±365;P< 0.05, respectively), and was reduced to the one-fifth that of healthy controls by d 3 (AUC 13CO2 470 ± 832 vs 2646 ± 365; P< 0.05, respectively).CONCLUSION: Both proximal and distal small intestinal motor activity are transiently disrupted in critically ill patients immediately after major surgery,with abnormal motility patterns extending as far as the ileum. These motor disturbances may contribute to impaired absorption of enteral nutrition, especially when

  10. Hybrid repair of a very late, post-aortic coarctation surgery thoracic aneurysm: a case report

    Directory of Open Access Journals (Sweden)

    Tilea Ioan

    2012-08-01

    Full Text Available Abstract Introduction Local aneurysms after surgical repair of coarctation of the aorta occur mainly in patients surgically treated by Dacron patch plasty during adulthood. The management of these patients is always problematic, with frequent complications and increased mortality rates. Percutaneous stent-graft implantation avoids the need for surgical reintervention. Case presentation We report a case involving the hybrid treatment by stent-graft implantation and transposition of the left subclavian artery to the left common carotid artery of an aneurysmal dilatation of the thoracic aorta that occurred in a 64-year-old Caucasian man, operated on almost 40 years earlier with a Dacron patch plasty for aortic coarctation. Our patient presented to our facility for evaluation with back pain and shortness of breath after minimal physical effort. A physical examination revealed stony dullness to percussion of the left posterior thorax, with no other abnormalities. The results of chest radiography, followed by contrast-enhanced computed tomography and aortography, led to a diagnosis of giant aortic thoracic aneurysm. Successful treatment of the aneurysm was achieved by percutaneous stent-graft implantation combined with transposition of the left subclavian artery to the left common carotid artery. His post-procedural recovery was uneventful. Three months after the procedure, computed tomography showed complete thrombosis of the excluded aneurysm, without any clinical signs of left lower limb ischemia or new onset neurological abnormalities. Conclusions Our patient’s case illustrates the clinical outcomes of surgical interventions for aortic coarctation. However, the very late appearance of a local aneurysm is rather unusual. Management of such cases is always difficult. The decision-making should be multidisciplinary. A hybrid approach was considered the best solution for our patient.

  11. Diagnosis of aortic aneurysms by scintigraphy and ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Caille, G. (Centre Hospitalier, Saint-Nazaire (France)); Chatal, J.F.; Tellier, J.L.; Talmant, C.; Guihard, R. (Centre Rene-Gauducheau, 44 - Nantes (France))

    1981-10-01

    Angioscintigraphy, performed on 50 patients suspected of aortic aneurysm and complemented by abdominal ultrasonography in 31 cases, disclosed: - Three cases of thoracic aortic aneurysm, 2 of which were confirmed by arteriography and surgery. It was impossible to perform surgery in the third case, no arteriography was done. Strict agreement with standard thoracic images had made the angioscintigraphic diagnosis seem correct. Twenty-seven cases of abdominal aortic aneurysms were confirmed by arteriography or surgery. Ultrasonography disclosed an abdominal aortic aneurysm in 26 cases, 20 of which were confirmed. The agreement of the two procedures in 10 unconfirmed cases led us to consider the diagnosis as correct. Angioscintigraphy appears to be a reliable procedure for detecting thoracic and abdominal aortic aneurysms. Ultrasonography is the simplest and least costly procedure for study of abdominal aortic aneurysms.

  12. Diagnosis of aortic aneurysms by scintigraphy and ultrasonography

    International Nuclear Information System (INIS)

    Angioscintigraphy, performed on 50 patients suspected of aortic aneurysm and complemented by abdominal ultrasonography in 31 cases, disclosed: - Three cases of thoracic aortic aneurysm, 2 of which were confirmed by arteriography and surgery. It was impossible to perform surgery in the third case, no arteriography was done. Strict agreement with standard thoracic images had made the angioscintigraphic diagnosis seems correct. - Twenty-seven cases of abdominal aortic aneurysms confirmed by arteriography or surgery. Ultrasonography disclosed an abdominal aortic aneurysm in 26 cases, 20 of which were confirmed. The agreement of the two procedures in 10 unconfirmed cases led us to consider the diagnosis as correct. Angioscintigraphy appears to be a reliable procedure for detecting thoracic and abdominal aortic aneurysms. Ultrasonography is the simplest and least costly procedure for study of abdominal aortic aneurysms

  13. Open surgical repair of abdominal aortic aneurysm: Proximal aortic control by endoaortic balloon - A novel approach

    OpenAIRE

    Balakrishnan Soundaravalli; Palaniappan, M.; Rajani Sundar; Chandrasekar, P.

    2012-01-01

    Patients with infrarenal abdominal aortic aneurysm with unfavorable anatomy for endovascular aneurysm repair have to undergo open surgical repair. Open surgery has its own morbidity in terms of proximal clamping and declamping, bleeding and prolonged hospital stay and mortality. We present two such patients with juxtarenal abdominal aortic aneurysm who underwent open surgical repair. The proximal aortic control during open surgical repair of the aneurysm was achieved by endoaortic balloon occ...

  14. Open surgical repair of abdominal aortic aneurysm: Proximal aortic control by endoaortic balloon - A novel approach

    Directory of Open Access Journals (Sweden)

    Balakrishnan Soundaravalli

    2012-01-01

    Full Text Available Patients with infrarenal abdominal aortic aneurysm with unfavorable anatomy for endovascular aneurysm repair have to undergo open surgical repair. Open surgery has its own morbidity in terms of proximal clamping and declamping, bleeding and prolonged hospital stay and mortality. We present two such patients with juxtarenal abdominal aortic aneurysm who underwent open surgical repair. The proximal aortic control during open surgical repair of the aneurysm was achieved by endoaortic balloon occlusion technique.

  15. Tobacco smoking and aortic aneurysm

    DEFF Research Database (Denmark)

    Sode, Birgitte F; Nordestgaard, Børge G; Grønbæk, Morten;

    2012-01-01

    BACKGROUND: We determined the predictive power of tobacco smoking on aortic aneurysm as opposed to other risk factors in the general population. METHODS: We recorded tobacco smoking and other risk factors at baseline, and assessed hospitalization and death from aortic aneurysm in 15,072 individuals...... General Population Study, respectively. According to the magnitude of the hazard ratios, tobacco consumption was the most important risk factor for hospitalization and death from aortic aneurysm, followed by male sex and hypertension in both cohorts. The population attributable risk of aortic aneurysm...... outcomes due to tobacco consumption was 64% and 47% in the Copenhagen City Heart Study and Copenhagen General Population Study, respectively, and ranked highest among population attributable risks of aortic aneurysm in both cohorts. The absolute 10-year risk for hospitalization or death from aortic...

  16. Micromanaging Abdominal Aortic Aneurysms

    Directory of Open Access Journals (Sweden)

    Lars Maegdefessel

    2013-07-01

    Full Text Available The contribution of abdominal aortic aneurysm (AAA disease to human morbidity and mortality has increased in the aging, industrialized world. In response, extraordinary efforts have been launched to determine the molecular and pathophysiological characteristics of the diseased aorta. This work aims to develop novel diagnostic and therapeutic strategies to limit AAA expansion and, ultimately, rupture. Contributions from multiple research groups have uncovered a complex transcriptional and post-transcriptional regulatory milieu, which is believed to be essential for maintaining aortic vascular homeostasis. Recently, novel small noncoding RNAs, called microRNAs, have been identified as important transcriptional and post-transcriptional inhibitors of gene expression. MicroRNAs are thought to “fine tune” the translational output of their target messenger RNAs (mRNAs by promoting mRNA degradation or inhibiting translation. With the discovery that microRNAs act as powerful regulators in the context of a wide variety of diseases, it is only logical that microRNAs be thoroughly explored as potential therapeutic entities. This current review summarizes interesting findings regarding the intriguing roles and benefits of microRNA expression modulation during AAA initiation and propagation. These studies utilize disease-relevant murine models, as well as human tissue from patients undergoing surgical aortic aneurysm repair. Furthermore, we critically examine future therapeutic strategies with regard to their clinical and translational feasibility.

  17. Aortic aneurysm surgery: problems and innovations Cirurgia do aneurisma aórtico: problemas e inovações

    Directory of Open Access Journals (Sweden)

    Ralf Kolvenbach

    2009-12-01

    Full Text Available A long way was traveled since the first surgery was performed for the treatment of abdominal aortic aneurysm. Throughout this time, several innovations have been created in order to reduce the invasiveness of the surgical procedures and to improve their safety and durability. This review discusses the major and recent advances on aortic aneurysm interventions, including, the endovascular aortic repair, the laparoscopic aortic surgery, the conventional hybrid and endovascular techniques, combined laparoscopic and endovascular techniques, as well as future prospects for both thoracic and abdominal aorta. Faced with so many changes and developments, modern vascular surgeons must keep their minds open to innovations and should develop comprehensive training with different techniques, to provide the best therapeutic option for their patients.Um longo caminho foi percorrido desde as primeiras intervenções cirúrgicas feitas para o tratamento do aneurisma de aorta abdominal. Ao longo deste tempo, várias inovações foram criadas, no sentido de reduzir a invasividade dos procedimentos e melhorar sua segurança e durabilidade. Nesta revisão, são discutidos os principais e recentes avanços em intervenções sobre aneurismas aórticos, incluindo a restauração aórtica endovascular, a cirurgia aórtica videolaparoscópica, as técnicas híbridas convencionais e endovasculares, as técnicas combinadas videolaparoscópicas e endovasculares, bem como as perspectivas futuras, tanto para aorta torácica como abdominal. Diante de tantas transformações e evolução, o cirurgião vascular moderno terá que ter sua mente aberta para as novidades e desenvolver capacitação ampla com diferentes técnicas para proporcionar a melhor opção terapêutica para seus pacientes.

  18. Unoperated aortic aneurysm

    DEFF Research Database (Denmark)

    Perko, M J; Nørgaard, M; Herzog, T M;

    1995-01-01

    . No significant differences in survival for patients with dissecting and nondissecting AA were detected. In all, 132 patients (78%) died and 78 (59%) of them died of rupture. Mean time to rupture was 1,300 +/- 8 days. Cumulative 5-year hazard of rupture for the dissecting AA was twice that of the nondissecting (p......From 1984 to 1993, 1,053 patients were admitted with aortic aneurysm (AA) and 170 (15%) were not operated on. The most frequent reason for nonoperative management was presumed technical inoperability. Survivals for patients with thoracic, thoracoabdominal, and abdominal AA were comparable...

  19. Emergent endovascular vs. open surgery repair for ruptured abdominal aortic aneurysms: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Chuan Qin

    Full Text Available OBJECTIVES: To systematically review studies comparing peri-operative mortality and length of hospital stay in patients with ruptured abdominal aortic aneurysms (rAAAs who underwent endovascular aneurysm repair (EVAR to patients who underwent open surgical repair (OSR. METHODS: The Medline, Cochrane, EMBASE, and Google Scholar databases were searched until Apr 30, 2013 using keywords such as abdominal aortic aneurysm, emergent, emergency, rupture, leaking, acute, endovascular, stent, graft, and endoscopic. The primary outcome was peri-operative mortality and the secondary outcome was length of hospital stay. RESULTS: A total of 18 studies (2 randomized controlled trials, 5 prospective studies, and 11 retrospective studies with a total of 135,734 rAAA patients were included. rAAA patients who underwent EVAR had significantly lower peri-operative mortality compared to those who underwent OSR (overall OR = 0.62, 95% CI = 0.58 to 0.67, P<0.001. rAAA patients with EVAR also had a significantly shorter mean length of hospital stay compared to those with OSR (difference in mean length of stay ranged from -2.00 to -19.10 days, with the overall estimate being -5.25 days (95% CI = -9.23 to -1.26, P = 0.010. There was no publication bias and sensitivity analysis showed good reliability. CONCLUSIONS: EVAR confers significant benefits in terms of peri-operative mortality and length of hospital stay. There is a need for more randomized controlled trials to compare outcomes of EVAR and OSR for rAAA.

  20. ABDOMINAL AORTIC ANEURYSM (AAA

    Directory of Open Access Journals (Sweden)

    Rajesh G

    2011-11-01

    Full Text Available AAA is defined as a distension of the infrarenal aorta by more than 50% (or 1.5 times compared with a corresponding healthy, aged and gender matched population. AAA afflicts 1 to 6 % of the general population aged more than 60 years and the incidence rises by approximately 0.15% annually. When the definition of a maximum external diameter ≥3 cm is used, the prevalence of AAA is upto 6 times greater in men than in women. AAAs are much more common than thoracic aortic aneurysms. Most common cause of AAA is atherosclerosis (95%. Less common causes include infectious or inflammatory origin or those associated with connective tissue disorders. Process of AAA formation is multifactorial. Other than the general risk factors for atherosclerosis, genetic predispo s iti on, aut o immunity and hemodynamic factors all play roles in its formation. AAA is 1.5 times more frequent in hypert ensive patients. Smokers have 8 times risk for developing AAA. The existence of familial aggre gation of AAA implicates genetic factors in the etiology of AAA. Women with AAA are more likely to have a positive family history of this disorder. Those with a family history of AAA have an increased risk of 30%, and their aneurysms tend to occur at a younger age and carry a greater risk of rupture than do sporadic aneurysms.

  1. Endovascular repair of aortic aneurysm: Preliminary results

    Directory of Open Access Journals (Sweden)

    Davidović Lazar

    2009-01-01

    Full Text Available Introduction. Endovascular aneurysm repair (EVAR has been introduced into clinical practice at the beginning of the 90's of the last century. Because of economic, political and social problems during the last 25 years, the introduction of this procedure in Serbia was not possible. Objective. The aim of this study was to present preliminary experiences and results of the Clinic for Vascular Surgery of the Serbian Clinical Centre in Belgrade in endovascular treatment of thoracic and abdominal aortic aneurysms. Methods. The procedure was performed in 33 patients (3 female and 30 male, aged from 42 to 83 years. Ten patients had a descending thoracic aorta aneurysm (three atherosclerotic, four traumatic - three chronic and one acute as a part of polytrauma, one dissected, two penetrated atherosclerotic ulcers, while 23 patients had the abdominal aortic aneurysm, one ruptured and two isolated iliac artery aneurysms. The indications for EVAR were isthmic aneurismal localisation, aged over 80 years and associated comorbidity (cardiac, pulmonary and cerebrovasular diseases, previous thoracotomy or multiple laparotomies associated with abdominal infection, idiopatic thrombocitopaenia. All of these patients had three or more risk factors. The diagnosis was established using duplex ultrasonography, angiography and MSCT. In the case of thoracic aneurysm, a Medtronic-Valiant® endovascular stent graft was implanted, while for the abdominal aortic aneurysm Medtronic-Talent® endovascular stent grafts with delivery systems were used. In three patients, following EVAR a surgical repair of the femoral artery aneurysm was performed, and in another three patients femoro-femoral cross over bypass followed implantation of aortouniiliac stent graft. Results. During procedure and follow-up period (mean 1.6 years, there were: one death, one conversion, one endoleak type 1, six patients with endoleak type 2 that disappeared during the follow-up period, one early graft

  2. Combined surgical and catheter-based treatment of extensive thoracic aortic aneurysm and aortic valve stenosis

    DEFF Research Database (Denmark)

    De Backer, Ole; Lönn, Lars; Søndergaard, Lars

    2015-01-01

    endovascular aneurysm repair (TEVAR) has changed and extended management options in thoracic aorta disease, including in those patients deemed unfit or unsuitable for open surgery. Accordingly, transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with symptomatic severe aortic......An extensive thoracic aortic aneurysm (TAA) is a potentially life-threatening condition and remains a technical challenge to surgeons. Over the past decade, repair of aortic arch aneurysms has been accomplished using both hybrid (open and endovascular) and totally endovascular techniques. Thoracic...

  3. Outcomes After Elective Aortic Aneurysm Repair

    DEFF Research Database (Denmark)

    de la Motte, L; Jensen, L P; Vogt, K;

    2013-01-01

    OBJECTIVE: To assess outcomes after treatment for asymptomatic abdominal aortic aneurysm (AAA) in Denmark in a period when both open surgery (OR) and endoluminal repair (EVAR) have been routine procedures. METHODS: We performed a retrospective nationwide cohort study of patients treated...... for asymptomatic AAA between 2007 and 2010. Data on demographics, procedural data, perioperative complications, length of stay (LOS), 30-day reinterventions and readmissions, late aneurysm and procedure-related complications and mortality were obtained from the Danish Vascular Registry and the Danish National...

  4. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... is actually an important factor. Most aneurysms we treat conservatively and we’ll just watch them. But ... has to be, and we generally don’t treat aneurysms until they get to be 5 to ...

  5. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... for the past three years, and his aneurysm has now grown to 5.4 centimeters. And this ... that in this particular patient that the aneurysm has reached the size where risk of rupture when ...

  6. Aneurysm sac enlargement after endovascular Abdominal Aortic Aneurysm repair

    NARCIS (Netherlands)

    Dingemans, Siem A; Jonker, Frederik H W; Moll, Frans L; van Herwaarden, JA

    2015-01-01

    The aim of this study is to give an overview of current knowledge regarding abdominal aortic aneurysm (AAA) growth after endovascular aortic aneurysm repair (EVAR) that could potentially lead to aortic rupture. A search on Pubmed was performed. A total of 705 articles were found after initial search

  7. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the age of 55 should be screened for aneurysms. And the way to screen is with a simple ultrasound. But sometimes a ...

  8. Aortic aneurysm secondary to umbilical artery catheterization

    International Nuclear Information System (INIS)

    A 14-month-girl presented with an asymptomatic posterior mediastinal mass. She had a history of prematurity, umbilical artery catheterization, and sepsis. The diagnosis of aortic aneurysm was made by dynamic computed tomography. The aneurysm was successfully resected. (orig.)

  9. [Abdominal aortic aneurysm: an uncommon presentation].

    Science.gov (United States)

    Taborda, Lúcia; Pereira, Laurinda; Amona, Eurides; Pinto, Erique Guedes; Rodrigues, Joaquim

    2011-01-01

    Most abdominal aortic aneurysms are asymptomatic, being accidentally found on physical examination or in routinely performed imaging studies. They only require surveillance (which is variable according to the aneurism size) and medical therapy in order to achieve risk factor reduction. However, in certain situations, according to the risk of aneurism rupture, elective surgery or endovascular procedure may be necessary. About 80% of the cases of aneurism rupture occur into the retroperitoneal space, with a high mortality rate. There are uncommon presentations of aneurism rupture as the aorto-caval fistula, which also require fast diagnosis and intervention. The authors present the case of a 71-year-old man, with the previous diagnosis of hypertension, acute myocardial infarction 2 months earlier (undergone primary Percutaneous Coronary Intervention) and tabagism, who was admitted at the emergency department with intense 24-hour-evolution epigastric pain. On physical examination, the Blood Pressure values measured at the lower limbs were about half the ones measured at the upper limbs and there was an abdominal pulsatile mass, with a high-intensity murmur. As the authors suspected aortic dissection, aneurysm, coarctation or thrombosis, it was done a Computed Tomography scanning with intravenous contrast, which revealed a ruptured abdominal aorta aneurysm with a mural thrombus. The doppler ultrasound confirmed the presence of a high debit aorto-caval fistula. The patient was immediately transferred to the Vascular Surgery. However he died 2 hours later, during surgery. PMID:22525642

  10. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... been following in the institute for the past three years, and his aneurysm has now grown to ... may get for other reasons, but we use three-dimensional reconstruction and we can reconstruct all the ...

  11. Surveillance intervals for small abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Bown, Matthew J; Sweeting, Michael J; Brown, Louise C;

    2013-01-01

    Small abdominal aortic aneurysms (AAAs [3.0 cm-5.4 cm in diameter]) are monitored by ultrasound surveillance. The intervals between surveillance scans should be chosen to detect an expanding aneurysm prior to rupture.......Small abdominal aortic aneurysms (AAAs [3.0 cm-5.4 cm in diameter]) are monitored by ultrasound surveillance. The intervals between surveillance scans should be chosen to detect an expanding aneurysm prior to rupture....

  12. Aneurysm growth after late conversion of thoracic endovascular aortic repair

    Directory of Open Access Journals (Sweden)

    Hirofumi Kasahara

    2015-01-01

    Full Text Available A 69-year-old man underwent thoracic endovascular aortic repair of a descending aortic aneurysm. Three years later, he developed impending rupture due to aneurysmal expansion that included the proximal landing zone. Urgent open surgery was performed via lateral thoracotomy, and a Dacron graft was sewn to the previous stent graft distally with Teflon felt reinforcement. Postoperatively, four sequential computed tomography scans demonstrated that the aneurysm was additionally increasing in size probably due to continuous hematoma production, suggesting a possibility of endoleaks. This case demonstrates the importance of careful radiologic surveillance after endovascular repair, and also after partial open conversion.

  13. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... microchip that acts a little bit like a cell phone technology. We’ll show you how that works. But this is the device that we’re going to put in that space between the endograft and the patient to the wall of the aneurysm. So in that space where ...

  14. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... for all of you listening, you can ask online. Just click the “Ask a question” button, and ... aneurysm. Please feel free to ask any questions online. Just click “Ask a question,” and they’ll ...

  15. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... racquet-like device whether or not there is flow in this sack after we replace in aneurysm. ... space age. That’s fine. Don’t go too high. Pull it down a little bit. Pull that ...

  16. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... an aneurysm, it’s important that you ask your doctor about your options. As I said, about 80 percent of the patients we treat end up -- 80 or 90 percent these days, end up being good candidates for this type of therapy. We would encourage you to seek the least ...

  17. Comparison of clinical curative effect between open surgery and endovascular repair of abdominal aortic aneurysm in China

    Institute of Scientific and Technical Information of China (English)

    WANG Si-wen; LIN Ying; YAO Chen; LIN Pei-liang; WANG Shen-ming

    2012-01-01

    Objective To compare clinical curative effects of open surgery (OS) or endovascular repair (EVAR) for patients with abdominal aortic aneurysm (AAA) in China.Data sources We performed a comprehensive search of both English and Chinese literatures involving case studies on retrograde OS or EVAR of AAA in China from January 1976 to December 2010.Study selection According to the inclusion criteria,76 articles were finally analyzed to compare patient characteristics,clinical success,complications,and prognosis.Results We analyzed a total of 2862 patients with 1757 undergoing OS (OS group) and 1105 undergoing EVAR (EVAR group).There was no significant difference in the success rate of the procedures.Operative time,length of ICU stay,fasting time,duration of total postoperative stay,blood loss,and blood transfusion requirements during the procedure were significantly lower in the EVAR group.A 30-day follow up revealed more cardiac,renal,pulmonary,and visceral complications in the OS group (P<0.01).Low-limb ischemia,however,was more common in the EVAR group (P<0.05).The 30-day mortality rate,including aorta-related and non-aorta related mortality,was significantly lower in the EVAR group (P<0.01).In the follow-up period,there were more patients with occlusions of artificial vessel and late endoleak in the EVAR group (P<0.01).The overall late mortality rate was higher in the OS group (P <0.01),especially non-aorta-related late mortality and mortality during the fourth to the sixth year (P<0.01).Conclusions EVAR was safer and less invasive for AAA patients.Patients suffered fewer complications and recovered sooner.However,complications such as artificial vessel occlusion,low-limb ischemia,and endoleak were common in EVAR.Clinicians should carry out further research to solve these complications and improve the efficacy of EVAR.

  18. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... the arteries, which is known as atherosclerosis, high blood pressure, smokers, or a family history of abdominal aortic ... imaging. We can integrate ultrasound imaging, the patient’s blood pressure, and so it’s a little bit like being ...

  19. Chylous Ascites after Abdominal Aortic Aneurysm Repair.

    Science.gov (United States)

    Ohki, Shinichi; Kurumisawa, Soki; Misawa, Yoshio

    2016-01-01

    A 73-year-old man was transferred for treatment of abdominal aortic aneurysm. He had no history of abdominal surgeries. Grafting between the infra-renal abdominal aorta and the bilateral common iliac arteries was performed. Proximal and distal cross clamps were applied for grafting. He developed chylous ascites on the 5th post-operative day, 2 days after initiation of oral intake. Fortunately, he responded to treatment with total parenteral hyper-alimentation for 10 days, followed by a low-fat diet. There was no recurrence of ascites. PMID:27087873

  20. [Albert Einstein and his abdominal aortic aneurysm].

    Science.gov (United States)

    Cervantes Castro, Jorge

    2011-01-01

    The interesting case of Albert Einstein's abdominal aortic aneurysm is presented. He was operated on at age 69 and, finding that the large aneurysm could not be removed, the surgeon elected to wrap it with cellophane to prevent its growth. However, seven years later the aneurysm ruptured and caused the death of the famous scientist.

  1. Idiopathic thoracic aortic aneurysm at pediatric age.

    Science.gov (United States)

    Marín-Manzano, E; González-de-Olano, D; Haurie-Girelli, J; Herráiz-Sarachaga, J I; Bermúdez-Cañete, R; Tamariz-Martel, A; Cuesta-Gimeno, C; Pérez-de-León, J

    2009-03-01

    A 6-year-old-boy presented with epigastric pain and vomiting over 1 year. Chest X-ray and esophagogastric transit showed a mediastinal mass. A chest computerized tomography angiogram demonstrated a descending thoracic aortic aneurysm. Analytical determinations carried out were all negative. The aneurysm was surgically repaired using a Dacron patch. The anatomopathological study described atherosclerotic lesions with calcifications, compatible with an atherosclerotic aneurysm wall. Aneurysms are uncommon in the pediatric population. Usually, no pathogenesis can be determined, and thus, such cases are grouped as idiopathic. Direct repair with or without patch is a therapeutic alternative in pediatric aneurysms and can allow the growth of the aortic circumference.

  2. ALTERNATIVE METHOD OF SURGICAL CORRECTION OF DISSECTING AORTIC ANEURYSMS WITH AORTIC INSUFFIECIENCY

    Directory of Open Access Journals (Sweden)

    M. L. Semenovsky

    2009-01-01

    Full Text Available Patients with dissecting aortic aneurysm and associated acute aortic insufficiency form a group of seriously ill patients with significant cardiac failure, generally involving other organs and systems. It justifies an attempt to reduce a surgical risk, by using more sparing procedures, including supracoronary replacement of the ascending aorta with its root reconstruction. The latter has been performed in 27 patients (mean 54,5 ± 2,1 years with dissecting aortic aneurysm and aortic valvular insufficiency in 1996 to 2009. The major etiological factor was atherosclerosis (88%/ Seventeen (63%, 6 (22,2% and 4 (16% had types I, IIA and II dissection, respectively. Overall hospital mortality was 11%. In late period, progressive aneurysm dissection needed reinterventions in 2 cases. The competence of the reconstructed aortic valve was satisfactory both just after surgery and throughout the follow-up. Indications for this option of chronic correction, surgical techniques, and immediate and long-term results are outlined. 

  3. Management of Concomitant Cancer and Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Abdullah Jibawi

    2011-01-01

    Full Text Available Background. The coexistence of neoplasm and abdominal aortic aneurysm (AAA presents a real management challenge. This paper reviews the literature on the prevalence, diagnosis, and management dilemmas of concurrent visceral malignancy and abdominal aortic aneurysm. Method. The MEDLINE and HIGHWIRE databases (1966-present were searched. Papers detailing relevant data were assessed for quality and validity. All case series, review articles, and references of such articles were searched for additional relevant papers. Results. Current challenges in decision making, the effect of major body-cavity surgery on an untreated aneurysm, the effects of major vascular surgery on the treatment of malignancy, the use of EVAR (endovascular aortic aneurysm repair as a fairly low-risk procedure and its role in the management of malignancy, and the effect of other challenging issues such as the use of adjuvant therapy, and patients informed decision-making were reviewed and discussed. Conclusion. In synchronous malignancy and abdominal aortic aneurysm, the most life-threatening lesion should be addressed first. Endovascular aneurysm repair where possible, followed by malignancy resection, is becoming the preferred initial treatment choice in most centres.

  4. Renal failure after operation for abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Olsen, P S; Schroeder, T; Perko, M;

    1990-01-01

    Among 656 patients undergoing surgery for abdominal aortic aneurysm, 81 patients (12%) developed postoperative renal failure. Before operation hypotension and shock occurred in 88% of the patients with ruptured aneurysm, whereas none of the patients operated electively were hypotensive. Dialysis...... cases the death was caused by renal failure only or in combination with failure of other organs. Analysis of the cumulative survival shows that, if the patients survive the postoperative period, their life expectancy is comparable to that of patients without renal complications....

  5. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... patient, Dr. Barry Katsen, who is a medical director of the Baptist Cardiac and Vascular Institute, and Dr. Ignacio Rua, who is a medical director of vascular surgery. Good afternoon, guys. Good afternoon. ...

  6. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... very, very good integrated care with surgery and radiology together. Okay. Okay. Jim. Yes, Barry. Okay. So ... best medical specialists we have. We have interventional radiology, vascular surgeons, board certified and highly trained. And ...

  7. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... can offer patients a very, very good integrated care with surgery and radiology together. Okay. Okay. Jim. ... seek the least invasive therapy for your own care as long as you’re an appropriate patient. ...

  8. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... the patient, Dr. Barry Katsen, who is a medical director of the Baptist Cardiac and Vascular Institute, and Dr. Ignacio Rua, who is a medical director of vascular surgery. Good afternoon, guys. Good ...

  9. Thoracic aortic aneurysm

    Science.gov (United States)

    ... eds. Rutherford's Vascular Surgery . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 135. Braverman AC. Diseases of ... Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 57. Lederle FA. Diseases of ...

  10. Screening for Abdominal Aortic Aneurysm

    OpenAIRE

    Linné, Anneli

    2014-01-01

    Abdominal Aortic Aneurysm (AAA) is a common disease with a prevalence of 1.5-2.0% in 65-year old men in Sweden. The risk of having AAA is increased with smoking, high age, family history of AAA and cardiovascular disease. Women have a lower prevalence (0.5%) and develop AAA later in life. An AAA seldom gives any symptom prior to rupture. Untreated rupture is associated with 100% mortality, while surgically treated rupture is associated with 25-70% mortality. Prophylactic sur...

  11. The role of transesophageal echocardiography in aortic surgery.

    Science.gov (United States)

    Nowak-Machen, Martina

    2016-09-01

    Aortic disease, when left untreated, is still associated with major morbidity and mortality. Aortic dissection and aortic aneurysm are the main reasons for performing aortic surgery procedures in the adult. Imaging techniques such as computed tomography and magnetic resonance imaging play a key role in the preoperative evaluation. Transesophageal echocardiography (TEE) has become a safe and invaluable perioperative imaging tool for aortic disease over the past decade with high sensitivity and specificity. TEE can increase patient safety and improve overall patient outcome in aortic surgery. Especially during endovascular aortic repair, TEE is more sensitive than other imaging modalities in diagnosing complications such as graft endoleaks. Newer echocardiographic techniques such as three-dimensional (3D) TEE and contrast-enhanced TEE are emerging and seem to have a valuable role especially in aortic dissection repair and endovascular aortic stent procedures. In the absence of contraindications, TEE should generally be performed during aortic surgery and endovascular aortic procedures. PMID:27650342

  12. Dissecting aortic aneurysm in maintenance hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Ounissi M

    2009-01-01

    Full Text Available The dissecting aortic aneurysm (DAA is a rare pathology that may result in fatal outcome. We report follow up of three cases of DAA patients undergoing maintenance hemo-dialysis who were managed conservatively.

  13. Hybrid treatment of recurring thoracoabdominal aortic aneurysm concomitant with retrograde type A aortic dissection

    Institute of Scientific and Technical Information of China (English)

    ZHANG Min-hong; GUO Wei; DU Xin; XIONG Jiang

    2010-01-01

    So far, standard therapy of complex thoracoabdominal aortic disease is open surgical repair requiring aortic clamping and replacement of the involved segment.Despite significant improvements, morbidity and mortality of open surgery remain high.I As a result, open surgery is often withheld owing to severe comorbidities of the patients. Endovascular technique has emerged as an alternative for treatment of these diseases in high risk patients,2 and has enlarged the options of treatment of complex aortic diseases. However, an endovascular approach alone is often deemed unsuitable for some complex aortic disorders because of the close proximity of the supraaortic or visceral branches. A hybrid open-endovascular approach has therefore been proposed as a viable alternative. We present here a unique patient with recurring thoracoabdominal aortic aneurysm (TAAA) concomitant with an aortic dissection (AD) treated by a hybrid open-endovascular approach.

  14. Thoraco-abdominal aortic aneurysm branched repair

    NARCIS (Netherlands)

    Verhoeven, E. L. G.; Tielliu, I. F. J.; Ferreira, M.; Zipfel, B.; Adam, D. J.

    2010-01-01

    Open thoraco-abdominal aortic aneurysm repair is a demanding procedure with high impact on the patient and the operating team. Results from expert centres show mortality rates between 3-21%, with extensive morbidity including renal failure and paraplegia. Endovascular repair of abdominal aortic aneu

  15. Testing the generalizability of national reimbursement rates with respect to local setting: the costs of abdominal aortic aneurysm surgery in Denmark

    Directory of Open Access Journals (Sweden)

    Søren Løvstad Christensen

    2010-09-01

    Full Text Available Søren Løvstad Christensen1, Mette Kjoelby1,2, Lars Ehlers31Health Technology Assessment and Health Services Research, Centre for Public Health, Central Denmark Region, Denmark; 2School of Public Health, Aarhus University, Denmark; 3Health Economics and Management, Aalborg University, DenmarkObjective: The purpose of this study is to investigate if the Danish national diagnosis-related group (DRG tariffs for surgery for abdominal aortic aneurysm (AAA were good estimates of the actual costs in two local hospitals in the Central Region of Denmark.Methods: We collected clinical data for 178 AAA patients operated at Skejby Hospital and Viborg Hospital in the period 2005–2006 from the Danish National Vascular Registry and economic data from the administrative systems in the hospitals. We used bootstrap methods to calculate 95% confidence intervals (CIs for the mean costs of surgery for ruptured AAA, nonruptured AAA and AAA where the patient died within 30 days by applying a cost-trimming rule that the Danish National Board of Health uses in calculating national DRG tariffs.Results: The national DRG tariff lies within the calculated Danish Krone (DKK CIs (CI ruptured AAA, 98,178–195,327 [€13,196–€26,254]; CI nonruptured AAA, 79,039–98,178 [€10,624–€13,196]; CI dead, 42,023–111,685 [€5,648–€15,011], and thus national DRG tariffs could be a good estimate for the actual costs in the local hospitals.Conclusion: The bootstrap method is useful for testing the generalizability of national DRG tariffs as estimates of local surgical costs.Keywords: bootstrap method, costs, DRG, abdominal aortic aneurysm

  16. Infected abdominal aortic aneurysm due to Morganella morganii: CT findings.

    Science.gov (United States)

    Kwon, Oh Young; Lee, Jong Seok; Choi, Han Sung; Hong, Hoon Pyo; Ko, Young Gwan

    2011-02-01

    An infected aortic aneurysm, or mycotic aneurysm, is a rare arterial dilatation due to destruction of the infected vessel wall. Common pathogens resulting in an infected aortic aneurysm are Salmonella and Clostridium species, as well as Staphylococcus aureus; Morganella morganii, on the other hand, is very rare. An infected abdominal aortic aneurysm has tendencies to grow rapidly and to rupture. The mortality rate is high in patients undergoing emergent surgical intervention. We report the case of a 65-year-old man who presented with an infected abdominal aortic aneurysm caused by M. morganii. A high index of suspicion and imaging tests are necessary in order to diagnose an infected aortic aneurysm.

  17. Monozygotic twins with Marfan's syndrome and ascending aortic aneurysm.

    Science.gov (United States)

    Redruello, Héctor Jorge; Cianciulli, Tomas Francisco; Rostello, Eduardo Fernandez; Recalde, Barbara; Lax, Jorge Alberto; Picone, Victorio Próspero; Belforte, Sandro Mario; Prezioso, Horacio Alberto

    2007-08-01

    Marfan's syndrome is a hereditary connective tissue disease, in which cardiovascular abnormalities (especially aortic root dilatation) are the most important cause of morbidity and mortality. In this report, we describe two 24-year-old twins, with a history of surgery for lens subluxation and severe cardiovascular manifestations secondary to Marfan's syndrome. One of the twins suffered a type A aortic dissection, which required replacement of the ascending aorta, and the other twin had an aneurysmal dilatation of the ascending aorta (46mm) and was prescribed medical treatment with atenolol and periodic controls to detect the presence of a critical diameter (50mm) that would indicate the need for prophylactic surgery.

  18. Aneurismas da aorta Aortic aneurysms

    Directory of Open Access Journals (Sweden)

    Januário M Souza

    1992-09-01

    Full Text Available Entre janeiro de 1979 e janeiro de 1992, foram realizadas 212 operações para correção de aneurismas e de dissecções da aorta. Neste trabalho serão analisados 104 procedimentos cirúrgicos (em 97 pacientes para correção de aneurismas. A idade dos pacientes variou de 14 a 79 anos (média 59,5 anos e o sexo predominante foi o masculino, com 75 pacientes. Os aneurismas localizavam-se na aorta ascendente em 46 pacientes, na croça em 8, na aorta descendente em 8, na aorta toráco-abdominal em 8, na aorta abdominal em 21, na aorta descendente e abdominal em 2, na aorta ascendente e tóraco-abdominal em 2, na aorta ascendente e descendente em 1, na aorta ascendente, croça e descendente em 1. Doenças cardiovasculares associadas estavam presentes em 39 pacientes, sendo valvopatia aórtica em 18 (excluídos os pacientes com ectasiaânulo-aórtíca, insuficiência coronária em 17, coarctação da aorta em 2, persistência do canal arterial em 1 e valvopatia mitral e aórtica em 1. A mortalidade imediata (hospitalar e/ou 30 dias foi de 14,4%, sendo de 27,7% (5/18 para pacientes com mais de 70 anos e de 11,3% (9/79 para pacientes com idade inferior a 70 anos. Os aneurismas localizados na aorta ascendente e croça foram operados como o auxílio de circulação extracorpórea. Parada circulatória e hipotermia profunda foram utilizadas em todos os pacientes com aneurisma da croça. O estudo tomográfico e angiográfico deve ser de toda a aorta, pela possibilidade de aneurismas de localizações múltiplas.Among 212 patients undergoing operation for aortic aneurysm and aortic dissection between January 1979 and January 1992, 97 were operated on for aneurysms. The aneurysms were localized in: ascending aorta in 46 patients, transverse aortic arch in 8, descending aorta in 8, thoracoabdominal aorta in 8, abdominal (infrarenal aorta in 21, descending and abdominal aorta in 2, ascending and thoracoabdominal aorta in 2, ascending and descending in 1

  19. Surgical Treatment of Aortic Aneurysm and Aortic Dissection:A Retrospective Analysis of 122 Cases

    Institute of Scientific and Technical Information of China (English)

    Tucheng SUN; Xionggang JIANG; Kailun ZHANG; Jie CAI; Shu CHEN; NYANGASSA B J; Zongquan SUN

    2009-01-01

    The study summarizes the clinical experience of surgical treatments of various types of thoracic aneurysm and aortic dissection.Clinical data of 122 patients with thoracic aneurysm and aortic dissection during July 2005 to July 2008 were retrospectively analyzed.The elective operations were performed in 107 patients while emergency surgery was done in 15 cases.Different surgical strategies were employed on the basis of diseased region,including simple ascending aortic replacement (n=3),aortic root replacement (n=43),hemi-arch replacement/total arch replacement + elephant trunk technique (n=32),thoracic/thoracoabdominal aortic replacement (n=8) and endovascular repair (n=36).In this series,there is 4 cases of perioperative death due to massive cerebral hemorrhage (n=1),respiratory failure (n=1) and multiple organ dysfunction syndrome (MODS) (n=2).Three cases developed post-operative massive cerebral infarction and the relatives of the patients abandoned treatment.Instant success rate of endovascular repair was 100%.The intimal rupture was sealed.Blood flow was unobstructed in true lumen and no false lumen was visualized.It was concluded that aggressive surgery should be considered in the patients with thoracic aneurysm and aortic dissection.Surgical procedures should vary with the location and the nature of the lesions.

  20. Endovascular repair of ruptured abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Šarac Momir

    2014-01-01

    Full Text Available Introduction. Rupture of an abdominal aortic aneurysm (AAA is a potentially lethal state. Only half of patients with ruptured AAA reach the hospital alive. The alternative for open reconstruction of this condition is endovascular repair (EVAR. We presented a successful endovascular reapir of ruptured AAA in a patient with a number of comorbidities. Case report. A 60-year-old man was admitted to our institution due to diffuse abdominal pain with flatulence and belching. Initial abdominal ultrasonography showed an AAA that was confirmed on multislice computed tomography scan angiography which revealed a large retroperitoneal haematoma. Because of patient’s comorbidites (previous surgery of laryngeal carcinoma and one-third laryngeal stenosis, arterial hypertension and cardiomyopathy with left ventricle ejection fraction of 30%, stenosis of the right internal carotid artery of 80% it was decided that endovascular repair of ruptured AAA in local anaesthesia and analgosedation would be treatment of choice. Endovascular grafting was achieved with aorto-bi-iliac bifurcated excluder endoprosthesis with complete exclusion of the aneurysmal sac, without further enlargment of haemathoma and no contrast leakage. The postoperative course of the patient was eventless, without complications. On recall examination 3 months after, the state of the patient was well. Conclusion. The alternative for open reconstruction of ruptured AAA in haemodynamically stable patients with suitable anatomy and comorbidities could be emergency EVAR in local anesthesia. This technique could provide greater chances for survival with lower intraoperative and postoperative morbidity and mortality, as shown in the presented patient.

  1. Surgical Management of Ascending Aortic Aneurysm and Its Complications

    Directory of Open Access Journals (Sweden)

    Sisira Sran

    2014-01-01

    Full Text Available Ascending aortic aneurysms involving the proximal aortic arch, arising anywhere from the aortic valve to the innominate artery, represent various problems in which open surgery is generally required. Surgical options include excision of the aortic pathology or wrapping the aneurysm shell with an aortic Dacron graft. Intervention using the latter method can lead to extravasation of blood along the suture lines resulting in continuous bleeding within the periprosthetic space. The Cabrol technique was developed as a method for decompression of postoperative leaks by the formation of a conduit system from the periprosthetic space to the right atrium. The coronary ostia are anastomosed to a second graft in an end-to-end fashion, which is then anastomosed to the ascending aortic conduit side to side. The native aorta is then sewn around the prosthesis, hereby creating a shunt to drain anastomotic leakage. This shunt reduces postsurgical risk of pseudoaneurysm formation and normally closes a few days following surgery. We discuss the case of a patient who underwent Cabrol’s variation and six months later was demonstrated to have a patent shunt.

  2. A longitudinal analysis of the relationship between in-hospital mortality in New York State and the volume of abdominal aortic aneurysm surgeries performed.

    OpenAIRE

    Hannan, E L; Kilburn, H; O'Donnell, J. F.; Bernard, H R; Shields, E P; Lindsey, M L; Yazici, A.

    1992-01-01

    This study uses New York State hospital discharge data to examine the relationship between in-hospital mortality for a patient receiving an abdominal aortic aneurysm resection and the volume of aneurysm operations performed in the previous year at the hospital where the operation took place and by the surgeon performing the operation. Previous research on this topic is extended in several respects: (1) A three-year data base is used to examine the manner in which hospital and surgeon volume j...

  3. Doxycycline inhibition of proteases and inflammation in abdominal aortic aneurysms

    OpenAIRE

    Khawaja, Hazem Al-

    2011-01-01

    The aim of this thesis is to evaluate the effect of doxycycline on the proteolytic and inflammatory processes in abdominal aneurysms. This data is essential for the development of pharmaceutical strategies for the stabilization of an AAA. Such an approach could reduce the need for elective surgery and endovascular repair. It has repeatedly been shown that AAA progression and rupture is related to the failure of collagen in the aortic wall. Yet the exact mechanism underlying this failure remai...

  4. Endovascular repair of abdominal aortic aneurysms.

    Science.gov (United States)

    Arnaoutakis, Dean J; Zammert, Martin; Karthikesalingam, Alan; Belkin, Michael

    2016-09-01

    Endovascular repair of abdominal aortic aneurysms is an important technique in the vascular surgeon's armamentarium, which has created a seismic shift in the management of aortic pathology over the past two decades. In comparison to traditional open repair, the endovascular approach is associated with significantly improved perioperative morbidity and mortality. The early survival benefit of endovascular abdominal aortic aneurysm repair is sustained up to 3 years postoperatively, but longer-term life expectancy remains poor regardless of operative modality. Nonetheless, most abdominal aortic aneurysms are now repaired using endovascular stent grafts. The technology is not perfect as several postoperative complications, namely endoleak, stent-graft migration, and graft limb thrombosis, can develop and therefore lifelong imaging surveillance is required. In addition, a postoperative inflammatory response has been documented after endovascular repair of aortic aneurysms; the clinical significance of this finding has yet to be determined. Subsequently, the safety and applicability of endovascular stent grafts are likely to improve and expand with the introduction of newer-generation devices and with the simplification of fenestrated systems. PMID:27650343

  5. Long-term safety and efficacy of endovascular abdominal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Propper BW

    2013-04-01

    Full Text Available Brandon W Propper, Christopher J Abularrage Division of Vascular Surgery and Endovascular Therapy, John Hopkins Hospital, Baltimore, MD, USA Abstract: Endovascular abdominal aortic aneurysm repair (EVAR is a safe and efficacious treatment for both unruptured and ruptured abdominal aortic aneurysms. While perioperative mortality is lower with EVAR, long-term outcomes are similar between EVAR and open repair, including quality of life and cost-effectiveness. We review the long-term outcomes from the EUROSTAR registry, and DREAM, EVAR 1, and OVER trials. Keywords: EVAR, endovascular, aneurysm, aortic, outcome, long-term

  6. Recurrent Sudden Sensorineural Hearing Loss in a Patient with Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Mehmet Kilickaya

    2014-12-01

    Full Text Available Etiologies of sudden sensorineural hearing loss (SSNHL include factors such as viral infections, embolism, aneurysm and vascular events. A 63-year-old male patient with a history of hypertension and aortic aneurysm surgery referred to our clinic with complaints of sensorineural hearing loss. The patient fully recovered after medical treatment. He had another SSNHL attack three months later; the examinations revealed that the recurrence of the patient%u2019s aortic aneurysms, which suggested that the etiology might be the microembolism associated with aneurysm in that case. We did not consider hyperbaric oxygen treatment (HBOT an option because it posed a relative risk for the patient. Additionally, as the patient underwent an operation primarily for aneurysm, the SSNHL treatment was interrupted, which resulted in permanent hearing loss. In conclusion, aortic aneurysm is a serious disease that may result in SSNHL, and might affect therapeutic options for this disease.

  7. Chylous complications after abdominal aortic surgery.

    Science.gov (United States)

    Haug, E S; Saether, O D; Odegaard, A; Johnsen, G; Myhre, H O

    1998-12-01

    Two patients developed chylous complications following abdominal aortic aneurysm repair. One patient had chylous ascitis and was successfully treated by a peritoneo-caval shunt. The other patient developed a lymph cyst, which gradually resorbed after puncture. Chylous complications following aortic surgery are rare. Patients in bad a general condition should be treated by initial paracentesis and total parenteral nutrition, supplemented by medium-chain triglyceride and low-fat diet. If no improvement is observed on this regimen, the next step should be implementation of a peritoneo-venous shunt, whereas direct ligation of the leak should be reserved for those who are not responding to this treatment. PMID:10204656

  8. Upper gastrointestinal obstruction secondary to aortoduodenal syndrome owing to a noninflammatory abdominal aortic aneurysm.

    LENUS (Irish Health Repository)

    Cahill, Kevin

    2012-01-31

    Aortoduodenal syndrome is a rare complication of an abdominal aortic aneurysm wherein the aneurysm sac obstructs the patient\\'s duodenum. It presents with the symptoms of an upper gastrointestinal tract obstruction and requires surgical intervention to relieve it. Previously, gastric bypass surgery was advocated, but now aortic replacement is the mainstay of treatment. We report a case of a 67-year-old woman whose aortoduodenal syndrome was successfully managed and review the literature on this topic.

  9. Diagnostic value of ultrasound, computed tomography, and angiography in ruptured aortic aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Landtman, M.; Kivisaari, L.; Bondestam, S.; Taavitsainen, M.; Standertskjoeld-Nordenstam, C.G.; Somer, K.

    1984-11-01

    Some ruptural aneurysms cause nonspecific symptoms and the patients are referred for radiological examination because of the problems of differential diagnosis from conditions such as renal colic, diverticulitis, herniated disc, aortic dissection etc. Seven such patients have been examined either with ultrasonography, computed tomography or angiography. The diagnostic methods are compared. The more recent US and CT imaging methods are sufficiently rapid and reliable for diagnostic purposes, which should improve the prognosis for patients requiring immediate surgery for ruptured aortic aneurysms.

  10. Screening for aortic aneurysm after treatment of coarctation.

    Science.gov (United States)

    Hoffman, James L; Gray, Robert G; LuAnn Minich, L; Wilkinson, Stephen E; Heywood, Mason; Edwards, Reggie; Weng, Hsin Ti; Su, Jason T

    2014-01-01

    Isolated coarctation of the aorta (CoA) occurs in 6-8 % of patients with congenital heart disease. After successful relief of obstruction, patients remain at risk for aortic aneurysm formation at the site of the repair. We sought to determine the diagnostic utility of echocardiography compared with advanced arch imaging (AAI) in diagnosing aortic aneurysms in pediatric patients after CoA repair. The Congenital Heart Databases from 1996 and 2009 were reviewed. All patients treated for CoA who had AAI defined by cardiac magnetic resonance imaging (MRI), computed tomography (CT), or catheterization were identified. Data collected included the following: type, timing, and number of interventions, presence and time to aneurysm diagnosis, and mortality. Patients were subdivided into surgical and catheterization groups for analysis. Seven hundred and fifty-nine patients underwent treatment for CoA during the study period. Three hundred and ninety-nine patients had at least one AAI. Aneurysms were diagnosed by AAI in 28 of 399 patients at a mean of 10 ± 8.4 years after treatment. Echocardiography reports were available for 380 of 399 patients with AAI. The sensitivity of echocardiography for detecting aneurysms was 24 %. The prevalence of aneurysms was significantly greater in the catheterization group (p Aneurysm was also diagnosed earlier in the catheterization group compared with the surgery group (p = 0.02). Multivariate analysis showed a significantly increased risk of aneurysm diagnosis in patients in the catheterization subgroup and in patients requiring more than three procedures. Aortic aneurysms continue to be an important complication after CoA repair. Although serial echocardiograms are the test of choice for following-up most congenital cardiac lesions in pediatrics, our data show that echocardiography is inadequate for the detection of aneurysms after CoA repair. Because the time to aneurysm diagnosis was shorter and the risk greater in the

  11. Volumetric analysis of abdominal aortic aneurysm

    Science.gov (United States)

    Baskin, Kevin M.; Kusnick, Catherine A.; Shamsolkottabi, Susanne; Lang, Elvira V.; Corson, J. D.; Stanford, William; Thompson, Brad H.; Hoffman, Eric A.

    1996-04-01

    The purpose of this study was to develop a valid, reliable and accurate system of measurement of abdominal aortic aneurysms, using volumetric analysis of x-ray computed tomographic data. This study evaluates illustrative cases, and compares measurements of AAA phantoms, using standard 2D versus volumetric methods. To validate the volumetric analysis, four phantom aneurysms were constructed in a range of diameters (4.5 - 7.0 cm) which presents the greatest management challenge to the clinician. These phantoms were imaged using a Toshiba Xpress SX helical CT. Separate scans were obtained at conventional (10 mm X 10 mm) and thin slice (5 mm X 5 mm) collimations. The thin slices were reconstructed at 2 mm intervals. Data from each of the 96 scans were interpreted using a standard 2D approach, then analyzed using task-oriented volumetric software. We evaluate patient assessments, and compare greatest outer diameters of phantoms, by standard versus volumetric methods. Qualitative differences between solutions based on standard versus volumetric analysis of illustrative patient cases are substantial. Expert radiologists' standard measurements of phantom aneurysms are highly reliable (r2 equals 0.901 - 0.958; p aneurysm diameters in the range of clinical interest. For the same phantoms, volumetric analysis was both more reliable (r2 equals 0.986 - 0.996; p abdominal aortic aneurysms. It is particularly valuable in the presence of aortic tortuosity, vessel eccentricity, and uncertain involvement of critical vessels.

  12. Activation of Endocannabinoid System Is Associated with Persistent Inflammation in Human Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Christopher Gestrich

    2015-01-01

    Full Text Available Human aortic aneurysms have been associated with inflammation and vascular remodeling. Since the endocannabinoid system modulates inflammation and tissue remodeling, we investigated its components in human aortic aneurysms. We obtained anterior aortic wall samples from patients undergoing elective surgery for aortic aneurysm or coronary artery disease as controls. Histological and molecular analysis (RT-qPCR was performed, and endocannabinoid concentration was determined using LC-MRM. Patient characteristics were comparable between the groups except for a higher incidence of arterial hypertension and diabetes in the control group. mRNA level of cannabinoid receptors was significantly higher in aneurysms than in controls. Concentration of the endocannabinoid 2-arachidonoylglycerol was significantly higher, while the second endocannabinoid anandamide and its metabolite arachidonic acid and palmitoylethanolamide were significantly lower in aneurysms. Histology revealed persistent infiltration of newly recruited leukocytes and significantly higher mononuclear cell density in adventitia of the aneurysms. Proinflammatory environment in aneurysms was shown by significant upregulation of M-CSF and PPARγ but associated with downregulation of chemokines. We found comparable collagen-stained area between the groups, significantly decreased mRNA level of CTGF, osteopontin-1, and MMP-2, and increased TIMP-4 expression in aneurysms. Our data provides evidence for endocannabinoid system activation in human aortic aneurysms, associated with persistent low-level inflammation and vascular remodeling.

  13. Mesenchymal stem cells for treatment of aortic aneurysms

    Institute of Scientific and Technical Information of China (English)

    Aika; Yamawaki-Ogata; Ryotaro; Hashizume; Xian-Ming; Fu; Akihiko; Usui; Yuji; Narita

    2014-01-01

    An aortic aneurysm(AA) is a silent but life-threatening disease that involves rupture. It occurs mainly in aging and severe atherosclerotic damage of the aortic wall. Even though surgical intervention is effective to prevent rupture, surgery for the thoracic and thoraco-abdom-inal aorta is an invasive procedure with high mortality and morbidity. Therefore, an alternative strategy for treatment of AA is required. Recently, the molecular pathology of AA has been clarified. AA is caused by an imbalance between the synthesis and degradation of extracellular matrices in the aortic wall. Chronic inflam-mation enhances the degradation of matrices directly and indirectly, making control of the chronic inflamma-tion crucial for aneurysmal development. Meanwhile, mesenchymal stem cells(MSCs) are known to be ob-tained from an adult population and to differentiate into various types of cells. In addition, MSCs have not only the potential anti-inflammatory and immunosuppres-sive properties but also can be recruited into damagedtissue. MSCs have been widely used as a source for celltherapy to treat various diseases involving graft-versus-host disease, stroke, myocardial infarction, and chronicinflammatory disease such as Crohn’s disease clinically.Therefore, administration of MSCs might be availableto treat AA using anti-inflammatory and immnosup-pressive properties. This review provides a summary ofseveral studies on "Cell Therapy for Aortic Aneurysm"including our recent data, and we also discuss the pos-sibility of this kind of treatment.

  14. Autologous adventitial overlay method reinforces anastomoses in aortic surgery.

    Science.gov (United States)

    Minato, Naoki; Okada, Takayuki; Sumida, Tomohiko; Watanabe, Kenichi; Maruyama, Takahiro; Kusunose, Takashi

    2014-05-01

    In this study, we present an inexpensive and effective method for providing a secure and hemostatic anastomosis using autologous adventitia obtained from a dissected or aneurysmal wall. The resected aortic wall is separated between the adventitia and media, and a soft, 2 × 10-cm adventitial strip is overlaid to cover the anastomotic margin. A graft is sutured to the aortic stump. This autologous adventitial overlay method can inexpensively and strongly reinforce the anastomosis during aortic surgery for dissection or aneurysm and will contribute to anastomotic hemostasis and long-term stability.

  15. Familial Abdominal Aortic Aneurysm : Clinical Features and Genetics

    NARCIS (Netherlands)

    K.M. van de Luijtgaarden (Koen)

    2016-01-01

    markdownabstractAbstract Cardiovascular disease is the most important cause of death in the world and encompasses occlusive as well as aneurysmal disease. The most common aneurysm in humans is the abdominal aortic aneurysm (AAA). The question is why the aorta dilates in aneurysmal disease and occ

  16. Giant aortic arch aneurysm complicating Kawasaki′s disease

    OpenAIRE

    Kaouthar Hakim; Rafik Boussada; Lilia Chaker; Fatma Ouarda

    2014-01-01

    Kawasaki disease (KD) is a common acute vasculitis in pediatric population that usually involves small- and middle-sized arteries, commonly coronary arteries. Although the incidence and natural course of coronary aneurysms after KD are well documented in studies, related reports on peripheral arterial and aortic aneurysms are scarce. We report the occurrence of a giant aortic aneurysm involving the horizontal part of aortic arch in a 28-month-old boy diagnosed with KD. This complication was m...

  17. Mast Cells in Abdominal Aortic Aneurysms

    DEFF Research Database (Denmark)

    Shi, Guo-Ping; Lindholt, Jes Sanddal

    2013-01-01

    , outer media and adventitia inflammation, aortic wall expansion, endothelium erosion, and eventual rupture and thrombosis. Experimental animal AAA models and MC reconstitution technique allowed examination of a direct role of MCs in AAA pathogenesis, and identification of the exact role of each MC......, and two cohort studies showing the systemic level of MC specific chymase and tryptase is associated with aneurysmal growth rate, need for later aneurysmal repair and even overall mortality. These observations offer new opportunities to prevent or slow AAA growth in humans, and specific antimastcell drugs...

  18. Elective visceral hybrid repair of type III thoracoabdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Marjanović Ivan

    2012-01-01

    Full Text Available Introduction. According to the classification given by Crawford et al. type III thoracoabdominal aortic aneurysm (TAAA is dilatation of the aorta from the level of the rib 6 to the separation of the aorta below the renal arteries, capturing all the visceral branch of aorta. Visceral hybrid reconstruction of TAAA is a procedure developed in recent years in the world, which involves a combination of conventional, open and endovascular aortic reconstruction surgery at the level of separation of the left subclavian artery to the level of visceral branches of aorta. Case report. We presented a 75-years-old man, with elective visceral hybrid reconstruction of type III TAAA. Computerized scanning (CT angiography of the patient showed type III TAAA with the maximum transverse diameter of aneurysm of 92 mm. Aneurysm started at the level of the sixth rib, and the end of the aneurysm was 1 cm distal to the level of renal arteries. Aneurysm compressed the esophagus, causing the patient difficulty in swallowing act, especially solid food, and frequent back pain. From the other comorbidity, the patient had been treated for a long time, due to chronic obstructive pulmonary disease and hypertension. In general endotracheal anesthesia with epidural analgesia, the patient underwent visceral hybrid reconstruction of TAAA, which combines classic, open vascular surgery and endovascular procedures. Classic vascular surgery is visceral reconstruction using by-pass procedure from the distal, normal aorta to all visceral branches: celiac trunk, superior mesenteric artery and both renal arteries, with ligature of all arteries very close to the aorta. After that, by synchronous endovascular technique a complete aneurysmal exclusion of thoracoabdominal aneurysm with thoracic stent-graft was performed. The postoperative course was conducted properly and the patient left the Clinic for Vascular Surgery on postoperative day 21. Control CT, performed 3 months after the surgery

  19. SURGICAL MANAGEMENT OF A RARE CASE OF MARFAN SYNDROME - THE RUPTURE OF AN ABDOMINAL AORTIC ANEURYSM

    Directory of Open Access Journals (Sweden)

    L. Stoica

    2005-10-01

    Full Text Available We present a rare manifestation of the Marfan syndrome. A 33 years old woman with a 10 cm diameter juxta-renal aortic aneurysm ruptured in the retro peritoneum arrived in hemorrhagic shock. Surgery was performed in emergency by thoraco-phreno-laparatomy, the aneurysm was resected and a 20 mm Dacron tube was sutured between the origin of the renal arteries and the aortic bifurcation. Rapid thoracic aortic cross-clamping to stop the hemorrhage and good aneurismal exposure by the division of the left renal vein was the key of this successful management. The patient recovered without any complication. Rupture of the abdominal aortic aneurysm is a life threatening complication which requires a rapid diagnosis and an emergency treatment by open surgery or by endovascular stent grafting. We present the surgical strategy in our case

  20. Diagnostic imaging of abdominal aortic aneurysms

    International Nuclear Information System (INIS)

    The survey explains the available methods for diagnostic imaging of aortic aneurysms, i.e. the conventional methods of ultrasonography and intra-arterial angiography as well as the modern tomographic and image processing techniques such as CT, DSA, and MRT. The various methods are briefly discussed with respect to their sensitivity and specificity. The authors expect that MRI will become the modality of choice, due to absence of radiation exposure of the patients

  1. Drug Therapy for Small Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Ramachandran Meenakshisundaram

    2010-03-01

    Full Text Available Abdominal aortic aneurysm is often asymptomatic, less recognized, and causes considerable mortalityand morbidity, if missed. The incidence varies from country to country and the occurrence is influencedby modifiable (smoking, coronary heart disease, hypertension, dyslipidemia, and prolonged steroid therapyand non-modifiable risk factors (increasing age, male gender, and positive family history. Most ofthe patients with such aneurysm do not exhibit symptoms and the diagnosis is made accidentally duringroutine medical investigations, abdominal ultrasonography, or by an astute surgeon during an abdominalprocedure. Sometimes the diagnosis is made in an emergency room, if the attending resident/doctor isaware of it. Despite good diagnosis and effective management, the outcomes of complicated cases arepoor and the treatment cost is prohibitive. Hence, we reviewed the literature to find out the pathogenesisof such aneurysms and the usefulness of available drugs in its prevention.

  2. Pulsatile blood flow in Abdominal Aortic Aneurysms

    Science.gov (United States)

    Salsac, Anne-Virginie; Lasheras, Juan C.; Singel, Soeren; Varga, Chris

    2001-11-01

    We discuss the results of combined in-vitro laboratory measurements and clinical observations aimed at determining the effect that the unsteady wall shear stresses and the pressure may have on the growth and eventual rupturing of an Abdominal Aortic Aneurysm (AAA), a permanent bulging-like dilatation occurring near the aortic bifurcation. In recent years, new non-invasive techniques, such as stenting, have been used to treat these AAAs. However, the development of these implants, aimed at stopping the growth of the aneurysm, has been hampered by the lack of understanding of the effect that the hemodynamic forces have on the growth mechanism. Since current in-vivo measuring techniques lack the precision and the necessary resolution, we have performed measurements of the pressure and shear stresses in laboratory models. The models of the AAA were obtained from high resolution three-dimensional CAT/SCANS performed in patients at early stages of the disease. Preliminary DPIV measurements show that the pulsatile blood flow discharging into the cavity of the aneurysm leads to large spikes of pressure and wall shear stresses near and around its distal end, indicating a possible correlation between the regions of high wall shear stresses and the observed location of the growth of the aneurysm.

  3. Early inflammatory response following elective abdominal aortic aneurysm repair: A comparison between endovascular procedure and conventional, open surgery

    Directory of Open Access Journals (Sweden)

    Marjanović Ivan

    2011-01-01

    Full Text Available Background/Aim. Abdominal aorta aneurysm (AAA represents a pathological enlargment of infrarenal portion of aorta for over 50% of its lumen. The only treatment of AAA is a surgical reconstruction of the affected segment. Until the late XX century, surgical reconstruction implied explicit, open repair (OR of AAA, which was accompanied by a significant morbidity and mortality of the treated patients. Development of endovascular repair of (EVAR AAA, especially in the last decade, offered another possibility of surgical reconstruction of AAA. The preliminary results of world studies show that complications of such a procedure, as well as morbidity and mortality of patients, are significantly lower than with OR of AAA. The aim of this paper was to present results of comparative clinical prospective study of early inflammatory response after reconstruction of AAA between endovascular and open, conventional surgical technique. Methods. A comparative clinical prospective study included 39 patients, electively operated on for AAA within the period of December 2008 - February 2010, divided into two groups. The group I counted 21 (54% of the patients, 58-87 years old (mean 74.3 years, who had been submited to EVAR by the use of excluder stent graft. The group II consisted of 18 (46% of the patients, 49-82 (mean 66.8 years, operated on using OR technique. All of the treated patients in both groups had AAA larager than 50 mm. The study did not include patients who have been treated as urgent cases, due to the rupture or with simptomatic AAA. Clinical, biochemical and inflamatory parameters in early postoperative period were analyzed, in direct postoperative course (number of leucocytes, thrombocytes, serum circulating levels of cytokine - interleukine (IL-2, IL-4, IL-6 and IL-10. Parameters were monitored on the zero, first, second, third and seventh postoperative days. The study was approved by the Ethics Commitee of the Military Medical Academy. Results

  4. An Aortoenteric Fistula Arising after Endovascular Management of a Mycotic Abdominal Aortic Aneurysm Complicated with a Psoas Abscess

    Directory of Open Access Journals (Sweden)

    Aytaç Gülcü

    2016-07-01

    Full Text Available Mycotic aortic aneurysms account for 1–3% of all aortic aneurysms. The management of this disease is controversial. Since open surgical repair is associated with high morbidity and mortality rates, endovascular aneurysm repair is an alternative treatment method with promising early and midterm outcomes, although its long-term durability is unknown. Secondary aortoenteric fistulas may occur iatrogenically after either aortic reconstructive surgery or endovascular repair. As the number of aneurysms managed with endovascular aneurysm repair has substantially increased, cases of aortoenteric fistulas referred for endovascular repair are augmented. We report the case of an aortoduodenal fistula manifested with duodenal perforation after staged endovascular and surgical treatment of a mycotic aortic aneurysm.

  5. An emergency visceral hybrid procedure for ruptured thoraco-abdominal aortic aneurysms

    NARCIS (Netherlands)

    E.M. von Meyenfeldt; J.M. Schnater; J.A. Reekers; R. Balm

    2009-01-01

    Rupture of a thoraco-abdominal aortic aneurysm (TAAA) is usually lethal. Patients with contained ruptures, who reach the hospital, have traditionally been subjected to open reconstructive surgery. However, especially in older patients, open surgery has a high mortality and morbidity rate. Visceral h

  6. Application of occluders in endovascular repair of aortic aneurysms

    Institute of Scientific and Technical Information of China (English)

    SHI Zhen-yu; FU Wei-guo; WANG Yu-qi; GUO Da-qiao; CHEN Bin; JIANG Jun-hao; XU Xin; YANG Jue; ZHU Ting

    2007-01-01

    @@ Since Parodi et al1 reported the first successful case of endovascular treatment for abdominal aortic aneurysm (AAA) in 1991, the endovascular repair has become an important option for the surgical treatment of aortic aneurysms.2-4 The occluder is a newly-developed device introduced intraluminally to block the blood flow in certain arteries.

  7. Decreased mortality of abdominal aortic aneurysms in a peripheral county

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Henneberg, E W; Fasting, H

    1995-01-01

    To analyse the effect on the mortality associated with abdominal aortic aneurysms, due to the establishment of a decentralised vascular surgical unit in the county of Viborg.......To analyse the effect on the mortality associated with abdominal aortic aneurysms, due to the establishment of a decentralised vascular surgical unit in the county of Viborg....

  8. Statin use and rupture of abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Wemmelund, H; Høgh, A; Hundborg, H H;

    2014-01-01

    BACKGROUND: Ruptured abdominal aortic aneurysm (rAAA) is associated with high mortality. Research suggests that statins may reduce abdominal aortic aneurysm (AAA) growth and improve rAAA outcomes. However, the clinical impact of statins remains uncertain in relation to both the risk and prognosis...

  9. A comparative study of iliac and abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Vammen, Sten; Lindholt, Jes Sanddal; Henneberg, E W;

    2000-01-01

    The aim of the paper is to compare the epidemiology, risk factors and manifestations of iliac and abdominal aortic aneurysms.......The aim of the paper is to compare the epidemiology, risk factors and manifestations of iliac and abdominal aortic aneurysms....

  10. Can release of urinary retention trigger abdominal aortic aneurysm rupture?

    Science.gov (United States)

    Luhmann, Andreas; Powell-Bowns, Matilda; Elseedawy, Emad

    2013-04-04

    Only 50% of abdominal aortic aneurysms present with the classic triad of hypotension, back pain and a pulsatile abdominal mass. This variability in symptoms can delay diagnosis and treatment. We present the case of a patient presenting with a unique combination of symptoms suggesting that decompression of urinary retention can lead to abdominal aortic aneurysm rupture.

  11. [Syphilitic aortic aneurysm. A case report].

    Science.gov (United States)

    Ben Halima, A; Ibn Elhadj, Z; Essmat, W; Léfi, A; Kammoun, I; Zouaoui, W; Marrakchi, S; Chine, S; Gargouri, S; Keskes, H; Kachboura, S

    2006-05-01

    The incidence of tertiary syphilis has declined in recent years owing to the early recognition of the disease and use of antibiotics. As a result, syphilitic aortic aneurysms are rarely encountered nowadays. We report the case of a 65 years old man, who was admitted to our hospital in June 2004 for dyspnea, cough and chest discomfort. On physical examination, blood pressure was 130/80 mmHg with no significant laterality, pulse rate was 70 per minute and there was a decrease of breath sounds over the right lung. Laboratory findings revealed a slight elevation of the erythrocyte sedimentation rate. Serological studies for syphilis showed a positive venereal disease laboratory test (VDRL) at 1/32 and a positive Treponema pallidum hemagglutination test (TPHA) at 1/2560. The chest radiography showed a right para cardiac opacity measuring 16 x 12 cm. Fiber optic bronchoscopy showed an extrinsic compression of the right upper lobar bronchus. Gadolinium-enhanced magnetic resonance angiography and 16 multidetector-row spiral computed aortography showed a huge partially thrombosed saccular aneurysm of the ascending aorta measuring 132 mm in diameter. The circulating lumen measured 53 mm in its largest diameter. This aneurysm involved the innominate artery. There was no other arterial involvement. The patient was given a three week course of intravenous penicillin followed by a successful surgical procedure in September 2004 with ascending aortic replacement and innominate artery reimplantation. This case illustrates well a formerly common, but now extremely rare disease.

  12. Use of omental pedicles in mycotic abdominal aortic aneurysm repair

    OpenAIRE

    Alibhai, M.K.; Samee, A; Ahmed, M.; Duffield, R.

    2011-01-01

    We report a case of a sixty year old man with a mycotic infra-renal abdominal aortic aneurysm complicated by a left psoas abscess. After treatment with parenteral antibiotics he underwent early aortic reconstruction with an in-situ prosthetic graft wrapped in an omental pedicle. Mycotic abdominal aortic aneurysms can be treated in this way despite the potential for graft infection from persisting retroperitoneal sepsis.

  13. [Endovascular repair of aortic aneurysm a paradigmatic shift

    DEFF Research Database (Denmark)

    Lönn, Lars Birger

    2008-01-01

    The evolution of endovascular aortic repair (EVAR) is rapid and global. The aim is to replace open surgery as a life-saving treatment. According to randomised controlled studies, abdominal EVAR is a better option than open repair in terms of safety and efficacy in the short run. However......, the overall survival in EVAR patients with severe morbidity is not influenced since mortality in this group is mainly unrelated to the aneurysm. Endovascular repair is also a solid alternative in thoracic pathologies and aortic ruptures. Patient selection and follow-up in EVAR is mainly governed by vascular...... imaging, especially 3-D CT reconstructions. There is a need for an increased number of endovascular specialists in Denmark since an increasing number of patients are suitable for EVAR treatment Udgivelsesdato: 2008/3/10...

  14. Aortic Disease in the Young: Genetic Aneurysm Syndromes, Connective Tissue Disorders, and Familial Aortic Aneurysms and Dissections

    Directory of Open Access Journals (Sweden)

    Marcelo Cury

    2013-01-01

    Full Text Available There are many genetic syndromes associated with the aortic aneurysmal disease which include Marfan syndrome (MFS, Ehlers-Danlos syndrome (EDS, Loeys-Dietz syndrome (LDS, familial thoracic aortic aneurysms and dissections (TAAD, bicuspid aortic valve disease (BAV, and autosomal dominant polycystic kidney disease (ADPKD. In the absence of familial history and other clinical findings, the proportion of thoracic and abdominal aortic aneurysms and dissections resulting from a genetic predisposition is still unknown. In this study, we propose the review of the current genetic knowledge in the aortic disease, observing, in the results that the causative genes and molecular pathways involved in the pathophysiology of aortic aneurysm disease remain undiscovered and continue to be an area of intensive research.

  15. In situ repair of a primary Brucella-infected abdominal aortic aneurysm: long-term follow-up.

    Science.gov (United States)

    Goudard, Yvain; Pierret, Charles; de La Villéon, Bruno; Mlynski, Amélie; de Kerangal, Xavier

    2013-02-01

    Infected aortic aneurysms represent 0.85 to 1.3% of aortic aneurysms. Most often, the implicated bacteria species are Salmonella sp., Staphylococcus sp. and Streptococcus sp. Brucella-related infected aortic aneurysms are very rare. Most often, they result from endocarditis or from a local septic focus. Combined treatment by antibiotics and surgery is the standard for infectious aneurysms. In the absence of formal factual data, the surgical treatment is still discussed in the literature, especially since endovascular treatments have been in full expansion. We are reporting the case of a female patient presenting with a Brucella-related infra-renal abdominal aortic aneurysm, without primitive infectious source (area) or identified endocarditis. Surgical treatment with in situ prosthetic replacement and omentoplasty in association with adapted antibiotics allowed a favorable outcome with an excellent result after an 8-year follow up.

  16. Infectious or Noninfectious? Ruptured, Thrombosed Inflammatory Aortic Aneurysm with Spondylolysis

    Energy Technology Data Exchange (ETDEWEB)

    Stefanczyk, Ludomir; Elgalal, Marcin, E-mail: telgalal@yahoo.co.uk [Medical University of Lodz, Department of Radiology and Diagnostic Imaging (Poland); Papiewski, Andrzej [Medical University of Lodz, Department of Gastroenterological Surgery (Poland); Szubert, Wojciech [Medical University of Lodz, Department of Radiology and Diagnostic Imaging (Poland); Szopinski, Piotr [Institute of Hematology and Transfusion Medicine, Clinic of Vascular Surgery (Poland)

    2013-06-15

    Osteolysis of vertebrae due to inflammatory aortic aneurysm is rarely observed. However, it is estimated that up to 10 % of infectious aneurysms coexist with bone tissue destruction, most commonly the vertebrae. Inflammatory aneurysms with no identified infection factor, along with infiltration of adjacent muscle and in particular extensive destruction of bone tissue have rarely been described in the literature. A case of inflammatory aneurysm with posterior wall rupture and inflammatory infiltration of the iliopsoas muscle and spine, together with extensive vertebral body destruction, is presented. The aneurysm was successfully treated with endovascular aneurysm repair EVAR.

  17. Nursing cooperation in endovascular aneurysm repair treatment for aortic dissection

    International Nuclear Information System (INIS)

    Objective: To summarize the main points of nursing cooperation in endovascular aneurysm repair treatment for aortic dissection. Methods: Preoperative psychological care and the other preparations were carefully conducted. During the operation, the patient's body was correctly placed. Active cooperation with the performance of angiography and close observation during heparinization were carried out. The proper delivery of catheter and stent to the operator was carefully done. Close observation for the patient's vital signs, the renal function and the changes of limb blood supply were made. Results: Under close cooperation of' the operators, nurses, anesthesiologists and technicians, the surgery was successfully accomplished in 35 patients. The monitoring of vital signs during the entire performance of operation was well executed. No surgical instruments delivery error's or surgery failure due to unsuitable cooperation occurred. Conclusion: Perfect preoperative preparation, strict nursing cooperation and team cooperation are the key points to ensure a successful endovascular aneurysm repair for aortic dissection. (authors)

  18. Endovascular Aortic Aneurysm Repair for Abdominal Aortic Aneurysm: Single Center Experience in 122 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yun Young; Song, Jang Hyeon; Kim, Yong Tae; Yim, Nam Yeol; Kim, Jae Kyu; Lee, Ho Kyun; Choi, Soo Jin Na; Chung, Sang Young [Dept. of Radiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju (Korea, Republic of); Kim, Soo Hyun; Chang, Nam Kyu [Dept. of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Hwasun (Korea, Republic of)

    2013-02-15

    To analyze a single center experience of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. Results of 122 patients who underwent EVAR were analyzed, retrospectively. Sex, age, aneurysmal morphology, hostile neck anatomy, preprocedural and postprocedural sac-diameter, technical and clinical success, postprocedural complication and need of additional procedure were analyzed. A total of 111 male and 11 female patients were included. Morphology of the aneurysms was as follows: fusiform (n = 108), saccular (n = 3) and ruptured type (n = 11). Sixty-four patients had hostile neck anatomy. The preprocedural mean sac-diameter was 52.4 mm. Postprocedural sac-diameter was decreased or stable in 110 patients (90.2%) and increased in 8 patients (6.6%). Technical success rate was 100% and clinical success rate was 86.1%. Fifty-one patients showed endoleak (41.8%) and 15 patients (12.3%) underwent secondary intervention due to type I endoleak (n = 4), type II endoleak (n = 4) and stent-graft thrombosis (n = 7). EVAR is a safe and effective therapy for abdominal aortic aneurysm, and it has high technical success and clinical success rate, and low complication rate.

  19. Congenital Aortic Stenosis and Aneurysms

    NARCIS (Netherlands)

    D. van der Linde (Denise)

    2013-01-01

    textabstractDue to improvements in pediatric cardio-thoracic surgery, anesthesia and diagnostics over the past decades, the number of adult patients with congenital heart disease (CHD) is growing. This causes an increasing demand in clinical practice for insight in long term outcome in both non-oper

  20. Open Surgical Repair for a Ruptured Abdominal Aortic Aneurysm with a Horseshoe Kidney

    OpenAIRE

    Ikeda, Akihiko; Tsukada, Toru; Konishi, Taisuke; Matsuzaki, Kanji; Jikuya, Tomoaki; HIRAMATSU, YUJI

    2015-01-01

    Horseshoe kidney is a congenital anomaly characterized by medial fusion of the bilateral kidneys. Treatment for an abdominal aortic aneurysm (AAA) with a horseshoe kidney is a technical challenge because of the complex anatomy. We report a successful open surgical repair for a ruptured AAA with a horseshoe kidney. An aortic grafting was performed with division of the renal isthmus through a transperitoneal approach. In the case of a ruptured AAA, quick open surgery is the most reliable treatm...

  1. Perioperative management of endovascular abdominal aortic aneurysm repair

    International Nuclear Information System (INIS)

    Objective: To summarize the clinical experience of perioperative management in performing endovascular abdominal aortic aneurysm repair (EVAR). Methods: EVAR was performed in 22 patients with abdominal aortic aneurysm. The clinical data were retrospectively analyzed. Before treatment the functions of main organs were evaluated and certain measures were adopted in order to protect them. Useful parameters, including the length, diameter, angle and configuration of the proximal and distal aneurysmal neck, the relationship of the aneurysm to aortic branches, the distance from the lowest renal artery to the bifurcation of abdominal aorta, and the quality of access vessels (such as diameter, tortuosity and calcification degree) were determined and assessed with CTA. According to the parameters thus obtained, the suitable stent-graft with ideal diameter and length was selected, and the optimal surgery pattern was employed. Local anesthesia was employed in 20 patients, among them the local anesthesia had to be changed to general anesthesia in one. Epidural anesthesia was carried out in one patient through the surgically-reconstructed iliac artery access,and general anesthesia was employed in one patient who had Stanford type A aortic dissection. The lowest renal artery must be accurately localized before deployment of stent-graft was started. At least one patent internal iliac artery should be reserved when bilateral internal iliac arteries needed to be covered, to be covered by stages or to be reconstructed. After stent-graft placement, angiography must be performed to find out if there was any endoleak and, if any, to determine the type of endoleak and to deal with it properly. Two cases had proximal type I endoleak, so balloon dilation was employed in one and cuff implantation in another one. Distal type I endoleak occurred in one case, but, unfortunately, the iliac artery ruptured when balloon dilation was employed, therefore the patient had to receive vascular repair

  2. Reoperation on aortic disease in patients with previous aortic valve surgery

    Institute of Scientific and Technical Information of China (English)

    SUN Xiao-gang; ZHANG Liang; YU Cun-tao; QIAN Xiang-yang; CHANG Qian

    2013-01-01

    Background Aortic valve replacement (AVR) is a safe and effective method in the treatment of aortic valve diseases.This study aimed to increase the understanding on re-treatment of aortic diseases after aortic valve surgery through a retrospective analysis of 47 related cases.Methods Forty-seven patients (38 males and 9 females) with previous aortic valve surgery have received reoperation on aorta from January 2003 to June 2012,and the mean interval time of re-intervention to aortic disease was 6 years ((6.0± 3.8) years).The secondary aortic surgery included aortic root replacement (14 cases),ascending aorta replacement (10 cases),aortic root/ascending aorta plus total arch replacement with stented elephant trunk implantation (21 cases),and total thoracoabdominal aorta replacement (2 cases).All these patients have received outpatient re-exams or follow-up by phone calls.Results After the initial aortic valve replacement,patients suffered from aortic dissection (25 cases,53%),ascending aortic aneurysm (12 cases,26%) or aortic root aneurysm (10 cases,21%).Diameter in ascending aorta increased (5.2±7.1) mm per year and aortic sinus (3.3±3.1) mm per year.The annual growth value of diameter in ascending aorta was higher in patients with rheumatic heart disease than that in Marfan syndrome (P<0.05).All 47 patients have received reoperation on aorta.One patient died in operating room because aortic dissection seriously involved right coronary artery.Seven patients had renal insufficiency after operation; neurological complications occurred in 14 patients including 7 patients with stroke and the others with transient brain dysfunction.All patients were followed up,the mean survival time was (97.25±17.63) months,95% confidence interval was 55.24-73.33 months.Eight cases were died during follow-up and five-year survival rate was 83%.Conclusion To reduce the aortic adverse events after first aortic valve surgery,it is necessary to actively treat and strictly

  3. Turner's syndrome associated with bicuspid aortic stenosis and dissecting aortic aneurysm

    OpenAIRE

    Slater, D N; Grundman, M. J.; Mitchell, L

    1982-01-01

    A case of Turner's syndrome is described associated with bicuspid aortic stenosis and fatal rupture of a thoracic dissecting aortic aneurysm. Histology of the aneurysm showed severe cystic medial necrosis. This association has not been previously described in the absence of coarctation.

  4. HLA-DR expression on monocytes and systemic inflammation in patients with ruptured abdominal aortic aneurysms

    NARCIS (Netherlands)

    Haveman, Jan Willem; van den Berg, Aad P.; Verhoeven, Eric L. G.; Nijsten, Maarten W. N.; van den Dungen, Jan J. A. M.; The, T. Hauw; Zwaveling, Jan Harm

    2006-01-01

    Introduction Mortality from ruptured abdominal aortic aneurysms (RAAA) remains high. Severe systemic inflammation, leading to multi-organ failure, often occurs in these patients. In this study we describe the level of HLA-DR expression in a consecutive group of patients following surgery for RAAA an

  5. [Anomalies of the subrenal inferior vena cava in the surgery of non-specific and inflammatory abdominal aortic aneurysms].

    Science.gov (United States)

    Gargiulo, M; Stella, A; Caputo, M; Brusori, S; Pedrini, L; Tarantini, S; Curti, T

    1993-01-01

    The sub-renal abnormalities of the lower vena cava (LVC) (left LVC, double LVC) are determined by a deterioration of the alteration process of supra-cardinal veins. Though they are rare, it is necessary to look for them during surgery of abdominal aorta in order to lower the risk of iatrogenic venous injuries. You will find below the description of six cases of sub-renal lower vena cava abnormality (3 double LVC, 3 left LVC) associated with an abdominal aorta aneurism (4 non specific aneurisms, 2 inflammations ones) as well as the diagnostic aspects and the technical issues they cause during the reconstruction of a non specific and inflammation aneurism of the abdominal aorta. PMID:8248315

  6. Comparison of arterial stiffness and microcirculatory changes following abdominal aortic aneurysm grafting.

    LENUS (Irish Health Repository)

    Moloney, M A

    2012-02-01

    BACKGOUND: Abdominal aortic aneurysm (AAA) surgery provides a unique opportunity to study the impact of arterial stiffness on central haemodynamics, reflected in augmentation index (AI). The aneurysmal aorta is significantly stiffer than undilated age-matched aorta. AIM: We investigated whether replacement of an aneurysmal aorta with a compliant graft would result in a decrease in AI, which would thus decrease myocardial workload parameters. METHODS: Patients undergoing elective open or endovascular AAA repair were assessed with applanation tonometry and laser fluximetry pre-operatively, immediately and long-term post-operatively. RESULTS: Replacement of a small segment of abnormal conduit vessel resulted in improvements in AI, demonstrating that arterial stiffness can be surgically manipulated. CONCLUSIONS: These results reflect a decreased myocardial workload post-aortic grafting. This decrease in AI is important from a risk factor management perspective, and arterial stiffness should become a further recognised and screened for risk factor in patients with known aneurysmal disease.

  7. Comparison of arterial stiffness and microcirculatory changes following abdominal aortic aneurysm grafting.

    LENUS (Irish Health Repository)

    Moloney, M A

    2010-11-11

    BACKGOUND: Abdominal aortic aneurysm (AAA) surgery provides a unique opportunity to study the impact of arterial stiffness on central haemodynamics, reflected in augmentation index (AI). The aneurysmal aorta is significantly stiffer than undilated age-matched aorta. AIM: We investigated whether replacement of an aneurysmal aorta with a compliant graft would result in a decrease in AI, which would thus decrease myocardial workload parameters. METHODS: Patients undergoing elective open or endovascular AAA repair were assessed with applanation tonometry and laser fluximetry pre-operatively, immediately and long-term post-operatively. RESULTS: Replacement of a small segment of abnormal conduit vessel resulted in improvements in AI, demonstrating that arterial stiffness can be surgically manipulated. CONCLUSIONS: These results reflect a decreased myocardial workload post-aortic grafting. This decrease in AI is important from a risk factor management perspective, and arterial stiffness should become a further recognised and screened for risk factor in patients with known aneurysmal disease.

  8. Perioperative factors analysis in patients with aortic aneurysm and aortic dissection aneurysm

    Institute of Scientific and Technical Information of China (English)

    LIU Jian; LIU Xiao-li; XIAO Ying-bin; WANG Xue-feng; CHEN Lin

    2004-01-01

    This study was undertaken to analyze the perioperative factors and complications that influence the final outcome after deep hypothermic circulatory arrest and superficial hypothermia during operations on aortic aneurysms from Jan 2000 to Jun 2004. The results show that deep hypthermic circulatory arrest group provided a high risk of pulmonary insufficiency-hypoxemia and temporary neurological dysfunction in complication but not increased the risk of hospital mortality.

  9. Proteomic identification of differentially expressed proteins in aortic wall of patients with ruptured and nonruptured abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Urbonavicius, Sigitas; Lindholt, Jes S.; Vorum, Henrik;

    2009-01-01

    To compare the basic proteomic composition of abdominal aortic aneurysm (AAA) wall tissue in patients with nonruptured and ruptured aneurysms.......To compare the basic proteomic composition of abdominal aortic aneurysm (AAA) wall tissue in patients with nonruptured and ruptured aneurysms....

  10. EXPERIENCE ON SURGICAL MANAGEMENT OF RUPTURE OF ABDOMINAL AORTIC ANEURYSM

    Institute of Scientific and Technical Information of China (English)

    管珩; 郑月宏; 李拥军; 刘昌伟; 刘暴; 叶炜

    2003-01-01

    Objective. To describe our surgical experience on rupture of abdominal aortic aneurysm .Methods. Two cases of ruptured aortic aneurysms with severe complication were analyzed. Aorta re-construction procedures were performed using bifurcated e-PTFE grafts during emergency operation. Diag-nosis, preoperative resuscitation, emergency surgical intervention, and postoperative complications of thesepatients were summarized and discussed.Results. Rupture of aortic aneurysm in both patients presented as a huge retroperitoneum haematomaby computed tomography scan. They were successfully saved by prompt body fluid compensation, emer-gency procedure, intraoperative resuscitation, and postoperative intensive care.Conclusions. Correct diagnosis, prompt surgical management, immediate intraoperative proximal aortaclamping during procedure, and effective management of postoperative complications were the key pointsto successful treatment of ruptured aortic aneurysm.

  11. Abdominal aortic aneurysm: Rupture of the anterior wall

    Directory of Open Access Journals (Sweden)

    Drašković Miroljub

    2007-01-01

    Full Text Available Introduction An aneurysm is a focal dilatation of an artery (aorta, involving an increase in diameter of at least 50% as compared to the expected normal diameter (over 3 cm. Abdominal aortic aneurysms (AAA cause thousands of deaths every year, many of which can be prevented with timely diagnosis and treatment. AAA can be asymptomatic for many years, but in one third of patients whose aneurysm ruptured, the mortality rate is 90%. In the past, palpation of the abdomen was the preferred method for identifying AAA. However, diagnostic imaging techniques, such as ultrasonography and computed tomography are more accurate and offer opportunities for early detection of AAA. Case report This paper is a case report of an 83-year old female patient. She was admitted due to severe pain in the abdomen. We already knew about the AAA (from her medical history. After using all available diagnostic procedures, rupture or dissection of the AAA were not confirmed. The patient underwent emergency surgery. During the operation, rupture of the anterior wall of the aneurysm was found. The anterior wall was filled with parietal thrombus, which hermetically closed the perforation. The patient was successfully operated and recovered. Conclusion The aim of this case report was to point out that our diagnostic procedures failed to confirm the rupture of AAA. We decided to apply surgical treatment, based on medical experience, clinical findings, ultrasonography and computed tomography and during operation rupture of AAA was confirmed. Patients with an already diagnosed AAA, or patients with clinical picture of rupture or dissection, are in urgent need for surgery, no matter what diagnostic tools are being used.

  12. Is screening for abdominal aortic aneurysm acceptable to the population?

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Juul, Søren; Henneberg, E W;

    1998-01-01

    The aim of the study was to analyse whether the selection and recruitment for hospital-based mass screening for abdominal aortic aneurysms (AAA) is acceptable for the population according to the criteria from the Council of Europe.......The aim of the study was to analyse whether the selection and recruitment for hospital-based mass screening for abdominal aortic aneurysms (AAA) is acceptable for the population according to the criteria from the Council of Europe....

  13. Failure to demonstrate Chlamydia pneumoniae in symptomatic abdominal aortic aneurysms by a nested polymerase chain reaction (PCR)

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Ostergård, L; Henneberg, E W;

    1998-01-01

    To investigate whether Chlamydia pneumoniae is present in symptomatic abdominal aortic aneurysms (AAA).......To investigate whether Chlamydia pneumoniae is present in symptomatic abdominal aortic aneurysms (AAA)....

  14. Thrombus Volume Change Visualization after Endovascular Abdominal Aortic Aneurysm Repair

    Science.gov (United States)

    Maiora, Josu; García, Guillermo; Macía, Iván; Legarreta, Jon Haitz; Boto, Fernando; Paloc, Céline; Graña, Manuel; Abuín, Javier Sanchez

    A surgical technique currently used in the treatment of Abdominal Aortic Aneurysms (AAA) is the Endovascular Aneurysm Repair (EVAR). This minimally invasive procedure involves inserting a prosthesis in the aortic vessel that excludes the aneurysm from the bloodstream. The stent, once in place acts as a false lumen for the blood current to travel down, and not into the surrounding aneurysm sac. This procedure, therefore, immediately takes the pressure off the aneurysm, which thromboses itself after some time. Nevertheless, in a long term perspective, different complications such as prosthesis displacement or bloodstream leaks into or from the aneurysmatic bulge (endoleaks) could appear causing a pressure elevation and, as a result, increasing the danger of rupture. The purpose of this work is to explore the application of image registration techniques to the visual detection of changes in the thrombus in order to assess the evolution of the aneurysm. Prior to registration, both the lumen and the thrombus are segmented

  15. Osteopontin and Osteoprotegerin as Potential Biomarkers in Abdominal Aortic Aneurysm before and after Treatment.

    Science.gov (United States)

    Filis, Konstantinos; Martinakis, Vasilios; Galyfos, George; Sigala, Fragiska; Theodorou, Dimitris; Andreadou, Ioanna; Zografos, Georgios

    2014-01-01

    Aim. Although osteopontin (OPN) and osteoprotegerin (OPG) have been associated with abdominal aortic aneurysms (AAAs), no association of these two biomarkers with AAA surgical or endovascular treatment has been reported. Material and Methods. Seventy-four AAA patients were prospectively selected for open or endovascular repair. All aneurysms were classified (Types A-E) according to aneurysmal extent in CT imaging (EUROSTAR criteria). All patients had preoperative serum OPN and OPG values measurements and 1 week after the procedure. Preoperative and postoperative values were compared with a control group of twenty patients (inguinal hernia repair). Results. Preoperative OPN values in patients with any type of aneurysm were higher than in the control group, while OPG values showed no difference. Postoperative OPN values in AAA patients were higher than in the control group. OPN values increased after open surgery and after EVAR. OPG values increased after open surgery but not after EVAR. There was no difference in OPN/OPG values between EVAR and open surgery postoperatively. Conclusions. OPN values are associated with aneurysm presence but not with aneurysm extent. OPG values are not associated either with aneurysm presence or with aneurysm extent. OPN values increase after AAA repair, independently of the type of repair.

  16. Risk factors influencing outcome of endovascular abdominol aortic aneurysm repair

    NARCIS (Netherlands)

    Leurs, Lina Jessica

    2006-01-01

    Abdominal Aortic Aneurysm (AAA) is a vascular disorder in which the abdominal aorta becomes permanently dilated to at least 1.5 times its normal diameter. The prevalence of AAA has increased rapidly during the last decade, and aneurysmal rupture is now the 13th most common cause of death in the West

  17. Open Versus Endovascular Stent Graft Repair of Abdominal Aortic Aneurysms

    DEFF Research Database (Denmark)

    Firwana, Belal; Ferwana, Mazen; Hasan, Rim;

    2014-01-01

    We performed an analysis to assess the need for conducting additional randomized controlled trials (RCTs) comparing open and endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Trial sequential analysis (TSA) is a statistical methodology that can calculate the required inform...

  18. MRI-based Assessment of Endovascular Abdominal Aortic Aneurysm Repair

    NARCIS (Netherlands)

    Laan, M.J. van der

    2007-01-01

    Imaging techniques play a key role in the Endovascular Abdominal Aortic Aneurysm Repair (EVAR) follow-up. The most important parameters monitored after EVAR are the aneurysm size and the presence of endoleaks. Currently, computed tomographic angiography (CTA) is the most commonly used imaging modali

  19. Appearance of femoropopliteal segment aneurysms in patients with abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Maksić Milanko

    2012-01-01

    Full Text Available Background/Aim. To promote better treatment outcome, as well as economic benefit it is very important to find out patients with simultaneous occurrence of both aortic and arterial aneurysms. The aim of this prospective study was to determine the frequency and factors affecting femoropopliteal (F-P segment aneurysms appearance in patients with abdominal aortic aneurysms (AAA. Methods. This study included 70 patients who had underwent elective or urgent surgery of AAA from January 1, 2006 to December 31, 2007. After ultrasonographic examination of F-P segment, all the patients were divided into two groups - those with adjunctive F-P segment aneurysm (n = 20 and the group of 50 patients with no adjunctive F-P segment aneurysm. In both groups demographic characteristics (gender, age, risk factors (diabetes mellitus, elevated serum levels of cholesterol and triglycerides, arterial hypertension, smoking, obesity and cardiovascular comorbidity (cerebrovascular desease, ischemic heart desease were investigated. Results. Twenty (28.57% patients who had been operated on because of AAA, had adjunctive aneurysmal desease of F-P segment. Diabetes was no statistically significantly more present among the patients who, beside AAA, had adjunctive aneurismal desease of F-P segment (χ2 = 0.04; DF = 1; p > 0.05. Also, in both groups there was no statistically significant difference in gender structure (χ2 = 2. 05; DF = 2; p > 0.05, age (χ2 = 5. 46; DF = 1; p > 0.05, total cholesterol level (χ2 = 0.89; DF = 1; p > 0.05 and triglyceride (χ2 = 0.89; DF = 1; p > 0.05 levels, the presence of arterial hypertension (χ2 = 1.38; DF = 2; p > 0.05, smoking (χ2 = 1.74; DF = 1; p > 0.05, obesity (χ2 = 1.76; DF = 1; p > 0.05 and presence of cerebrovascular desease (χ2 = 2.34; DF = 1; p > 0.05. Conversly, ischemic heart desease was statistically significantly more present among the patients who, beside AAA, had adjunctive aneurismal desease of F-P segment (χ2 = 5

  20. Modification of an endovascular stent graft for abdominal aortic aneurysm

    Science.gov (United States)

    Moloye, Olajompo Busola

    Endovascular surgery is currently used to treat abdominal aortic aneurysms (AAA). A stent graft is deployed to exclude blood flow from the aneurysm sac. It is an effective procedure used in preventing aneurysm rupture, with reduced patient morbidity and mortality compared to open surgical repair. Migration and leakage around the device ("endoleak") due to poor sealing of the stent graft to the aorta have raised concerns about the long-term durability of endovascular repair. A preliminary study of cell migration and proliferation is presented as a prelude to a more extensive in vivo testing. A method to enhance the biological seal between the stent graft and the aorta is proposed to eliminate this problem. This can be achieved by impregnating the stent graft with 50/50 poly (DL-lactide co glycolic acid) (PLGA) and growth factors such as basic fibroblast growth factor (bFGF) or connective tissue growth factor (CTGF), at the proximal and distal ends. It is hypothesized that as PLGA degrades it will release the growth factors that will promote proliferation and migration of aortic smooth muscle cells to the coated site, leading to a natural seal between the aorta and the stent graft. In addition, growth factor release should promote smooth muscle cell (SMC) contraction that will help keep the stent graft in place at the proximal and distal ends. It is shown that a statistically significant effect of increased cell proliferation and migration is observed for CTGF release. Less of an effect is noted for bFGF or just the PLGA. The effect is estimated to be large enough to be clinically significant in a future animal study. The long term goal of this study is to reduce migration encounter after graft deployment and to reduce secondary interventions of EVAR especially for older patients who are unfit for open surgical treatment.

  1. Familial abdominal aortic aneurysm: prevalence and implications for screening.

    Science.gov (United States)

    Adams, D C; Tulloh, B R; Galloway, S W; Shaw, E; Tulloh, A J; Poskitt, K R

    1993-11-01

    The high prevalence of abdominal aortic aneurysm (AAA) in men over the age of 65 has led to the establishment of ultrasound screening programmes for this group. The apparent familial tendency towards AAA formation suggests that relatives of aneurysm patients may form another subpopulation in whom screening is appropriate. The first degree relatives of 100 consecutive aneurysm patients were identified. Of 110 relatives over 50 years of age, two were known to have had AAA and ultrasound scans were performed on 74, providing information on aortic size for 76 relatives (69%). No further aortic aneurysms (antero-posterior diameter > or = 4.0 cm) were found on scanning. However, nine relatives were demonstrated to have aortic dilatation (2.5-3.9 cm). Aortic dilatation was observed in 21% of male first degree relatives over 50 years of age, affecting 27% of sons and 17% of brothers. Only 4% of the sisters and none of the daughters were found to have aortic dilatation. The prevalence of aortic enlargement seems to be sufficiently high amongst male first degree relatives of AAA patients over 50 years of age to justify aortic screening.

  2. Experimental Model of Saccular Abdominal Aortic Aneurysm in Swines with Pericardium Sac

    Directory of Open Access Journals (Sweden)

    Maurício de Amorim Aquino

    2016-02-01

    Full Text Available Abstract Objective: To consider modifications in an experimental model of saccular aortic aneurysm, aiming at better reproducibility, to be used in the development of vascular prostheses. Methods: Experimental study in two phases, developed in the Center of Experimental Surgery and Bioterium (CCEB of the University of Health Sciences of Alagoas (UNCISAL, with 11 hybrid swine, female, mean weight of 20 ± 5 kg, according to modifications in the Perini technique was performed. In the first phase, the aneurysm was confectioned with bovine pericardial patch. In the second phase, fifteen days later, the patency of the aneurysms was confirmed by Doppler ultrasonography. The described variables were aortic and aneurysm sac patency, incidence of rupture, morbidity and mortality. The statistical analysis program used was STATA v.8. Results: All animals survived to the procedures. Surgical mean time was 73 minutes. Aneurysm rupture, proximal or distal aortic thrombosis, visceral or legs ischemia weren't observed. Parietal thrombus formation was observed in all of the aneurysms, two of which (18%; IC 95% = 3.98 - 48.84 were occluded and nine (82%; IC 95% = 51.15 - 96.01 were patent. Conclusion: In this series, the modifications carried out in the technique related to the surgical approach, race, anesthesia, and imaging exams reproduced the experimental model, reducing its costs, without hindering the analysis of the variables. The satisfactory patency ratio allows the method to be used in experimental models for the development of vascular prostheses.

  3. Epidemiology of aortic disease - aneurysm, dissection, occlusion

    International Nuclear Information System (INIS)

    The physiological infrarenal aortic diameter varies between 12.4 mm in women an 27.6 mm in men. As defined, an aneurysmatic dilatation begins with 29 mm. According to that, 9% of all people above the age of 65 are affected by an abdominal aortic aneurysm (AAA). Compared with the female sex, the male sex predominates at a rate of about 5:1. The disease is predominant in men of the white race. In black men, black and white women the incidence of AAA is identical. 38 to 50 percent of the AAA patients (patients) suffer from hypertension, 33 to 60% from coronary, 28% from cerebrovascular and 25% from peripheral occlusive disease. The AAA expansion rate varies between 0.2 and 0.8 cm per year and is exponential from a diameter of 5 cm on. In autopsy studies, the rupture rates with AAA diameters of 7 cm were below 5%, 39% and 65%, respecitvely. 70% of the AAA patients do not die of a rupture, but of a cardiac disease. Serum markers, such as metalloproteinases and procollagen peptides are significantly increased in AAA patients. Thoraco-abdominal aneurysms (TAA) make up only 2 to 5% of all degenerative aneurysms. 20 to 30% of the TAA patients are also affected by an AAA. 80% of the TAA are degenerative, 15 to 20% are a consequence of the chronic dissection - including 5% of Marfan patients -, 2% occur in case of infections and 1 to 2% in case of aortitis. The TAA incidence in 100,000 person-years is 5.9% during a monitoring period of 30 years. In case of TAA, an operation is indicated with a maximum diameter of 5.5 to 6 cm and more and, in case of a Marfan's syndrome (incidence of 1:10,000), with a maximum diameter of 5.5 cm and more. With regard to aorto-iliac occlusive diseases, there are defined 3 types of distribution. Type I refers to the region of the bifurcation itself. Type II defines the diffuse aortoiliac spread of the disease. Type III designates multiple-level occlusions also beyond the inguinal ligament. Type I patients in most cases are female and more

  4. Adding an endovascular aortic surgery program to a rural regional medical centre

    Science.gov (United States)

    Marelli, Daniel; Woo, Edward; Watson, Michael; Fedalen, Paul; Wang, Grace; Stallings, Megan; Fairman, Ronald; Mannion, John

    2013-01-01

    Background Abdominal aortic aneurysms requiring surgical intervention are generally treated by endovascular means. Such procedures are not always offered in rural hospitals, possibly leaving patients underserved. We reviewed our experience initiating an endoaortic surgery program. Methods A surgeon in a rural centre was credentialed to perform endovascular aortic aneurysm repair through collaboration with a university centre and was proctored locally for the first 5 abdominal aneurysm repairs. Web-based image storage was used to review complex cases as part of an ongoing partnership. Referred patients were screened for multiple aneurysms and underwent long-term monitoring. Results In all, 160 patients were evaluated for 176 aortic pathologies. Twenty-five patients (17 men) aged 55–89 years underwent 26 endovascular abdominal (n = 23) or thoracic (n = 3) aortic procedures. Emergent endovascular procedures were not performed. There were no operative deaths, requirements for dialysis or conversions to open repair. Two endoleaks required early reintervention. The median length of stay in hospital for endovascular procedures was 2.5 days. Chronic endoleaks were observed in 7 patients. An additional 8 patients underwent open abdominal aneurysm repair locally and 15 patients were referred to the university program. Conclusion Creation of an endovascular aortic surgery program in a rural hospital is feasible through collaboration with a high-volume centre. Patient safety is enhanced by obtaining second opinions using web-based image review. Most interventions are for abdominal aortic aneurysms, but planning for a comprehensive aortic clinic is preferable. PMID:24067525

  5. Treatment of infrarenal abdominal aortic dissection concomitant with an aneurysm

    Institute of Scientific and Technical Information of China (English)

    WANG Li-xin; ZHU Ting; FU Wei-guo; WANG Yu-qi; XI Xun; GUO Da-qiao; CHEN Bin; JIANG Jun-hao; YANG Ju; SHI Zhen-yu

    2007-01-01

    @@ Aortic dissection occurs when layers of the aortic walls are separated by the blood flow through an intimal tear. Dissection of the aorta most frequently originates in the ascending aorta (70%), followed by the descending aorta (22%), the aortic arch (7%) and the abdominal aorta (1/%).1 The dissection limited to the abdominal aorta is rare.2 An isolated abdominal aortic dissection (IAAD) concomitant with an abdominal aortic aneurysm (AAA) is uncommon. We present here one patient with IAAD and AAA treated by endovascular therapy.

  6. Treatment of abdominal aortic aneurysm in nine countries 2005-2009: a vascunet report

    DEFF Research Database (Denmark)

    Mani, K; Lees, T; Beiles, B;

    2011-01-01

    To study contemporary treatment and outcome of abdominal aortic aneurysm (AAA) repair in nine countries.......To study contemporary treatment and outcome of abdominal aortic aneurysm (AAA) repair in nine countries....

  7. Rapid prototyping in aortic surgery.

    Science.gov (United States)

    Bangeas, Petros; Voulalas, Grigorios; Ktenidis, Kiriakos

    2016-04-01

    3D printing provides the sequential addition of material layers and, thus, the opportunity to print parts and components made of different materials with variable mechanical and physical properties. It helps us create 3D anatomical models for the better planning of surgical procedures when needed, since it can reveal any complex anatomical feature. Images of abdominal aortic aneurysms received by computed tomographic angiography were converted into 3D images using a Google SketchUp free software and saved in stereolithography format. Using a 3D printer (Makerbot), a model made of polylactic acid material (thermoplastic filament) was printed. A 3D model of an abdominal aorta aneurysm was created in 138 min, while the model was a precise copy of the aorta visualized in the computed tomographic images. The total cost (including the initial cost of the printer) reached 1303.00 euros. 3D imaging and modelling using different materials can be very useful in cases when anatomical difficulties are recognized through the computed tomographic images and a tactile approach is demanded preoperatively. In this way, major complications during abdominal aorta aneurysm management can be predicted and prevented. Furthermore, the model can be used as a mould; the development of new, more biocompatible, less antigenic and individualized can become a challenge in the future. PMID:26803324

  8. GenTAC Registry Report: Gender Differences Among Individuals with Genetically-Triggered Thoracic Aortic Aneurysm and Dissection

    Science.gov (United States)

    Holmes, Kathryn W.; Maslen, Cheryl L.; Kindem, Mark; Kroner, Barbara L.; Song, Howard K.; Ravekes, William; Dietz, H.C.; Weinsaft, Jonathan W.; Roman, Mary J.; Devereux, Richard B.; Pyeritz, Reed E.; Bavaria, Joseph; Milewski, Karianna; Milewicz, Dianna; LeMaire, Scott A.; Hendershot, Tabitha; Eagle, Kim A.; Tolunay, H. Eser; Desvigne-Nickens, Patrice; Silberbach, Michael

    2013-01-01

    Previous data suggest women are at increased risk of death from aortic dissection. Therefore, we analyzed data from the GenTAC registry, the NIH-sponsored program that collects information about individuals with genetically-triggered thoracic aortic aneurysms and cardiovascular conditions. We performed cross-sectional analyses in adults with Marfan syndrome (MFS), familial thoracic aortic aneurysm or dissection (FTAAD), bicuspid aortic valve (BAV) with thoracic aortic aneurysm or dissection, and subjects under 50 years of age with thoracic aortic aneurysm or dissection (TAAD<50y). Women comprised 32% of 1449 subjects and were 21% of subjects with BAV, 34% with FTAAD, 22% with TAAD <50y, and 47% with MFS. Thoracic aortic dissections occurred with equal gender frequency yet women with BAV had more extensive dissections. Aortic size was smaller in women but was similar after controlling for BSA. Age at operation for aortic valve dysfunction, aneurysm or dissection did not differ by gender. Multivariate analysis (adjusting for age, BSA, hypertension, study site, diabetes, and subgroup diagnoses) showed that women had fewer total aortic surgeries (OR= 0.65, p < 0.01) and were less likely to receive angiotensin converting enzyme inhibitors (ACEi) (OR=0.68, p < 0.05). As in BAV, other genetically-triggered aortic diseases such as FTAAD and TAAD<50 are more common in males. In women, decreased prevalence of aortic operations and less treatment with ACEi may be due to their smaller absolute aortic diameters. Longitudinal studies are needed to determine if women are at higher risk for adverse events. PMID:23444191

  9. An incidentally detected giant membranous interventricular septal aneurysm secondary to previous surgery for subaortic valvular stenosis

    Science.gov (United States)

    Karagöz, Ahmet; Çelik, Abdullah; Vural, Aslı; Başer, Bengi

    2014-01-01

    Ventricular septal aneurysms are rare clinical entities and their certain prevalence and clinical significance are not well known. Most of them are thought to develop during or after the closure process of the accompanying ventricular septal defects. Although a majority of the patients are typically asymptomatic, the potential risks should also be kept in mind. We present a case of a membranous interventricular septal aneurysm that developed after surgery for subaortic valvular stenosis. The points that make our case worth reporting are development of the aneurysm after aortic surgery and lack of a concomitant ventricular septal defect. On the basis of the existence of an aortic valve surgery history and reports that do not mention any ventricular septal defect and ventricular septal aneurysm when she was operated, we suggest that the aneurysmatic formation in the membranous portion of the interventricular septum developed due to valve surgery in the postoperative wound healing period. PMID:25240004

  10. The effect of endoleak on intra-aneurysmal pressure after EVE for abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To investigate the intra-aneurysmal pressure curve in the presence of endoleak after endovascular exclusion (EVE) for abdominal aortic aneurysm (AAA). Methods: Infrarenal aortic aneurysms were created with bovine jugular vein segments or patches. Then they were underwent incomplete endovascular exclusion of the aneurysm and formation of endoleaks. The pressures of blood flow outside the graft into the sac were measured. Results: The intrasac pressure was higher than systemic pressure in the presence of endoleak. After sealing the endoleak, pressure decreased significantly, and the pressure cure showed approximately linear. Conclusion: The change of intra-aneurysmal pressure curve reflected the load on aneurysmal wall after EVE, and can also help to determine the endoleak existence

  11. Maximal aneurysm diameter follow-up is inadequate after endovascular abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    Wever, JJ; Blankensteijn, JD; Mali, WPTM; Eikelboom, BC

    2000-01-01

    Background: follow-up after endovascular abdominal aortic aneurysm repair (EAR) generally consists of serial diameter measurements. A size change after EAR, however, is the consequence of alterations of the excluded aneurysm sac volume. Objective: to assess the agreement between diameter measurement

  12. An unusual case of bilateral coronary artery aneurysms and aortic aneurysms complicated by stenotic lesions

    Energy Technology Data Exchange (ETDEWEB)

    Nakamizo, Reiichirou; Toda, Genji; Koide, Yuji; Kawahara, Fumitaka; Seto, Shinji; Yano, Katsusuke [Nagasaki Univ. (Japan). Graduate School of Biomedical Sciences

    2003-03-01

    A 71-year-old Japanese woman presented with a chief complaint of throbbing sensations in the abdomen. When she was 16 years old, she was exposed to atomic radiation since she was 1.2 km away from the drop zone of the Nagasaki atomic bomb. Abdominal CT performed at the age of 61 revealed the presence of localized calcification below the renal artery, together with abdominal aortic aneurysms measuring 4.9 cm in maximum diameter. Since the abdominal aortic aneurysms enlarged in May 2000, the patient was admitted to our department for further examinations and treatment on July 7. Although the patient did not complain of thoracic symptoms, cardiac catheterization revealed the presence of multiple coronary artery aneurysms and severe stenosis in the main trunk of the left coronary artery and proximal regions of the right coronary artery, together with a complicated collateral circulation course. Coronary artery aneurysms were localized similar to the abdominal aortic aneurysms, and were complicated by severe calcification and obstructive lesions. Coronary arterial bypass grafting was performed after the severity of the coronary artery aneurysms was morphologically evaluated. The course of the abdominal aortic aneurysms was followed without surgical treatment. Although the etiology of the aneurysm formation in this patient was investigated, it remained unclear. (author)

  13. 3D image analysis of abdominal aortic aneurysm

    Science.gov (United States)

    Subasic, Marko; Loncaric, Sven; Sorantin, Erich

    2002-05-01

    This paper presents a method for 3-D segmentation of abdominal aortic aneurysm from computed tomography angiography images. The proposed method is automatic and requires minimal user assistance. Segmentation is performed in two steps. First inner and then outer aortic border is segmented. Those two steps are different due to different image conditions on two aortic borders. Outputs of these two segmentations give a complete 3-D model of abdominal aorta. Such a 3-D model is used in measurements of aneurysm area. The deformable model is implemented using the level-set algorithm due to its ability to describe complex shapes in natural manner which frequently occur in pathology. In segmentation of outer aortic boundary we introduced some knowledge based preprocessing to enhance and reconstruct low contrast aortic boundary. The method has been implemented in IDL and C languages. Experiments have been performed using real patient CTA images and have shown good results.

  14. Endovascular repair:alternative treatment of ruptured abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    GUO Wei; ZHANG Hong-peng; LIU Xiao-ping; YIN Tai; JIA Xin; LIANG Fa-qi; ZHANG Guo-hua

    2009-01-01

    Background As an alternative to open aneurysm repair,endovascular aortic repair(EVAR)has been applied to ruptured abdominal aortic aneurysm(rAAA).The aim of this study was to evaluate the immediate and long-term outcomes of EVAR for rAAA.Methods From July 1997 to September 2007,20 men and six women with rAAA(median age,68 years)were treated with EVAR.Most patients with suspected rAAA underwent emergency computed tomographic angiography(CTA).The procedure was performed under general or local anesthesia.Endovascular clamping was attempted in hemodynamically unstable patients.Bifurcated endografts and aorto-uni-iliac(AUI)endografts with crossover bypass were used.Patients had CT scan prior to discharge,3,6,12 months after discharge,and annually thereafter.Results Time between diagnosis and EVAR ranged from 1 hour to 5 days.EVAR was performed under general anesthesia in 21 patients,and under local anesthesia in five patients.Endovascular aortic clamping was performed in four patients.There was no conversion to open surgery during EVAR.Stent-graft insertion was successful in all patients.One patient died during EVAR from acute myocardial infarction.Ten patients had systolic blood pressure<80 mm Hg.Eleven patients received a blood transfusion.Mean aneurysm size was(47c12)mm.Mean ICU stay was(8±3)days,mean hospital stay(18±6)days,and mean procedure time(120±32)minutes.The 30-day mortality was 23%(6/26patients),and major morbidity 35%(9/26 patients).Early endoleak occurred in 8/26 patients(31%).The mean follow-up was(18±7)months.No patient demonstrated migration of the stent-graft.Conclusions EVAR is a safe and effective option for treatment of acute rAAA,independent of the patient's general condition.Immediate and mid-term outcomes are favorable,but long-term outcome is unknown.Multi-center studies are necessary to establish the role of EVAR for rAAA.

  15. Aneurysm diameter and proximal aortic neck diameter influence clinical outcome of endovascular abdominal aortic repair : A 4-year EUROSTAR experience

    NARCIS (Netherlands)

    Waasdorp, EJ; de Vries, JPPM; Hobo, R; Leurs, LJ; Buth, J; Moll, FL

    2005-01-01

    Our objective was to evaluate the effect of preoperative aneurysm and aortic neck diameter on clinical outcome after infrarenal abdominal endovascular aneurysm repair (EVAR). Data of patients in the European Collaborators Registry on Stent-Graft Techniques for Abdominal Aortic Aneurysm Repair (EUROS

  16. Endovascular Aortic Aneurysm and Dissection Repair (EVAR) in Iran: Descriptive Midterm Follow-up Results

    Science.gov (United States)

    Haji Zeinali, Ali Mohammad; Marzban, Mehrab; Zafarghandi, Mohammadreza; Shirzad, Mahmood; Shirani, Shapour; Mahmoodian, Roshanak; Sheikhvatan, Mehrdad; Lotfi-Tokaldany, Masoumeh

    2016-01-01

    Background: Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain. Objectives: The current study describes for the first time our initial four-year experience of elective endovascular aortic repair (EVAR) at Tehran heart center, the first and a major referral heart center in Iran, as a pioneer of EVAR in Iran. Patients and Methods: A total of 51 patients (46 men) who had the diagnosis of either an abdominal aortic aneurysm (AAA) (n = 36), thoracic aortic aneurysm (TAA) (n = 7), or thoracic aortic dissection (TAD) (n = 8) who had undergone EVAR by Medtronic stent grafts by our team between December 2006 and June 2009 were reviewed. Results: The rate of in-hospital aneurysm-related deaths in the group with AAA stood at 2.8% (one case), while there was no in-hospital mortality in the other groups. All patients were followed up for 13-18 months. The cumulative death rate in follow-up was nine cases from the total 51 cases (18%), out of which six cases were in the AAA group (four patients due to non-cardiac causes and two patients due to aneurysm-related causes), one case in the TAA group (following a severe hemoptysis), and two cases in the TAD group (following an expansion of dissection from re-entrance). The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD. Conclusion: The endovascular stent-graft repair of the abdominal and thoracic aortic aneurysm and aortic dissection had high technical success rates in tandem with low-rate early mortality and morbidity, short hospital stay, and acceptable mid-term free symptom survival among Iranian patients. PMID:27110330

  17. Endovascular Aortic Aneurysm and Dissection Repair (EVAR in Iran: Descriptive Midterm Follow-up Results

    Directory of Open Access Journals (Sweden)

    Haji Zeinali

    2016-01-01

    Full Text Available Background Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain. Objectives The current study describes for the first time our initial four-year experience of elective endovascular aortic repair (EVAR at Tehran heart center, the first and a major referral heart center in Iran, as a pioneer of EVAR in Iran. Patients and Methods A total of 51 patients (46 men who had the diagnosis of either an abdominal aortic aneurysm (AAA (n = 36, thoracic aortic aneurysm (TAA (n = 7, or thoracic aortic dissection (TAD (n = 8 who had undergone EVAR by Medtronic stent grafts by our team between December 2006 and June 2009 were reviewed. Results The rate of in-hospital aneurysm-related deaths in the group with AAA stood at 2.8% (one case, while there was no in-hospital mortality in the other groups. All patients were followed up for 13-18 months. The cumulative death rate in follow-up was nine cases from the total 51 cases (18%, out of which six cases were in the AAA group (four patients due to non-cardiac causes and two patients due to aneurysm-related causes, one case in the TAA group (following a severe hemoptysis, and two cases in the TAD group (following an expansion of dissection from re-entrance. The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD. Conclusion The endovascular stent-graft repair of the abdominal and thoracic aortic aneurysm and aortic dissection had high technical success rates in tandem with low-rate early mortality and morbidity, short hospital stay, and acceptable mid-term free symptom survival among Iranian patients.

  18. Percutaneous Zenith endografting for abdominal aortic aneurysms.

    Science.gov (United States)

    Heyer, Kamaldeep S; Resnick, Scott A; Matsumura, Jon S; Amaranto, Daniel; Eskandari, Mark K

    2009-03-01

    A completely percutaneous approach to infrarenal abdominal aortic aneurysm (AAA) endografting has the theoretic benefits of being minimally invasive and more expedient. Our goal was to demonstrate the utility of this approach using a suprarenal fixation device and a suture-mediated closure system. We conducted a single-institution, retrospective review of 14 patients who underwent percutaneous AAA repair with the Zenith device between August 2003 and March 2007. Immediate and delayed access-related outcomes were examined over a mean follow-up of 12.1+/-2.0 months. Mean AAA size was 5.6 cm. Immediate arterial closure and technical success rate was 96% (27/28 vessels). One immediate hemostatic failure required open surgical repair. Over follow-up, one vessel required operative repair for new-onset claudication. No other immediate or delayed complications (thrombosis, pseudoaneurysm, infection, or deep venous thrombosis) were detected. A percutaneous approach for the treatment of AAA has several advantages over femoral artery cutdown but also has its own unique set of risks in the immediate and late postoperative period. Ultimately, the "preclose technique" can be safely applied for the Zenith device despite its large-bore delivery system.

  19. Diabetes and Abdominal Aortic Aneurysm Growth.

    Science.gov (United States)

    Takagi, Hisato; Umemoto, Takuya

    2016-07-01

    We performed a systematic literature search and a meta-analysis to assess the association between diabetes mellitus (DM) and abdominal aortic aneurysm (AAA) growth. Databases including MEDLINE and EMBASE were searched through June 2015 using PubMed and OVID. For each study, data regarding AAA growth rates in both the DM and the non-DM groups were used to generate standardized mean differences (SMDs) and 95% confidence intervals (CIs). Our search identified 19 relevant studies including data on 9777 patients with AAA. Pooled analyses demonstrated a statistically significant slower growth rates in DM patients than in non-DM patients (unadjusted SMD, -0.32; 95% CI, -0.40 to -0.24; P plot asymmetry, even adjustment of the asymmetry did not alter the beneficial effect of DM. In conclusion, on the basis of a meta-analysis of data on a total of 9777 patients (19 studies) identified through a systematic literature search, we confirmed the association of DM with slower growth rates of AAA. PMID:26311742

  20. Aortic aneurysm after patch aortoplasty for coarctation: analysis of patch size and wall growth.

    Science.gov (United States)

    Al-Hroob, A; Husayni, T S; Freter, A; Chiemmongkoltip, P; Ilbawi, M N; Arcilla, R A

    2003-01-01

    Aortic aneurysm may develop after surgery for coarctation of aorta especially patch aortoplasty. The size of patch and of adjacent native aortic wall was analyzed to determine whether aortic dilatation represents a true aneurysm. Electron beam tomography (EBT) was done on 19 patients, three months to 17.5 years after patch aortoplasty. Tomograms of aorta were obtained in 6-mm slices, and maximal cross-sectional area was digitized to obtain: total circumference (Ct), patch component (Cp), and aortic wall component (Cw). Ct, Cp, and Cw were normalized to the circumference of distal aorta (Cda) as: isthmus/distal aorta (Ct/Cda), patch segment/distal aorta (Cp/Cda), wall segment/distal aorta (Cw/Cda). Ct/Cda ranged from 109% to 260%. In 12 patients (group A), it varied from 168% to 260%; and in seven (group B), 109% to 133%. There was strong correlation (r = 0.92) between Ct/Cda and Cp/Cda. Ct/Cda, Cp/Cda, and Cp/Cw were higher in group A than B (p <0.001) but Cw/Cda did not differ. Cw/Cda was greater than the coarctation/distal aorta diameter ratios of preoperative angiograms, consistent with accelerated aortic wall growth postsurgery. No definite aneurysm was seen. Localized dilatation of aorta following patch aortoplasty in children is primarily due to a large synthetic patch and, partly, to increased aortic wall growth. Serial EBT or magnetic resonance imaging is indicated to monitor aortic wall growth and occurrence of aneurysm.

  1. Neurologic injury after endovascular exclusion of abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To investigate the mechanism of neurologic injury after endovascular graft exclusion of abdominal aortic aneurysms and the methods of prevention and treatment. Materials: Since March 1997 to October 2002, endovascular graft exclusion for abdominal aortic aneurysm have been preformed on 136 patients, with one occurrence of neurologic injury after the operation. The main body-short limb graft was used in this case (Talent) and the operation was successful. The patient complained of bilateral lower extremities pain and disability. Electromusculogram showed bilateral femoral nerve injury. Then the patient was treated with vitamin B12, hyperbaric oxygen and physical therapy for 2 months outcoming with the symptom improvement. Conclusions: Neurologic injury after endovascular graft exclusion for abdominal aortic aneurysms is possible due to the occlusion of the lumbar artery during the operation. Early treatment is important and more effective. Later nerve nutrition and physical treatment can improve some symptoms partly

  2. Twins with progressive thoracic aortic aneurysm, recurrent dissection and ACTA2 mutation.

    Science.gov (United States)

    Ware, Stephanie M; Shikany, Amy; Landis, Benjamin J; James, Jeanne F; Hinton, Robert B

    2014-10-01

    Thoracic aortic aneurysm (TAA) is a genetically mediated disease with variable age of onset. In the pediatric age range, nonsyndromic TAA frequently has a milder course than syndromic forms of TAA, such as Marfan syndrome or Loeys-Dietz syndrome. Herein, we describe 17-year-old identical twin brothers with severe progressive TAA due to a novel de novo ACTA2 mutation. Interestingly, both boys were diagnosed at age 11 with congenital mydriasis, a recently recognized manifestation of some ACTA2 mutations due to smooth muscle dysfunction. One of the brothers presented with acute-onset lower back pain that was identified as dissection of an abdominal aortic aneurysm. Imaging of the chest at this time showed severe fusiform TAA. Cardiac imaging in his twin showed similar TAA, but no abdominal aortic aneurysm. Both brothers underwent valve-sparing aortic root replacement, but have had progressive aortic disease with recurrent dissection requiring multiple surgeries. This case emphasizes the importance of identifying physical stigmata of smooth muscle dysfunction, such as mydriasis, as potential markers for associated aortopathy and vascular diseases.

  3. MRI follow-up of abdominal aortic aneurysms after endovascular repair

    NARCIS (Netherlands)

    Cornelissen, S.A.P.

    2012-01-01

    Aneurysm size changes form the basis of the follow-up after endovascular abdominal aortic aneurysm repair, because aneurysm growth increases rupture risk. Aneurysm growth can be caused by endoleak (leakage of blood in the aneurysm sac). Therefore, accurate endoleak detection is important in growing

  4. Acute Testicular Ischemia following Endovascular Abdominal Aortic Aneurysm Repair Identified in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Nathan Finnerty

    2014-01-01

    Full Text Available Endovascular aneurysm repair (EVAR is perhaps the most widely utilized surgical procedure for patients with large abdominal aortic aneurysms. This procedure is minimally invasive and reduces inpatient hospitalization requirements. The case involves a 72-year-old male who presented to the emergency department with right testicular ischemia two days following EVAR. Given the minimal inpatient hospitalization associated with this procedure, emergency physicians are likely to encounter associated complications. Ischemic and thromboembolic events following EVAR are extremely rare but require prompt vascular surgery intervention to minimize morbidity and mortality.

  5. Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management

    OpenAIRE

    Scaife, Mark; Giannakopoulos, Triantafillos; Al-Khoury, Georges E.; Chaer, Rabih A.; Avgerinos, Efthymios D.

    2016-01-01

    Ultrasound (US) is a well-established screening tool for detection of abdominal aortic aneurysms (AAAs) and is currently recommended not only for those with a relevant family history but also for all men and high-risk women older than 65 years of age. The advent of minimally invasive endovascular techniques in the treatment of AAAs [endovascular aneurysm repair (EVAR)] has increased the need for repeat imaging, especially in the postoperative period. Nevertheless, preoperative planning, intra...

  6. Meta analysis of outcomes of open surgery versus endovascular aneurysm repair for ruptured abdominal aortic aneurysms%开放手术和腔内修复术治疗腹主动脉瘤破裂的 meta 分析(附2例报告)

    Institute of Scientific and Technical Information of China (English)

    戈小川; 刘建伟

    2013-01-01

      目的比较开放手术和腔内修复术(EVAR)治疗腹主动脉瘤破裂的效果和预后的差异。方法从2例行 EVAR 治疗腹主动脉瘤破裂的经验出发,检索 EVAR 和开放手术治疗该疾病的文献报道并作 meta 分析。结果一共纳入14篇文献,均是单中心研究,大部分都是观察报告,只有1篇是随机对照试验。EVAR 组术后30天死亡率为18%(95%CI:12%~23%),开放手术组为39%(95%CI:34%~44%),两组比较差异有统计学意义(P <0.01)。EVAR 组的平均住院天数及ICU 天数比开放手术组的时间明显缩短,两组比较差异有统计学意义(P <0.05)。EVAR 组平均术中出血量也小于开放手术组(746 ml vs 3435 ml,P <0.01);但在平均术中输液(血)量、手术时间和术后并发症上,两组比较差异无统计学意义(P <0.05)。结论EVAR 治疗腹主动脉瘤破裂和开放手术比较有更低的死亡率、更短的住院时间和更少的出血量,患者术后恢复较快,但术后并发症发生率无显著性差异,而长期生存率仍不明确。%Objective To compare the result of endovascular aneurysm repair(EVAR) and open surgery for ruptured abdominal aortic aneurysms. Method From the experience of 2 patients underwent EVAR treatment of abdominal aortic aneurysm in our hospital, we retrieved the reports on EVAR and surgical treatment of ruptured abdominal aortic aneurysms and made meta-analysis literature. Results Total 14 studies were included in this study. All studies were single-center study, including 13 observational reports and a randomized controlled trial (RCT) report. The 30-day mortality of EVAR group was 18% (95% CI: 12% ~ 23%), while surgery group was 39% (95% CI: 34% ~ 44%), the difference was statistically significant (P < 0.01 ). EVAR group was significantly shorter time than surgery group on the average days in hospital and in ICU (P < 0.05). The average blood loss in EVAR group was

  7. Abdominal aortic aneurysms: treatment with Zenith endoluminal stent-graft

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy and safety of Zenith transrenal stent-graft in repairing the abdominal aortic aneurysms. Methods: Endoluminal stent-grafts repair was performed in 5 male patients with abdominal aortic aneurysms. Their age ranged from 52 years to 73 years with a mean of 65 years. Three-dimensional CT angiography demonstrated Blum type B in 4 cases and Blum type C in 1 case. The diameter of aneurysmal neck was between 21 mm and 25 mm (mean 22.8 mm), and the length of aneurysmal neck was between 16.5 mm and 32.8 mm (mean 25.6mm). Stent-grafts were inserted through surgically exposed femoral arteries in general anesthesia with the fluoroscopic guidance. The Zenith transrenal bifurcated stent-grafts were applied in all 5 patients. Results: The endoluminal stent-graft repair was successful in all 5 patients with operational duration of 1.8-3.0 hours. The hospitalization duration was 7-14 days following the procedure. No endoleaks occurred in the 5 cases following the contrast-enhanced CT scans seven days after the interventions. Still no endoleaks or stent-grafts migration recurred in 2 patients followed up at the 2nd and 11th month, respectively. During the follow-up from 6 months to 55 months (mean 26.6 months), five patients were still asymptomatic. Conclusion: Zenith aortic stent-graft repair of abdominal aortic aneurysms is an effective and safe treatment method

  8. Study on hemodynamics in patient-specific thoracic aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    The objective of this study is to investigate the hemodynamics in patient-specific thoracic aortic aneurysm and discuss the reason for formation of aortic plaque.A 3-Dimensional pulsatile blood flow in thoracic aorta with a fusiform aneurysm and 3 main branched vessels was studied numerically with the average Reynolds number of 1399 and the Womersley number of 19.2.Based on the clinical 2-Dimensional CT slice data,the patient-specific geometry model was constructed using medical image process software.Un...

  9. Clipping techniques in cerebral aneurysm surgery.

    Science.gov (United States)

    Acciarri, Nicola; Toniato, Giovanni; Raabe, Andreas; Lanzino, Giuseppe

    2016-03-01

    The history of cerebral aneurysm surgery owes a great tribute to the tenacity of pioneering neurosurgeons who designed and developed the clips used to close the aneurysms neck. However, until the beginning of the past century, surgery of complex and challenging aneurysms was impossible due to the lack of surgical microscope and commercially available sophisticated clips. The modern era of the spring clips began in the second half of last century. Until then, only malleable metal clips and other non-metallic materials were available for intracranial aneurysms. Indeed, the earliest clips were hazardous and difficult to handle. Several neurosurgeons put their effort in developing new clip models, based on their personal experience in the treatment of cerebral aneurysms. Finally, the introduction of the surgical microscope, together with the availability of more sophisticated clips, has allowed the treatment of complex and challenging aneurysms. However, today none of the new instruments or tools for surgical therapy of aneurysms could be used safely and effectively without keeping in mind the lessons on innovative surgical techniques provided by great neurovascular surgeons. Thanks to their legacy, we can now treat many types of aneurysms that had always been considered inoperable. In this article, we review the basic principles of surgical clipping and illustrate some more advanced techniques to be used for complex aneurysms. PMID:26657306

  10. Endovascular stent-graft placement and secondary intervention for abdominal aortic aneurysm in a patient who had a previously inserted iliac stent

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Yong Sun; Cho, Soon Gu; Hong, Kee Chun [Inha University College of Medicine, Incheon (Korea, Republic of)

    2007-04-15

    Endovascular repair of abdominal aortic aneurysm is associated with low morbidity and mortality rates when compared to open surgery, and this can be used in patients who are at a high risk for open surgical repair. Also, secondary intervention is an important for achieving intermediate and long term success of endovascular repair of abdominal aortic aneurysm as this can resolve complications. We report here on endovascular stent-graft placement and a secondary interventional procedure in the abdominal aortic aneurysm of a patient who had a previously inserted iliac stent.

  11. Surgical Repair of Abdominal Aortic and Renal Artery Aneurysms in Takayasu's Arteritis.

    Science.gov (United States)

    Wetstein, Paul J; Clark, Margaret E; Cafasso, Danielle E; Golarz, Scott R; Ayubi, Farhan S; Kellicut, Dwight C

    2016-01-01

    Takayasu's arteritis is a large vessel vasculitis that can be a challenging diagnosis to make and has a varied clinical presentation. Management largely depends on affected vessel disease severity and individual patient considerations. The diagnosis must be considered in a young patient with large vessel aneurysms. We present a case of a 30 year-old woman of Pacific Islander descent who presented to the Tripler Army medical Center Vascular Surgery Department in Honolulu, Hawai'i seeking repair of her abdominal aortic and renal artery aneurysms prior to conception. A 30 year-old Pacific Islander woman with a history of a saccular abdominal aortic aneurysm and renal artery aneurysms presented to our clinic seeking vascular surgery consultation prior to a planned pregnancy. She had a renal artery stent placed at an outside institution for hypertension. She met the diagnosis of Takayasu's arteritis by Sharma's criteria. Physical exam was significant for a palpable, pulsatile, abdominal mass and CT angiography revealed a saccular irregular-appearing infra-renal abdominal aortic aneurysm, extending to the aortic bifurcation, with a maximum diameter of 3.3 cm. A right renal artery aneurysm was also identified proximally, contiguous with the aorta, with a maximal transverse diameter of 1.7 cm. The patient underwent a supraceliac bypass to the right renal artery with a 7 mm Dacron graft, as well as excision of the right renal artery aneurysm. The abdominal aortic aneurysm was replaced using a Hemashield Dacron bifurcated 14 mm x 7 mm bypass graft. Intraoperative measurements of the renal artery aneurysm were 1.5 x 1.5 cm and the saccular appearing distal abdominal aortic aneurysm measured 3.6 x 3.3 cm. The patient was discharged from the hospital 7 days post-operatively. At 1-year follow up, CT scan of the abdominal aorta revealed the repair was without any evidence of aneurysm formation, anastomotic pseudoaneurysm formation, or areas of stenosis. She has remained

  12. Impact of intraoparetive parametres on survival of patients with ruptured abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Marković Miroslav

    2004-01-01

    well as type of rupture and level of aortic cross-clamping. Aortic cross-clamping time was significantly shorter in survivors, and longest in patients that died intraoperatively (p<0.05. Intraoperative systolic tension value influenced the outcome in patients; it was significantly higher in survivors (p<0.01. Interposition of tubular graft gave better results compared with aorto-iliac and aorto-femoral reconstruction (p<0.01. Duration of surgery was significantly higher in patients with lethal outcome (p<0.05, as well as intraoperative blood loss (p<0.05. Intraoperative diuresis was significantly lower in patients with lethal outcome (p<0.05. Ruptured abdominal aortic aneurysm still remains one of the most dramatic surgical states with very high mortality. Important intraoperative factors that influence the outcome of surgical treatment can be defined. Therapeutic efforts should be concentrated on those factors that are possible to correct, which would hopefully lead to better survival of patients. Nevertheless, screening for abdominal aortic aneurysm and elective surgical intervention before rupture occurs should be the best solution for this complex problem.

  13. Management of Traumatic Aortic and Splenic Rupture in a Patient With Ascending Aortic Aneurysm.

    Science.gov (United States)

    Topcu, Ahmet Can; Ciloglu, Ufuk; Bolukcu, Ahmet; Dagsali, Sabri

    2016-08-01

    Traumatic aortic rupture is rupture of all or part of the aortic wall, mostly resulting from blunt trauma to the chest. The most common site of rupture is the aortic isthmus. Traumatic rupture of the ascending aorta is rare. A 62-year-old man with a family history of ascending aortic aneurysm was referred to our hospital after a motor vehicle accident. He had symptoms of cardiogenic shock. A contrast-enhanced computed tomographic scan revealed rupture of the proximal ascending aorta and an ascending aortic aneurysm with a diameter of 55 mm at the level of the sinuses of Valsalva. Transthoracic echocardiography at the bedside revealed severe aortic valvular insufficiency. We performed a successful Bentall procedure. During postoperative recovery, the patient experienced a cerebrovascular accident. Transesophageal echocardiography did not reveal thrombosis of the mechanical prosthesis. The patient's symptoms resolved in time, and he was discharged from the hospital on postoperative day 47 without any sequelae. He has been symptom free during a 6-month follow-up period. We suggest that individuals who have experienced blunt trauma to the chest and have symptoms of traumatic aortic rupture and a known medical history of ascending aortic aneurysm should be evaluated for a rupture at the ascending aorta and the aortic isthmus. PMID:27449463

  14. Endovascular Exclusion of an Abdominal Aortic Aneurysm in Patients with Concomitant Abdominal Malignancy: Early Experience

    Energy Technology Data Exchange (ETDEWEB)

    Choi, You Ri; Chang, Nam Kyu [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of); Shin, Hyo Hyun; Oh, Hyun Jun; Kim, Jae Kyu; Choi, Soo Jin Na; Chung, Sang Young [Chonnam National University Hospital, Gwangju (Korea, Republic of); Yim, Nam Yeol [Armed Forces Yangju Hospital, Yangju (Korea, Republic of)

    2010-08-15

    To assess the outcomes of endovascular aortic aneurysm repair (EVAR) for the treatment of an abdominal aortic aneurysm in patients undergoing curative surgical treatment for concomitant abdominal malignancy. The study included 12 patients with abdominal neoplasia and an abdominal aortic aneurysm (AAA), which was treated by surgery and stent EVAR. The neoplasm consisted of the gastric, colorectal, pancreas, prostate, and gall bladder. The follow up period was 3-21 months (mean 11.8 months). All medical records and imaging analyses were reviewed by CTA and/or color Doppler US, retrospectively. Successful endoluminal repair was accomplished in all twelve patients. The mean interval time between EVAR and surgery was 58.6 days. Small amounts of type 2 endoleaks were detected in two patients (17%). One patient developed adult respiratory distress syndrome after Whipple's operation 20 days after surgery, which led to hopeless discharge. No procedure-related mortality, morbidity, or graft-related infection was noted. Exclusion of AAA in patients with accompanying malignancy show with a relatively low procedure morbidity and mortality. Hence, endoluminal AAA repair in patients with synchronous neoplasia may allow greater flexibility in the management of an offending malignancy

  15. Fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    GUO Wei; ZHANG Hong-peng; LIU Xiao-ping; JIA Xin; XIONG Jiang; MA Xiao-hui

    2013-01-01

    Background Endovascular stent-graft with fenestration can improve proximal sealing in patients with juxtarenal abdominal aortic aneurysm (JAAA).The purpose of this study was to describe our primary experience and evaluate the safety and efficacy of fenestrated device for JAAA in high-risk patients.Methods Between March 2011 and May 2012,nine male patients (mean age,(79.6±8.6) years) with asymptomatic JAAAs underwent elective deployment of the Zenith fenestrated stent-grafts at a single institution.All patients were treated in the hybrid operating room under general anesthesia.Follow-up computed tomography angiography (CTA) was routinely performed before discharge,at 3,6,and 12 months and annually thereafter.Results Procedural success was achieved in all cases.Total sixteen small fenestrations,two large fenestrations and eight scallops were used.Intra-operative complications occurred in four patients,which included one proximal type Ⅰ endoleak,two type Ⅱ endoleaks,and one renal artery dissection.The mean hospital stay was (8.9±1.4) days,mean blood loss was (360.5±46.8) ml,and mean iodinated contrast volume was (230.6±58.3) ml.The mean follow-up time was (7.6±4.2) months.The visceral graft patency was 100% until now.One patient had an increase of serum creatinine of more than 30%,but did not require dialysis.No patients died,no stent fractured,and migration were diagnosed during the follow-up.Conclusions The early results of fenestrated device for high-risk patients with complex JAAAs are satisfactory.However,long-term fenestrated graft durability and branch vessel patency remain to be determined.

  16. Endovascular therapy for abdominal aortic aneurysm and iliac artery aneurysm using SEAL aortic stent-graft: A single center experience

    Energy Technology Data Exchange (ETDEWEB)

    Park, Su Young; Kim, Jeong Ho; Byun, Sung Su; Kang, Jin Mo; Choi, Sang Tae; Park, Jae Hyung [Gachon University Gil Hospital, Incheon (Korea, Republic of)

    2015-03-15

    The aim of this study was to evaluate the safety and efficacy of SEAL aortic stent-graft for abdominal aortoiliac aneurysms. Between October 2007 and January 2014, 33 patients with abdominal aortoiliac aneurysms were treated with SEAL aortic stent-graft. We evaluated the technical success rate, clinical and CT follow-up periods, major complications, need for additional interventional treatment, aneurysm-related mortality and clinical success rate. SEAL bifurcated aortic stent-graft was successfully placed in 32 patients (97%). Clinical and CT follow-up periods were 24 and 14 months, respectively. Endoleak developed in 13 patients (41%): spontaneous regression or decrease in 6, need for additional treatment in 4 and follow-up loss in 3. Significant stenosis of stent-graft occurred in 4 patients (12%) and was treated with stenting in 3. Migration of stent-graft was noted in 3 patients (9%) and treated with additional stent-grafting. Aneurysm-related mortality was 9% (3 of 33). The placement of SEAL stent-graft was effective in 26 patients (79%). The placement of SEAL aortic stent-graft was safe and effective in patients with aneurysms of abdominal aorta and iliac arteries. However, complicating endoleaks, stenosis and migration of the stent-graft developed during the follow-up. Therefore, regular CT follow-up seems to be mandatory.

  17. Chaotic flow in an aortic aneurysm

    Science.gov (United States)

    Parashar, Abhinav; Singh, Rahul; Panigrahi, P. K.; Muralidhar, K.

    2013-06-01

    Oscillatory flow in straight and deformed geometries is seen in various biomedical applications. The nature of flow plays a significant role in the pathogenesis of an abdominal aortic aneurysm. The present study examines the onset of chaotic flow inside a bulged tube under oscillating flow conditions. An experimental facility is set up for generating the oscillatory flow field inside the model. A fusiform shaped model is hollowed out in a rectangular silicone model. A mixture of water and glycerin is used as the working liquid. Two-camera imaging system placed at right angles is used for three-component velocity measurement of a spherical particle inside the model. Images recorded as a time sequence are analyzed by a particle tracking algorithm. The particle trajectories in space and instantaneous velocities within the bulge have been obtained from experiments as well as numerical simulation. The frequency of oscillation considered is 1.2 Hz and the peak Reynolds numbers are in the range of 650-1200 (experiments) and 1000-3500 (simulation). The dimensionless frequency defined by the Womersely number is in the range of 10-12. Velocity signals obtained from the experiment have been analyzed to study chaotic behavior of fluid flow. Chaos is quantified in terms of the largest Lyapunov exponent, positive values being a signature of chaos. The Lyapunov exponent increases with Reynolds number and is significantly higher in the bulged geometry compared to that of the straight tube. The signature of chaotic flow is also seen in power spectra and Poincaré plots.

  18. Long telomeres in blood leukocytes are associated with a high risk of ascending aortic aneurysm.

    Directory of Open Access Journals (Sweden)

    Tuija J Huusko

    Full Text Available Ascending aortic aneurysm is a connective tissue disorder. Even though multiple novel gene mutations have been identified, risk profiling and diagnosis before rupture still represent a challenge. There are studies demonstrating shorter telomere lengths in the blood leukocytes of abdominal aortic aneurysm patients. The aim of this study was to measure whether relative telomere lengths are changed in the blood leukocytes of ascending aortic aneurysm patients. We also studied the expression of telomerase in aortic tissue samples of ascending aortic aneurysms. Relative lengths of leukocyte telomeres were determined from blood samples of patients with ascending aortic aneurysms and compared with healthy controls. Telomerase expression, both at the level of mRNA and protein, was quantified from the aortic tissue samples. Mean relative telomere length was significantly longer in ascending aortic aneurysm blood samples compared with controls (T/S ratio 0.87 vs. 0.61, p<0.001. Expressions of telomerase mRNA and protein were elevated in the aortic aneurysm samples (p<0.05 and p<0.01. Our study reveals a significant difference in the mean length of blood leukocyte telomeres in ascending aortic aneurysm and controls. Furthermore, expression of telomerase, the main compensating factor for telomere loss, is elevated at both the mRNA and protein level in the samples of aneurysmal aorta. Further studies will be needed to confirm if this change in telomere length can serve as a tool for assessing the risk of ascending aortic aneurysm.

  19. Laparo- and thoracoscopic aortic aneurysm neck optimization and treatment of potential endoleaks type IA and II in a porcine model

    Directory of Open Access Journals (Sweden)

    Brian O. Kloster

    2016-02-01

    Conclusion: Using these minimal invasive endoscopic approaches, it seems feasible to externally band aneurysm necks and ligate aortic side branches in a pig model. These procedures could potentially be considered as alternatives to OCs in controlling endoleaks and in improving the safety of endovascular interventions. As endoscopic aortic surgery is challenging a learning curve is expected. Practicing the described procedures using this model, can be used as a learning tool prior to similar interventions on humans.

  20. Mass or high-risk screening for abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Henneberg, E W; Fasting, H;

    1997-01-01

    Abdominal aortic aneurysm (AAA) is known to be associated with various diseases, especially hypertension, acute myocardial infarction (AMI), chronic obstructive airway disease (COAD), and intermittent claudication. These associations have led to a debate about whether screening of older men for AAA...

  1. Discrepancies in abdominal aortic aneurysm expressions and repair

    NARCIS (Netherlands)

    Hurks, R.

    2011-01-01

    Abdominal Aortic Aneurysm (AAA) disease is a growing healthcare burden. Besides theassociated cardiovascular comorbidities, the AAA itself poses a risk for the patient in two fashions. First, it could rupture, which is associated with high mortality and morbidity. This thesis focused on the second,

  2. Abdominal aortic aneurysms : clinical insights and outcome after endovascular repair

    NARCIS (Netherlands)

    Zandvoort, H.J.A.

    2013-01-01

    Abdominal aortic aneurysm (AAA) is a focal dilatation of the abdominal aorta. The pathophysiology of AAA is a complex multifactorial process and much is still unknown. Histologic and biochemical analysis of AAA wall characteristics can contribute to a better insight in AAA pathophysiology. To make t

  3. Asthma Associates With Human Abdominal Aortic Aneurysm and Rupture

    DEFF Research Database (Denmark)

    Liu, Cong-Lin; Wemmelund, Holger; Wang, Yi;

    2016-01-01

    OBJECTIVE: Both asthma and abdominal aortic aneurysms (AAA) involve inflammation. It remains unknown whether these diseases interact. APPROACH AND RESULTS: Databases analyzed included Danish National Registry of Patients, a population-based nationwide case-control study included all patients with...

  4. A variant in LDLR is associated with abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Bradley, Declan T; Hughes, Anne E; Badger, Stephen A;

    2013-01-01

    Abdominal aortic aneurysm (AAA) is a common cardiovascular disease among older people and demonstrates significant heritability. In contrast to similar complex diseases, relatively few genetic associations with AAA have been confirmed. We reanalyzed our genome-wide study and carried through...

  5. Mesenteric ischemia after abdominal aortic aneurysm repair : a systemic review

    NARCIS (Netherlands)

    Bruggink, J. L. M.; Tielliu, I. F. J.; Zeebregts, C. J.; Pol, R. A.

    2014-01-01

    Mesenteric ischemia after abdominal aneurysm repair is a devastating complication with mortality rates up to 70%. Incidence however is relatively low. The aim of this review was to provide an overview on current insights, diagnostic modalities and on mesenteric ischemia after abdominal aortic aneury

  6. Vascular diseases: aortitis, aortic aneurysms, and vascular calcification.

    Science.gov (United States)

    Ladich, Elena; Yahagi, Kazuyuki; Romero, Maria E; Virmani, Renu

    2016-01-01

    Inflammatory diseases of the aorta broadly include noninfectious and infectious aortitis, periaortitis, atherosclerosis, and inflammatory atherosclerotic aneurysms. Aortitis is uncommon but is increasingly recognized as an important cause of aortic aneurysms and dissections. Abdominal (AAA) and thoracic aortic aneurysms (TAA) have different pathologies and etiologies. AAAs are the most common type of aortic aneurysm, and the vast majority of these are atherosclerotic. The causes of TAA vary depending on the site of involvement, but medial degeneration is a common pathologic substrate, regardless of etiology, and genetic influences play a prominent role in TAA expression. Standardized classification schemes for inflammatory and degenerative diseases of the aorta have only recently been added to the pathology literature. A brief overview of the new histopathologic classifications for aortic inflammatory and degenerative diseases has recently been published by the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology as a consensus document on the surgical pathology of the aorta. Vascular calcification is a highly regulated biologic process, and the mechanisms leading to vascular calcification are under investigation. Calcification may occur in the intima (atherosclerotic) or in the media secondary to metabolic disease. Rarely, vascular calcification may be associated with genetic disorders. PMID:27526100

  7. A variant in LDLR is associated with abdominal aortic aneurysm

    NARCIS (Netherlands)

    Bradley, D.T.; Hughes, A.E.; Badger, S.A.; Jones, G.T.; Harrison, S.C.; Wright, B.J.; Bumpstead, S.; Baas, A.F.; Gretarsdottir, S.; Burnand, K.; Child, A.H.; Clough, R.E.; Cockerill, G.; Hafez, H.; Scott, D.J.; Ariens, R.A.; Johnson, A.; Sohrabi, S.; Smith, A.; Thompson, M.M.; Bockxmeer, F.M. van; Waltham, M.; Matthiasson, S.E.; Thorleifsson, G.; Thorsteinsdottir, U.; Blankensteijn, J.D.; Teijink, J.A.; Wijmenga, C.; Graaf, J. de; Kiemeney, L.A.L.M.; Wild, J.B.; Edkins, S.; Gwilliam, R.; Hunt, S.E.; Potter, S.; Lindholt, J.S.; Golledge, J.; Norman, P.E.; Rij, A. van; Powell, J.T.; Eriksson, P.; Stefansson, K.; Thompson, J.R.; Humphries, S.E.; Sayers, R.D.; Deloukas, P.; Samani, N.J.; Bown, M.J.

    2013-01-01

    BACKGROUND: Abdominal aortic aneurysm (AAA) is a common cardiovascular disease among older people and demonstrates significant heritability. In contrast to similar complex diseases, relatively few genetic associations with AAA have been confirmed. We reanalyzed our genome-wide study and carried thro

  8. High heritability of liability to abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Mejnert Jørgensen, Trine; Houlind, Kim Christian; Christensen, Kaare;

    2016-01-01

    OBJECTIVE: First degree relatives of patients with abdominal aortic aneurysm (AAA) have an increased risk of developing AAA; however, despite intensive investigation, the specific genetic factors involved in the development of the disease are still largely unknown. In twin studies the influence o...

  9. Antimicrobial Treatment to Impair Expansion of Abdominal Aortic Aneurysm (AAA)

    DEFF Research Database (Denmark)

    Bergqvist, David; Lindeman, Johannes H N; Lindholt, Jes Sanddal;

    2013-01-01

    Antimicrobial treatment to attenuate expansion of abdominal aortic aneurysm has been suggested, especially with the focus on Chlamydophila. In this systematic literature review only four randomized trials were identified. In two small studies there is an indication of an effect of roxithromycin...

  10. Bicuspid Aortic Valve Disease and Ascending Aortic Aneurysms: Gaps in Knowledge

    Directory of Open Access Journals (Sweden)

    Katie L. Losenno

    2012-01-01

    Full Text Available The bicuspid aortic valve is the most common congenital cardiac anomaly in developed nations. The abnormal bicuspid morphology of the aortic valve results in valvular dysfunction and subsequent hemodynamic derangements. However, the clinical presentation of bicuspid aortic valve disease remains quite heterogeneous with patients presenting from infancy to late adulthood with variable degrees of valvular stenosis and insufficiency and associated abnormalities including aortic coarctation, hypoplastic left heart structures, and ascending aortic dilatation. Emerging evidence suggests that the heterogeneous presentation of bicuspid aortic valve phenotypes may be a more complex matter related to congenital, genetic, and/or connective tissue abnormalities. Optimal management of patients with BAV disease and associated ascending aortic aneurysms often requires a thoughtful approach, carefully assessing various risk factors of the aortic valve and the aorta and discerning individual indications for ongoing surveillance, medical management, and operative intervention. We review current concepts of anatomic classification, pathophysiology, natural history, and clinical management of bicuspid aortic valve disease with associated ascending aortic aneurysms.

  11. Open aortic surgery after thoracic endovascular aortic repair.

    Science.gov (United States)

    Coselli, Joseph S; Spiliotopoulos, Konstantinos; Preventza, Ourania; de la Cruz, Kim I; Amarasekara, Hiruni; Green, Susan Y

    2016-08-01

    In the last decade, thoracic endovascular aortic aneurysm repair (TEVAR) has emerged as an appealing alternative to the traditional open aortic aneurysm repair. This is largely due to generally improved early outcomes associated with TEVAR, including lower perioperative mortality and morbidity. However, it is relatively common for patients who undergo TEVAR to need a secondary intervention. In select circumstances, these secondary interventions are performed as an open procedure. Although it is difficult to assess the rate of open repairs after TEVAR, the rates in large series of TEVAR cases (>300) have ranged from 0.4 to 7.9 %. Major complications of TEVAR that typically necessitates open distal aortic repair (i.e., repair of the descending thoracic or thoracoabdominal aorta) include endoleak (especially type I), aortic fistula, endograft infection, device collapse or migration, and continued expansion of the aneurysm sac. Conversion to open repair of the distal aorta may be either elective (as for many endoleaks) or emergent (as for rupture, retrograde complicated dissection, malperfusion, and endograft infection). In addition, in select patients (e.g., those with a chronic aortic dissection), unrepaired sections of the aorta may progressively dilate, resulting in the need for multiple distal aortic repairs. Open repairs after TEVAR can be broadly classified as full extraction, partial extraction, or full salvage of the stent-graft. Although full and partial stent-graft extraction imply failure of TEVAR, such failure is generally absent in cases where the stent-graft can be fully salvaged. We review the literature regarding open repair after TEVAR and highlight operative strategies.

  12. Acute Contained Ruptured Aortic Aneurysm Presenting as Left Vocal Fold Immobility

    Directory of Open Access Journals (Sweden)

    Sharon H. Gnagi

    2015-01-01

    Full Text Available Objective. To recognize intrathoracic abnormalities, including expansion or rupture of aortic aneurysms, as a source of acute onset vocal fold immobility. Methods. A case report and review of the literature. Results. An 85-year-old female with prior history of an aortic aneurysm presented to a tertiary care facility with sudden onset hoarseness. On laryngoscopy, the left vocal fold was immobile in the paramedian position. A CT scan obtained that day revealed a new, large hematoma surrounding the upper descending aortic stent graft consistent with an acute contained ruptured aortic aneurysm. She was referred to the emergency department for evaluation and treatment by vascular surgery. She was counseled regarding surgical options and ultimately decided not to pursue further treatment. Her vocal fold immobility was subsequently treated via office-based injection medialization two weeks after presentation and again 5 months after the initial injection which dramatically improved her voice. Follow-up CT scan at 8 months demonstrated a reduction of the hematoma. The left vocal cord remains immobile to date. Conclusion. Ortner’s syndrome, or cardiovocal syndrome, is hoarseness secondary to left recurrent laryngeal nerve palsy caused by cardiovascular pathology. It is a rare condition and, while typically presenting gradually, may also present with acute symptomatology.

  13. Case report: ruptured aortic aneurysm into oesophagus - treatment by covered stent

    International Nuclear Information System (INIS)

    Full text: A case report of a 70 year old man acutely presenting with a large descending thoracic aortic aneurysm, ruptured into the adjacent oesophagus. He was treated with an Aneurex covered stent (Medtronics). This patient has a long history of ischaemic heart disease, hypertension and previously treated abdominal aortic aneurysm. After diagnosis by CT, the bleeding was emergency temponaded by insertion of a Sengstaken-Blackmore tube into the oesophagus and inflated to arterial pressure. After stabilisation in ICU, it was decided that open surgery would probably prove fatal, and insertion of a covered thoracic aortic stent was performed in theatre with a femoral artery cut-down. Post-operatively the bleeding from the aortic aneurysm ceased. However, the patient has ongoing problems with large, open oesophageal ulcer with chronic ooze requiring intermittent transfusions, chronic infection with MRSA, requiring long term antibiotics, feeding via feeding gastrostomy tubes. The patient is stable 12 months after presentation. Treatment of this otherwise fatal problem by covered stent has permitted survival benefit. However, there are significant, unresolved issues of oesophageal ulcer and ongoing MRSA infection. Copyright (2002) Blackwell Science Pty Ltd

  14. Adventitial vasa vasorum arteriosclerosis in abdominal aortic aneurysm.

    Directory of Open Access Journals (Sweden)

    Hiroki Tanaka

    Full Text Available Abdominal aortic aneurysm (AAA is a common disease among elderly individuals. However, the precise pathophysiology of AAA remains unknown. In AAA, an intraluminal thrombus prevents luminal perfusion of oxygen, allowing only the adventitial vaso vasorum (VV to deliver oxygen and nutrients to the aortic wall. In this study, we examined changes in the adventitial VV wall in AAA to clarify the histopathological mechanisms underlying AAA. We found marked intimal hyperplasia of the adventitial VV in the AAA sac; further, immunohistological studies revealed proliferation of smooth muscle cells, which caused luminal stenosis of the VV. We also found decreased HemeB signals in the aortic wall of the sac as compared with those in the aortic wall of the neck region in AAA. The stenosis of adventitial VV in the AAA sac and the malperfusion of the aortic wall observed in the present study are new aspects of AAA pathology that are expected to enhance our understanding of this disease.

  15. Efficacy analysis of endovascular aneurysm repair and open surgery repair in patients with abdominal aortic aneurysm%腹主动脉瘤腔内修复与开腹手术治疗的疗效分析

    Institute of Scientific and Technical Information of China (English)

    唐佃俊; 张健; 辛世杰; 伦语; 沈世凯; 宋建博; 姜晗; 段志泉

    2015-01-01

    Objective To analyze and compare the clinical efficacies of endovascular aneurysm repair (EVAR) and open surgery repair (OSR) in patients with abdominal aortic aneurysm (AAA).Methods The clinical data of 271 patients with AAA who received surgery at the First Hospital of China Medical University between January 2004 and December 2014 were retrospectively analyzed.Of the 271 patients,153 patients undergoing EVAR were allocated into the EVAR group and 118 patients undergoing OSR into the OSR group,respectively.All the patients underwent a primary screening of preoperative ultrasonography and were diagnosed by three-dimensional computed tomography angiography (CTA),then urgent and severe patients were confirmed by abdominal enhanced CT.The procedures of EVAR:guide wire was inserted into the abdominal arota from femoral artery incision and branched stent was placed.The procedures of OSR:AAA was resected by median abdoninal incision,thrombi and sclerosis plaques in endovascular wall were cleared,and end-to-end abdominal aortic anastomosis and end-to-side iliac aortic anastomosis were performed using Y-shaped blood vessel prosthesis.All the patients were followed up by telephone interview up to December 31,2014.The operation situation,complications at postoperative day 30,short-term complications (between postoperative 3 months and 3 years),medium-and long-term complications (more than postoperative 3 years),mortality and survival rate were observed.Measurement data with normal distribution were presented as x ± s and analyzed using the t test,and count data were analyzed using the chi-square test or Fisher exact probability.Survival curve was drawn by the Kaplan-Meier method,and survival rate was analyzed using the Log-rank test.Results All the patients were confirmed as with AAA by preoperative three-dimensional CTA.The operation time,volume of intraoperative blood loss,volume of intraoperative blood transfusion,time for out-off-bed activity,duration of hospital stay

  16. A proposal for standardizing computed tomography reports on abdominal aortic aneurysms; Proposta para padronizacao do relatorio de tomografia computadorizada nos aneurismas da aorta abdominal

    Energy Technology Data Exchange (ETDEWEB)

    Torlai, Fabiola Goda; Meirelles, Gustavo S. Portes [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil); Miranda Junior, Fausto; Fonseca, Jose Honorio A.P. da [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Cirurgia; Ajzen, Sergio; D' Ippolito, Giuseppe [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Diagnostico por Imagem]. E-mail: giuseppe_dr@uol.com.br

    2006-07-15

    Objective: to propose a model to standardize computed tomography reports on abdominal aortic aneurysms. Materials and methods: interviews were carried out with members of the Vascular Surgery Division of our institution, in the period between April and October 2004, aiming at developing a standardized model of computed tomography reports on abdominal aortic aneurysms. Based on this model, a questionnaire was elaborated and sent to other nine surgeons, all of them experienced in the field of abdominal aortic surgery. The questionnaires response rate was 55.5% (5/9). Results: the most frequently mentioned parameters of interest for evaluation of abdominal aortic aneurysms were: maximum diameter of proximal aortic neck, proximal aortic neck length to lower renal arteries, shape of proximal aortic neck, maximum diameter of the aneurysm and diameter of the common iliac arteries. These data allowed the development of a proposal for a model to standardize computed tomography reports. Conclusion: a model for standardized tomographic analysis of abdominal aortic aneurysms has met vascular surgeons' needs for following-up patients and planning their treatment. (author)

  17. Natural history of abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Perko, M J; Schroeder, T V; Olsen, P S;

    1993-01-01

    .53, corresponding to an annual risk of 30%. Diameter of the aneurysm was found to be the only factor with a significant impact on the rate of rupture. The cumulative 5-year hazard rate of rupture among patients with aneurysms cm and > or = 6 cm was 0.2 and 0.6, respectively, corresponding to an annual risk...

  18. Myocardial Infarction and Aortic Root Mycotic Aneurysm Complicating Aortic Valve Endocarditis: Utility of Cardiac CT.

    Science.gov (United States)

    Moores, Aimee E; Cahill, Michael S; Villines, Todd C

    2016-01-01

    Aortic mycotic aneurysms are a rare but life-threatening potential complication of infective endocarditis. Rapid deterioration of the vascular wall in highly focal areas makes these pseudoaneurysms particularly prone to rupture, resulting in uncontrolled aortic hemorrhage. While computed tomography angiography (CTA) is the imaging modality of choice for the evaluation of mycotic aneurysms, it is not routinely performed in patients with known or suspected infective endocarditis (IE). However, current valvular heart disease guidelines support the use of cardiac CTA in cases of IE and suspected perivalvular extension when there is inadequate or ambiguous visualization on echocardiography. Here, we describe a case of IE in which cardiac CTA was used for two purposes: to assess perivalvular complications and to define coronary anatomy in a patient with a suspected embolic myocardial infarction. Subsequent detection of an aortic root mycotic aneurysm not previously demonstrated on transthoracic or transesophageal echocardiography allowed for timely and uncomplicated surgical intervention, while avoiding invasive coronary angiography. PMID:27642299

  19. Anesthetic considerations for endovascular abdominal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Harikrishnan Kothandan

    2016-01-01

    Full Text Available Aneurysm is defined as a localized and permanent dilatation with an increase in normal diameter by more than 50%. It is more common in males and can affect up to 8% of elderly men. Smoking is the greatest risk factor for abdominal aortic aneurysm (AAA and other risk factors include hypertension, hyperlipidemia, family history of aneurysms, inflammatory vasculitis, and trauma. Endovascular Aneurysm Repair [EVAR] is a common procedure performed for AAA, because of its minimal invasiveness as compared with open surgical repair. Patients undergoing EVAR have a greater incidence of major co-morbidities and should undergo comprehensive preoperative assessment and optimization within the multidisciplinary settings. In majority of cases, EVAR is extremely well-tolerated. The aim of this article is to outline the Anesthetic considerations related to EVAR.

  20. Anesthetic considerations for endovascular abdominal aortic aneurysm repair

    Science.gov (United States)

    Kothandan, Harikrishnan; Haw Chieh, Geoffrey Liew; Khan, Shariq Ali; Karthekeyan, Ranjith Baskar; Sharad, Shah Shitalkumar

    2016-01-01

    Aneurysm is defined as a localized and permanent dilatation with an increase in normal diameter by more than 50%. It is more common in males and can affect up to 8% of elderly men. Smoking is the greatest risk factor for abdominal aortic aneurysm (AAA) and other risk factors include hypertension, hyperlipidemia, family history of aneurysms, inflammatory vasculitis, and trauma. Endovascular Aneurysm Repair [EVAR] is a common procedure performed for AAA, because of its minimal invasiveness as compared with open surgical repair. Patients undergoing EVAR have a greater incidence of major co-morbidities and should undergo comprehensive preoperative assessment and optimization within the multidisciplinary settings. In majority of cases, EVAR is extremely well-tolerated. The aim of this article is to outline the Anesthetic considerations related to EVAR. PMID:26750684

  1. Giant Aortic Root Aneurysm Presenting as Acute Type A Aortic Dissection

    OpenAIRE

    Raz, Guy M.; Stamou, Sotiris C.

    2014-01-01

    A 49-year-old woman with four months of increasing episodic palpitations, chest pain, and shortness of breath presented to an outside clinic where a new 4/6 systolic ejection murmur was identified. A transthoracic echocardiogram revealed a large aortic root aneurysm. The patient underwent emergent repair of the dissected root aneurysm with a modified Bentall procedure utilizing a #19 St Jude Valsalva mechanical valve conduit. Postoperatively, she required a permanent pacemaker placement. Her ...

  2. Aortic aneurysm and diverticulum of Kommerell: a dreadful concomitance

    Directory of Open Access Journals (Sweden)

    Fernando Peixoto Ferraz de Campos

    2012-12-01

    Full Text Available First described in 1936, the diverticulum of Kommerell (DOK is a dilatation of the proximal segment of an aberrant subclavian artery. Appearing more frequently in the left-sided aortic arch, the aberrant right subclavian artery passes behind the esophagus toward the right arm, causing symptoms in the minority of cases. Diagnosis is generally incidental with this pattern. When symptomatic, dysphagia, respiratory symptoms, hoarseness, chest pain, and upper limb ischemia are the most common complaints. Although debatable, the origin of DOK is accepted as being degenerative or congenital. The degenerative condition is normally associated with atherosclerosis and occurs more frequently after the age of 50 years with no gender predominance. Complications may be life threatening and are more commonly related to the diverticulum aneurysm or when associated with aortic diseases such as aneurysms or dissection. The authors present a case of a 67-year-old male with a history of acute chest pain, neurological disturbances, and hypertensive crisis. The diagnostic workup revealed an aortic arch aneurysm with intramural hematoma and a diverticulum aneurysm of Kommerell. Treatment was conservative at first. The patient presented a satisfactory outcome and was referred to an outpatient clinic for follow up and further therapeutic consolidation.

  3. Clinical outcomes of endovascular aneurysm repair of abdominal aortic aneurysm complicated with hypertension: A 5-year experience

    Science.gov (United States)

    Peng, Xi-Tao; Yuan, Qi-Dong; Cui, Ming-Zhe; Fang, Hong-Chao

    2016-01-01

    Objective: To evaluate the therapeutic effects of endovascular aneurysm repair (EVAR) on abdominal aortic aneurysm (AAA) complicated with hypertension. Methods: Fifty-two patients with AAA complicated with hypertension treated in our hospital were retrospectively analyzed. They were divided into an observation group (34 cases) and a control group (18 cases). The control group was treated by incision of AAA and artificial blood vessel replacement, and the observation group was treated by EVAR. Results: All surgeries were performed successfully. However, compared with the control group, the observation group had significantly less surgical time, intraoperative blood loss and blood transfusion, as well as significantly higher total hospitalization expense (PEVAR should be preferentially selected in the treatment of AAA complicated with hypertension due to minimal invasion, safety, stable postoperative vital signs and improved quality of life. PMID:27022336

  4. Primary congenital abdominal aortic aneurysm: a case report with perinatal serial follow-up imaging

    International Nuclear Information System (INIS)

    Abdominal aortic aneurysms in neonates and infants are rare and are usually associated with infection, vasculitis, connective tissue disorder, or iatrogenic trauma such as umbilical catheterization. An idiopathic congenital abdominal aortic aneurysm is the least common category and there are few descriptions of the imaging features. We present the antenatal and postnatal imaging findings of an idiopathic congenital abdominal aortic aneurysm including the findings on US, MRI and CT. (orig.)

  5. Primary congenital abdominal aortic aneurysm: a case report with perinatal serial follow-up imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Im; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung [Seoul National University College of Medicine, Seoul National University Hospital, Department of Radiology, Seoul (Korea); Kim, Sang Joon [Seoul National University College of Medicine, Seoul National University Hospital, Department of Surgery, Seoul (Korea); Seo, Jeong-Wook [Seoul National University College of Medicine, Seoul National University Hospital, Department of Pathology, Seoul (Korea)

    2008-11-15

    Abdominal aortic aneurysms in neonates and infants are rare and are usually associated with infection, vasculitis, connective tissue disorder, or iatrogenic trauma such as umbilical catheterization. An idiopathic congenital abdominal aortic aneurysm is the least common category and there are few descriptions of the imaging features. We present the antenatal and postnatal imaging findings of an idiopathic congenital abdominal aortic aneurysm including the findings on US, MRI and CT. (orig.)

  6. Chronic Paraspinal Pain due to Multiple Aortic Aneurysms.

    Science.gov (United States)

    Basu, Arindam; Biswas, Nirendra Mohan; Roy, Pinaki; Maity, Pranab Kumar; Mukhopadhyay, Mainak

    2015-05-01

    Aneurysms of the aorta are not uncommon, both of the thoracic aorta or the abdominal aorta and may be associated with congenital aortic valve diseases, cystic medial necrosis, Marfan's Syndrome or Ehlers-Danlos syndrome, or atherosclerosis. We report a case of a 46 year old smoker who had developed multiple aneurysms of the aorta in both the thoracic and abdominal parts and was incidentally diagnosed on work-up of a chronic back pain associated with venous prominence on left side of chest and left arm. PMID:26591150

  7. Complex pathologies of angiotensin Ⅱ-induced abdominal aortic aneurysms

    Institute of Scientific and Technical Information of China (English)

    Alan DAUGHERTY; Lisa A. CASSIS; Hong LU

    2011-01-01

    Angiotensin Ⅱ (Angll) is the primary bioactive peptide of the renin angiotensin system that plays a critical role in many cardiovascular diseases.Subcutaneous infusion of Angll into mice induces the development of abdominal aortic aneurysms (AAAs).Like human AAAs,Angll-induced AAA tissues exhibit progressive changes and considerable heterogeneity.This complex pathology provides an impediment to the quantification of aneurysmal tissue composition by biochemical and immunostaining techniques.Therefore,while the mouse model of Angll-induced AAAs provides a salutary approach to studying the mechanisms of the evolution of AAAs in humans,meaningful interpretation of mechanisms requires consideration of the heterogeneous nature of the diseased tissue.

  8. Open and endovascular repair of juxtarenal abdominal aortic aneurysms: a systematic review

    Directory of Open Access Journals (Sweden)

    Sergio Quilici Belczak

    2014-09-01

    Full Text Available This systematic review focuses on the 30-day mortality associated with open surgery and fenestrated endografts for short-necked (<15 mm juxtarenal abdominal aortic aneurysms. A search for studies published in English and indexed in the PubMed and Medline electronic databases from 2002 to 2012 was performed, using “juxtarenal abdominal aortic aneurysm” and “treatment” as the main keywords. Among the 110 potentially relevant studies that were initially identified, eight were in accordance with the inclusion criteria in the analysis. Similar outcomes for open and endovascular repair were observed for 30-day mortality. No differences were observed regarding the secondary outcomes (duration of surgery, hospital stay, postoperative renal dysfunction and late mortality, except that the late mortality rate was significantly higher for the patients treated with open repair after a median follow-up of 24 months. Fenestrated endografting is a viable alternative to conventional surgery in juxtarenal abdominal aortic aneurysms with a proximal neck <15 mm.

  9. Mycotic aneurysm of the aortic arch presenting with left vocal cord palsy.

    Science.gov (United States)

    Tokmaji, George; Gosev, Igor; Kumamaru, Kanako Kunishima; Bolman, Ralph Morton

    2013-07-01

    We report a case of a 71-year-old man with a mycotic aneurysm of the aortic arch who presented with progressive hoarseness. Three weeks prior to this event the patient was admitted to an outside hospital in septic condition and was diagnosed with a mycotic abdominal aortic aneurysm. Resection of the infected abdominal aortic aneurysm with right axillofemoral and femoral-femoral bypass grafts was performed and the patient was discharged home on intravenous antibiotics. At our institution, the aortic arch aneurysm was treated with extensive debridement and replaced with a Dacron prosthesis under circulatory arrest with antegrade cerebral perfusion through the axillofemoral bypass. PMID:23816081

  10. Management of an aorto-esophageal fistula, complicating a descending thoracic aortic aneurysm endovascularly repaired.

    Science.gov (United States)

    Georvasili, Vaia K; Bali, Christina; Peroulis, Michalis; Kouvelos, George; Avgos, Stavros; Godevenos, Dimitris; Liakakos, Theodoros; Matsagkas, Miltiadis

    2016-04-01

    Aorto-esophageal fistula (AEF) is a rare but devastating complication of thoracic aorta endovascular repair (TEVAR). We report a case of a 64-year-old male who presented with chest pain and high CRP levels 10 months after TEVAR for a 9 cm diameter descending thoracic aortic aneurysm. The diagnosis of an AEF was confirmed and the patient was treated conservatively with broad spectrum antibiotics and total parental alimentation. After control of sepsis was achieved, esophagectomy with gastric tube reconstruction was performed and an omental pedicle was used to cover the aortic wall. No intervention to the aorta was made at that time due to the potentially infected mediastinum. The patient's recovery was uneventful and 2 years postoperatively he is in good condition and lives a normal life. Esophagectomy seems to be a mandatory stage of treatment in the setting of AEF. In cases where signs of graft infection are persistent, aortic surgery might be also necessary. PMID:24838140

  11. Fluid-structure interaction of a patient-specific abdominal aortic aneurysm treated with an endovascular stent-graft.

    LENUS (Irish Health Repository)

    Molony, David S

    2009-01-01

    BACKGROUND: Abdominal aortic aneurysms (AAA) are local dilatations of the infrarenal aorta. If left untreated they may rupture and lead to death. One form of treatment is the minimally invasive insertion of a stent-graft into the aneurysm. Despite this effective treatment aneurysms may occasionally continue to expand and this may eventually result in post-operative rupture of the aneurysm. Fluid-structure interaction (FSI) is a particularly useful tool for investigating aneurysm biomechanics as both the wall stresses and fluid forces can be examined. METHODS: Pre-op, Post-op and Follow-up models were reconstructed from CT scans of a single patient and FSI simulations were performed on each model. The FSI approach involved coupling Abaqus and Fluent via a third-party software - MpCCI. Aneurysm wall stress and compliance were investigated as well as the drag force acting on the stent-graft. RESULTS: Aneurysm wall stress was reduced from 0.38 MPa before surgery to a value of 0.03 MPa after insertion of the stent-graft. Higher stresses were seen in the aneurysm neck and iliac legs post-operatively. The compliance of the aneurysm was also reduced post-operatively. The peak Post-op axial drag force was found to be 4.85 N. This increased to 6.37 N in the Follow-up model. CONCLUSION: In a patient-specific case peak aneurysm wall stress was reduced by 92%. Such a reduction in aneurysm wall stress may lead to shrinkage of the aneurysm over time. Hence, post-operative stress patterns may help in determining the likelihood of aneurysm shrinkage post EVAR. Post-operative remodelling of the aneurysm may lead to increased drag forces.

  12. Fluid-structure interaction of a patient-specific abdominal aortic aneurysm treated with an endovascular stent-graft

    Directory of Open Access Journals (Sweden)

    McGloughlin Tim M

    2009-10-01

    Full Text Available Abstract Background Abdominal aortic aneurysms (AAA are local dilatations of the infrarenal aorta. If left untreated they may rupture and lead to death. One form of treatment is the minimally invasive insertion of a stent-graft into the aneurysm. Despite this effective treatment aneurysms may occasionally continue to expand and this may eventually result in post-operative rupture of the aneurysm. Fluid-structure interaction (FSI is a particularly useful tool for investigating aneurysm biomechanics as both the wall stresses and fluid forces can be examined. Methods Pre-op, Post-op and Follow-up models were reconstructed from CT scans of a single patient and FSI simulations were performed on each model. The FSI approach involved coupling Abaqus and Fluent via a third-party software - MpCCI. Aneurysm wall stress and compliance were investigated as well as the drag force acting on the stent-graft. Results Aneurysm wall stress was reduced from 0.38 MPa before surgery to a value of 0.03 MPa after insertion of the stent-graft. Higher stresses were seen in the aneurysm neck and iliac legs post-operatively. The compliance of the aneurysm was also reduced post-operatively. The peak Post-op axial drag force was found to be 4.85 N. This increased to 6.37 N in the Follow-up model. Conclusion In a patient-specific case peak aneurysm wall stress was reduced by 92%. Such a reduction in aneurysm wall stress may lead to shrinkage of the aneurysm over time. Hence, post-operative stress patterns may help in determining the likelihood of aneurysm shrinkage post EVAR. Post-operative remodelling of the aneurysm may lead to increased drag forces.

  13. 主动脉瘤的误诊及防范%Aortic aneurysm of the misdiagnosis and protection

    Institute of Scientific and Technical Information of China (English)

    陈洪喜; 程云

    2013-01-01

    aneurysm misdiagnosis rate is high ,the clinician to not familiar with this disease and clinical manifestation is not typical ,for high -risk patients (age>60 years old ,in the family has a history of abdominal aortic aneurysm rupture occurred ,or have high blood pressure or a history of smoking ) using abdominal ultrasound as found abdominal aortic aneurysm screening methods and for suspected aortic aneurysm patients in critical con-dition of abdominal ultrasound ,with adequate support therapy ,blood transfusion ,infusion for laparotomy surgery at the same time ,anti -shock treatment can reduce aortic aneurysm misdiagnosis .%主动脉瘤误诊率高,临床医师对本病不够熟悉并且临床表现不典型,对高危患者(年龄>60岁、家族中有发生腹主动脉瘤破裂病史,或有高血压或吸烟史)采用腹部超声检查作为发现腹主动脉瘤的筛选方法及对怀疑主动脉瘤的病情危急病人行腹部超声,在给予充分的支持疗法、输血、输液等抗休克治疗的同时争取手术剖腹探查,可以减少主动脉瘤误诊。

  14. Endograft-preserving therapy of a patient with Coxiella burnetii-infected abdominal aortic aneurysm: a case report

    Directory of Open Access Journals (Sweden)

    Kloppenburg Geoffrey TL

    2011-12-01

    Full Text Available Abstract Introduction Coxiella burnetii, the causative agent of Q fever, may cause endocarditis and vascular infections that result in severe morbidity and mortality. We report a case of a C. burnetii-infected abdominal aorta and its management in a patient with a previous endovascular aortic aneurysm repair. Case presentation A 62-year-old Caucasian man was admitted to our hospital three months after endovascular aortic aneurysm repair with a bifurcated stent graft. He had increasing abdominal complaints and general malaise. A computed tomography scan of his abdomen revealed several para-aneurysmal abscesses. Surgery was performed via midline laparotomy. The entire abdominal wall of his aneurysmal sac, including the abscesses, was removed. The vascular endoprosthesis showed no macroscopic signs of infection. The decision was made to leave the endograft in place because of the severe cardiopulmonary comorbidities, thereby avoiding suprarenal clamping and explantation of this device with venous reconstruction. The proximal and distal parts of the endograft were secured to the aortic wall and common iliac artery walls, respectively, to avoid future migration. Polymerase chain reaction for C. burnetii was positive in all specimens of aortic tissue. Specific antibiotic therapy was initiated. Our patient was discharged in good clinical condition after six days. Conclusions In our patient, the infection was limited to the abdominal aneurysm wall, which was removed, leaving the endograft in place. Vascular surgeons should be familiar with this bailout procedure in high-risk patients.

  15. Hybrid procedures for thoracoabdominal aortic aneurysms and dissections

    Institute of Scientific and Technical Information of China (English)

    ZHANG Hong-peng; GUO Wei; LIU Xiao-ping; JIA Xin; XIONG Jiang; MA Xiao-hui

    2013-01-01

    Background Hybrid procedures including debranching of visceral and renal arteries followed by endovascular exclusion of the thoracoabdominal aortic aneurysm (TAAA) have recently been proposed as a less invasive alternative to conventional TAAA surgery.This study aimed to evaluate the immediate and long-term outcomes of hybrid procedures for TAAA in high-risk patients.Methods Between September 1998 and May 2012,32 high-risk TAAA patients (five females,median age 61.5 years)underwent hybrid procedures at a single institution.Simultaneous approach and staged approach were performed on the basis of patients' conditions.Follow-up computed tomography angiography (CTA) was routinely performed before discharge and at 6,12 months and annually thereafter.Results Procedural success was achieved in all cases.The median hospital stay was (21.5±2.3) days,and the median procedure time was (420±31) minutes.Blood loss averaged (2100±261) ml.A total of 124 visceral artery bypasses was performed.Two patients (6.3%) died within 30 days.One patient exhibited complete paraplegia (3.1%).The visceral graft patency was 96.1% at 3 years.All-cause survival rates were 93.8%,87.5%,81.3% and 53.1% at 1,2,3 and 5 years,respectively.No patient died due to aortic events.The freedom rates from aortic events were 96.9%,93.6%,87.5%,68.8% at 1,2,3 and 5 years,respectively.Conclusions The results of visceral hybrid repair for high-risk patients with complex TAAAs are encouraging.However,the procedure is still a significant physiological insult to patients.Until branched and fenestrated endovascular repair become more common,hybrid procedure will continue to have a role in high-risk patients.

  16. Plasma cytokine levels and risks of abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Liao, Mengyang; Liu, Cong-Lin; Lv, Bing-Jie;

    2015-01-01

    BACKGROUND: Abdominal aortic aneurysm (AAA) is characterized by inflammatory cell accumulation in AAA lesions that produce inflammatory cytokines and advance its pathogenesis. Peripheral cytokines may predict the degree or risk of AAA. METHODS AND RESULTS: ELISA determined plasma interleukin-6 (IL6...... with systolic blood pressure, whereas CRP associated positively with diastolic blood pressure and body mass index. CRP was an independent AAA risk factor and correlated positively with aortic diameters before and after adjustments for other risk factors. IFN-γ, IL17A, and CRP correlated positively with cross...

  17. Categorization of aortic aneurysm thrombus morphology by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Motte, Louise de la, E-mail: louise.de.la.motte@rh.regionh.dk [Department of Vascular Surgery, Rigshospitalet and University of Copenhagen (Denmark); Pedersen, Mads Møller, E-mail: phd@medit.dk [Department of Radiology, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen (Denmark); Thomsen, Carsten, E-mail: carsten.thomsen@rh.regionh.dk [Department of Radiology, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen (Denmark); Vogt, Katja, E-mail: Vogt@dadlnet.dk [Department of Vascular Surgery, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen (Denmark); Schroeder, Torben V., E-mail: Torben.Veith.schroeder@rh.regionh.dk [Department of Vascular Surgery, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen (Denmark); Lonn, Lars, E-mail: lonn.lars@gmail.com [Department of Vascular Surgery and Department of Radiology, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen (Denmark)

    2013-10-01

    Background: Magnetic resonance imaging (MRI) has been proposed for qualitative categorization of intraluminal thrombus morphology. We aimed to correlate the qualitative MRI categorization previously described to quantitative measurements of signal intensity and to compare morphological characteristics of intraluminal thrombus specimens to the appearance on magnetic resonance imaging. Methods: Thirty-four patients undergoing open surgery for abdominal aortic aneurysm had a preoperative MRI obtained with a 1.5 T magnet. Qualitative categorization was performed (blinded and in consensus) and correlated to intraluminal thrombus to muscle signal-intensity ratios. Morphology of intraluminal thrombus specimens collected during surgery were compared to the magnetic resonance imaging categories and specimen weight was correlated to thrombus volume measured on preoperative computer tomography angiography. Results: Blinded MRI categorization resulted in agreement in 22 out of 34 intraluminal thrombi (Kappa value 0.3, p = 0.006). Medians (p = 0.004) and distribution (p = 0.002) of signal-intensity ratios varied significantly across the three MRI categories obtained by consensus. Heterogeneous and homogenous specimen appearance corresponded to similar appearances on MRI in 78% and 55% respectively, resulting in an overall Kappa = 0.4 (p = 0.04). Intraluminal thrombus volume and weight correlated well (r{sub s} 0.831, p < 0.001) with a mean difference of 60 g (95% CI 38–80 g), without proportional bias. Conclusion: Qualitative evaluation of intraluminal thrombus morphology based on MRI can be quantified by measuring signal-intensity ratios. Concurrently a fair agreement to blinded qualitative evaluation of thrombus specimens can be obtained. However, the evaluation is impaired by loss of a large proportion of thrombus during sampling.

  18. Genetic Algorithm for Analysis of Abdominal Aortic Aneurysms in Radiology Reports

    Energy Technology Data Exchange (ETDEWEB)

    Patton, Robert M [ORNL; Beckerman, Barbara G [ORNL; Treadwell, Jim N [ORNL; Potok, Thomas E [ORNL

    2010-01-01

    An abdominal aortic aneurysm is a problem in which the wall of the artery that supplies blood to the abdomen and lower extremities expands under pressure or balloons outward. Patients must undergo surgery to repair such aneurysm, and there is currently no known indicator of success or failure from this surgery. Our work uses a genetic algorithm to analyze radiology reports from these patients to look for common patterns in the language used as well as common features of both successful and unsuccessful surgieries. The results of the genetic algorithm show that patients with complications or unusual characteristics can be identified from a set of radiology reports without the use of search keywords, clustering, categorization, or ontology. This allows medical researchers to search and identify interesting patient records without the need for explicitly defining what interesting patient records are.

  19. The effect of flow recirculation on abdominal aortic aneurysm

    Science.gov (United States)

    Taib, Ishkrizat; Amirnordin, Shahrin Hisham; Madon, Rais Hanizam; Mustafa, Norrizal; Osman, Kahar

    2012-06-01

    The presences of flow recirculation at the abdominal aortic aneurysm (AAA) region yield the unpredictable failure of aneurismal wall. The failure of the aneurismal wall is closely related to the hemodynamic factor. Hemodynamic factor such as pressure and velocity distribution play a significance role of aneurysm growth and rupture. By using the computational approach, the influence of hemodynamic factor is investigated using computational fluid dynamic (CFD) method on the virtual AAA model. The virtual 3D AAAs model was reconstructed from Spiral Computed Tomography scan (CT-scan). The blood flow is assumed as being transient, laminar and Newtonian within a rigid section of the vessel. The blood flow also driven by an imposed of pressure gradient in the form of physiological waveform. The pulsating blood flow is also considered in this simulation. The results on pressure distribution and velocity profile are analyzed to interpret the behaviour of flow recirculation. The results show the forming of vortices is seen at the aneurysm bulge. This vortices is form at the aneurysm region then destroyed rapidly by flow recirculation. Flow recirculation is point out much higher at distal end of aneurysm closed to iliac bifurcation. This phenomenon is managed to increase the possibility of aneurysm growth and rupture.

  20. Systemic levels of cotinine and elastase, but not pulmonary function, are associated with the progression of small abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Jørgensen, B; Klitgaard, N A;

    2003-01-01

    to study whether smoking and impaired pulmonary function are associated with the expansion of abdominal aortic aneurysms (AAA).......to study whether smoking and impaired pulmonary function are associated with the expansion of abdominal aortic aneurysms (AAA)....

  1. Circumaortic Left Renal Vein Associated with Juxtarenal Abdominal Aortic Aneurysm

    OpenAIRE

    Hashizume, Koji; Taniguchi, Shinichiro; Ariyoshi, Tsuneo; Hisata, Yoichi; Tanigawa, Kazuyoshi; Miura, Takashi; Sumi, Mizuki; Eishi, Kiyoyuki

    2013-01-01

    The patient was an 82-year-old man who was found to have a juxtarenal abdominal aortic aneurysm accompanied by a circumaortic left renal vein (CLRV). During dissection of the proximal anastomosis site the CLRV was injured, but was successfully repaired. A graft implantation was performed below the renal arteries. The incidence of CLRV is thought to be rare, however it is found in 7% of cadavers donated for anatomy. CLRV may cause unexpected bleeding by inadvertent dissection of the abdominal ...

  2. Mechanical stress in abdominal aortic aneurysms using artificial neural networks

    OpenAIRE

    Soudah Prieto, Eduardo; Rodriguez, Jose; López González, Roberto

    2015-01-01

    Combination of numerical modeling and artificial intelligence (AI) in bioengineering processes are a promising pathway for the further development of bioengineering sciences. The objective of this work is to use Artificial Neural Networks (ANN) to reduce the long computational times needed in the analysis of shear stress in the Abdominal Aortic Aneurysm (AAA) by finite element methods (FEM). For that purpose two different neural networks are created. The first neural network (Mesh Neural Netw...

  3. HAS-1 genetic polymorphism in sporadic abdominal aortic aneurysm

    OpenAIRE

    Alberto Balbarini; Rossella Di Stefano; Marco Nuti; Stefano Landi; Chiara Armani

    2009-01-01

    The hyaluronan synthase 1 (HAS-1) gene encodes a plasma membrane protein that synthesizes hyaluronan (HA), an extracellular matrix molecule. Accumulating evidence emphasizes the relevance of HA metabolism in an increasing number of processes of clinical interest, including abdominal aortic aneurysm (AAA). The existence of aberrant splicing variants of the HAS-1 gene could partly explain the altered extracellular matrix architecture and influence various biological functions, resulting in prog...

  4. The radiation burden from increasingly complex endovascular aortic aneurysm repair

    OpenAIRE

    Thakor, Avnesh S.; Winterbottom, Andrew; Mercuri, Mathew; Cousins, Claire; Gaunt, Michael E

    2011-01-01

    Objectives With increasing experience, endovascular aortic aneurysm repair (EVAR) has been extended to patients with less suitable aorto-iliac anatomy in an attempt to reduce peri-operative mortality. However, more complex EVAR procedures may take longer and can result in higher rates of complications, additional interventional procedures and more frequent radiological imaging, which may offset some of the benefit. This study determined the radiation burden for standard EVAR, as determined by...

  5. Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management

    OpenAIRE

    Mark eScaife; Triantafillos eGiannakopoulos; Georges eAlkhoury; Chaer, Rabih A.; Avgerinos, Efthymios D.

    2016-01-01

    Ultrasound (US) is a well-established screening tool for detection of abdominal aortic aneurysms (AAA) and is currently recommended not only for those with a relevant family history but for all men and high-risk women older than 65 years of age. The advent of minimally invasive endovascular techniques in the treatment of AAAs (EVAR) has increased the need for repeat imaging especially in the post-operative period. Nevertheless, preoperative planning, intraoperative execution and postoperative...

  6. Abdominal Aortic Diameter Is Increased in Males with a Family History of Abdominal Aortic Aneurysms

    DEFF Research Database (Denmark)

    Mejnert Jørgensen, Trine; Houlind, K; Green, A;

    2014-01-01

    OBJECTIVE: To investigate, at a population level, whether a family history of abdominal aortic aneurysm (AAA) is independently related to increased aortic diameter and prevalence of AAA in men, and to elucidate whether the mean aortic diameter and the prevalence of AAA are different between...... participants with male and female relatives with AAA. DESIGN: Observational population-based cross-sectional study. MATERIALS: 18,614 male participants screened for AAA in the VIVA-trial 2008-2011 with information on both family history of AAA and maximal aortic diameter. METHODS: Standardized ultrasound scan...... measurement of maximum antero-posterior aortic diameter. Family history obtained by questionnaire. Multivariate regression analysis was used to test for confounders: age, sex, smoking, comorbidity and medication. RESULTS: From the screened cohort, 569 participants had at least one first degree relative...

  7. Infrarenal abdominal aortic aneurysm. Endovascular repair with stent grafts; Infrarenales Bauchaortenaneurysma. Endovaskulaere Stent-Graft-Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, M.; Voshage, G.; Landwehr, P. [Klinik fuer Diagnostische und Interventionelle Radiologie, Gefaesszentrum Hannover, Diakoniekrankenhaus Henriettenstiftung gGmbH, Hannover (Germany); Busch, T. [Klinik fuer Gefaesschirurgie, Gefaesszentrum Hannover, Diakoniekrankenhaus Henriettenstiftung gGmbH, Hannover (Germany)

    2008-09-15

    As an alternative to surgery, endovascular therapy with stent grafts has become the second main treatment option for infrarenal abdominal aortic aneurysms. Unlike surgery, endovascular treatment with stent grafts is also applicable in patients unfit for open repair. Despite current improvements in endovascular repair devices, significant anatomic barriers still exclude this technique for a large number of patients. Computed tomography, magnetic resonance imaging, and ultrasound are essential for diagnostics, preintervention planning, and postintervention follow-up of abdominal aneurysms treated with stent grafts. This review covers etiology, pathology, and diagnostic aspects. Materials and methods for endovascular treatment of abdominal aortic aneurysms are presented in detail, and clinical results and complications are discussed. (orig.) [German] Die endovaskulaere Therapie des infrarenalen Bauchaortenaneurysmas hat sich als Alternative zur offenen chirurgischen Versorgung etabliert. Im Gegensatz zu Letzterer ist die Aneurysmatherapie mittels Stent-Grafts auch bei schwerkranken, nicht operationsfaehigen Patienten moeglich, wobei der Nutzen kontrovers diskutiert wird. Im Gegensatz zur klassischen transabdominellen Operation ist die Stent-Graft-Technik anatomischen Einschraenkungen unterworfen, die aber kuenftig aufgrund bereits abzusehender technischer Weiterentwicklungen eine geringere Rolle spielen werden. Die Diagnostik, die Entscheidung fuer eine endovaskulaere Therapie, die praeinterventionelle Planung und die Nachsorge erfordern den Einsatz bildgebender Verfahren, v. a. der Computer- und Magnetresonanztomographie sowie der Sonographie. Die fuer die endovaskulaere Aneurysmabehandlung relevanten Aspekte der Diagnostik werden dargestellt. Auf die Technik, die Materialien, die Ergebnisse und die Komplikationen der Stent-Graft-Behandlung wird ausfuehrlich eingegangen. (orig.)

  8. Branched and fenestrated options to treat aortic arch aneurysms.

    Science.gov (United States)

    Maurel, Blandine; Mastracci, Tara M; Spear, Rafaelle; Hertault, Adrien; Azzaoui, Richard; Sobocinski, Jonathan; Haulon, Stephan

    2016-10-01

    Conventional surgical repair of aortic arch aneurysms using cardiopulmonary bypass and hypothermic circulatory arrest remains the gold standard, however it is associated with a substantial mortality and morbidity rate, especially in the elderly. Hybrid techniques avoid aortic cross-clamping and circulatory arrest, but are of limited use and are only applicable to selected patients. The development of new devices to treat aortic arch aneurysms endovascularly has the potential to offer a treatment modality to patients unfit for an open repair. We present the challenges specific to endovascular arch repair based on our experience and the literature available from the first experience in 1999 to the third generation graft currently commonly used. Following an initial learning curve associated with the use of the third generation arch branch device, along with careful patient selection and operator experience, early results are promising. Technical success was achieved in all cases, there was no early mortality and strokes were noted in 11%. As with branched and fenestrated technology for thoracoabdominal aneurysm repair, the use of total endovascular repair for arch pathology will require an evolution in endovascular practice and device design. However, at present, the early use of the latest generation device offers a novel approach to patients who previously had no surgical options. PMID:27332680

  9. Advances in determining abdominal aortic aneurysm size and growth.

    Science.gov (United States)

    Kontopodis, Nikolaos; Lioudaki, Stella; Pantidis, Dimitrios; Papadopoulos, George; Georgakarakos, Efstratios; Ioannou, Christos V

    2016-02-28

    Abdominal aortic aneurysm is a common pathology in the aging population of the developed world which carries a significant mortality in excess of 80% in case of rupture. Aneurysmal disease probably represents the only surgical condition in which size is such a critical determinant of the need for intervention and therefore the ability to accurately and reproducibly record aneurysm size and growth over time is of outmost importance. In the same time that imaging techniques may be limited by intra- and inter-observer variability and there may be inconsistencies due to different modalities [ultrasound, computed tomography (CT)], rapid technologic advancement have taken aortic imaging to the next level. Digital imaging, multi-detector scanners, thin slice CT and most- importantly the ability to perform 3-dimensional reconstruction and image post-processing have currently become widely available rendering most of the imaging modalities used in the past out of date. The aim of the current article is to report on various imaging methods and current state of the art techniques used to record aneurysm size and growth. Moreover we aim to emphasize on the future research directions and report on techniques which probably will be widely used and incorporated in clinical practice in the near future. PMID:26981224

  10. Transesophageal echocardiography in surgical management of pseudoaneurysm of mitral-aortic intervalvular fibrosa with aneurysms of right sinus of Valsalva and left main coronary artery

    OpenAIRE

    Shreedhar S Joshi; Arkalgud Marigowda Jagadeesh; Arul Furtado; Seetharam Bhat

    2013-01-01

    Pseudoaneurysm of mitral-aortic intervalvular fibrosa (MAIVF) is a rare complication associated with aortic and/or mitral valve surgery complicated by infective endocarditis. We report pseudoaneurysm of MAIVF in a young adult without overt cardiac disease or previous cardiac surgery. The patient had a rare combination of pseudoaneurysm of MAIVF impinging on anterior mitral leaflet causing moderate mitral regurgitation, right sinus of Valsalva aneurysm extending into interventricular septum, a...

  11. 42 CFR 410.19 - Ultrasound screening for abdominal aortic aneurysms: Condition for and limitation on coverage.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Ultrasound screening for abdominal aortic aneurysms... screening for an abdominal aortic aneurysm as a result of an initial preventive physical examination (as... for an abdominal aortic aneurysm under Medicare program; and (3) Is included in at least one of...

  12. Fenestrated and branched endograft repair of juxtarenal aneurysms after previous open aortic reconstruction

    NARCIS (Netherlands)

    Beck, Adam W.; Bos, Wendy T. G. J.; Vourliotakis, Georgios; Zeebregts, Clark J.; Tielliu, Ignace F. J.; Verhoeven, Eric L. G.

    2009-01-01

    Objective: Para-anastomotic aortic aneurysms and progressive aneurysmal degeneration of the aorta after previous open aortic reconstruction pose a challenging clinical scenario. Due to the proximity to the visceral arteries, endovascular exclusion is typically not an option. However, the development

  13. Iliac branched device implantation in tortuous iliac anatomy after previous open ruptured aortic aneurysm repair

    NARCIS (Netherlands)

    Vourliotakis, G.; Bracale, U. M.; Sondakh, A.; Tielliu, I. F. J.; Prins, T. R.; Verhoeven, E. L. G.

    2012-01-01

    The aim of this paper was to present iliac branched device (IBD) implantation in a fit 67-year-old man with tortuous iliac anatomy after previous emergent open abdominal aortic aneurysm (AAA) repair. The patient underwent open treatment for a ruptured abdominal aortic aneurysm in another hospital. T

  14. Critical role of mast cell chymase in mouse abdominal aortic aneurysm formation

    DEFF Research Database (Denmark)

    Sun, J; Zhang, J; Lindholt, Jes S.;

    2009-01-01

    Mast cell chymase may participate in the pathogenesis of human abdominal aortic aneurysm (AAA), yet a direct contribution of this serine protease to AAA formation remains unknown.......Mast cell chymase may participate in the pathogenesis of human abdominal aortic aneurysm (AAA), yet a direct contribution of this serine protease to AAA formation remains unknown....

  15. Natural history of abdominal aortic aneurysm with and without coexisting chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Heickendorff, Lene; Antonsen, Sebastian;

    1998-01-01

    To study the relation between abdominal aortic aneurysms and chronical obstructive pulmonary disease (COPD), in particular the suggested common elastin degradation caused by elastase and smoking.......To study the relation between abdominal aortic aneurysms and chronical obstructive pulmonary disease (COPD), in particular the suggested common elastin degradation caused by elastase and smoking....

  16. Identification of peroxiredoxin-1 as a novel biomarker of abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Martinez-Pinna, Roxana; Ramos-Mozo, Priscila; Madrigal-Matute, Julio;

    2011-01-01

    In the search of novel biomarkers of abdominal aortic aneurysm (AAA) progression, proteins released by intraluminal thrombus (ILT) were analyzed by a differential proteomic approach.......In the search of novel biomarkers of abdominal aortic aneurysm (AAA) progression, proteins released by intraluminal thrombus (ILT) were analyzed by a differential proteomic approach....

  17. Cost effectiveness of abdominal aortic aneurysm screening and rescreening in men in a modern context

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Laustsen, Jesper; Lindholt, Jes Sanddal

    2012-01-01

    To assess the cost effectiveness of different screening strategies for abdominal aortic aneurysm in men, from the perspective of a national health service.......To assess the cost effectiveness of different screening strategies for abdominal aortic aneurysm in men, from the perspective of a national health service....

  18. Serum-elastin-peptides as a predictor of expansion of small abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Heickendorff, Lene; Henneberg, E W;

    1997-01-01

    To optimise the indication and time for operation for abdominal aortic aneurysm (AAA), we analysed whether or not serum-elastin-peptides (SEP) could be a potential predictor for expansion.......To optimise the indication and time for operation for abdominal aortic aneurysm (AAA), we analysed whether or not serum-elastin-peptides (SEP) could be a potential predictor for expansion....

  19. Insulin-like growth factor I - a novel biomarker of abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Lindholt, J S; Martin-Ventura, J L; Urbonavicius, S;

    2011-01-01

    The study aimed to test the potential role of insulin-like growth factor I (IGF-I) and IGF-II as biomarkers for abdominal aortic aneurysm (AAA).......The study aimed to test the potential role of insulin-like growth factor I (IGF-I) and IGF-II as biomarkers for abdominal aortic aneurysm (AAA)....

  20. Proteomic Analysis of Intraluminal Thrombus Highlights Complement Activation in Human Abdominal Aortic Aneurysms

    DEFF Research Database (Denmark)

    Martinez-Pinna, Roxana; Madrigal-Matute, Julio; Tarin, Carlos;

    2013-01-01

    To identify proteins related to intraluminal thrombus biological activities that could help to find novel pathological mechanisms and therapeutic targets for human abdominal aortic aneurysm (AAA).......To identify proteins related to intraluminal thrombus biological activities that could help to find novel pathological mechanisms and therapeutic targets for human abdominal aortic aneurysm (AAA)....

  1. Fatores de morbimortalidade na cirurgia eletiva do aneurisma da aorta abdominal infra-renal: experiência de 134 casos Morbidity and mortality factors in the elective surgery of infrarenal abdominal aortic aneurysm: a case study with 134 patients

    Directory of Open Access Journals (Sweden)

    Aquiles Tadashi Ywata de Carvalho

    2008-09-01

    aortic aneurysm (AAA can result in serious complications. To optimize treatment outcome it is important to identify patients at risk of having complications and implement prophylaxis. OBJECTIVES: To analyze early surgical mortality rate and postsurgical complications, and to identify risk factors related to morbidity and mortality. METHOD: A total of 134 patients with infrarenal AAA submitted to elective surgical correction from February 2001 to December 2005 were analyzed. RESULTS: The mortality rate (5.2% was secondary mainly to acute myocardial infarction and intestinal ischemia. Heart-related complications were the most frequent, followed by lung and kidney complications. Presence of diabetes mellitus, congestive heart failure, coronary artery disease, and scintigraphy suggestive of ischemia were related to cardiac complications. Advanced age, chronic obstructive lung disease and reduced forced vital capacity were related to higher risks of atelectasis and pulmonary infection. Presence of renal failure, prolonged aortic clamping and high urea rates were related to acute renal failure. Smoking and advanced age were associated with lower limb ischemia. Presence of obstructive coronary insufficiency and prolonged aortic clamping and surgery time were associated with higher mortality rate. CONCLUSION: The morbidity and mortality rate was compatible with data found in the national and international literature, secondary to cardiac, pulmonary and kidney complications. Identified risk factors before and during the surgery were related to these complications.

  2. Transesophageal echocardiography in surgical management of pseudoaneurysm of mitral-aortic intervalvular fibrosa with aneurysms of right sinus of Valsalva and left main coronary artery

    Directory of Open Access Journals (Sweden)

    Shreedhar S Joshi

    2013-01-01

    Full Text Available Pseudoaneurysm of mitral-aortic intervalvular fibrosa (MAIVF is a rare complication associated with aortic and/or mitral valve surgery complicated by infective endocarditis. We report pseudoaneurysm of MAIVF in a young adult without overt cardiac disease or previous cardiac surgery. The patient had a rare combination of pseudoaneurysm of MAIVF impinging on anterior mitral leaflet causing moderate mitral regurgitation, right sinus of Valsalva aneurysm extending into interventricular septum, and left main coronary artery aneurysm. Transesophageal echocardiography helped in confirming the lesions, delineating the anatomy of all the lesions, and assessing the adequacy of surgical repair.

  3. Hybrid procedure in the treatment of thoracoabdominal aortic aneurysms: Case report

    Directory of Open Access Journals (Sweden)

    Davidović Lazar B.

    2013-01-01

    Full Text Available Introduction. Treatment of thoracoabdominal aortic aneurysms is a major problem in vascular surgery. Conventional open repair is associated with significant rates of mortality and morbidity and therefore, there is a need for better solutions. One of them is a hybrid procedure that includes visceral debranching. This paper presents the first such case performed in Serbia, with a brief overview on all published procedures worldwide. Case Outline. A 57-year-old woman was admitted to the hospital because of thoracoabdominal aneurysms type V by Crawford-Safi classifications. Because of the significant comorbidities it was concluded that conventional treatment would bear unacceptably high perioperative risk, and that the possible alternative could be the hybrid procedure in two stages. In the first stage aortobiliacal reconstruction with bifurcated Dacron graft (16×8 mm and visceral debranching with hand made tailored branched graft was done. In the second act, the thoracoabdominal aneurysm was excluded with implantation of the endovascular Valiant stent graft, 34×150 mm (Medtronic, Santa Rosa, CA. Control MSCT angiography showed a proper visceral branch patency and positioning of the stent graft without endoleaks. Nine months after the procedure the patient was symptom-free, with no aneurysm, diameter change and no graft-related complication. All visceral branches were patent. Conclusion. So far about 500 cases of visceral debranching have been published with the aim of treating thoracoabdominal aneurysms, and still we have no valid guidelines concerning this method. However, in carefully selected high-risk patients this is an excellent alternative to open surgery of thoracoabdominal aneurysms.

  4. Fusobacterium necrophorum in an Abdominal Aortic Aneurysm, Treated by Once Daily Ertapenem

    OpenAIRE

    Wotherspoon, D.; Street, J. A.; Hedderwick, S.; Baker, R.

    2012-01-01

    Inflammatory aneurysms may make up a small percentage of the total number of abdominal aortic aneurysms, but they present their own unique challenges. We present a case of a 65-year-old man whose aneurysm was found to be colonized by Fusobacterium necrophorum.

  5. Thoracic aortic aneurysm: A rare cause of elevated hemidiaphragm.

    Science.gov (United States)

    Ejazi, Md Arshad; Alam, Md Mazhar; Shameem, Mohammad; Bhargava, Rakesh; Adil Wafi, C G; Salauddin

    2016-01-01

    Phrenic nerve palsy causing hemidiaphragm paralysis is a very uncommon feature of thoracic aortic aneurysm. In one case, a 30 year male complained of chronic dull aching chest pain, and hoarseness of voice; posteroanterior view chest radiograph revealed large spherical radiopacity on the left upper lung zone with smooth lobulated margin with elevated left hemidiaphragm. On Colour Doppler sonography, lesion was anechoic on gray scale sonography but on Doppler analysis revealed intense internal vascularity within it with characteristic "Ying Yang" sign. The finding favor the vascular origin of the lesion and a diagnosis of an arterial aneurysm was made Contrast-enhanced computed tomography (CT) of the thorax revealed a large well defined spherical lesion of 8 × 10 cm size with smooth well defined margin arising from the aortic arch and attenuation of impending rupture or dissection were lesion on immediate post contrast and delayed scan was similar to that of aorta. Left hemidiaphragm elevation was explained by the gross mass effect of the aneurysm causing right phrenic nerve palsy. PMID:27578939

  6. Thoracic aortic aneurysm: A rare cause of elevated hemidiaphragm

    Directory of Open Access Journals (Sweden)

    Md Arshad Ejazi

    2016-01-01

    Full Text Available Phrenic nerve palsy causing hemidiaphragm paralysis is a very uncommon feature of thoracic aortic aneurysm. In one case, a 30 year male complained of chronic dull aching chest pain, and hoarseness of voice; posteroanterior view chest radiograph revealed large spherical radiopacity on the left upper lung zone with smooth lobulated margin with elevated left hemidiaphragm. On Colour Doppler sonography, lesion was anechoic on gray scale sonography but on Doppler analysis revealed intense internal vascularity within it with characteristic "Ying Yang" sign. The finding favor the vascular origin of the lesion and a diagnosis of an arterial aneurysm was made Contrast-enhanced computed tomography (CT of the thorax revealed a large well defined spherical lesion of 8 × 10 cm size with smooth well defined margin arising from the aortic arch and attenuation of impending rupture or dissection were lesion on immediate post contrast and delayed scan was similar to that of aorta. Left hemidiaphragm elevation was explained by the gross mass effect of the aneurysm causing right phrenic nerve palsy.

  7. Endovascular abdominal aortic aneurysm repair in the geriatric population

    Institute of Scientific and Technical Information of China (English)

    Athanasios Saratzis; Saif Mohamed

    2012-01-01

    Abdominal aortic aneurysm (AAA) is a relatively common pathology among the elderly. More people above the age of 80 will have to undergo treatment of an AAA in the future. This review aims to summarize the literature focusing on endovascular repair of AAA in the geriatric population. A systematic review of the literature was performed, including results from endovascular abdominal aortic aneurysm repair (EVAR) registries and studies comparing open repair and EVAR in those above the age of 80. A total of 15 studies were identified. EVAR in this population is efficient with a success rate exceeding 90% in all cases, and safe, with early mortality and morbidity being superior among patients undergoing EVAR against open repair. Late survival can be as high as 95% after 5 years. Aneurysm-related death over long-term follow-up was low after EVAR, ranging from 0 to 3.4%. Endovascular repair can be offered safely in the geriatric population and seems to compare favourably with open repair in all studies in the literature to date.

  8. Surgery of gigantic infrarenal aneurysm of abdominal aorta

    OpenAIRE

    N. Rustempašić; I. Arslani; D. Totić; A. Hadžimehmedagić; H. Vranić; E. Solaković

    2005-01-01

    The case shows gigantic aneurysm of abdominal aorta, localized infrarenally, as well as aneurysms of bilateral iliac arteries, which were solved successfully by resection of aneurism of abdominal aorta, closure of iliac arteries near aortic bifurcation, and interposition of aorta-bifemural vascular graft. There were no postoperative complications,and final outcome was fully satisfactory.

  9. Surgery of gigantic infrarenal aneurysm of abdominal aorta

    Directory of Open Access Journals (Sweden)

    N. Rustempašić

    2005-08-01

    Full Text Available The case shows gigantic aneurysm of abdominal aorta, localized infrarenally, as well as aneurysms of bilateral iliac arteries, which were solved successfully by resection of aneurism of abdominal aorta, closure of iliac arteries near aortic bifurcation, and interposition of aorta-bifemural vascular graft. There were no postoperative complications,and final outcome was fully satisfactory.

  10. Doxycycline inhibition of proteases and inflammation in abdominal aortic aneurysms

    NARCIS (Netherlands)

    Khawaja, Hazem Al-

    2011-01-01

    The aim of this thesis is to evaluate the effect of doxycycline on the proteolytic and inflammatory processes in abdominal aneurysms. This data is essential for the development of pharmaceutical strategies for the stabilization of an AAA. Such an approach could reduce the need for elective surgery a

  11. Comparison of Colour Duplex Ultrasound with Computed Tomography to Measure the Maximum Abdominal Aortic Aneurysmal Diameter

    Directory of Open Access Journals (Sweden)

    C. Gray

    2014-01-01

    Full Text Available Introduction. Maximum diameter of an abdominal aortic aneurysm (AAA is the main indication for surgery. This study compared colour duplex ultrasound (CDU and computed tomography (CT in assessing AAA diameter. Patients and Methods. Patients were included if they had both scans performed within 90 days. Pearson’s correlation coefficient, paired t-test, and limits of agreement (LOA were calculated for the whole group. Subgroup analysis of small (6.5 cm aneurysms was performed. A P value of <0.05 was considered statistically significant. Results. 389 patients were included, giving 130 pairs of tests for comparison. Excellent correlation was in the whole group (r = 0.95 and in the subgroups (r = 0.94; 0.69; 0.96, resp.. Small LOA between the two imaging modalities was found in all subgroups. Conclusion. Small aneurysms can be accurately measured using CDU. CDU is preferable for small AAAs, but cannot supplant CT for planning aortic intervention.

  12. Endovascular Repair of Abdominal Aortic Aneurysms in the Presence of a Transplanted Kidney

    Energy Technology Data Exchange (ETDEWEB)

    Silverberg, Daniel, E-mail: silverberg-d@msn.com; Yalon, Tal; Halak, Moshe [The Chaim Sheba Medical Center, The Department of Vascular Surgery (Israel)

    2015-08-15

    PurposeTo present our experience performing endovascular repair of abdominal aortic aneurysms in kidney transplanted patients.MethodsA retrospective review of all patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) performed at our institution from 2007 to 2014. We identified all patients who had previously undergone a kidney transplant. Data collected included: comorbidities, preoperative imaging modalities, indication for surgery, stent graft configurations, pre- and postoperative renal function, perioperative complications, and survival rates.ResultsA total of 267 EVARs were performed. Six (2 %) had a transplanted kidney. Mean age was 74 (range, 64–82) years; five were males. Mean time from transplantation to EVAR was 7.5 (range, 2–12) years. Five underwent preoperative planning with noncontrast modalities only. Devices used included bifurcated (n = 3), aortouniiliac (n = 2), and tube (n = 1) stent grafts. Technical success was achieved in all patients. None experienced deterioration in renal function. Median follow-up was 39 (range, 6–51) months. Four patients were alive at the time of the study. Two patients expired during the period of follow-up from unrelated causes.ConclusionsEVAR is an effective modality for the management of AAAs in the coexistence of a transplanted kidney. It can be performed with minimal morbidity and mortality without harming the transplanted kidney. Special consideration should be given to device configuration to minimize damage to the renal graft.

  13. Endoleak Assessment Using Computational Fluid Dynamics and Image Processing Methods in Stented Abdominal Aortic Aneurysm Models

    Science.gov (United States)

    Lu, Yueh-Hsun; Mani, Karthick; Panigrahi, Bivas; Hsu, Wen-Tang

    2016-01-01

    Endovascular aortic aneurysm repair (EVAR) is a predominant surgical procedure to reduce the risk of aneurysm rupture in abdominal aortic aneurysm (AAA) patients. Endoleak formation, which eventually requires additional surgical reoperation, is a major EVAR complication. Understanding the etiology and evolution of endoleak from the hemodynamic perspective is crucial to advancing the current posttreatments for AAA patients who underwent EVAR. Therefore, a comprehensive flow assessment was performed to investigate the relationship between endoleak and its surrounding pathological flow fields through computational fluid dynamics and image processing. Six patient-specific models were reconstructed, and the associated hemodynamics in these models was quantified three-dimensionally to calculate wall stress. To provide a high degree of clinical relevance, the mechanical stress distribution calculated from the models was compared with the endoleak positions identified from the computed tomography images of patients through a series of imaging processing methods. An endoleak possibly forms in a location with high local wall stress. An improved stent graft (SG) structure is conceived accordingly by increasing the mechanical strength of the SG at peak wall stress locations. The presented analytical paradigm, as well as numerical analysis using patient-specific models, may be extended to other common human cardiovascular surgeries.

  14. Endoleak Assessment Using Computational Fluid Dynamics and Image Processing Methods in Stented Abdominal Aortic Aneurysm Models

    Directory of Open Access Journals (Sweden)

    Yueh-Hsun Lu

    2016-01-01

    Full Text Available Endovascular aortic aneurysm repair (EVAR is a predominant surgical procedure to reduce the risk of aneurysm rupture in abdominal aortic aneurysm (AAA patients. Endoleak formation, which eventually requires additional surgical reoperation, is a major EVAR complication. Understanding the etiology and evolution of endoleak from the hemodynamic perspective is crucial to advancing the current posttreatments for AAA patients who underwent EVAR. Therefore, a comprehensive flow assessment was performed to investigate the relationship between endoleak and its surrounding pathological flow fields through computational fluid dynamics and image processing. Six patient-specific models were reconstructed, and the associated hemodynamics in these models was quantified three-dimensionally to calculate wall stress. To provide a high degree of clinical relevance, the mechanical stress distribution calculated from the models was compared with the endoleak positions identified from the computed tomography images of patients through a series of imaging processing methods. An endoleak possibly forms in a location with high local wall stress. An improved stent graft (SG structure is conceived accordingly by increasing the mechanical strength of the SG at peak wall stress locations. The presented analytical paradigm, as well as numerical analysis using patient-specific models, may be extended to other common human cardiovascular surgeries.

  15. Renal replacement therapies after abdominal aortic aneurysm repair--a review.

    Science.gov (United States)

    Hudorović, Narcis; Lovricević, Ivo; Brkić, Petar; Ahel, Zaky; Vicić-Hudorović, Visnja

    2011-09-01

    The objective of this review is to assess the incidence of postoperative acute renal failure that necessitates the application of hemofiltration and to determine the factors that influence the outcome in patients undergoing surgical repair of abdominal aortic aneurysm. In addition, the review aims to assess the outcomes of postoperative early hemofiltration as compared to late intensive hemofiltration. Different forms of renal replacement therapies for use in abdominal aortic aneurysm surgery patients are discussed. Electronic literature searches were performed using Pubmed, Medline, Embase, Sumsearch, Cinahil, The Cochrane Central Register of Controlled Trials and Excerpta Medica. The search identified 419 potentially eligible studies, of which 119 were excluded based on the title and abstract. Of the remaining 300 studies, full articles were collected and re-evaluated. Forty-five articles satisfied our inclusion criteria, of which only 12 were of the IA Level of evidence. The search results indicated that the underlying disease, its severity and stage, the etiology of acute renal failure, clinical and hemodynamic status of the patient, the resources available, and different costs of therapy might all influence the choice of the renal replacement therapy strategy. However, clear guidelines on renal replacement therapy duration are still lacking. Moreover, it is not known whether in acute renal failure patients undergoing abdominal aortic aneurysm surgery, renal replacement therapy modalities can eliminate significant amounts of clinically relevant inflammatory mediators. This review gives current information available in the literature on the possible mechanisms underlying acute renal failure and recent developments in continuous renal replacement treatment modalities. PMID:22384777

  16. Management of a dislocated endovascular aneurysm repair in a challenging giant abdominal aortic aneurysm.

    Science.gov (United States)

    Geers, Joachim; Daenen, Geert; Stabel, Patrick

    2016-02-01

    Introduction A case report of a contained rupture of an abdominal aneurysm, treated by endovascular technique (EVAR), but complicated by perioperative endoprosthesis limb dislocation. Case report An 81-year old male presented at the emergency department with a contained rupture of an infrarenal aortic aneurysm and bilateral extensive iliac aneurysmatic disease. Open repair was no option, due to the pulmonary condition. The patient was prepped for an emergency EVAR. After placing a bifurcated endoprosthesis, angiography revealed a type IIIa endoleak, due to a dislocation between two left iliac extensions. We converted to a right-sided aorto-uni-iliac endoprosthesis with a femorofemoral bypass. A postoperative CT-scan showed a complete exclusion of the aneurysm, a patent aorto-uni-iliac endoprosthesis and a femorofemoral bypass without an endoleak. Discussion EVAR is feasible with a hostile neck AAA, even in a ruptured AAA. In large AAA, one should consider an overlap larger than suggested in the instructions for use. PMID:27385140

  17. Endotension - a cause of failure in endovascular repair of abdominal aortic aneurysms

    International Nuclear Information System (INIS)

    The phenomenon of aortic aneurysm enlargement after endovascular repair without detectable endoleak is called 'endotension'. It is caused by persistent pressurization within the excluded aneurysm sac and may cause subsequent rupture of the aneurysm. We undertake a review of current knowledge about causes, significance and treatment of endotension as a failure in endovascular aortic aneurysm repair. The goal of endovascular abdominal aortic aneurysm repair is to prevent aneurysm ruptures by excluding the aneurysms from the aortic circulation. AAA (Abdominal Aortic Aneurysm) after EVAR (Endovascular Aneurysm Repair) can enlarge even in the absence of detectable endoleak because of persistent pressurization within the excluded aneurysm. There are many theories about the mechanism of pressure transmission into the excluded aneurismal sac. Some laboratory and clinical research shows that endotension can be connected with attachment side failure, graft fabrics or aneurysm sac geometry. Pressure transmission by the thrombus, poor outflow, osmotic effect or ultrafiltration are the other possible mechanisms causing this phenomenon. Maximal diameter measurement by CT is considered to be the best management method in patients after EVAR. However, lack of aneurysm sac shrinkage observed in some cases does not mean the presence of endotension. The role of pulsatility inside the excluded aneurysm sac remains unclear. Several possible concepts of endotension treatment have been discussed, including both open surgical convention and nonoperative approach. The absence of endoleak after endovascular repair not always means that there is no pressurization within the aneurysm. Success of endovascular repair can be evaluated indirectly by observation of changes in the diameter of the aneurysm sac after EVAR. Thus, it is essential to follow up patients after endovascular repair in order to detect any late complications including endotension

  18. Inflammatory abdominal aortic aneurysm presenting as bilateral hydroureteronephrosis: a case report and review of literature.

    Science.gov (United States)

    Galosi, Andrea Benedetto; Grilli Cicilioni, Carlo; Sbrollini, Giulia; Angelini, Andrea; Maselli, Guevar; Carbonari, Luciano

    2014-12-01

    We report a case of Inflammatory Abdominal Aortic Aneurysm (IAAA) producing bilateral hydro-ureteronephrosis. A 74-year-old patient presented to urologist office for bilateral hydronephrosis detected by kidney and bladder ultrasound (US). Patient reported lower urinary tract symptoms and inconstant and slight low back pain irradiated to inguinal region dating 3 weeks. Renal function, urine analysis and abdominal examination were normal. However the repeated ultrasound in the urologist office revealed abdominal aortic aneurism extended to iliac vessels. The patient was sent directly to vascular surgery unit where contrast computerized tomography (CT) and successful surgical repair were done. Final diagnosis was IAAA. The post-operative course was uneventful. Renal function was regular and the hydronephrosis reduced spontaneously under monitoring by CT and US. We review diagnosis and management of hydronephrosis that is sometimes linked to IAAA rather than standard AAA. Abdominal ultrasound is mandatory in any bilateral hydronephrosis and it could save lives. PMID:25641477

  19. Inflammatory abdominal aortic aneurysm presenting as bilateral hydroureteronephrosis: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Andrea Benedetto Galosi

    2014-12-01

    Full Text Available We report a case of Inflammatory Abdominal Aortic Aneurysm (IAAA producing bilateral hydro-ureteronephrosis. A 74-year-old patient presented to urologist office for bilateral hydronephrosis detected by kidney and bladder ultrasound (US. Patient reported lower urinary tract symptoms and inconstant and slight low back pain irradiated to inguinal region dating 3 weeks. Renal function, urine analysis and abdominal examination were normal. However the repeated ultrasound in the urologist office revealed abdominal aortic aneurism extended to iliac vessels. The patient was sent directly to vascular surgery unit where contrast computerized tomography (CT and successful surgical repair were done. Final diagnosis was IAAA. The post-operative course was uneventful. Renal function was regular and the hydronephrosis reduced spontaneously under monitoring by CT and US. We review diagnosis and management of hydronephrosis that is sometimes linked to IAAA rather than standard AAA. Abdominal ultrasound is mandatory in any bilateral hydronephrosis and it could save lives.

  20. Abdominal aortic aneurysm repair in patient with a renal allograft: a case report.

    Science.gov (United States)

    Kim, Hyung-Kee; Ryuk, Jong-Pil; Choi, Hyang Hee; Kwon, Sang-Hwy; Huh, Seung

    2009-02-01

    Renal transplant recipients requiring aortic reconstruction due to abdominal aortic aneurysm (AAA) pose a unique clinical problem. The concern during surgery is causing ischemic injury to the renal allograft. A variety of strategies for protection of the renal allograft during AAA intervention have been described including a temporary shunt, cold renal perfusion, extracorporeal bypass, general hypothermia, and endovascular stent-grafting. In addition, some investigators have reported no remarkable complications of the renal allograft without any specific measures. We treated a case of AAA in a patient with a renal allograft using a temporary aortofemoral shunt with good result. Since this technique is safe and effective, it should be considered in similar patients with AAA and previously placed renal allografts.

  1. Profile of patients with abdominal aortic aneurysm referred to the Vascular Unit, Hospital Kuala Lumpur.

    Science.gov (United States)

    Zainal, A A; Yusha, A W

    1998-12-01

    A prospective collection of patients referred with a diagnosis of abdominal aortic aneurysm (AAA) to the Vascular Unit, Hospital Kuala Lumpur (HKL) between February 1993 to July 1995 were analysed. There were a total of 124 patients, with a 85 per cent (%) male preponderance. Malays formed the largest ethnic group contributing about 60%. The median age of the patients was 69 years (range 49-84). Emergency referrals and admission accounted for 46.8% of patients. Hypertension and ischaemic heart disease were the two most common co-morbid medical conditions. The number of patients who underwent surgery was only 56 (45.2%). Of this total, 34 were done electively with an operative mortality of 8.8% (3 pts). The operative mortality for emergency surgery was 59.1%. AAA is relatively common in the older age group, especially in men and it should be actively looked for, as elective surgery can be offered with acceptable morbidity and mortality.

  2. Ruptured Aortic Aneurysm From Late Type II Endoleak Treated by Transarterial Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Gunasekaran, Senthil, E-mail: sgunasekaran@lumc.edu [Loyola University Medical Center Chicago (United States); Funaki, Brian, E-mail: bfunaki@radiology.bsd.uchicago.edu; Lorenz, Jonathan, E-mail: jlorenz@radiology.bsd.uchicago.edu [University of Chicago Medical Center (United States)

    2013-02-15

    Endoleak is the most common complication after endovascular aneurysm repair. The most common type of endoleak, a type II endoleak, typically follows a benign course and is only treated when associated with increasing aneurysm size. In this case report, we describe a ruptured abdominal aortic aneurysm due to a late, type II endoleak occurring 10 years after endovascular aneurysm repair that was successfully treated by transarterial embolization.

  3. Abdominal aortic aneurysm calcification and thrombus volume are not associated with outcome following endovascular abdominal aortic aneurysm repair

    Energy Technology Data Exchange (ETDEWEB)

    Rai, Divyajeet; Velu, Ramesh; Tosenovsky, Patrik; Quigley, Francis [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); The Townsville Hospital, Department of Vascular and Endovascular Surgery, Douglas (Australia); Wisniowski, Brendan; Walker, Philip J. [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); University of Queensland, School of Medicine and Centre for Clinical Research, Department of Vascular Surgery, Royal Brisbane and Women' s Hospital, Herston, QLD (Australia); Bradshaw, Barbara [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); Golledge, Jonathan [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); The Townsville Hospital, Department of Vascular and Endovascular Surgery, Douglas (Australia); University of Queensland, School of Medicine and Centre for Clinical Research, Department of Vascular Surgery, Royal Brisbane and Women' s Hospital, Herston, QLD (Australia)

    2014-08-15

    Aortic calcification and thrombus have been postulated to worsen outcome following endovascular abdominal aortic aneurysm repair (EVAR). The purpose of this study was to assess the association of abdominal aortic aneurysm (AAA) calcification and thrombus volume with outcome following EVAR using a reproducible, quantifiable computed tomography (CT) assessment protocol. Patients with elective EVAR performed between January 2002 and 2012 at the Townsville Hospital, Mater Private Hospital (Townsville) and Royal Brisbane and Women's Hospital (RBWH) were included if preoperative CTAs were available for analysis. AAA calcification and thrombus volume were measured using a semiautomated workstation protocol. Outcomes were assessed in terms of clinical failure, endoleak (type I, type II) and reintervention. Univariate and multivariate analyses were performed. Median follow-up was 1.7 years and the interquartile range 1.0-3.8 years. One hundred thirty-four patients undergoing elective EVAR were included in the study. Rates of primary clinical success and freedom from reintervention were 82.8 % and 88.9 % at the 24-month follow-up. AAA calcification and thrombus volume were not associated with clinical failure, type I endoleak, type II endoleak or reintervention. AAA calcification and thrombus volume were not associated with poorer outcome after EVAR in this study. (orig.)

  4. Abdominal aortic aneurysm calcification and thrombus volume are not associated with outcome following endovascular abdominal aortic aneurysm repair

    International Nuclear Information System (INIS)

    Aortic calcification and thrombus have been postulated to worsen outcome following endovascular abdominal aortic aneurysm repair (EVAR). The purpose of this study was to assess the association of abdominal aortic aneurysm (AAA) calcification and thrombus volume with outcome following EVAR using a reproducible, quantifiable computed tomography (CT) assessment protocol. Patients with elective EVAR performed between January 2002 and 2012 at the Townsville Hospital, Mater Private Hospital (Townsville) and Royal Brisbane and Women's Hospital (RBWH) were included if preoperative CTAs were available for analysis. AAA calcification and thrombus volume were measured using a semiautomated workstation protocol. Outcomes were assessed in terms of clinical failure, endoleak (type I, type II) and reintervention. Univariate and multivariate analyses were performed. Median follow-up was 1.7 years and the interquartile range 1.0-3.8 years. One hundred thirty-four patients undergoing elective EVAR were included in the study. Rates of primary clinical success and freedom from reintervention were 82.8 % and 88.9 % at the 24-month follow-up. AAA calcification and thrombus volume were not associated with clinical failure, type I endoleak, type II endoleak or reintervention. AAA calcification and thrombus volume were not associated with poorer outcome after EVAR in this study. (orig.)

  5. Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Koike, Yuya, E-mail: r06118@hotmail.co.jp; Nishimura, Jun-ichi, E-mail: jun-ichi-n@nifty.com; Hase, Soichiro, E-mail: haseman@hotmail.co.jp; Yamasaki, Motoshige, E-mail: genyamasaki@gmail.com [Kawasaki Saiwai Hospital, Department of Interventional Radiology (Japan)

    2015-04-15

    PurposeThe purpose of this study was to demonstrate a sac angiography technique and evaluate the feasibility of N-butyl cyanoacrylate (NBCA) embolization of the ruptured abdominal aortic aneurysm (AAA) sac in emergency endovascular aneurysm repair (EVAR) in hemodynamically unstable patients.MethodsA retrospective case series of three patients in whom sac angiography was performed during emergency EVAR for ruptured AAA was reviewed. After stent graft deployment, angiography within the sac of aneurysm (sac angiography) was performed by manually injecting 10 ml of contrast material through a catheter to identify the presence and site of active bleeding. In two patients, sac angiography revealed active extravasation of the contrast material, and NBCA embolization with a coaxial catheter system was performed to achieve prompt sealing.ResultsSac angiography was successful in all three patients. In the two patients who underwent NBCA embolization for aneurysm sac bleeding, follow-up computed tomography (CT) images demonstrated the accumulation of NBCA consistent with the bleeding site in preprocedural CT images.ConclusionsEVAR is associated with a potential risk of ongoing bleeding from type II or IV endoleaks into the disrupted aneurysm sac in patients with severe coagulopathy. Therefore, sac angiography and NBCA embolization during emergency EVAR may represent a possible technical improvement in the treatment of ruptured AAA in hemodynamically unstable patients.

  6. Long-term results after repair of ruptured and non-ruptured abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Kuzmanović Ilija B.

    2004-01-01

    Full Text Available INTRODUCTION Abdominal aortic aneurysm can be repaired by elective procedure while asymptomatic, or immediately when it is complicated - mostly due to rupture. Treating abdominal aneurysm electively, before it becomes urgent, has medical and economical reason. Today, the first month mortality after elective operations of the abdominal aorta aneurysm is less than 3%; on the other hand, significant mortality (25%-70% has been recorded in patients operated immediately because of rupture of the abdominal aneurysm. In addition, the costs of elective surgical treatment are significantly lower. OBJECTIVE The objective of this study is to compare long-term survival of patients that underwent elective or immediate repair of abdominal aortic aneurysm (due to rupture, and to find out the factors influencing the long-term survival of these patients. MATERIAL AND METHODS Through retrospective review of prospectively collected data of the Institute for Cardiovascular Diseases of Clinical Center of Serbia, Belgrade, 56 patients that had elective surgery and 35 patients that underwent urgent operation due to rupture of abdominal aneurysm were followed up. Only the patients that survived 30 postoperative days were included in this review, and were followed up (ranging from 2 to 126 months. Electively operated patients were followed during 58.82 months on the average (range 7 to 122, and urgently operated were followed over 52.26 months (range 2 to 126. There was no significant difference of the length of postoperative follow-up between these two groups. RESULTS During this period, out of electively operated and immediately operated patients, 27 and 22 cases died, respectively. There was no significant difference (p>0,05a of long-term survival between these two groups. Obesity and early postoperative complications significantly decreased long-term survival of both electively and immediately operated patients. Graft infection, ventral hernia, aneurysm of

  7. Endotension: rupture of abdominal aortic aneurysm Endotensão: ruptura de aneurisma de aorta abdominal

    Directory of Open Access Journals (Sweden)

    Alexandre Campos Moraes Amato

    2012-06-01

    Full Text Available Aortic endovascular exclusion technique called 'chimney' consists of placing stents through abdominal aortic visceral branches and a prosthesis that excludes the thoraco-abdominal aneurysm. Stents and an aortic endoprosthesis are placed in the renal arteries. This method is primarily used when open surgery is too risky. The mechanism that provides aneurysm sac increase without the visible presence of endoleaks has not been fully elucidated. The expansion of the aneurysm sac, due to endotension, is difficult to diagnose, even with the use of advanced imaging tests. Its diagnosis is made by exclusion. We present a case of a late complication in a high-risk patient after a 'chimney' endovascular procedure. Following the surgery, the patient presented a ruptured aneurysm sac without a visible endoleak. A second intervention was not feasible due to the high risk of occluding all of the branches, and complicated by previous 'chimney'. Endotension is a possible cause of aneurysm rupture and death.A técnica de exclusão endovascular conhecida como 'chaminé' consiste na colocação de stent em ramos viscerais e de endoprótese excluindo o aneurisma toracoabdominal. São colocados stents revestidos nas artérias renais e uma endoprótese aórtica, que o método utilizado quando a cirurgia aberta tem risco muito alto. O mecanismo que causa a expansão aneurismática sem a presença detectável de vazamento pelos métodos de imagem não está completamente esclarecido. A expansão do saco aneurismático por endotensão é de difícil diagnóstico, mesmo com o uso de técnicas de imagem avançadas, como tomografia computadorizada e eco-Doppler, sendo o diagnóstico por exclusão. Apresenta-se um caso de complicação tardia após o tratamento endovascular pela técnica da 'chaminé'. Após a cirurgia, o paciente apresentou ruptura sem endoleak visível. Outro procedimento endovascular foi impossibilitado pela técnica da 'chaminé', que dificulta novos

  8. Lower respiratory tract infection and rapid expansion of an abdominal aortic aneurysm: a case report

    Directory of Open Access Journals (Sweden)

    Puppala Sapna

    2010-10-01

    Full Text Available Abstract Introduction The rate of abdominal aortic aneurysm expansion is related to multiple factors. There is some evidence that inflammation can accelerate aneurysm expansion. However, the association between pulmonary sepsis and rapid abdominal aortic aneurysm expansion is rarely reported. Case presentation Here we present a case of a rapidly expanding abdominal aortic aneurysm in a 68-year-old Caucasian man with a concomitant lower respiratory tract infection and systemic sepsis requiring intensive monitoring and urgent endovascular intervention. Our patient had an uncomplicated post-operative recovery and a follow-up computed tomography scan at one month demonstrated no evidence of an endoleak. Conclusion This case highlights the potential association between pulmonary sepsis and rapid abdominal aortic aneurysm expansion. In such cases, a policy of frequent monitoring should be adopted to identify those patients requiring definitive management.

  9. Repair of abdominal aortic aneurysms with aorto-uni-iliac stentgraft and femoro-femoral bypass.

    Science.gov (United States)

    Smit, J G M; van Marle, J

    2012-03-29

    Endovascular repair (EVAR) is accepted as effective treatment for abdominal aortic aneurysms (AAAs) and has become the standard of care in many instances. The standard bifurcated stentgraft (BFG) is often not possible in patients with unfavourable aneurysm morphology. The aorto-uni-iliac (AUI) graft configuration with femoro-femoral bypass (FFBP) is a promising alternative which may extend the scope of EVAR for AAAs. The aim of this study was to evaluate the feasibility, efficacy and durability of AUI with FFBP. Design. The results of a single institution and a single surgeon were prospectively collected from January 2002 to August 2010. All patients were followed up at 1, 3, 6 and 12 months and then annually. Results. There were 33 patients (27 males) with a mean age of 71.7 years (range 46 - 84). Open surgery posed an unacceptably high risk to all patients owing to advanced age and/or American Society of Anesthesiologists (ASA) classification 3/4. Ineligibility for BFG was due to unfavourable anatomy or a combination of factors in most cases (31 patients). Two patients had anastomotic aneurysms after previous open surgery. The technical success rate was 100%. One severe intra-operative complication occurred (perforated iliac artery). Two patients (ASA 4) died within 30 days (peri-operative mortality rate 6.1%). Seven patients (21.1%) developed postoperative wound complications. Eight patients died during follow-up of non-aneurysm-related conditions. Twenty-three patients are alive, with mean follow-up of 24.4 months and a survival rate of 69.7%. Two complications occurred during long-term follow-up, namely 1 case of graft sepsis and 1 of FFBP occlusion. Conclusion. AUI with FFBP is a safe, effective and durable alternative in high-risk patients with AAAs where standard open repair is contraindicated and BFG repair is not possible owing to unfavourable aneurysm morphology.

  10. Antiphospholipid antibodies predict progression of abdominal aortic aneurysms.

    Directory of Open Access Journals (Sweden)

    Christina Duftner

    Full Text Available Antiphospholipid antibodies (aPLs frequently occur in autoimmune and cardiovascular diseases and correlate with a worse clinical outcome. In the present study, we evaluated the association between antiphospholipid antibodies (aPLs, markers of inflammation, disease progression and the presence of an intra-aneurysmal thrombus in abdominal aortic aneurysm (AAA patients. APLs ELISAs were performed in frozen serum samples of 96 consecutive AAA patients and 48 healthy controls yielding positive test results in 13 patients (13.5% and 3 controls (6.3%; n.s.. Nine of the 13 aPL-positive AAA patients underwent a second antibody testing >12 weeks apart revealing a positive result in 6 cases. APL-positive patients had increased levels of inflammatory markers compared to aPL-negative patients. Disease progression was defined as an increase of the AAA diameter >0.5 cm/year measured by sonography. Follow-up was performed in 69 patients identifying 41 (59.4% patients with progressive disease. Performing multipredictor logistic regression analysis adjusting for classical AAA risk factors as confounders, the presence of aPLs at baseline revealed an odds ratio of 9.4 (95% CI 1.0-86.8, p = 0.049 to predict AAA progression. Fifty-five patients underwent a computed tomography in addition to ultrasound assessment indicating intra-aneurysmal thrombus formation in 82.3%. Median thrombus volume was 46.7 cm3 (1.9-377.5. AAA diameter correlated with the size of the intra-aneurysmal thrombus (corrcoeff = 0.721, p<0.001, however neither the presence nor the size of the intra-aneurysmal thrombus were related to the presence of aPLs. In conclusion, the presence of aPLs is associated with elevated levels of inflammatory markers and is an independent predictor of progressive disease in AAA patients.

  11. Randomized clinical trial of mast cell inhibition in patients with a medium-sized abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Sillesen, H; Eldrup, N; Hultgren, R;

    2015-01-01

    BACKGROUND: Abdominal aortic aneurysm (AAA) is thought to develop as a result of inflammatory processes in the aortic wall. In particular, mast cells are believed to play a central role. The AORTA trial was undertaken to investigate whether the mast cell inhibitor, pemirolast, could retard...... the growth of medium-sized AAAs. In preclinical and clinical trials, pemirolast has been shown to inhibit antigen-induced allergic reactions. METHODS: Inclusion criteria for the trial were patients with an AAA of 39-49 mm in diameter on ultrasound imaging. Among exclusion criteria were previous aortic...... surgery, diabetes mellitus, and severe concomitant disease with a life expectancy of less than 2 years. Included patients were treated with 10, 25 or 40 mg pemirolast, or matching placebo for 52 weeks. The primary endpoint was change in aortic diameter as measured from leading edge adventitia...

  12. Hybrid-repair of thoraco-abdominal or juxtarenal aortic aneurysm: what the radiologist should know

    Energy Technology Data Exchange (ETDEWEB)

    Krauss, Tobias; Pfammatter, Thomas; Hechelhammer, Lukas; Marincek, Borut; Frauenfelder, Thomas [University Hospital Zurich, Department of Medical Radiology, Institute of Diagnostic Radiology, Zurich (Switzerland); Mayer, Dieter; Lachat, Mario [University Hospital Zurich, Clinic for Cardiovascular Surgery, Zurich (Switzerland)

    2010-04-15

    Endovascular aneurysm repair of the infrarenal or thoracic aorta has been shown to be a less invasive alternative to open surgery. A combined aneurysm of the thoracic and abdominal aorta is complex and challenging; the involvement of renal and/or visceral branches requires new treatment methods. A hybrid approach is currently an accepted alternative to conventional surgery. Renal and/or visceral revascularisation enables subsequent stent-graft placement into the visceral portion of the aorta. Knowledge of the surgical procedure and a precise assessment of the vascular morphology are crucial for pre-procedural planning and for detection of post-procedural complications. Multi-detector computed tomography angiography (MDCTA) combined with two- and three-dimensional (2D and 3D) rendering is useful for pre-interventional planning and for the detection of post-procedural complications. Three-dimensional rendering allows proper anatomical analyses, influencing interventional strategies and resulting in a better outcome. With the knowledge of procedure-specific MDCTA findings in various vascular conditions, the radiologist and surgeon are able to perform an efficient pre-interventional planning and follow-up examination. Based on our experience with this novel technique of combined open and endovascular aortic aneurysm treatment, this pictorial review illustrates procedure-specific imaging findings, including common and rare complications, with respect to 2D and 3D post-processing techniques. (orig.)

  13. Screening for abdominal aortic aneurysms Rastreamento de aneurismas da aorta abdominal

    Directory of Open Access Journals (Sweden)

    Telmo Pedro Bonamigo

    2003-01-01

    Full Text Available OBJECTIVE AND METHODS: Screening for abdominal aortic aneurysms may be useful to decrease mortality related to rupture. We conducted a study to assess the prevalence of abdominal aortic aneurysms in southern Brazil and to define risk factors associated with high prevalence of this disorder. The screening was conducted using abdominal ultrasound. Three groups were studied: Group 1 - cardiology clinic patients; Group 2 - individuals with severe ischemic disease and previous coronary surgery, or important lesions on cardiac catheterism; Group 3 - individuals without cardiac disease selected from the general population. All individuals were male and older than 54 years of age. The ultrasonographic diagnosis of aneurysm was based on an anteroposterior abdominal aorta diameter of 3 cm, or on an abdominal aorta diameter 0.5 cm greater than that of the supra-renal aorta. RESULTS: A total of 2.281 people were screened for abdominal aortic aneurysms in all groups: Group 1 - 768 individuals, Group 2 - 501 individuals, and Group 3 - 1012 individuals. The prevalence of aneurysms was 4.3%, 6.8% and 1.7%, respectively. Age and cigarette smoking were significantly associated with increased prevalence of aneurysms, as was the diagnosis of peripheral artery disease. DISCUSSION: We concluded that screening may be an important tool to prevent the mortality associated with abdominal aortic aneurysms surgery. Additionally, the cost of screening can be decreased if only individuals presenting significant risk factors, such as coronary and peripheral artery disease, smokers and relatives of aneurysm patients, are examined.OBJETIVO E MÉTODOS: O rastreamento de aneurisma da aorta abdominal infra-renal é importante pois pode diminuir a mortalidade relacionada à ruptura. Realizamos um estudo para definir a prevalência desses aneurismas em diversos segmentos da população em nossa região do Brasil. O rastreamento foi realizado utilizando-se a ecografia de abdômen. Tr

  14. Unusual perigraft abscess formation associated with stent graft infection after endovascular aortic repair of abdominal aortic aneurysm: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyo Jin; Kim, Song Soo; Ahn, Moon Sang; Lee, Jae Hwan; Shin, Byung Seok; KIm, Jin Hwan [Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon (Korea, Republic of)

    2014-03-15

    Although a stent graft infection after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) is a rare complication, it carries a high mortality and morbidity rate. We report a rare case of stent graft infection that led to an unusual perigraft abscess formation without any associated aortoenteric fistula two years after the EVAR of AAA.

  15. [Completion pneumonectomy combined with graft replacement of thoracic aortic aneurysm by simple clamping].

    Science.gov (United States)

    Shimamoto, A; Takao, M; Kanemitsu, S; Fujinaga, K; Yan, G; Cruz, B P; Onoda, K; Shimono, T; Shimpo, H; Namikawa, S; Yuasa, H; Yada, I

    1999-01-01

    A 59-years-old male patient who had left upper lobe partial resection 30 years ago. He was seen at the family physician because of cough. A chest X-ray was showing an abnormal mass shadow measuring 3 x 4 cm in left lower lobe like honey comb. And squamous cell carcinoma (SCC) was detected in his sputum. He was diagnosed as primary lung cancer and introduced to our department to have operation. Chest CT-scan was showing lung tumor suspected SCC measuring 4.3 x 2.6 cm in segment 8 faced chest wall. At the same time, we detected thoracic aortic aneurysm and subcarinal lymph node, but could not see where the boundary is, so it was hard to distinguish between parietal thrombus with thoracic aortic aneurysm and swelling subcarinal lymph node. We decided it swelling subcarinal lymph node by three-dimensional treated CT-scan. Aortic angiography was showing proximal descending aortic aneurysm measuring diameter was 4.5 cm. Abdominal CT-scan was showing infrarenal abdominal aortic aneurysm measuring diameter was 5.5 cm. He was diagnosed as primary lung cancer (It. S8, SCC) (cT2N2M0, Stage IIIB), thoracic aortic aneurysm, abdominal aortic aneurysm, and idiopathic pulmonary fibrosis, and had completion pneumonectomy (R 2 b) for primary lung cancer and graft replacement with aneurysm dissection for thoracic aortic aneurysm without extracorporeal circulation. In this operation, we could find swelling subcarinal lymph node measuring 5 x 3 cm instead of parietal thrombus with thoracic aortic aneurysm. Pathological examination diagnosed middle differential SCC and no metastasis from dissected lymph node (PT2N0M0, Stage I A). PMID:10024802

  16. Deep gluteal grounding pad burn after abdominal aortic aneurysm repair.

    Science.gov (United States)

    Sapienza, Paolo; Venturini, Luigi; Cigna, Emanuele; Sterpetti, Antonio V; Biacchi, Daniele; di Marzo, Luca

    2015-01-01

    Although skin burns at the site of grounding pad are a known risk of surgery, their exact incidence is unknown. We first report the case of a patient who presented a deep gluteal burn at the site of the grounding pad after an abdominal aortic aneurism repair, the etiology and the challenging treatment required to overcome this complication. PMID:26099000

  17. Ruptured thoracic aortic aneurysm in patient with systemic lupus erythematosus Aneurisma roto da aorta descendente em paciente com lúpus eritematoso sistêmico

    OpenAIRE

    Daniel Oliveira de Conti; Ricardo Ribeiro Dias; Alfredo Inácio Fiorelli; Noedir A. G Stolf

    2011-01-01

    It is reported a ruptured descending thoracic aortic aneurysm in a 25-year-old systemic lupus erythematosus woman who underwent 19 years steroid therapy. She was treated with 2 endovascular stent-grafts, discharged from hospital 13 days after the procedure in good health. Three months later she returned with hemorrhagic shock due to high digestive hemorrhage secondary to an aortic-esophageal fistula. She underwent to an open emergency surgery, and died during the post-operative period.Pacient...

  18. The future of aortic surgery in Europe

    DEFF Research Database (Denmark)

    Czerny, Martin; Bachet, Jean; Bavaria, Joseph;

    2012-01-01

    At least every ten years, each specialty should reflect upon its past, its present and its future, in order to be able to reconfirm the direction in which it is headed, to adopt suggestions from inside and outside and, consequently, to improve. As such, the aim of this manuscript is to provide th...... in Europe, namely the Vascular Domain of the European Association of Cardio-Thoracic Surgery (EACTS)....... the interested reader with an overview of how aortic surgery and (perhaps more accurately) aortic medicine has evolved in Europe, and its present standing; also to provide a glimpse into the future, trying to disseminate the thoughts of a group of people actively involved in the development of aortic medicine...

  19. MicroRNA expression signature in human abdominal aortic aneurysms

    Directory of Open Access Journals (Sweden)

    Pahl Matthew C

    2012-06-01

    Full Text Available Abstract Background Abdominal aortic aneurysm (AAA is a dilatation of the aorta affecting most frequently elderly men. Histologically AAAs are characterized by inflammation, vascular smooth muscle cell apoptosis, and extracellular matrix degradation. The mechanisms of AAA formation, progression, and rupture are currently poorly understood. A previous mRNA expression study revealed a large number of differentially expressed genes between AAA and non-aneurysmal control aortas. MicroRNAs (miRNAs, small non-coding RNAs that are post-transcriptional regulators of gene expression, could provide a mechanism for the differential expression of genes in AAA. Methods To determine differences in miRNA levels between AAA (n = 5 and control (n = 5 infrarenal aortic tissues, a microarray study was carried out. Results were adjusted using Benjamini-Hochberg correction (adjusted p  Results A microarray study identified eight miRNAs with significantly different expression levels between AAA and controls (adjusted p  Conclusions Our genome-wide approach revealed several differentially expressed miRNAs in human AAA tissue suggesting that miRNAs play a role in AAA pathogenesis.

  20. Case Series of Patients with Ruptured Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Spencer, Taylor

    2015-05-01

    Full Text Available Introduction: Traditionally, patients with suspected ruptured abdominal aortic aneurysm (rAAA are taken immediately for operative repair. Computed tomography (CT has been considered contraindicated. However, with the emergence of endovascular repair, this approach to suspected rAAA could be changing. Methods: We present retrospective data in a case series of 110 patients with rAAA. Patients were managed at a single tertiary medical center over a five-year period. At this site, there was an established multidisciplinary protocol in which patients with suspected rAAA undergo CT with consideration for endovascular aortic repair (EVAR. Results: Our results demonstrated a mortality of 30% with our institutional protocol for CT in suspected rAAA. Comparing patients who ultimately had EVAR with open repair, those able to have endovascular aneurysm repair (EVAR had lower mortality, shorter hospital stays for survivors, and a greater likelihood of being discharged to home than those with open repair. While survivors were more likely to have had EVAR, surviving patients were younger, had a significantly lower creatinine at presentation, and required fewer blood transfusions than those who died. Conclusion: Based on this case series, an institutional approach endorsing CT for presumed rAAA appears to be reasonable. Our results suggest that EVAR may be beneficial in appropriately-selected patients and that CT may potentially facilitate superior management options for patient care. [West J Emerg Med. 2015;16(3:367–371.

  1. TEVAR for Flash Pulmonary Edema Secondary to Thoracic Aortic Aneurysm to Pulmonary Artery Fistula.

    Science.gov (United States)

    Bornak, Arash; Baqai, Atif; Li, Xiaoyi; Rey, Jorge; Tashiro, Jun; Velazquez, Omaida C

    2016-01-01

    Enlarging aneurysms in the thoracic aorta frequently remain asymptomatic. Fistulization of thoracic aortic aneurysms (TAA) to adjacent structures or the presence of a patent ductus arteriosus and TAA may lead to irreversible cardiopulmonary sequelae. This article reports on a large aneurysm of the thoracic aorta with communication to the pulmonary artery causing pulmonary edema and cardiorespiratory failure. The communication was ultimately closed after thoracic endovascular aortic aneurysm repair allowing rapid symptom resolution. Early diagnosis and closure of such communication in the presence of TAA are critical for prevention of permanent cardiopulmonary damage.

  2. The outcome of abdominal aortic aneurysm repair in northern Malaysia.

    Science.gov (United States)

    Lakhwani, M N; Yeoh, K C; Gooi, B H; Lim, S K

    2003-08-01

    A prospective study of all infrarenal abdominal aortic aneurysm (AAA) repairs both as electives and emergencies in Penang between January 1997 to December 2000 is presented. The objectives of the study were to determine the age, gender, racial distribution of the patients, the incidence, and risk factors and to summarize treatments undertaken and discuss the outcome. Among the races, the Malays were the most common presenting with infrarenal AAA. The mean age of patients operated was 68.5 years. Males were more commonly affected compared to females (12:1). Most infrarenal AAA repairs were performed as emergency operations, 33 cases (61.1%) compared to electives, 21 cases (38.9%). Total survival was 70.3% (elective 85.7%; emergency 57.6%). Mortality rate was 31.5% and the primary reason is the lack of operating time available for urgent operation and for treatment of concurrent disease states. Mycotic aneurysm with its triad of abdominal pain, fever and abdominal mass resulted in a significantly higher mortality (46.6%). Ninety six percent of the infrarenal AAA had transverse diameter greater than 6 cm. Morphologically 90.7% were fusiform AAA rather than saccular aneurysm (9.3%). Pulmonary complications (35.2%) were more common than cardiac complications (11.1%) possibly related to the urgent nature of the operation, smoking or history of pulmonary tuberculosis. Bleeding (14.8%) was the most common cause of mortality in ruptured mycotic infrarenal AAA.

  3. National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions

    Science.gov (United States)

    2015-12-08

    Marfan Syndrome; Turner Syndrome; Ehlers-Danlos Syndrome; Loeys-Dietz Syndrome; FBN1, TGFBR1, TGFBR2, ACTA2 or MYH11 Genetic Mutation; Bicuspid Aortic Valve Without Known Family History; Bicuspid Aortic Valve With Family History; Bicuspid Aortic Valve With Coarctation; Familial Thoracic Aortic Aneurysm and Dissections; Shprintzen-Goldberg Syndrome; Other Aneur/Diss of Thoracic Aorta Not Due to Trauma, <50yo; Other Congenital Heart Disease

  4. MR findings of thoracic and abdominal aortic aneurysms: comparison with angiographic and surgical findings

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Yoong Ki; Kim, Tae Kyoung; Song, Jae Uoo; Kim, Seung Hoon; Lee, Han Kyung; Chung, Jin Wook; Park, Jae Hyung [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    1994-11-15

    To assess the utility of spin-echo magnetic resonance(MR) imaging in the evaluation of thoracic and abdominal aortic aneurysm. The spin-echo MR images of 27 aortic aneurysms in 22 patients were analyzed and correlated with angiography and/or operative findings retrospectively. Evaluations included location, type, and maximum diameter of the aneuyusm, mural thrombus, major branch involvement, and relationship with adjacent organ. The location of aneurysms was ascending thoracic aorta in seven cases, ascending thoracic aorta and aortic arch in one, descending thoracic aorta in six, thoracoabdominal aorta in three, and abdominal aorta in eight. Nineteen were fusiform, and eight were saccular. The mean of maximum diameters of the aneurysms was 7.9cm (4-10cm) on MR and 7.3cm (3-10cm) on angiography. Mural thrombus were noted in 13 cases on MR imaging and seven cases on angiography. Angiography also underestimated the amount of mural thrombus. Eight cases involved major aortic branches. Although MR imaging and angiography were equal in the assessment of major abdominal aortic branches, MR imaging could not clearly demonstrate arch vessels, especially left subclavian artery, in aortic arch aneurysms. Among seven ascending thoracic aneurysms, six had aortic regurgitation. MR imaging showed left ventricular enlargement in all six cases. There was pericardial effusion in four cases which were noted only on MR imaging. MR imaging demonstrated hydronephrosis and renal atrophy in two cases of abdominal aortic aneurysms respectively. In the assessment of size of the aneurysm, mural thrombus, and relation with adjacent organs, MR imaging was better than angiography. MR and angiographic findings were equal in the assessment of the location and type of the aneurysm. Angiography was better than MR imaging in the assessment of major branch involvement, especially left subclavian artery.

  5. A primary aorto-duodenal fistula associated with an inflammatory abdominal aortic aneurysm: a case report.

    Directory of Open Access Journals (Sweden)

    Honjo,Osami

    2005-08-01

    Full Text Available

    Primary aorto-enteric fistula (PAEFis a serious complication of abdominal aortic aneurysm(AAA. We report a patient with PAEF associated with inflammatory AAA who underwent emergent surgery. A 52-year-old male presented with recurrent hematemesis. A computer tomography scan showed a sealed rupture of the AAA adjacent to the duodenum. At surgery, a coin-sized PAEF was noted. The aorta was replaced with a Dacron graft in situ . Histological examination revealed the characteristics of an inflammatory AAA. The postoperative course was uneventful, and there has been no evidence of infection during a follow-up period of 3 years. We discuss the etiologic and surgical considerations regarding this unusual entity.

  6. When a Patient Declines Curative Care: Management of a Ruptured Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Sangeeta Lamba

    2013-09-01

    Full Text Available The management of major vascular emergencies in the emergency department (ED involves rapid, aggressive resuscitation followed by emergent definitive surgery. However, for some patients this traditional approach may not be consistent with their goals and values. We explore the appropriate way to determine best treatment practices when patients elect to forego curative care in the ED, while reviewing such a case. We present the case of a 72-year-old patient who presented to the ED with a ruptured abdominal aortic aneurysm, but refused surgery. We discuss the transition of the patient from a curative to a comfort care approach with appropriate direct referral to hospice from the ED. Using principles of autonomy, decision-making capacity, informed consent, prognostication, and goals-of-care, ED clinicians are best able to align their approach with patients’ goals and values. [West J Emerg Med. 2013;14(5:555–558.

  7. When a patient declines curative care: management of a ruptured aortic aneurysm.

    Science.gov (United States)

    Lamba, Sangeeta; Bonanni, Megan; Courage, Cheryl A; Nagurka, Roxanne; Zalenski, Robert J

    2013-09-01

    The management of major vascular emergencies in the emergency department (ED) involves rapid, aggressive resuscitation followed by emergent definitive surgery. However, for some patients this traditional approach may not be consistent with their goals and values. We explore the appropriate way to determine best treatment practices when patients elect to forego curative care in the ED, while reviewing such a case. We present the case of a 72-year-old patient who presented to the ED with a ruptured abdominal aortic aneurysm, but refused surgery. We discuss the transition of the patient from a curative to a comfort care approach with appropriate direct referral to hospice from the ED. Using principles of autonomy, decision-making capacity, informed consent, prognostication, and goals-of-care, ED clinicians are best able to align their approach with patients' goals and values. PMID:24106558

  8. Intimal aortic sarcoma mimicking ruptured thoracoabdominal type IV aneurysm. a rare case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Dedeilias Panagiotis

    2011-12-01

    Full Text Available Abstract Primary intimal aortic sarcoma represents a very rare and highly lethal medical entity. Diagnosis is made either by embolic events caused by the tumor or by surrounding tissue symptoms such as pain. Herein we report an extremely rare case of a 51-year-old man previously operated for ascending aortic aneurysm, who presented with clinical and radiological findings suggestive of a ruptured thoracoabdominal type IV aneurysm. The patient underwent radical resection of the aorta and surrounding tissue with placement of a composite 4-branched graft. The diagnosis was made by frozen section and regular histopathologic examination of the specimen and the patient received adjuvant chemotherapy. Nine months after surgery the patient is still alive and has no signs of recurrence. We review the literature and discuss the option of postoperative chemotherapy.

  9. Abdominal Aortic Surgery: Anesthetic Implications

    OpenAIRE

    Cunningham, Anthony J.

    1991-01-01

    The objectives of the review are to highlight the clinical characteristics of the patient population; to assess multivariate risk factor analysis and the invasive/non-invasive techniques available for risk factor identification and management in this high-risk surgical population; to assess the major hemodynamic, metabolic, and regional blood flow changes associated with aortic cross-clamping/unclamping procedures and techniques for their modification or attenuation; and to assess the influen...

  10. Preoperative Predictors of Long-Term Mortality after Elective Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm

    Science.gov (United States)

    Nagai, Saya; Kudo, Toshifumi; Inoue, Yoshinori; Akaza, Miho; Sasano, Tetsuo

    2016-01-01

    Objective: This study aimed to clarify long-term mortality and its predictors in patients with abdominal aortic aneurysm (AAA) who underwent endovascular aneurysm repair (EVAR). Materials and Methods: Patients with AAA who underwent elective EVAR at Tokyo Medical and Dental University hospital between 2008 and 2011 were reviewed. The patients’ data were retrospectively collected from medical records. Results: Sixty-four patients were identified for this study. In long-term follow-up, the survival rate was significantly lower in patients with high preoperative C-reactive protein (CRP) levels. Patients with obstructive lung disease (FEV1/FVC EVAR for AAA as well as for other diseases. Conclusions: A high preoperative CRP level was a predictor of increased long-term mortality in patients with AAA who underwent EVAR. No specific leading causes of death were identified for this increase in the mortality rate. PMID:27087872

  11. Inflammatory abdominal aortic aneurysm:clinical features and long term outcome in comparison with atherosclerotic abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    YIN Ming-di; ZHANG Jian; WANG Shao-ye; DUAN Zhi-quan; XIN Shi-jie

    2010-01-01

    Background Inflammatory abdominal aortic aneurysms (IAAAs) are rare but distinct clinical entities of atherosclerotic abdominal aortic aneurysms (aAAAs).In this study we report a 20-year single institution experience for IAAA and analyze their clinical features and long term outcome in comparison with aAAA.Methods Between 1988 and 2008, 412 cases of abdominal aortic aneurysms (AAAs) underwent elective surgical operations, 11 (2.7%) of whom were diagnosed as IAAAs and 389 (94.4%) were diagnosed as aAAAs.The former group was matched in a case control fashion to a group of 33 patients with aAAAs having similar characteristics of age, gender, and preoperative risk factors.All available clinical, pathologic, and postoperative variables were retrospectively reviewed, and the two groups were compared.Results The two groups did not differ significantly in clinical characteristics and preoperative risk factors, although patients with IAAAs were significantly more symptomatic (100% vs.42.4%, P=0.001) and had larger aneurysms on admission ((7.4±0.7) cm vs.(6.3±0.9) cm, P=0.006).In IAAAs, the preoperative erythrocyte sedimentation rate was found to be significantly elevated compared to aAAA group ((44.5±9.1) mm/h vs.(11.4±5.4) mm/h, P <0.05).Surgical morbidity and mortality rates did not differ between the two groups.The operation time for patients with IAAAs was significantly longer than that for patients with aAAAs ((308±36) minutes vs.(224±46) minutes, P <0.05), but the cross-clamp time was similar in both groups ((41.5±6.2) minutes vs.(41.8±6.2) minutes, P=0.92).A five-year survival rate analysis showed no significant difference between the two groups (P=0.711).Conclusions Despite having more symptoms, larger size and longer operation time, patients with IAAA can now be treated with approaches that cause Iow morbidity and mortality, similar to patients with aAAA.Long term outcome of IAAA patients is of no difference from aAAA patients.

  12. Uncertainty Quantification applied to flow simulations in thoracic aortic aneurysms

    Science.gov (United States)

    Boccadifuoco, Alessandro; Mariotti, Alessandro; Celi, Simona; Martini, Nicola; Salvetti, Maria Vittoria

    2015-11-01

    The thoracic aortic aneurysm is a progressive dilatation of the thoracic aorta causing a weakness in the aortic wall, which may eventually cause life-threatening events. Clinical decisions on treatment strategies are currently based on empiric criteria, like the aortic diameter value or its growth rate. Numerical simulations can give the quantification of important indexes which are impossible to be obtained through in-vivo measurements and can provide supplementary information. Hemodynamic simulations are carried out by using the open-source tool SimVascular and considering patient-specific geometries. One of the main issues in these simulations is the choice of suitable boundary conditions, modeling the organs and vessels not included in the computational domain. The current practice is to use outflow conditions based on resistance and capacitance, whose values are tuned to obtain a physiological behavior of the patient pressure. However it is not known a priori how this choice affects the results of the simulation. The impact of the uncertainties in these outflow parameters is investigated here by using the generalized Polynomial Chaos approach. This analysis also permits to calibrate the outflow-boundary parameters when patient-specific in-vivo data are available.

  13. Reconstructive surgery of the aortic valve

    Directory of Open Access Journals (Sweden)

    Mendonça José Teles de

    2003-01-01

    Full Text Available OBJECTIVE: Lacking an ideal valve substitute and motivated by the good results of mitral valve repair since 1990, we faced with determination aortic valve reconstruction surgery. The objective of this paper is to show our experience with this procedure. METHOD: Between January of 1990 and December of 2001; 136 aortic valve repair surgeries were performed. Seventy-five (55.1% of the patients were female and the ages ranged from 4 to 70 years (mean 23.3 ± 1.2 years. Every patient had rheumatic valve disease and insufficiency was the most prevalent type (108 patients - 79.4%, followed by double aortic lesion in 16 (11.7% patients and stenosis in 12 (8.8%. The surgical techniques used were: subcommissural annuloplasty in 74 (54.4% patients, commissurotomy in 38 (27.9%, cusp extension with pericardium in 17 (12.5%, substitution of one cusp in 2 (1.4%, cusp suspension by annuloplasty in 37 (27.2% and Valsalva sinus remodeling in 27 (19.8%. The surgery exclusively involved the aortic valve in 57 (41.9% patients and was associated in 79 (mitral valve replacement in 12, mitral repair in 65, coronary artery bypass grafting in 1 and pulmonary commissurotomy in 1. RESULTS: Hospital mortality was 2.2% and 22 (16.2% patients underwent a new surgery during the follow-up period (57.7 ± 3.5 months. CONCLUSIONS: Aortic valve repair is a safe surgical procedure that can be used in an increasing number of patients with promising results.

  14. Fenestrated and Chimney Technique for Juxtarenal Aortic Aneurysm: A Systematic Review and Pooled Data Analysis

    Science.gov (United States)

    Li, Yue; Hu, Zhongzhou; Bai, Chujie; Liu, Jie; Zhang, Tao; Ge, Yangyang; Luan, Shaoliang; Guo, Wei

    2016-01-01

    Juxtarenal aortic aneurysms (JAA) account for approximately 15% of abdominal aortic aneurysms. Fenestrated endovascular aneurysm repair (FEVAR) and chimney endovascular aneurysm repair (CH-EVAR) are both effective methods to treat JAAs, but the comparative effectiveness of these treatment modalities is unclear. We searched the PubMed, Medline, Embase, and Cochrane databases to identify English language articles published between January 2005 and September 2013 on management of JAA with fenestrated and chimney techniques to conduct a systematic review to compare outcomes of patients with juxtarenal aortic aneurysm (JAA) treated with the two techniques. We compared nine F-EVAR cohort studies including 542 JAA patients and 8 CH-EVAR cohorts with 158 JAA patients regarding techniques success rates, 30-day mortality, late mortality, endoleak events and secondary intervention rates. The results of this systematic review indicate that both fenestrated and chimney techniques are attractive options for JAAs treatment with encouraging early and mid-term outcomes. PMID:26869488

  15. Lessons learnt from the EUROSTAR registry on endovascular repair of abdominal aortic aneurysm repair

    International Nuclear Information System (INIS)

    Objective: The EUROSTAR project is a multicentred database of the outcome of endovascular repair of infra-renal aortic aneurysms. To date 92 European centres of vascular surgery have contributed. The purpose of the article here is to review the medium term (up to 4 years) results of endovascular aneurysm repair as reported to Eurostar. Patients and methods: Patients intended for endovascular aneurysm repair were notified to the EUROSTAR Data Registry Centre before treatment in order to eliminate bias due to selective reporting. The following data was collected on all patients: (1) their demographic details and the anatomical characteristics of their aneurysms, (2) details of the endovascular device used, (3) procedural complications and the immediate outcome, (4) results of contrast enhanced CT imaging at 3, 6, 12 and 18 months after operation and at yearly intervals thereafter, (5) all adverse events. Life table analysis was performed to determine the cumulative rates of: (1) death from all causes, (2) secondary intervention. Risk factors for rupture and late conversion were identified by regression analysis. Results: By July 2000, 2862 patients had been registered and their median duration of follow-up was 12 mo (range 0-72). Successful deployment was achieved in 2812 patients with a perioperative (30 day) mortality of 2.9%. In 2464 patients enrolled by March 2000 late rupture of the aneurysm occurred in 14 patients for an annual cumulative rate of 1%. The significant factors were proximal type I endoleak (P=0.001), midgraft (type III) endoleak (P=0.001), graft migration (P=0.001) and post-operative kinking of the endograft (P=0.001). Forty-one patients had late conversion to open repair for an annual cumulative rate (risk) of approximately 2.1%. Risk factors (indications) for late conversion were: proximal type I endoleak (P=0.001), midgraft (type III) endoleak (P=0.001), type II endoleak (P=0.003), graft migration (P=0.001), graft kinking (P=0.001) and distal

  16. Reproducibility of ECG-gated Ultrasound Diameter Assessment of Small Abdominal Aortic Aneurysms

    DEFF Research Database (Denmark)

    Bredahl, K; Eldrup, N; Meyer, C;

    2013-01-01

    No standardised ultrasound procedure to obtain reliable growth estimates for abdominal aortic aneurysms (AAA) is currently available. We investigated the feasibility and reproducibility of a novel approach controlling for a combination of vessel wall delineation and cardiac cycle variation....

  17. Soluble TWEAK plasma levels predict expansion of human abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Martín-Ventura, J L; Lindholt, Jes S.; Pavón Moreno, Miguel Ángel;

    2010-01-01

    Diminished soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) concentrations are associated with cardiovascular diseases. We have analyzed sTWEAK levels and its relation with expansion rate in subjects with abdominal aortic aneurysm (AAA)....

  18. 9.1 cm abdominal aortic aneurysm in a 69-year-old male patient

    Institute of Scientific and Technical Information of China (English)

    Celine; Saade; Bhavi; Pandya; Muhammad; Raza; Mustafain; Meghani; Deepak; Asti; Foad; Ghavami

    2015-01-01

    We are presenting a case of one of the largest unruptured abdominal aortic aneurysm ever reported. Presented here is a rare case of a 69-year-old active smoker male with history of hypertension and incidental diagnosis of abdominal aortic aneurysm of 6.2 cm in 2003, who refused surgical intervention at the time of diagnosis with continued smoking habit and was managed medically. Patient was subsequently admitted in 2012 to the hospital due to unresponsiveness secondary to hypoglycemia along with diagnosis of massive symptomatic pulmonary embolism and nonST elevation myocardial infarction. With the further inpatient workup along with known history of abdominal aortic aneurysm, subsequent computed tomography scan of abdomen pelvis revealed increased in size of infrarenal abdominal aortic aneurysm to 9.1 cm of without any signs of rupture. Patient was unable to undergo any surgical intervention this time because of his medical instability and was eventually passed away under hospice care.

  19. Current state in tracking and robotic navigation systems for application in endovascular aortic aneurysm repair

    NARCIS (Netherlands)

    De Ruiter, Quirina M B; Moll, Frans L.; Van Herwaarden, Joost A.

    2015-01-01

    Objective This study reviewed the current developments in manual tracking and robotic navigation technologies for application in endovascular aortic aneurysm repair (EVAR). Methods EMBASE and MEDLINE databases were searched for studies reporting manual tracking or robotic navigation systems that are

  20. Balloon aortic valvuloplasty as a bridge to aortic valve surgery for severe aortic stenosis.

    Science.gov (United States)

    Nwaejike, Nnamdi; Mills, Keith; Stables, Rod; Field, Mark

    2015-03-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in patients with severe aortic stenosis, can balloon valvuloplasty be used as a bridge to aortic valve replacement? Altogether 463 papers were found using the reported search, of which 11 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that balloon aortic valvuloplasty is recommended as a bridge to aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI) in patients with severe symptomatic aortic stenosis. Institutional practices, local and logistic factors can affect patient selection and management approaches to severe aortic stenosis, but having the facility to offer balloon aortic valvuloplasty (especially in the TAVI era) provides another management option for patients who would otherwise have been considered unacceptably high risk for aortic valve surgery. The increased incidence of balloon aortic valvuloplasty mirrors the increase in the use of TAVI with a sharp increase in activity from 2006. Success rates for bridging from balloon aortic valvuloplasty to definite surgical intervention are in the range 26.3-74%, with AVR or TAVI occurring within 8 weeks to 7 months. Complications from balloon aortic valvuloplasty such as aortic regurgitation (AR) can be managed successfully. Up to 40% of patients selected by balloon aortic valvuloplasty to have TAVI or AVR do not have these procedures within 2 years. While most of these patients are excluded for objective clinical reasons such as terminal disease/malignancy or other persistent contraindication, some patients refuse definitive treatment and others die while on the waiting list. Outcomes in patients bridged to AVR/TAVI are better than in patients treated with balloon aortic valvuloplasty

  1. Stent-grafting for unfavorable abdominal aortic aneurysm:a practical challenge

    Institute of Scientific and Technical Information of China (English)

    HU Zuo-jun; CHANG Guang-qi; LI Xiao-xi; HUANG Xue-ling; YIN Heng-hui; WANG Shen-ming

    2009-01-01

    Background The endovascular treatment of abdominal aortic aneurysm (AAA) has improved greatly in the last 15 years.The present study aimed to evaluate the endografting experience for the treatment of unfavorable abdominal aortic aneurysm (uAAA).Methods During December 2001 and December 2007,41 patients with uAAA were treated with endografting using concomitant techniques.Patients were followed up for 1 to 48 months (mean 20.5 months).Results Technical success rate was 97.6% (40/41) with 1 failure converted to open surgery for an unaccessed lilac stenosis.Nine (22.5%) type Ⅰ endoleaks (5 proximal and 4 distal) were observed on the completion angiograrns and successfully corrected with aortic cuffs and iliac extensions during the procedure.Twenty-two of the planed adjunctive procedures were concomitantly performed just before endograft-implantation.There were 2 (5.0%) type Ⅰ endoleaks at 30 days;one type Ⅰ patient was treated by open conversion,another type Ⅰ patient died from a rupture before treatment in the ward,causing a 2.5% of initial mortality.The two type Ⅱ endoleaks were observed without aneurismal expansion.No buttock or leg claudication or ischemic colitis occured.During late follow-up,one additional death occurred from stroke.One new type Ⅰ endoleak was encountered from thrombocytopenia,which caused a 2.6% secondary endoleak that converted to an open surgery in the third month after a failed transabdominal banding of the aortic neck in the second month.All type Ⅱ endoleaks had disappeared in the third and sixth month.The Endografts did not present signs of material fatigue and no other type of endoleak formed.One patient presented with left limb ischemia,which underwent percutaneous transluminal angioplasty.There was no additional aneurysm rupture or any endograft imgration.Conclusion The endografting with concomitant procedures is a feasible and efficient alternative for managing unfavorable AAAs,achieving low morbidity and mortality rates

  2. Aortic Endoprosthesis for the Treatment of Native Aortic Coarctation and Concomitant Aneurysm in an Octogenarian Patient.

    Science.gov (United States)

    Rabellino, Martín; Kotowicz, Vadim; Kenny, Alberto; Kohan, Andres Alejandro; García-Mónaco, Ricardo

    2015-11-01

    We report a case of an 82-year-old female patient with native coarctation of the aorta and poststenotic aneurysm of the descending thoracic aorta. On consultation, she was receiving 4 antihypertensive drugs, and physical examination revealed nonpalpable lower-limb pulses with intermittent claudication at 50 min. Because of her age, high surgical risk and combination of lesions, endovascular treatment was suggested. Placement of a Valiant thoracic aorta endoprosthesis followed by coarctation angioplasty was performed. At 48 hr, the patient was discharged on 1 antihypertensive drug, palpable pulses on both limbs and a normal ankle-brachial index. At 1 month follow-up, the patient remained as discharged and multislice computed tomography angiography depicted complete coarctation expansion without residual stenosis, exclusion of the aortic aneurysm, and no signs of endoleaks. PMID:26318556

  3. Aortic Endoprosthesis for the Treatment of Native Aortic Coarctation and Concomitant Aneurysm in an Octogenarian Patient.

    Science.gov (United States)

    Rabellino, Martín; Kotowicz, Vadim; Kenny, Alberto; Kohan, Andres Alejandro; García-Mónaco, Ricardo

    2015-11-01

    We report a case of an 82-year-old female patient with native coarctation of the aorta and poststenotic aneurysm of the descending thoracic aorta. On consultation, she was receiving 4 antihypertensive drugs, and physical examination revealed nonpalpable lower-limb pulses with intermittent claudication at 50 min. Because of her age, high surgical risk and combination of lesions, endovascular treatment was suggested. Placement of a Valiant thoracic aorta endoprosthesis followed by coarctation angioplasty was performed. At 48 hr, the patient was discharged on 1 antihypertensive drug, palpable pulses on both limbs and a normal ankle-brachial index. At 1 month follow-up, the patient remained as discharged and multislice computed tomography angiography depicted complete coarctation expansion without residual stenosis, exclusion of the aortic aneurysm, and no signs of endoleaks.

  4. Daily diurnal variation in admissions for ruptured abdominal aortic aneurysms.

    LENUS (Irish Health Repository)

    Killeen, Shane

    2012-02-03

    BACKGROUND: Many vascular events, such as myocardial infarction and cerebrovascular accident, demonstrate a circadian pattern of presentation. Blood pressure is intimately related to these pathologies and is the one physiological variable consistently associated with abdominal aortic aneurysm rupture. It also demonstrates a diurnal variation. The purpose of this study was to determine if rupture of an abdominal aortic aneurysm (RAAA) exhibits a diurnal variation. METHODS: A retrospective cohort-based study was performed to determine the timing of presentation of RAAA to the vascular unit of Cork University Hospital over a 15-year period. Time of admission, symptom onset, and co-morbidities such as hypertension were noted. Fournier\\'s analysis and chi-squared analysis were performed. To ameliorate possible confounding factors, patients admitted with perforated peptic ulcers were examined in the same manner. RESULTS: A total of 148 cases of RAAA were identified, with a male preponderance (71.7% [124] male versus 29.3% [44] female patients) and a mean age of 74.4 +\\/- 7.2 years at presentation. 70.9% (105) were known to have hypertension, 52.2% (77) were current smokers, and 46.8% (69) were being treated for chronic obstructive airway disease (COAD). Time of symptom onset was recorded in 88.5% (131) of patients. There was a marked early morning peak in RAAA admissions, with the highest number of RAAA being admitted between 08.00 and 09.59. A second, smaller peak was observed at 14.00-15.59. These findings were suggestive of diurnal variation. [chi(2) =16.75, p < 0.003]. Some 40% (59) of patients were admitted between 00.00 and 06.00, an incidence significantly higher than for other time periods (06.00-12.00, 12.00-18.00, and 18.00-24.00) [chi(2) = 18.72; df = 3; p < 0.0003]. A significantly higher number of patients admitted between 00.00 and 06.00 were known hypertensives (chi(2) = 7.94; p < 0.05). CONCLUSIONS: The findings of this study suggest a distinct

  5. Ruptured Juxtarenal Abdominal Aortic Aneurysm Treated With a Fenestrated EVAR Graft Intended for a Different Patient.

    Science.gov (United States)

    Al-Jundi, Wissam; Elboushi, Amro; Lees, Tim; Williams, Robin

    2016-08-01

    Treatment of juxtarenal abdominal aortic aneurysms (AAAs) remains challenging. A 79-year-old male who had infrarenal endovascular repair of abdominal aortic aneurysm (EVAR) 13 years previously presented with leaking juxtarenal AAA. Emergency fenestrated EVAR (FEVAR) was performed utilizing a stent graft designed and built for a different patient. Despite the need to embolize the celiac artery prior to covering it with the stent graft in order to achieve adequate proximal seal, the patient had uneventful recovery. PMID:27334480

  6. Plasma cathepsin S and cystatin C levels and risk of abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Lv, Bing-Jie; Lindholt, Jes Sanddal; Cheng, Xiang;

    2012-01-01

    Human abdominal aortic aneurysm (AAA) lesions contain high levels of cathepsin S (CatS), but are deficient in its inhibitor, cystatin C. Whether plasma CatS and cystatin C levels are also altered in AAA patients remains unknown.......Human abdominal aortic aneurysm (AAA) lesions contain high levels of cathepsin S (CatS), but are deficient in its inhibitor, cystatin C. Whether plasma CatS and cystatin C levels are also altered in AAA patients remains unknown....

  7. Temporary extracorporeal bypass modalities during aortic surgery.

    Science.gov (United States)

    Bassin, Levi; Bell, David

    2016-09-01

    The key to aortic surgery is protection of the brain, heart, spinal cord, and viscera. For operations involving the aortic arch, the focus is on cerebral protection, while for pathology involving the descending thoracic aorta, the focus is on spinal protection. Optimal cerebral and spinal protection requires an extensive knowledge of the operative steps and an understanding of the cardiopulmonary bypass modalities that are possible. A bloodless field is required when operating on the aorta. As a result, periods of ischemia to the central nervous system and end-organ viscera are often unavoidable. The main techniques to mitigate ischemia include hypothermia and selective perfusion of the ischemic organ in question. This chapter will first briefly review bypass modalities and then describe how they can be used for various aortic scenarios. PMID:27650344

  8. Multidirectional flow analysis by cardiovascular magnetic resonance in aneurysm development following repair of aortic coarctation

    Directory of Open Access Journals (Sweden)

    Stalder Aurelien F

    2008-06-01

    Full Text Available Abstract Aneurysm formation is a life-threatening complication after operative therapy in coarctation. The identification of patients at risk for the development of such secondary pathologies is of high interest and requires a detailed understanding of the link between vascular malformation and altered hemodynamics. The routine morphometric follow-up by magnetic resonance angiography is a well-established technique. However, the intrinsic sensitivity of magnetic resonance (MR towards motion offers the possibility to additionally investigate hemodynamic consequences of morphological changes of the aorta. We demonstrate two cases of aneurysm formation 13 and 35 years after coarctation surgery based on a Waldhausen repair with a subclavian patch and a Vosschulte repair with a Dacron patch, respectively. Comprehensive flow visualization by cardiovascular MR (CMR was performed using a flow-sensitive, 3-dimensional, and 3-directional time-resolved gradient echo sequence at 3T. Subsequent analysis included the calculation of a phase contrast MR angiography and color-coded streamline and particle trace 3D visualization. Additional quantitative evaluation provided regional physiological information on blood flow and derived vessel wall parameters such as wall shear stress and oscillatory shear index. The results highlight the individual 3D blood-flow patterns associated with the different vascular pathologies following repair of aortic coarctation. In addition to known factors predisposing for aneurysm formation after surgical repair of coarctation these findings indicate the importance of flow sensitive CMR to follow up hemodynamic changes with respect to the development of vascular disease.

  9. Characterization of the transport topology in patient-specific abdominal aortic aneurysm models

    Science.gov (United States)

    Arzani, Amirhossein; Shadden, Shawn C.

    2012-08-01

    Abdominal aortic aneurysm (AAA) is characterized by disturbed blood flow patterns that are hypothesized to contribute to disease progression. The transport topology in six patient-specific abdominal aortic aneurysms was studied. Velocity data were obtained by image-based computational fluid dynamics modeling, with magnetic resonance imaging providing the necessary simulation parameters. Finite-time Lyapunov exponent (FTLE) fields were computed from the velocity data, and used to identify Lagrangian coherent structures (LCS). The combination of FTLE fields and LCS was used to characterize topological flow features such as separation zones, vortex transport, mixing regions, and flow impingement. These measures offer a novel perspective into AAA flow. It was observed that all aneurysms exhibited coherent vortex formation at the proximal segment of the aneurysm. The evolution of the systolic vortex strongly influences the flow topology in the aneurysm. It was difficult to predict the vortex dynamics from the aneurysm morphology, motivating the application of image-based flow modeling.

  10. Simulation of bifurcated stent grafts to treat abdominal aortic aneurysms (AAA)

    CERN Document Server

    Egger, Jan; Freisleben, Bernd

    2016-01-01

    In this paper a method is introduced, to visualize bifurcated stent grafts in CT-Data. The aim is to improve therapy planning for minimal invasive treatment of abdominal aortic aneurysms (AAA). Due to precise measurement of the abdominal aortic aneurysm and exact simulation of the bifurcated stent graft, physicians are supported in choosing a suitable stent prior to an intervention. The presented method can be used to measure the dimensions of the abdominal aortic aneurysm as well as simulate a bifurcated stent graft. Both of these procedures are based on a preceding segmentation and skeletonization of the aortic, right and left iliac. Using these centerlines (aortic, right and left iliac) a bifurcated initial stent is constructed. Through the implementation of an ACM method the initial stent is fit iteratively to the vessel walls - due to the influence of external forces (distance- as well as balloonforce). Following the fitting process, the crucial values for choosing a bifurcated stent graft are measured, ...

  11. Giant aortic arch aneurysm complicating Kawasaki disease: an original case report

    OpenAIRE

    Kaouthar, Hakim; Rafik, Boussaada; Jihen, Ayari; Imen, Hamdi; Lilia, Chaker; Fatma, Ouarda; Hela, Msaad

    2013-01-01

    Kawasaki disease (KD) is a common acute vasculitis in pediatric population that usually involves small and middle-sized arteries, commonly coronary arteries. Although the incidence and natural course of coronary aneurysms after KD are well documented, related reports on peripheral arterial and aortic aneurysms are scarce.

  12. Emergency abdominal aortic aneurysm repair with a preferential endovascular strategy : Mortality and cost-effectiveness analysis

    NARCIS (Netherlands)

    Kapma, Marten R.; Groen, Henk; Oranen, Bjorn I.; van der Hilst, Christian S.; Tielliu, Ignace F.; Zeebregts, Clark J.; Prins, Ted R.; van den Dungen, Jan J.; Verhoeven, Eric L.

    2007-01-01

    Purpose: To assess mortality and treatment costs of a new management protocol with preferential use of emergency endovascular aneurysm repair (eEVAR) for acute abdominal aortic aneurysm (AAA). Methods: From September 2003 until February 2005, 49 consecutive patients (45 men; mean age 71 years) with

  13. Immunoglobulin A antibodies against Chlamydia pneumoniae are associated with expansion of abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Lindholt, J.S; Juul, Svend; Vammen, S;

    1999-01-01

    BACKGROUND: The aim of this study was to examine the possible association between the progression of small abdominal aortic aneurysm (AAA) and chronic infection with Chlamydia pneumoniae. METHODS: Patients from a hospital-based mass screening programme for AAA with annual follow-up (mean 2.7 years....... pneumoniae. Aneurysm progression correlated with evidence of chronic C. pneumoniae infection....

  14. Long-term outcome of ruptured abdominal aortic aneurysm: Impact of treatment and age

    NARCIS (Netherlands)

    J.W. Raats (Jelle W.); H.C. Flu (Hans C.); G.H. Ho; E.J. Veen (Eelco J.); L.D. Vos (L.); E.W. Steyerberg (Ewout); L. van der Laan (Lyckle)

    2014-01-01

    textabstractBackground: Despite advances in operative repair, ruptured abdominal aortic aneurysm (rAAA) remains associated with high mortality and morbidity rates, especially in elderly patients. The purpose of this study was to evaluate the outcomes of emergency endovascular aneurysm repair (eEVAR)

  15. Suprarenal Fixation Resulting in Intestinal Ischemia after Endovascular Aortic Aneurysm Repair

    NARCIS (Netherlands)

    Pol, Robert A.; Keus, Frederick; Prins, Ted R.; Zeebregts, Clark J.

    2014-01-01

    Endovascular aneurysm repair (EVAR) may be associated with specific stent- and procedure-related complications. Hepatic artery anatomic variability may lead to dramatic consequences when unanticipated. A 64-year-old man presented with a 6-cm abdominal aortic aneurysm, suitable for an EVAR procedure.

  16. Collected World and Single Center Experience With Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms

    NARCIS (Netherlands)

    Veith, Frank J.; Lachat, Mario; Mayer, Dieter; Malina, Martin; Holst, Jan; Mehta, Manish; Verhoeven, Eric L. G.; Larzon, Thomas; Gennai, Stefano; Coppi, Gioacchino; Lipsitz, Evan C.; Gargiulo, Nicholas J.; van der Vliet, J. Adam; Blankensteijn, Jan; Buth, Jacob; Lee, W. Anthony; Biasi, Giorgio; Deleo, Gaetano; Kasirajan, Karthikeshwar; Moore, Randy; Soong, Chee V.; Cayne, Neal S.; Farber, Mark A.; Raithel, Dieter; Greenberg, Roy K.; van Sambeek, Marc R. H. M.; Brunkwall, Jan S.; Rockman, Caron B.; Hinchliffe, Robert J.

    2009-01-01

    Background: Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial. Objective: To clarify these we examined a c

  17. Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms.

    NARCIS (Netherlands)

    Veith, F.J.; Lachat, M.; Mayer, D.; Malina, M.; Holst, J.; Mehta, M.; Verhoeven, E.L.; Larzon, T.; Gennai, S.; Coppi, G.; Lipsitz, E.C.; Gargiulo, N.J.; Vliet, J.A. van der; Blankensteijn, J.D.; Buth, J.; Lee, W.A.; Biasiol, G.; Deleo, G.; Kasirajan, K.; Moore, R.; Soong, C.V.; Cayne, N.S.; Farber, M.A.; Raithel, D.; Greenberg, R.K.; Sambeek, M.R. van; Brunkwall, J.S.; Rockman, C.B.; Hinchliffe, R.J.

    2009-01-01

    BACKGROUND: Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial. OBJECTIVE: To clarify these we examined a c

  18. Fenestrated stent-grafting after previous endovascular abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    Vourliotakis, G.; Bos, W. T. G. J.; Beck, A. W.; Van den Dungen, J. J. A. M.; Prins, T. R.; Verhoeven, E. L. G.

    2010-01-01

    Aim. The aim of this study was to present their experience and highlight the technical difficulties associated with the use of fenestrated stent-grafts to treat juxta and pararenal abdominal aortic aneurysms (AAA) in patients having undergone a previous infrarenal endovascular aneurysm repair (EVAR)

  19. The diagnosis and management of abdominal aortic aneurysms: a comparison of computed tomography, ultrasound and aortography

    International Nuclear Information System (INIS)

    It is suggested that all clinically significant abdominal aneurysms can be shown by infusion C.T. or ultrasound and routine aortography is no longer indicated. These methods give more information about wall thickness and wall thrombus but do not give detailed information about the extent of an aneurysm and its exact relationship to important aortic branches. They should complement rather than replace aortography

  20. Endovascular therapy of abdominal aortic aneurysm: results of a mid-term follow-up

    International Nuclear Information System (INIS)

    Prospective study to evaluate clinical results and complications of endovascular abdominal aortic aneurysm treatment in a mid-term follow-up. Materials and methods: A total of 122 patients (9 females, 113 males, average age 70.0±7,9 years) with abdominal aortic aneurysms were treated with stent grafts (53 Vanguard or Stentor endografts, 69 Talent endografts). Group I consisted of 40 patients who had all aortic tributaries of the aneurysm sac occluded prior to endovalscular grafting, either spontaneously by parietal thrombosis or by selective coil embolization of the respective ostia preserving collateral circulation distal to the vessel occlusion. Group II consisted of 82 patients and included all cases without or with incomplete coil embolization with at least one patent vessel. Stent grafting was performed in general anesthesia in the first 21 patients, followed by peridural anesthesia in 15 cases, and local anesthesia with conscious sedation in 86 cases. The results were evaluated with Spiral-CT, MRI and radiographs of the endovascular graft, with follow-up examinations obtained at 3, 6, 12 months, and every year - Implantation was successfully completed in all cases without primary conversion surgery, laparotomy or any significant complication. Mean follow-up was 29±21 months (maximum 82 months). The 30-day mortality was 0,8% due to a myocardial infarction 3 days after discharge from the hospital. A total of 47 re-interventions were performed in 29 patients (23.8%), with 35 re-interventions in 18 cases with Vanguard or Stentor endografts and 12 re-interventions in 11 patients with Talent endografts. 23 percutaneous re-interventions included distal graft extension (n=11), Wallstent for kinking and limb stenosis (n=3), and secondary coil embolization of collateral vessels (n=9). 24 surgical re-interventions included proximal graft extension (n=6), new endovascular grafts (n=3), surgical clipping of lumbar and mesenteric artery branches for type-II endoleaks

  1. Redo-EVAR After Surgical Repair in Ruptured Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Şahin Bozok

    2015-12-01

    Full Text Available Endovascular aneurysm repair (EVAR is an adequate means for treating infrarenal abdominal aortic aneurysms (AAA. However, secondary interventions are required in approximately 15% to 20% of patients. The aim of this paper was to report our knowledge with stent grafts in secondary interventions after EVAR in a 73-year-old patient. One of the exceptional complications of EVAR are endoleaks which may lead to expansion of aneurysm and rupture if not repaired.

  2. Redo-EVAR After Surgical Repair in Ruptured Abdominal Aortic Aneurysm

    OpenAIRE

    Şahin Bozok; Sedat Ozan Karakişi; Şaban Ergene; Nebiye Tüfekçi; Gökhan İlhan; Hakan Karamustafa

    2015-01-01

    Endovascular aneurysm repair (EVAR) is an adequate means for treating infrarenal abdominal aortic aneurysms (AAA). However, secondary interventions are required in approximately 15% to 20% of patients. The aim of this paper was to report our knowledge with stent grafts in secondary interventions after EVAR in a 73-year-old patient. One of the exceptional complications of EVAR are endoleaks which may lead to expansion of aneurysm and rupture if not repaired.

  3. Redo-EVAR After Surgical Repair in Ruptured Abdominal Aortic Aneurysm

    Science.gov (United States)

    Bozok, Şahin; Ozan Karakişi, Sedat; Ergene, Şaban; Tufekçi, Nebiye; Ilhan, Gökhan; Karamustafa, Hakan

    2015-01-01

    Endovascular aneurysm repair (EVAR) is an adequate means for treating infrarenal abdominal aortic aneurysms (AAA). However, secondary interventions are required in approximately 15% to 20% of patients. The aim of this paper was to report our knowledge with stent grafts in secondary interventions after EVAR in a 73-year-old patient. One of the exceptional complications of EVAR are endoleaks which may lead to expansion of aneurysm and rupture if not repaired. PMID:26702349

  4. Diagnostic imaging of abdominal aortic aneurysms; Diagnostik des Bauchaortenaneurysmas

    Energy Technology Data Exchange (ETDEWEB)

    Kraemer, S.C.; Goerich, J. [Ulm Univ. (DE). Abt. Radiologie 1 (Roentgendiagnostik); Pamler, R. [Ulm Univ. (Germany). Abt. fuer Torax- und Gefaesschirurgie

    1999-07-01

    The survey explains the available methods for diagnostic imaging of aortic aneurysms, i.e. the conventional methods of ultrasonography and intra-arterial angiography as well as the modern tomographic and image processing techniques such as CT, DSA, and MRT. The various methods are briefly discussed with respect to their sensitivity and specificity. The authors expect that MRI will become the modality of choice, due to absence of radiation exposure of the patients. [German] Klassische Verfahren der Diagnostik von Aortenaneurysmen sind Ultrasonographie sowie die intraarterielle Angiographie. Inzwischen werden mehr und mehr die modernen Schnittbildtechniken und Rekonstruktionsverfahren wie CT, DSA und MRT verwendet. Die verschiedenen Methoden werden bez/''uglich ihrer Sensitivit/''at und Spezifizit/''at diskutiert. Die Autoren nehmen an, da/ss sich die MRT wegen der fehlenden Strahlenbelastung als Methode der Wahl durchsetzen wird. (orig/MG)

  5. ED 02-4 MEDICAL THERAPY OF ABDOMINAL AORTIC ANEURYSMS.

    Science.gov (United States)

    Jiang, Xiongjing

    2016-09-01

    Abdominal aortic aneurysm (AAA) is an important cause of mortality in older adults. Most AAAs are asymptomatic and screening programs have been introduced to identify AAAs. There is currently some recommendations for medical optimisation of patients with AAA, such as anti-hypertension, statin, Anti-platelet therapy, B-blockade, et al. Some medical treatments to limit progression of small AAAs, which have examined the potential of targeting inflammation, proteolysis, the renin-angiotensin system, the coagulation system and sex hormones as approaches to limiting AAA pathogenesis are investigated as well as. However, there is not generally accepted medical therapy for AAAs yet, Few of the treatment targets have translated into an agent, which can effectively reduce AAA progression in clinical practice. PMID:27643007

  6. Animal Models Used to Explore Abdominal Aortic Aneurysms

    DEFF Research Database (Denmark)

    Lysgaard Poulsen, J; Stubbe, J; Lindholt, J S

    2016-01-01

    OBJECTIVE: Experimental animal models have been used to investigate the formation, development, and progression of abdominal aortic aneurysms (AAAs) for decades. New models are constantly being developed to imitate the mechanisms of human AAAs and to identify treatments that are less risky than...... those used today. However, to the authors' knowledge, there is no model identical to the human AAA. The objective of this systematic review was to assess the different types of animal models used to investigate the development, progression, and treatment of AAA and to highlight their advantages...... and limitations. METHODS: A search protocol was used to perform a systematic literature search of PubMed and Embase. A total of 2,830 records were identified. After selection of the relevant articles, 564 papers on animal AAA models were included. RESULTS: The most common models in rodents, including elastase...

  7. HAS-1 genetic polymorphism in sporadic abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Alberto Balbarini

    2009-04-01

    Full Text Available The hyaluronan synthase 1 (HAS-1 gene encodes a plasma membrane protein that synthesizes hyaluronan (HA, an extracellular matrix molecule. Accumulating evidence emphasizes the relevance of HA metabolism in an increasing number of processes of clinical interest, including abdominal aortic aneurysm (AAA. The existence of aberrant splicing variants of the HAS-1 gene could partly explain the altered extracellular matrix architecture and influence various biological functions, resulting in progressive arterial wall failure in the development of AAA. In the present study, we assessed the hypothesis that HAS-1 genetic 833A/G polymorphism could be associated with the risk of AAA by performing a case-control association study, involving AAA patients and healthy matched donors.

  8. Atmospheric pressure variations and abdominal aortic aneurysm rupture.

    LENUS (Irish Health Repository)

    Killeen, S D

    2012-02-03

    BACKGROUND: Ruptured abdominal aortic aneurysm (RAAA) presents with increased frequency in the winter and spring months. Seasonal changes in atmospheric pressure mirrors this pattern. AIM: To establish if there was a seasonal variation in the occurrence of RAAA and to determine if there was any association with atmospheric pressure changes. METHODS: A retrospective cohort-based study was performed. Daily atmospheric pressure readings for the region were obtained. RESULTS: There was a statistically significant monthly variation in RAAA presentation with 107 cases (52.5%) occurring from November to March. The monthly number of RAAA and the mean atmospheric pressure in the previous month were inversely related (r = -0.752, r (2) = 0.566, P = 0.03), and there was significantly greater daily atmospheric pressure variability on days when patients with RAAA were admitted. CONCLUSION: These findings suggest a relationship between atmospheric pressure and RAAA.

  9. Cytokine amplification and macrophage effector functions in aortic inflammation and abdominal aortic aneurysm formation.

    Science.gov (United States)

    Ijaz, Talha; Tilton, Ronald G; Brasier, Allan R

    2016-08-01

    On April 29, 2015, Son and colleagues published an article entitled "Granulocyte macrophage colony-stimulating factor (GM-CSF) is required for aortic dissection/intramural haematoma" in Nature Communications. The authors observed that the heterozygous Kruppel-like transcription factor 6 (KLF6) deficiency or absence of myeloid-specific KLF6 led to upregulation of macrophage GM-CSF expression, promoted the development of aortic hematoma/dissection, and stimulated abdominal aortic aneurysm (AAA) formation when the vessel wall was subjected to an inflammatory stimulus. The additional findings of increased adventitial fibrotic deposition, marked infiltration of macrophages, and increased expression of matrix metalloprotease-9 (MMP-9) and IL-6 were blocked with neutralizing GM-CSF antibodies, or recapitulated in normal mice with excess GM-CSF administration. The authors concluded that GM-CSF is a key regulatory molecule in the development of AAA and further suggested that activation of GM-CSF is independent of the transforming growth factor β (TGFβ)-Smad pathway associated with the Marfan aortic pathology. In this perspective, we expand on this mechanism, drawing from previous studies implicating a similar essential role for IL-6 signaling in macrophage activation, Th17 expansion and aortic dissections. We propose a sequential "two-hit" model of vascular inflammation involving initial vascular injury followed by recruitment of Ly6C(hi) macrophages. Aided by fibroblast interactions inflammatory macrophages produce amplification of IL-6 and GM-CSF expression that converge on a common, pathogenic Janus kinase (JAK)-signal transducers and activations of transcription 3 (STAT3) signaling pathway. This pathway stimulates effector functions of macrophages, promotes differentiation of Th17 lymphocytes and enhances matrix metalloproteinase expression, ultimately resulting in deterioration of vascular wall structural integrity. Further research evaluating the impact of

  10. Using machine learning methods for predicting inhospital mortality in patients undergoing open repair of abdominal aortic aneurysm.

    Science.gov (United States)

    Monsalve-Torra, Ana; Ruiz-Fernandez, Daniel; Marin-Alonso, Oscar; Soriano-Payá, Antonio; Camacho-Mackenzie, Jaime; Carreño-Jaimes, Marisol

    2016-08-01

    An abdominal aortic aneurysm is an abnormal dilatation of the aortic vessel at abdominal level. This disease presents high rate of mortality and complications causing a decrease in the quality of life and increasing the cost of treatment. To estimate the mortality risk of patients undergoing surgery is complex due to the variables associated. The use of clinical decision support systems based on machine learning could help medical staff to improve the results of surgery and get a better understanding of the disease. In this work, the authors present a predictive system of inhospital mortality in patients who were undergoing to open repair of abdominal aortic aneurysm. Different methods as multilayer perceptron, radial basis function and Bayesian networks are used. Results are measured in terms of accuracy, sensitivity and specificity of the classifiers, achieving an accuracy higher than 95%. The developing of a system based on the algorithms tested can be useful for medical staff in order to make a better planning of care and reducing undesirable surgery results and the cost of the post-surgical treatments. PMID:27395372

  11. The role of gadolinium-enhanced MR imaging in the preoperative evaluation of inflammatory abdominal aortic aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Anbarasu, A.; McWilliams, R.G. [Department of Radiology, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP (United Kingdom); Harris, P.L. [Department of Vascular Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP (United Kingdom)

    2002-07-01

    Inflammatory abdominal aortic aneurysm is an uncommon variant of abdominal aortic aneurysms. Thorough preoperative imaging of the extent of the aneurysm and inflammation and the associated complications are crucial in the management of this condition. We report a case of inflammatory abdominal aortic aneurysm where, after the initial contrast-enhanced CT, gadolinium-enhanced MR imaging was used to define the true extent of the inflammation and differentiate inflammation from mural thrombus at the iliac extension of the aneurysm. The imaging appearances are presented and the impact of MR imaging on further surgical management options including endovascular repair are discussed. (orig.)

  12. Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management

    Science.gov (United States)

    Scaife, Mark; Giannakopoulos, Triantafillos; Al-Khoury, Georges E.; Chaer, Rabih A.; Avgerinos, Efthymios D.

    2016-01-01

    Ultrasound (US) is a well-established screening tool for detection of abdominal aortic aneurysms (AAAs) and is currently recommended not only for those with a relevant family history but also for all men and high-risk women older than 65 years of age. The advent of minimally invasive endovascular techniques in the treatment of AAAs [endovascular aneurysm repair (EVAR)] has increased the need for repeat imaging, especially in the postoperative period. Nevertheless, preoperative planning, intraoperative execution, and postoperative surveillance all mandate accurate imaging. While computed tomographic angiography and angiography have dominated the field, repeatedly exposing patients to the deleterious effects of cumulative radiation and intravenous nephrotoxic contrast, US technology has significantly evolved over the past decade. In addition to standard color duplex US, 2D, 3D, or 4D contrast-enhanced US modalities are revolutionizing AAA management and postoperative surveillance. This technology can accurately measure AAA diameter and volume, and most importantly, it can detect endoleaks post-EVAR with high sensitivity and specificity. 4D contrast-enhanced US can even provide hemodynamic information about the branch vessels following fenestrated EVARs. The need for experienced US operators and accredited vascular labs is mandatory to guarantee the reliability of the results. This review article presents a comprehensive overview of the literature on the state-of-art US imaging in AAA management, including post-EVAR follow-up, techniques, and diagnostic accuracy. PMID:27303669

  13. Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management.

    Science.gov (United States)

    Scaife, Mark; Giannakopoulos, Triantafillos; Al-Khoury, Georges E; Chaer, Rabih A; Avgerinos, Efthymios D

    2016-01-01

    Ultrasound (US) is a well-established screening tool for detection of abdominal aortic aneurysms (AAAs) and is currently recommended not only for those with a relevant family history but also for all men and high-risk women older than 65 years of age. The advent of minimally invasive endovascular techniques in the treatment of AAAs [endovascular aneurysm repair (EVAR)] has increased the need for repeat imaging, especially in the postoperative period. Nevertheless, preoperative planning, intraoperative execution, and postoperative surveillance all mandate accurate imaging. While computed tomographic angiography and angiography have dominated the field, repeatedly exposing patients to the deleterious effects of cumulative radiation and intravenous nephrotoxic contrast, US technology has significantly evolved over the past decade. In addition to standard color duplex US, 2D, 3D, or 4D contrast-enhanced US modalities are revolutionizing AAA management and postoperative surveillance. This technology can accurately measure AAA diameter and volume, and most importantly, it can detect endoleaks post-EVAR with high sensitivity and specificity. 4D contrast-enhanced US can even provide hemodynamic information about the branch vessels following fenestrated EVARs. The need for experienced US operators and accredited vascular labs is mandatory to guarantee the reliability of the results. This review article presents a comprehensive overview of the literature on the state-of-art US imaging in AAA management, including post-EVAR follow-up, techniques, and diagnostic accuracy. PMID:27303669

  14. Various complications of abdominal aortic aneurysm : CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Hoon; Byun, Jae Young; Kim, Bum Soo; Kim, Euy Neyung; Yoon, Yeo Dong; Kim, Ki Tae; Lee, Jae Mun; Shinn, Kyung Sub [The Catholic Univ. of Korea, College of Medicine, Seoul (Korea, Republic of)

    1997-03-01

    To evaluate on abdominal CT the type and incidence of various complications of abdominal aortic aneurysm (AAA). Twenty six suspected cases of AAA were confirmed by operation(n=21) and by CT(n=5). The etiology, size, shape and incidence of various complications of AAA were then retrospectively evaluated. In addition, post-operative complications were also evaluated in five cases. The etiology of the aneurysm was atherosclerotic in 18 cases and mycotic in three;it showed the presence of Behcet disease in three cases, of tuberculosis in one, and of Marfan syndrome in one. Among the 18 fusiform AAA, the mean maximum diameter of ruptured AAA(7.5{+-}3cm, n=3) was significantly larger than that of unruptured AAA(4.9{+-}1.6cm, n=15) (p<0.05). The saccular type was much more likely to rupture than the fusiform type(p<0.00001). Out of the eight saccular AAA, seven ruptured ; their mean maximum diameter was 3.9{+-}1.3cm This was significantly smaller than that of ruptured fusiform aneurysm(p<0.05). The most common complication was rupture, and occurred ten of 26 cases(38%). Others included hydronephrosis in three cases, bowel infarction in one, and perianeurysmal retroperitoneal fibrosis in one case. Various post-oper-ative complications developed in five patients; these comprised periprosthetic pseudoaneurysm with hematoma (two cases), bowel ischemia (one), focal renal infarction (one), and secondary aorticoduodenal fistula (one). The most common complication of AAA was rupture, the rate of which was much higher in the saccular type with smaller size than the fusiform type. Other various and uncommon complications were observed. CT was helpful in detecting complications arising from AAA and in planning its treatment.

  15. Various complications of abdominal aortic aneurysm : CT findings

    International Nuclear Information System (INIS)

    To evaluate on abdominal CT the type and incidence of various complications of abdominal aortic aneurysm (AAA). Twenty six suspected cases of AAA were confirmed by operation(n=21) and by CT(n=5). The etiology, size, shape and incidence of various complications of AAA were then retrospectively evaluated. In addition, post-operative complications were also evaluated in five cases. The etiology of the aneurysm was atherosclerotic in 18 cases and mycotic in three;it showed the presence of Behcet disease in three cases, of tuberculosis in one, and of Marfan syndrome in one. Among the 18 fusiform AAA, the mean maximum diameter of ruptured AAA(7.5±3cm, n=3) was significantly larger than that of unruptured AAA(4.9±1.6cm, n=15) (p<0.05). The saccular type was much more likely to rupture than the fusiform type(p<0.00001). Out of the eight saccular AAA, seven ruptured ; their mean maximum diameter was 3.9±1.3cm This was significantly smaller than that of ruptured fusiform aneurysm(p<0.05). The most common complication was rupture, and occurred ten of 26 cases(38%). Others included hydronephrosis in three cases, bowel infarction in one, and perianeurysmal retroperitoneal fibrosis in one case. Various post-oper-ative complications developed in five patients; these comprised periprosthetic pseudoaneurysm with hematoma (two cases), bowel ischemia (one), focal renal infarction (one), and secondary aorticoduodenal fistula (one). The most common complication of AAA was rupture, the rate of which was much higher in the saccular type with smaller size than the fusiform type. Other various and uncommon complications were observed. CT was helpful in detecting complications arising from AAA and in planning its treatment

  16. The endovascular repair or open surgery for abdominal aortic aneurysm%高风险患者腹主动脉瘤手术与腔内治疗效果的比较

    Institute of Scientific and Technical Information of China (English)

    王伟; 郭伟; 刘小平; 尹太; 贾鑫; 张宏鹏; 杜昕

    2009-01-01

    Objective To compare the therapeutic effect of endovascular repair (EVAR) and open surgical repair(OSR) of abdominal aortic aneurysm in high-risk patients. Methods The clinical data of 55 patients from 1998 to 2008 with infrarenal abdominal aortic aneurysm who received surgical treatment were analyzed by using the customized probability index. The perioperative and short term advantages and disadvantages of OSR group (n=20) were compared with EVAR group (n=35). Results All patients in OSR group were followed up, 94% patients in EVAR group were followed up, the mean follow up time were 75 and 70 months respectively. (1) Compared to OSR group, the EVAR group had shorter operation time [(3.1±0.6) h vs (4.9±0.9) h, P<0.05], (2) EVAR group had shorter ICU and hospital stay after operation and less blood loss (P<0.01), (3) Compared to OSR group, the EVAR group had lower mortality within 30 d(2.86% vs 15%), (4)the EVAR group had lower peri-operative complications(17% vs 40%), (5) The main complications of EVAR were endoleak (8.57%), (6) The main complications of OSR was cadiovascular incidence(25%). Conclusions Endovascular treatment, indicated for AAA in high-risk patients, can cut down the perioperative incidence of cadiovascular events, mortality and complications. CPI is useful to estimate the perioperative incidence of cadiovascular events, mortality and complications, and can be used to guide the therapeutic method.%目的 比较高风险患者腹主动脉瘤(abdominal aortic aneurysm,AAA)手术治疗(opensurgical repair,OSR)与腔内治疗(endovascular aneurysm repair,EVAR)的效果,探讨高风险患者AAA治疗方式的选择.方法 利用(customized probability index,CPI)危险评分方法[1]筛选出我院1998年至2008年高风险患者55例,比较OSR组(20例)与EVAR组(35例)围手术期及术后近期结果.结果 OSR组随访率100%,平均随访6年3个月.EVAR组随访率94%,平均随访5年10个月.(1)手术时间高风险患者EVAR组(3.1±0.6)h

  17. Endovascular Repair Versus Open Surgery in Patients with Abdominal Aortic Aneurysm%腹主动脉瘤开腹手术与腔内治疗的比较

    Institute of Scientific and Technical Information of China (English)

    崔庆丰; 戴向晨; 朱理玮

    2011-01-01

    Objective To compare the therapeutic effect of endovascular aortic repair (EVAR) and open surgical repair (OSR) for treatment of abdominal aortic aneurysm. Methods Thirty-five patients with abdominal aortic aneurysm were treated by EVAR (n=14) and OSR (n=21). The patients' preoperative status, intraoperative variables, perioperative conditions, postoperative complications and survival rate were compared. Results The average age of the patients in EVAR group was older than that in OSR group (P < 0.05). the operating time,the intraoperative blood loss and intrapoerative blood transfusion were less in EVAR group than in OSR group (P < 0.01), And time observation in ICU, time for bedside activities and time to take in food were shorter in EVAR group (P< 0.01). The postoperative morbidity was lower in EVAR group (P < 0.05), but with more complications on long term follow up (P < 0.05). Conclusion EVAR is a safer and less traumatic method than OSR, and patients can recover more rapidly, it is suitable for patients of advanced age and those with more complication. OSR is suitable for younger patients and those with less complications or patients who can not undergo EVAR.%目的:比较腹主动脉瘤腔内修复术与开放手术的疗效.方法:对35例肾下型腹主动脉瘤患者分别进行开放手术( 21例)与腔内修复术(14例)治疗,比较两组术前评估、手术、围手术期及术后随访情况.结果:腔内修复组年龄较高(P<0.05),手术时间、术中出血量、输血量较开腹手术低(P< 0.01),所需营养支持、监护、卧床时间短(P< 0.01),围手术期并发症发生率低(P< 0.05),但远期并发症发生率较高(P< 0.05).结论:腹主动脉瘤腔内支架治疗较为安全,创伤更小,患者恢复速度较快,适合于高龄及合并症较多的患者.传统开放手术适于年轻、合并症少及无法行腔内修复术的患者.

  18. Dilatation of the proximal neck of infrarenal aortic aneurysms after endovascular AAA repair

    NARCIS (Netherlands)

    Wever, JJ; de Nie, AJ; Blankensteijn, JD; Broeders, IAMJ; Mail, WPTM; Eikelboom, BC

    2000-01-01

    Objectives: to assess size changes of the proximal aortic neck after endograft placement. Methods: since 1994, 54 consecutive patients have undergone abdominal aortic aneurysm (AAA) repair with the Endovascular Technologies (EVT) endograft. The study group comprised the 33 patients who had completed

  19. Troubleshooting techniques for the Endurant™ device in endovascular aortic aneurysm repair.

    Science.gov (United States)

    Georgiadis, George S; Antoniou, George A; Trellopoulos, George; Georgakarakos, Efstratios I; Argyriou, Christos; Lazarides, Miltos K

    2014-01-01

    Endovascular aortic aneurysm repair with the Endurant™ stent-graft system has been shown to be safe and effective in high-risk surgical patients with complex suprarenal and/or infrarenal abdominal aortic aneurysm anatomy. The wireformed M-shaped stent architecture and proximal springs with anchoring pins theoretically permit optimal sealing in shorter and more angulated proximal aneurysm necks even under off-label conditions. Nonetheless, extremely difficult anatomical situations and inherent graft system-related limitations must be anticipated. Herein, we describe our techniques to overcome the capture of the tip sleeve within the suprarenal bare-stent anchoring pins, other endograft segments, and native vessels. PMID:25182343

  20. Possible dual role of decorin in abdominal aortic aneurysm.

    Directory of Open Access Journals (Sweden)

    Koshiro Ueda

    Full Text Available Abdominal aortic aneurysm (AAA is characterized by chronic inflammation, which leads to pathological remodeling of the extracellular matrix. Decorin, a small leucine-rich repeat proteoglycan, has been suggested to regulate inflammation and stabilize the extracellular matrix. Therefore, the present study investigated the role of decorin in the pathogenesis of AAA. Decorin was localized in the aortic adventitia under normal conditions in both mice and humans. AAA was induced in mice using CaCl2 treatment. Initially, decorin protein levels decreased, but as AAA progressed decorin levels increased in all layers. Local administration of exogenous decorin prevented the development of CaCl2-induced AAA. However, decorin was highly expressed in the degenerative lesions of human AAA walls, and this expression positively correlated with matrix metalloproteinase (MMP-9 expression. In cell culture experiments, the addition of decorin inhibited secretion of MMP-9 in vascular smooth muscle cells, but had the opposite effect in macrophages. The results suggest that decorin plays a dual role in AAA. Adventitial decorin in normal aorta may protect against the development of AAA, but macrophages expressing decorin in AAA walls may facilitate the progression of AAA by up-regulating MMP-9 secretion.

  1. Detection of periodontal pathogens in the patients with aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    Ding Fang; Lyu Yalin; Han Xiao; Zhang Hai; Liu Dongyu; Hei Wei; Liu Yinhua

    2014-01-01

    Background The occurrence and development of aortic aneurysm (AA) are associated with infection.Some researchers have detected the DNA of periodontal pathogens in AA samples in certain populations.However,it has not been done in Chinese population.The objective of this study was to evaluate the prevalence of periodontal pathogens in oral tissue samples and aneurysm samples of AA patients.Methods Eighty-nine subjects with AA and 59 subjects without AA were examined.Periodontal clinical parameters were evaluated.Unstimulated saliva and subgingival plaque somples were collected from all subjects.Twenty-six dissected AA samples were obtained.Evidence of eight periodontal pathogens including Porphyromonas gingivalis (Pg),Actinobacillus actinomycetemcomitans (Aa),Prevotella intermedia (Pi),Tannerella forsythensis (Tf),Treponema denticola (Td),Campylobacter rectus (Cr),Fusobacterium nucleatum (Fn),and Prevotella nigrescens (Pn) was ascertained in all samples by 16S rRNA-based polymerase chain reaction (PCR) assay.Results The periodontal indexes including plaque index (PLI),probing depth (PD),bleeding index (BI),and clinical attachment loss (CAL),of the six Ramfjord index teeth were significantly higher in the AA group than those in the control group (P <0.01).Eight periodontal pathogens in subgingival plaque samples were more frequently detected in the AA group than in control group.The difference in prevalence between the groups was significant for six (out of eight) periodontal pathogens assayed (Pg,Pi,Fn,Pn,Tf,and Td,P <0.01).Additionally,all eight periodontal pathogens were more frequently detected in saliva samples of the AA group than in those of the control group,again with six (out of eight) (Pg,Pi,Fn,Cr,Tf,and Td) displaying significant differences in prevalence between the two groups (P <0.01).Out of 26 aneurysm samples examined,Pg,Pi,Fn,Crand Tfwere detected in 6 (23.1%),2 (7.7%),3 (11.5%),1 (3.8%),2 (7.7%),respectively,and Aa,Pn,and Td were not

  2. Design and development of a decision aid to enhance shared decision making by patients with an asymptomatic abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Dirk T Ubbink

    2008-11-01

    Full Text Available Dirk T Ubbink1,2, Anouk M Knops1, Sjaak Molenaar1, Astrid Goossens11Department of Quality Assurance and Process Innovation and 2Department of Surgery, Academic Medical Center, Amsterdam, The NetherlandsObjective: To design, develop, and evaluate an evidence-based decision aid (DA for patients with an asymptomatic abdominal aortic aneurysm (AAA to inform them about the pros and cons of their treatment options (ie, surgery or watchful observation and to help them make a shared decision.Methods: A multidisciplinary team defined criteria for the desired DA as to design, medical content and functionality, particularly for elderly users. Development was according to the international standard (IPDAS. Fifteen patients with an AAA, who were either treated or not yet treated, evaluated the tool.Results: A DA was developed to offer information about the disease, the risks and benefits of surgical treatment and watchful observation, and the individual possibilities and threats based on the patient’s aneurysm diameter and risk profile. The DA was improved and judged favorably by physicians and patients.Conclusion: This evidence-based DA for AAA patients, developed according to IPDAS criteria, is likely to be a simple, user-friendly tool to offer patients evidence-based information about the pros and cons of treatment options for AAA, to improve patients’ understanding of the disease and treatment options, and may support decision making based on individual values.Keywords: decision support techniques, research design, program development, abdominal aortic aneurysm, decision making

  3. Intraoperative microvascular Doppler monitoring in intracranial aneurysm surgery

    Institute of Scientific and Technical Information of China (English)

    HUI Pin-jing; YAN Yan-hong; ZHANG Shi-ming; WANG Zhong; YU Zheng-quan; ZHOU You-xin; LI Xiang-dong

    2013-01-01

    Background Surgical treatment of intracranial aneurysms is often compromised by incomplete exclusion of the aneurysm or stenosis of parent vessels.Intraoperative microvascular Doppler (IMD) is an attractive,noninvasive,and inexpensive tool.The present study aimed to evaluate the usefulness and reliability of IMD for guiding clip placement in aneurysm surgery.Methods A total of 92 patients with 101 intracranial aneurysms were included in the study.IMD with a 1.5-mm diameter,20-MHz microprobe was used before and after clip application to confirm aneurysm obliteration and patency of parent vessels and branching arteries.IMD findings were verified postoperatively with digital subtraction angiography (DSA) or dual energy computed tomography angiography (DE-CTA).Ninety consecutive patients,harboring 108 aneurysms,who underwent surgery without IMD was considered as the control group.Results The microprobe detected all vessels of the Circle of Willis and their major branches.Clips were repositioned in 24 (23.8%) aneurysms on the basis of the IMD findings consistent with incomplete exclusion and/or stenosis.IMD identified persistent weak blood flow through the aneurismal sac of 11 of the 101 (10.9%) aneurysms requiring clip adjustment.Stenosis or occlusion of the parent or branching arteries as indicated by IMD necessitated immediate clip adjustment in 19 aneurysms (18.8%).The mean duration of the IMD procedure was 4.8 minutes.The frequency of clip adjustment (mean:1.8 times per case) was associated with the size and location of the aneurysm.There were no complications related to the use of IMD,and postoperative angiograms confirmed complete aneurysm exclusion and parent vessel patency.About 8.3% (9/108) aneurysms were unexpectedly incompletely occluded,and 10.2% (11/108) aneurysms and parent vessel stenosis without IMD were detected by postoperative DSA or DE-CTA.IMD could reduce the rate of residual aneurysm and unanticipated vessel stenosis which demonstrated

  4. Ruptured aortic aneurysm in a coyote (Canis latrans) from South Carolina.

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Debra, Lee; Schrecengost, Joshua; Kilgo, John; Ray, Scott; Miller, Karl V.

    2007-07-01

    Abstract – A radio-collared adult female coyote (Canis latrans) from South Carolina was found dead with no apparent signs of trauma or struggle. Necropsy revealed a ruptured aortic aneurysm within the thoracic cavity as well as severe heartworm infection, with paracites present in the caudal vena cava. Histologically, inflammatory cell infiltrates were frequent in the aneurysm and consisted of eosinophils, neutrophils, lymphocytes, plasma cells, and macrophages. Bacteria, fungi, and paracites were not found in the aneurysm. Death was due to exsanguinations. This represents a first report of an aneurysm in a coyote.

  5. Combined general-epidural anesthesia with continuous postoperative epidural analgesia preserves sigmoid colon perfusion in elective infrarenal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Venetiana Panaretou

    2012-01-01

    Full Text Available Background: In elective open infrarenal aortic aneurysm repair the use of epidural anesthesia and analgesia may preserve splanchnic perfusion. The aim of this study was to investigate the effects of epidural anesthesia on gut perfusion with gastrointestinal tonometry in patients undergoing aortic reconstructive surgery. Methods: Thirty patients, scheduled to undergo an elective infrarenal abdominal aortic reconstructive procedure were randomized in two groups: the epidural anesthesia group (Group A, n=16 and the control group (Group B, n=14. After induction of anesthesia, a transanally inserted sigmoid tonometer was placed for the measurement of sigmoid and gastric intramucosal CO 2 levels and the calculation of regional-arterial CO 2 difference (ΔPCO 2 . Additional measurements included mean arterial pressure (MAP, cardiac output (CO, systemic vascular resistance (SVR, and arterial lactate levels. Results: There were no significant intra- and inter-group differences for MAP, CO, SVR, and arterial lactate levels. Sigmoid pH and PCO 2 increased in both the groups, but this increase was significantly higher in Group B, 20 min after aortic clamping and 10 min after aortic declamping. Conclusions: Patients receiving epidural anesthesia during abdominal aortic reconstruction appear to have less severe disturbances of sigmoid perfusion compared with patients not receiving epidural anesthesia. Further studies are needed to verify these results.

  6. Combined general–epidural anesthesia with continuous postoperative epidural analgesia preserves sigmoid colon perfusion in elective infrarenal aortic aneurysm repair

    Science.gov (United States)

    Panaretou, Venetiana; Siafaka, Ioanna; Theodorou, Dimitrios; Manouras, Andreas; Seretis, Charalampos; Gourgiotis, Stavros; Katsaragakis, Stylianos; Sigala, Fragiska; Zografos, George; Filis, Konstantinos

    2012-01-01

    Background: In elective open infrarenal aortic aneurysm repair the use of epidural anesthesia and analgesia may preserve splanchnic perfusion. The aim of this study was to investigate the effects of epidural anesthesia on gut perfusion with gastrointestinal tonometry in patients undergoing aortic reconstructive surgery. Methods: Thirty patients, scheduled to undergo an elective infrarenal abdominal aortic reconstructive procedure were randomized in two groups: the epidural anesthesia group (Group A, n=16) and the control group (Group B, n=14). After induction of anesthesia, a transanally inserted sigmoid tonometer was placed for the measurement of sigmoid and gastric intramucosal CO2 levels and the calculation of regional–arterial CO2 difference (ΔPCO2). Additional measurements included mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR), and arterial lactate levels. Results: There were no significant intra- and inter-group differences for MAP, CO, SVR, and arterial lactate levels. Sigmoid pH and PCO2 increased in both the groups, but this increase was significantly higher in Group B, 20 min after aortic clamping and 10 min after aortic declamping. Conclusions: Patients receiving epidural anesthesia during abdominal aortic reconstruction appear to have less severe disturbances of sigmoid perfusion compared with patients not receiving epidural anesthesia. Further studies are needed to verify these results. PMID:23493852

  7. Long-term benefit and cost-effectiveness analysis of screening for abdominal aortic aneurysms from a randomized controlled trial

    DEFF Research Database (Denmark)

    Lindholt, Jes S.; Sørensen, J; Søgaard, R;

    2010-01-01

    The aim was to estimate long-term mortality benefits and cost-effectiveness of screening for abdominal aortic aneurysm (AAA) in men aged 64-73 years.......The aim was to estimate long-term mortality benefits and cost-effectiveness of screening for abdominal aortic aneurysm (AAA) in men aged 64-73 years....

  8. The cardiac cycle is a major contributor to variability in size measurements of abdominal aortic aneurysms by ultrasound

    DEFF Research Database (Denmark)

    Grøndal, Nikolaj Fibiger; Bramsen, Morten; Thomsen, Marie Dahl;

    2012-01-01

    The objective of the study was to evaluate the impact of the cardiac cycle on ultrasound measurements of abdominal aortic aneurysm (AAA) diameters.......The objective of the study was to evaluate the impact of the cardiac cycle on ultrasound measurements of abdominal aortic aneurysm (AAA) diameters....

  9. Visualization of Complex Flow Patterns in Angiotensin II-Induced Dissecting Murine Abdominal Aortic Aneurysms with High Frequency Ultrasound

    OpenAIRE

    Schroeder, Hilary D.; Yrineo, Alexa A.; Bogucki, Amy E; Goergen, Craig J.

    2013-01-01

    Abdominal aortic aneurysm (AAA) rupture is a common cause of mortality in the United States. Current treatments are only employed once the risk of rupture outweighs the risks associated with surgery. Murine models have been developed to characterize AAA pathogenesis in the hope that new treatments will be developed. For this study, angiotensin II (AngII) was infused subcutaneously into apolipoprotein E-deficient (ApoE-/-) mice using an osmotic mini-pump over 28 days. ApoE-/- mice (16-week-old...

  10. Clipping Surgery for Unruptured Middle Cerebral Artery Aneurysms.

    Science.gov (United States)

    Nakagomi, Tadayoshi; Furuya, Kazuhide; Tanaka, Junichi; Takanashi, Shigehiko; Watanabe, Takehiro; Shinohara, Takayuki; Ogawa, Akiko; Fujii, Norio

    2016-01-01

    Clipping surgeries for 139 consecutive unruptured middle cerebral aneurysms were performed between April 1991 and March 2014. Left hemiparesis occurred in one case (0.7 %). Transient symptoms arose in six patients due to perforator injury, arterial branch occlusion, damage to the venous system, or chronic subdural hematoma. Neither mortality nor decline in cognitive function was noted in this study. Clipping surgery for unruptured middle cerebral artery aneurysms can be done with minimal morbidity. However, meticulous management during the perioperative period as well as the use of modern technologies during the surgery, such as MEP monitoring and ICG videoangiography, are needed for safe and secure clipping surgery. PMID:27637633

  11. Chronic contained rupture of an abdominal aortic aneurysm presenting as a Grynfeltt lumbar hernia. A case report.

    Science.gov (United States)

    Dobbeleir, J; Fourneau, I; Maleux, G; Daenens, K; Vandekerkhof, J; Nevelsteen, A

    2007-06-01

    We report a unique case of chronic contained thoraco-abdominal aneurysm rupture presenting as a Grynfeltt lumbar hernia. A 79-year-old man presented with backpain and a bluish swelling in the left lumbar region in the presence of a non tender aortic aneurysm. CT scan confirmed contained rupture of a type IV thoraco-abdominal aortic aneurysm. The peri-aortic haematoma protruded through the lumbar wall causing a Grynfeltt lumbar hernia. The aneurysm was replaced through a thoraco-phreno-lumbotomy. The patient survived and is doing well six months postoperatively.

  12. Aortocaval fistula (ACF) in patients operated for ruptured aortic aneurysm (rAAA)

    DEFF Research Database (Denmark)

    Warning, Karina; Houlind, Kim Christian; Ravn, Hans

    Aortocaval fistula (ACF) in patients operated for Ruptured Acute Aorta Aneurysm (rAAA): A surgical challenge. Introduction Aortocaval fistula is a rare complication of abdominal aortic aneurysm (AAA). It been reported to be present in less than 1% of all AAAs. ACF arise in patients with large...... aneurysms and is typically discovered peroperatively in patients with rAAA. Open surgical treatment is associated with high mortality and morbidity. ACF is a result of spontaneously rupture of large atherosclerotic aneurysms into the inferior vena cava in 80%, 15% arise after trauma and 5% are iatrogenic....... Patients During the last 9 month, we have operated three cases with rAAA and ACF. All patients had an open, acute operation. All ACFs detected during operation. Common for all operations was that the patients had large aneurysms (>10 cm) and extensive bleeding (3-4 l) immediately when the aneurysm...

  13. Chronic complete thrombosis of abdominal aortic aneurysm: an unusual presentation of an unusual complication.

    Science.gov (United States)

    Pejkic, Sinisa; Opacic, Dragan; Mutavdzic, Perica; Radmili, Oliver; Krstic, Nevena; Davidovic, Lazar

    2015-02-01

    Although mural thrombosis frequently accompanies aneurysmal disease, complete thrombosis is distinctly unusual complication of abdominal aortic aneurysm (AAA). A case study of a patient with chronic, asymptomatic complete thrombosis of a large juxtarenal AAA is presented along with a literature review and discussion of the potential secondary complications, mandating aggressive management of this condition. A 67-year-old man with multiple atherogenic risk factors and unattended complaints consistent with a recent episode of a transient right hemispheric ischemic attack was referred to our clinic with a diagnosis of a thrombosed AAA established by computed tomography. Duplex ultrasonography and aortography confirmed the referral diagnosis and also revealed near occlusion of the left internal carotid artery. The patient underwent a two-stage surgery, with preliminary left-sided carotid endarterectomy followed three days later by an aneurysmectomy and aortobifemoral reconstruction. He had an uncomplicated recovery and was discharged home on postoperative day 7, remaining asymptomatic at the 42-month follow-up. Complete thrombosis is an uncommon presentation of AAA and may be clinically silent. It is frequently associated with other manifestations of generalized atherosclerosis. Radical open repair yields durable result and is the preferred treatment modality.

  14. Endovascular Aortic Aneurysm Repair with Chimney and Snorkel Grafts: Indications, Techniques and Results

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Rakesh P., E-mail: rpatel9@nhs.net [Northwick Park Hospital, Department of Vascular Radiology (United Kingdom); Katsargyris, Athanasios, E-mail: kthanassos@yahoo.com; Verhoeven, Eric L. G., E-mail: Eric.Verhoeven@klinikum-nuernberg.de [Klinikum Nuernberg, Department of Vascular and Endovascular Surgery (Germany); Adam, Donald J., E-mail: donald.adam@tiscali.co.uk [Heartlands Hospital, Department of Vascular Surgery (United Kingdom); Hardman, John A., E-mail: johnhardman@doctors.org.uk [Royal United Hospital Bath, Department of Vascular Radiology (United Kingdom)

    2013-12-15

    The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR.

  15. The Potential Role of DNA Methylation in Abdominal Aortic Aneurysms

    Directory of Open Access Journals (Sweden)

    Evan J. Ryer

    2015-05-01

    Full Text Available Abdominal aortic aneurysm (AAA is a complex disorder that has a significant impact on the aging population. While both genetic and environmental risk factors have been implicated in AAA formation, the precise genetic markers involved and the factors influencing their expression remain an area of ongoing investigation. DNA methylation has been previously used to study gene silencing in other inflammatory disorders and since AAA has an extensive inflammatory component, we sought to examine the genome-wide DNA methylation profiles in mononuclear blood cells of AAA cases and matched non-AAA controls. To this end, we collected blood samples and isolated mononuclear cells for DNA and RNA extraction from four all male groups: AAA smokers (n = 11, AAA non-smokers (n = 9, control smokers (n = 10 and control non-smokers (n = 11. Methylation data were obtained using the Illumina 450k Human Methylation Bead Chip and analyzed using the R language and multiple Bioconductor packages. Principal component analysis and linear analysis of CpG island subsets identified four regions with significant differences in methylation with respect to AAA: kelch-like family member 35 (KLHL35, calponin 2 (CNN2, serpin peptidase inhibitor clade B (ovalbumin member 9 (SERPINB9, and adenylate cyclase 10 pseudogene 1 (ADCY10P1. Follow-up studies included RT-PCR and immunostaining for CNN2 and SERPINB9. These findings are novel and suggest DNA methylation may play a role in AAA pathobiology.

  16. The potential role of DNA methylation in abdominal aortic aneurysms.

    Science.gov (United States)

    Ryer, Evan J; Ronning, Kaitryn E; Erdman, Robert; Schworer, Charles M; Elmore, James R; Peeler, Thomas C; Nevius, Christopher D; Lillvis, John H; Garvin, Robert P; Franklin, David P; Kuivaniemi, Helena; Tromp, Gerard

    2015-01-01

    Abdominal aortic aneurysm (AAA) is a complex disorder that has a significant impact on the aging population. While both genetic and environmental risk factors have been implicated in AAA formation, the precise genetic markers involved and the factors influencing their expression remain an area of ongoing investigation. DNA methylation has been previously used to study gene silencing in other inflammatory disorders and since AAA has an extensive inflammatory component, we sought to examine the genome-wide DNA methylation profiles in mononuclear blood cells of AAA cases and matched non-AAA controls. To this end, we collected blood samples and isolated mononuclear cells for DNA and RNA extraction from four all male groups: AAA smokers (n = 11), AAA non-smokers (n = 9), control smokers (n = 10) and control non-smokers (n = 11). Methylation data were obtained using the Illumina 450k Human Methylation Bead Chip and analyzed using the R language and multiple Bioconductor packages. Principal component analysis and linear analysis of CpG island subsets identified four regions with significant differences in methylation with respect to AAA: kelch-like family member 35 (KLHL35), calponin 2 (CNN2), serpin peptidase inhibitor clade B (ovalbumin) member 9 (SERPINB9), and adenylate cyclase 10 pseudogene 1 (ADCY10P1). Follow-up studies included RT-PCR and immunostaining for CNN2 and SERPINB9. These findings are novel and suggest DNA methylation may play a role in AAA pathobiology. PMID:25993294

  17. Novel risk predictor for thrombus deposition in abdominal aortic aneurysms

    Science.gov (United States)

    Nestola, M. G. C.; Gizzi, A.; Cherubini, C.; Filippi, S.; Succi, S.

    2015-10-01

    The identification of the basic mechanisms responsible for cardiovascular diseases stands as one of the most challenging problems in modern medical research including various mechanisms which encompass a broad spectrum of space and time scales. Major implications for clinical practice and pre-emptive medicine rely on the onset and development of intraluminal thrombus in which effective clinical therapies require synthetic risk predictors/indicators capable of informing real-time decision-making protocols. In the present contribution, two novel hemodynamics synthetic indicators, based on a three-band decomposition (TBD) of the shear stress signal, are introduced. Extensive fluid-structure computer simulations of patient-specific scenarios confirm the enhanced risk-prediction capabilities of the TBD indicators. In particular, they permit a quantitative and accurate localization of the most likely thrombus deposition in realistic aortic geometries, where previous indicators would predict healthy operation. The proposed methodology is also shown to provide additional information and discrimination criteria on other factors of major clinical relevance, such as the size of the aneurysm.

  18. Thoracic aortic aneurysm in a buck associated with caseous lymphadenitis

    Directory of Open Access Journals (Sweden)

    R.R. Pinheiro

    2013-06-01

    Full Text Available This paper reports the clinical, bacteriological and pathological findings of a thoracic aortic aneurysm in a four-year-old Anglo-Nubian goat buck, related to a framework of visceral caseous lymphadenitis. General clinical examination showed heart rate of 75 beats per minute, respiratory rate of 20 movements per minute and ruminal movements of four movements per minute. Superficial lymph nodes were normal upon palpation. Rectal temperature was slightly high (40.5°C. Blood test showed an intense leukocytosis (54,000/µL, characterized by strong neutrophil shift to the left. At necropsy, a large blood clot was detected in the thoracic cavity. The thickening of the myocardium and dilatation of the aorta in the thoracic portion, presenting a saculiform format was also observed. A large number of abscesses were disseminated in the media and intima layers of aorta. The aorta lumen obstruction by arterial plaques consisting of inflammatory infiltrate, predominantly neutrophilic was also detected. Abscesses were found spread in turbinate, rumen, reticulum, kidneys, liver, spleen, testicles and aorta wall. The microbiological exam of exudate confirmed Corynebacterium pseudotuberculosis as the causal agent.

  19. Contemporary Applications of Ultrasound in Abdominal Aortic Aneurysm Management

    Directory of Open Access Journals (Sweden)

    Mark eScaife

    2016-05-01

    Full Text Available Ultrasound (US is a well-established screening tool for detection of abdominal aortic aneurysms (AAA and is currently recommended not only for those with a relevant family history but for all men and high-risk women older than 65 years of age. The advent of minimally invasive endovascular techniques in the treatment of AAAs (EVAR has increased the need for repeat imaging especially in the post-operative period. Nevertheless, preoperative planning, intraoperative execution and postoperative surveillance all mandate accurate imaging. While CTA and angiography have dominated the field, repeatedly exposing patients to the deleterious effects of cumulative radiation and intravenous nephrotoxic contrast, ultrasound technology has significantly evolved over the past decade. In addition to standard color duplex US, 2D, 3D or 4D contrast enhanced US modalities are revolutionizing AAA management and postoperative surveillance. This technology can accurately measure AAA diameter and volume and most importantly it can detect endoleaks post EVAR with high sensitivity and specificity. 4D contrast enhanced US can even provide hemodynamic information about the branch vessels following fenestrated EVARs. The need for experienced US operators and accredited vascular labs is mandatory to guarantee the reliability of the results. This review article presents a comprehensive overview of the literature on the state-of-art US imaging in AAA management, including post EVAR follow-up, techniques and diagnostic accuracy.

  20. Infected aortic aneurysm presenting as prevertebral abscess in magnetic resonance imaging: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Jung Re; Ko, Seong Joo; Heo, Sang Taek; Kim, Jin Seok; Kim, Seung Hyoung [Jeju National University School of Medicine, Jeju (Korea, Republic of)

    2013-09-15

    The differential diagnosis of mass-like lesions around the aorta includes saccular pseudoaneurysms and abscesses. A 69-year-old female was admitted with multiple abscesses and fluid collections in several muscles and joints. Methicillin susceptible Staphylococcus aureus was isolated from her blood and pus. Even though she was treated with repeated operations and appropriate antibiotics, her conditions worsened with persistent fever and newly developed abscesses at other sites. Serial enhanced computed tomography (CT) revealed a newly developed saccular abdominal aortic aneurysm in the retroaortic space at the celiac axis level. However, the infected aortic aneurysm mimicked a prevertebral abscess on enhanced spinal magnetic resonance imaging (MRI) due to its heterogeneous signal intensity caused by intraaneurysmal turbulent blood flow. We report to alert the pitfall in the diagnosis of saccular aortic aneurysm using spinal MRI and the importance of serial enhanced CT study in highly suspicious patients.

  1. Perioperative nursing for patients receiving endovascular therapy for ruptured abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Objective: To discuss the nursing strategy and practical measures for patients with ruptured abdominal aortic aneurysm during the perioperative period of endovascular intervention. Methods: Endovascular therapy was carried out in 34 patients with ruptured abdominal aortic aneurysm,who were encountered in our department during the period of July 1997 to September 2008. The clinical data were retrospectively analyzed and the nursing points were summarized. Results: The average hospitalization days of the 34 patients were (14 ± 5) days, the mortality rate within 30 days was 23.5% (8/34). No nursing-related complications occurred. Conclusion: A comprehensive understanding of the mechanism, development and clinical evolution of ruptured abdominal aortic aneurysm is very important for nursing care. For nursing staff, well mastering the relevant nursing technique, carefully guarding against any nursing errors and lessening patient's suffering as far as possible, all these are the task of primary importance. (authors)

  2. 破裂腹主动脉瘤腔内治疗与手术治疗效果比较%Comparing the effects of endovascular and open surgery repair of ruptured abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    韩万里; 戴向晨; 罗宇东; 范海伦; 冯舟; 朱杰昌; 张益伟

    2015-01-01

    Objective:To compare and analyze effects of endovascular repair (EVAR) and open surgery repair (OSR) in patients with ruptured abdominal aortic aneurysm (rAAA). Methods: Clinical data of patients with rAAA were analyzed retrospectively. Outcome parameters included mortality (intraoperation, 30 day, 6 month and 12 month), complications, reinterventions, and length of hospital stay. Results:Thirty-five consecutive patients with rAAAs were presented, 12 of whom underwent EVAR, and 23 underwent OSR. Twenty-eight males and 7 females, age from 37 to 84 years with an mean of(68.37±10.04). At baseline, There was no significant differece in age , gender , comorbidities and preoperative hemodynamic stability between the two groups (P>0.05). The intraoperation, 30 day, 6 month and 12 month mortalities were 0.0%(0 of 12), 0.0%(0 of 12), 0.0%(0 of 12), and 0.0%(0 of 8) after EVAR, compared with 17.4%(4 of 23, P=0.275), 30.4%(7 of 23, P=0.070), 34.8% (8 of 23, P=0.032), and 45.0% (9 of 20, P=0.029) after OSR, respectively. Median length of hospital stay was 11.0 days (interquartile range, 7.0~16.0) after rEVAR and 17.0 days (interquartile range, 14.0~27.0) after OSR (P=0.024). Conclusion:These data suggest that EVAR can be a first-line treatment for rAAA. However, anatomical conditions should be considered with caution. Aortouniiliac is a fast and effective way to control bleeding. Further observation of abdominal compartment syndrome is essential for EVAR.%目的:比较破裂腹主动脉瘤(rAAA)腔内治疗(EVAR)与开放手术(OSR)的治疗情况。方法:回顾性分析分别采取开放手术或腔内治疗的rAAA患者临床资料。比较两组术前一般情况、围手术期死亡率及并发症发生率、术后死亡率、术后住院时间等。结果:rAAA患者共35例,其中男28例,女7例,年龄37~84岁,平均(68.37±10.04)岁。 OSR 23例、EVAR 12例。两组在年龄、性别、合并症及术前血流动力学稳定性

  3. Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery Joint Position Statement on Open and Endovascular Surgery for Thoracic Aortic Disease.

    Science.gov (United States)

    Appoo, Jehangir J; Bozinovski, John; Chu, Michael W A; El-Hamamsy, Ismail; Forbes, Thomas L; Moon, Michael; Ouzounian, Maral; Peterson, Mark D; Tittley, Jacques; Boodhwani, Munir

    2016-06-01

    In 2014, the Canadian Cardiovascular Society (CCS) published a position statement on the management of thoracic aortic disease addressing size thresholds for surgery, imaging modalities, medical therapy, and genetics. It did not address issues related to surgical intervention. This joint Position Statement on behalf of the CCS, Canadian Society of Cardiac Surgeons, and the Canadian Society for Vascular Surgery provides recommendations about thoracic aortic disease interventions, including: aortic valve repair, perfusion strategies for arch repair, extended arch hybrid reconstruction for acute type A dissection, endovascular management of arch and descending aortic aneurysms, and type B dissection. The position statement is constructed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and has been approved by the primary panel, an international secondary panel, and the CCS Guidelines Committee. Advent of endovascular technology has improved aortic surgery safety and extended the indications of minimally invasive thoracic aortic surgery. The combination of safer open surgery with endovascular treatment has improved patient outcomes in this rapidly evolving subspecialty field of cardiovascular surgery.

  4. Impact of poroelasticity of intraluminal thrombus on wall stress of abdominal aortic aneurysms

    OpenAIRE

    Polzer Stanislav; Gasser T; Markert Bernd; Bursa Jiri; Skacel Pavel

    2012-01-01

    Abstract Background The predictions of stress fields in Abdominal Aortic Aneurysm (AAA) depend on constitutive descriptions of the aneurysm wall and the Intra-luminal Thrombus (ILT). ILT is a porous diluted structure (biphasic solid–fluid material) and its impact on AAA biomechanics is controversially discussed in the literature. Specifically, pressure measurements showed that the ILT cannot protect the wall from the arterial pressure, while other (numerical and experimental) studies showed t...

  5. Endoleakage after endovascular treatment of abdominal aortic aneurysms: diagnosis, significance and treatment

    Energy Technology Data Exchange (ETDEWEB)

    Golzarian, Jafar [University of Iowa, University of Iowa Heath Care, IA (United States); Valenti, David [McGill University, Royal Victoria Hospital, McGill University Health Centre, Montreal (Canada)

    2006-12-15

    Endoleak, also called leakage, leak and Perigraft leak, is a major complication and its persistence represents a failure of endovascular aortic aneurysm repair. Its detection and treatment is therefore of primary importance, since endoleak can be associated with pressurization (increase in pressure) of the sac, resulting in expansion and rupture of the aneurysm. The aim of this paper is to discuss the definition, significance, diagnosis and different options to treat endoleak. (orig.)

  6. Successful abdominal aortic aneurysm resection in long-term survivors of cardiac transplantation.

    OpenAIRE

    Defraigne, Jean-Olivier; SakalihasanN, Natzi; DEMOULIN, Julie; Limet, Raymond

    1995-01-01

    With the improvement of survival rates following cardiac transplantation, the probability of recipients developing extracardiac disease is increased. Three cases are reported of abdominal aortic aneurysm successfully operated on in cardiac allograft recipients 1 to 4 years after transplantation. Indications for transplantation were valvular, idiopathic and ischaemic cardiomyopathy. Post-transplant hypertension and hyperlipidaemia may have played a role in the rapid growth of the aneurysms. Ca...

  7. Novel Use of an Iliac Branch Device in the Treatment of an Abdominal Aortic Aneurysm.

    Science.gov (United States)

    Shiraev, Timothy P; Dubenec, Steven

    2016-07-01

    Iliac branch devices (IBDs) are commonly used to treat iliac artery aneurysms and maintain patency of the internal iliac artery or its branches. This case report illustrates another possible application for an IBD. We present the case of a 77-year-old male who underwent repair of his infrarenal aneurysm with an IBD as a bifurcated aortic stent-graft in a small diameter aorta to maintain bilateral common iliac artery patency. PMID:27174353

  8. The use of silicone materials to model abdominal aortic aneurysm behaviour

    OpenAIRE

    Doyle, Barry J.; Callanan, Anthony; Corbett, Timothy J.; Cloonan, Aidan J.; O'Donnell, Michael R.; Vorp, David A.; McGloughlin, Timothy M

    2008-01-01

    peer-reviewed This paper aims to identify the rupture locations of abdominal aortic aneurysms. Dow Corning Sylgard 184 was mechanically characterised. Five idealised models were then manufactured using this silicone rubber which were subsequently inflated to rupture with the images recorded using a high speed camera. Four of the five models tested ruptured at inflection points in the proximal and distal regions of the aneurysm sac, and not at regions of maximum diameter. US National Hea...

  9. Experimental Study of a Thoracic Aortic Aneurysm Prior to and After Surgical Repair Hemodynamics

    Science.gov (United States)

    Kerlo, Anna-Elodie; Frankel, Steven; Chen, Jun; Vlachos, Pavlos

    2014-11-01

    Once a Thoracic Aortic Aneurysm (TAA) is detected, the risk of rupture is estimated based on the TAA diameter compared to the normal aortic diameter and its expansion rate. However, there are no reliable predictors that can provide accurate prognosis, and each aneurysm may progress differently. This work aims to assess the hemodynamic characteristics and flow structures associated with TAAs. The flow in a patient specific thoracic aortic aneurysm is compared to the same patient after treatment, in order to quantify the differences in the hydrodynamic forces acting on the aneurysm. Flow visualization with dye and Particle Image Velocimetry (PIV) are used to study flow features within both geometries. Local flow patterns are visualized to predict potential areas of recirculation and low shear stresses as they are associated with thrombogenicity. Understanding the differences in flow features between a thoracic aortic aneurysm and a normal aorta (or a TAA after surgical repair) may lead to a better understanding of disease mechanisms that will enable clinicians to better estimate the risk of rupture.

  10. Aortocaval Fistula Resulting From Rupture of Abdominal Aortic Dissecting Aneurysm Treated by Delayed Endovascular Repair

    Science.gov (United States)

    Wang, Tiehao; Huang, Bin; Zhao, Jichun; Yang, Yi; Yuan, Ding

    2016-01-01

    Abstract Aortocaval fistula (ACF) after rupture of an abdominal aortic dissecting aneurysm is a rare emergency situation, which has a high mortality. However, the diagnosis is usually delayed, which increases the difficulties of treatment. We describe a case that successfully delayed use of endovascular aneurysm repair (EVAR) for ACF resulting from rupture of abdominal aortic dissecting aneurysm. We describe a special case of a 70-year-old male with an abdominal aortic dissecting aneurysm rupturing into inferior vena cava (IVC). On account of his atypical presentation, the diagnosis had been delayed for half a year. Due to severe metabolic sequelaes of the ACF and preexisting conditions, the traditional open repair was too risky. Minimally invasive EVAR was performed with a successful result. There were no endoleak or fistula at the follow-up of 9th month. EVAR is the most suitable method in patients with ACF from rupture of abdominal aortic dissecting aneurysm. Further educational programs should be developed, which may give rise to earlier diagnosis and treatment with better outcomes. PMID:27149481

  11. Characterization of human aortic elastase found in patients with abdominal aortic aneurysms.

    Science.gov (United States)

    Cohen, J R; Mandell, C; Wise, L

    1987-10-01

    Recent evidence indicates that the homeostatic balance between elastase and antiprotease activity is altered in the infrarenal aorta of those patients with different types of aortic pathologic findings. The specific properties of elastase found in the aorta of patients with abdominal aortic aneurysms (AAA) are discussed herein. Activity of elastase extracted from ten pooled AAA specimens was observed when incubated with several inhibitors: 13.2 per cent for phenyl-suphonyl flouride (PSF); 43.3 per cent for ethylenediaminetetraacetic acid (EDTA); 77.7 per cent for pepstatin; 137.0 per cent for leupeptin, and 24.0 per cent for alpha-1-antitrypsin. Irreversible inhibition by PSF indicates that the elastase is a serine protease. The elastase is most likely not a metallo enzyme, since it had no absolute requirement for divalent cations as indicated by only partial inhibition by EDTA. Elastase activity is most likely not due to cathepsins B or D, since cathepsins are active in an acid pH and selectively inhibited by leupeptin and pepstatin. The pH curve revealed a maximum activity at pH 8.2 and elastase activity was significantly inhibited by alpha-1-antitrypsin in a dose response manner determining functional elastase activity. These data indicate that the elastase in the aorta of patients with an AAA has the exact properties of the serine elastase found in the smooth muscle cells of the aorta in rats. These results also confirm the critical role of alpha-1-antitrypsin in determining functional elastase activity. Smooth muscle cell regulation of elastin metabolism may be important in determining why some patients have AAA and others have occlusive aortic disease develop.

  12. Plasma levels of cathepsins L, K, and V and risks of abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Lv, Bing-Jie; Lindholt, Jes S; Wang, Jing;

    2013-01-01

    Cathepsin L (CatL), cathepsin K (CatK), and cathepsin V (CatV) are potent elastases implicated in human arterial wall remodeling. Whether plasma levels of these cathepsins are altered in patients with abdominal aortic aneurysms (AAAs) remains unknown.......Cathepsin L (CatL), cathepsin K (CatK), and cathepsin V (CatV) are potent elastases implicated in human arterial wall remodeling. Whether plasma levels of these cathepsins are altered in patients with abdominal aortic aneurysms (AAAs) remains unknown....

  13. Hybrid endografts combinations for the treatment 
of endoleak in endovascular abdominal aortic aneurysm repair.

    Science.gov (United States)

    Georgiadis, George S; Trellopoulos, George; Antoniou, George A; Georgakarakos, Efstratios I; Nikolopoulos, Evagelos S; Iatrou, Christos; Lazarides, Miltos K

    2013-01-01

    Hybrid endografting in endovascular abdominal aortic aneurysm repair (EVAR) is defined as the process of placing a series of two or more different types of covered stents, usually to treat a complex abdominal aortic aneurysm (AAA) or a primary or secondary endoleak. We describe the treatment of a type III, a type Ib, and a type Ia endoleak in three patients respectively, using hybrid solutions, assembling components from different manufacturers. An update of the current clinical and experimental evidence on the application of anatomically compatible, hybrid endograft systems in conventional EVAR is also provided. PMID:23280081

  14. Surgical Treatment of a Voluminous Infrarenal Abdominal Aortic Aneurysm with Horseshoe Kidney: Tips and Tricks.

    Science.gov (United States)

    De Caridi, Giovanni; Massara, Mafalda; Greco, Michele; Mastrojeni, Claudio; Serra, Raffaele; Salomone, Ignazio; La Spada, Michele

    2015-01-01

    Horseshoe kidney is a common urology anomaly, while its association with infrarenal abdominal aortic aneurysm represents a very rare condition. Surgical approach remains controversial however, we believe that the left retroperitoneal approach should be preferred in order to avoid isthmus resection with any subsequent renal infarction, urinary tract damage and to facilitate renal arteries reimplantation, when required. We present a case of voluminous infrarenal abdominal aortic aneurysm associated with horseshoe kidney, successfully treated through a left retroperitoneal approach on the retro-renal space. PMID:26730260

  15. [Endovascular repair of abdominal aortic aneurysm in a patient with transplanted kidney].

    Science.gov (United States)

    Khabazov, R I; Chupin, A V; Kolosov, R V; Deriabin, S V

    2016-01-01

    Endovascular repair of the abdominal aorta is a method of choice in pronounced concomitant pathology and high risk of open surgical treatment. The article deals with a clinical case report of successful surgical management of a patient with an infrarenal aortic aneurysm, transplanted kidney, chronic renal insufficiency, secondary diabetes mellitus, multifocal atherosclerosis with predominant involvement of coronary arteries and lower-limb arteries, in whom open surgical treatment was associated with high risk. Endoprosthetic repair of the abdominal aortic aneurysm was performed with a good postoperative outcome. PMID:27626264

  16. Enhanced Recovery after Elective Open Surgical Repair of Abdominal Aortic Aneurysm: A Complementary Overview through a Pooled Analysis of Proportions from Case Series Studies

    OpenAIRE

    Gurgel, Sanderland J. T.; Regina El Dib; Paulo do Nascimento

    2014-01-01

    OBJECTIVES: To evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) programs in elective open surgical repair (OSR) of abdominal aortic aneurysm (AAA). BACKGROUND: Open surgical repair of AAA is associated with high morbidity and mortality, prolonged hospital stay and high costs. ERAS programs contribute to the optimization of treatment by reducing hospital stay and improving clinical outcomes. METHODS: A review of PubMed, EMBASE and LILACS databases was conducted. As on...

  17. Mycotic Saccular Abdominal Aortic Aneurysm in an Infant after Cardiac Catheterization: A Case Report.

    Science.gov (United States)

    Benrashid, Ehsan; McCoy, Christopher C; Rice, Henry E; Shortell, Cynthia K; Cox, Mitchell W

    2015-10-01

    Abdominal aortic aneurysms (AAAs) are a rare entity in the pediatric population. Children with mycotic (infectious) AAA in particular are at risk of life-threatening rupture due to their rapid expansion coupled with aortic wall thinning and deterioration. Here, we present the case of a 10-month-old infant with prior 2-staged repair for hypoplastic left heart syndrome that was incidentally discovered to have a mycotic AAA on abdominal ultrasound (US) for evaluation of renovascular hypertension. Before the time of evaluation with US, the infant had developed methicillin-resistant Staphylococcus aureus bacteremia 3 days after cardiac catheterization with percutaneous thoracic aortic balloon angioplasty. She had normal aortic contours on contrasted computed tomography scan of the abdomen approximately 2 weeks before the aforementioned US evaluation. This infant subsequently underwent open aneurysmorrhaphy with cryopreserved vein patch angioplasty with resolution of her aneurysmal segment.

  18. Giant Thoracic Aneurysm Following Valve Replacement for Bicuspid Aortic Valve.

    Science.gov (United States)

    Tran, Cao; Ul Haq, Ehtesham; Nguyen, Ngoc; Omar, Bassam

    2015-01-01

    Bicuspid aortic valve is a common congenital anomaly associated with aortopathy, which can cause aortic root dilatation, necessitating regular screening if the aortic root is > 4.0 cm. Despite the low absolute incidence of aortic complications associated with bicuspid aortic valve in the general population, the consequences of such complications for an individual patient can be devastating. Herein we propose a balanced algorithm that incorporates recommendations from the three major guidelines for follow-up imaging of the aortic root and ascending thoracic aorta in patients with a bicuspid aortic valve, maintaining the current recommendations with regard to surgical thresholds. PMID:26827748

  19. Long-term implications of emergency versus elective proximal aortic surgery in Marfan syndrome patients in the GenTAC Registry

    Science.gov (United States)

    Song, Howard K.; Kindem, Mark; Bavaria, Joseph E.; Dietz, Harry C.; Milewicz, Dianna M.; Devereux, Richard B.; Eagle, Kim A.; Maslen, Cheryl L.; Kroner, Barbara L.; Pyeritz, Reed E.; Holmes, Kathryn W.; Weinsaft, Jonathan W.; Menashe, Victor; Ravekes, William; LeMaire, Scott A.

    2011-01-01

    Objective Marfan syndrome patients with aortic root aneurysms undergo elective aortic root replacement to avoid the life-threatening outcomes of aortic dissection and emergency repair. The long-term implications of failed aortic surveillance leading to acute dissection and emergency repair are poorly defined. We compared the long-term clinical courses of Marfan syndrome patients who survive emergency versus elective proximal aortic surgery. Methods The GenTAC Registry is an NIH-funded, multicenter database and biorepository that enrolls patients with genetically triggered thoracic aortic aneurysms. Of the 635 patients with Marfan syndrome enrolled as of March 2011, 194 had undergone proximal aortic replacement. Patients were grouped according to emergent (n=47) or elective (n=147) status at the time of surgery. Results Patients in the emergent group were more likely to have incomplete proximal aortic resection; 83% of emergency procedures included aortic root replacement, compared with 95% of elective procedures. At long-term follow-up (mean, >6 years), emergent patients had a higher incidence of chronic dissection of the distal aorta and had significantly larger diameters in distal aortic segments than elective patients. Additionally, emergent patients had undergone more operations (1.31 vs 1.11 procedures/patient; P=0.01) and had lower activity scores on a health-related quality-of-life survey. Conclusions For Marfan syndrome patients, failed aortic surveillance and consequent emergency dissection repair have important long-term implications with regard to status of the distal aorta, the need for multiple procedures, and quality of life. These findings emphasize the importance of aortic surveillance and timely elective aortic root aneurysm repair for Marfan syndrome patients. PMID:22104675

  20. Impact of aortic aneurysm on hospitalizations in patients with marfan syndrome: a multi-institutional study.

    Science.gov (United States)

    Collins, R Thomas; Phomakay, Venusa; Zarate, Yuri A; Tang, Xinyu

    2015-01-01

    Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder affecting 1 in 3,000 people. Cardiovascular involvement is a prominent feature of MFS, with aortic dissection and/or rupture being the leading cause of death. Advances in the medical and surgical care of patients with MFS have improved survival. Hospital resource utilization and outcomes have not been evaluated in a large population of patients with MFS. We sought to analyze pediatric hospital resource utilization and outcomes in patients with MFS. Nationally distributed data from 43 pediatric hospitals in the 2004-2011 Pediatric Health Information System database were used to identify patients admitted to the hospital with International Classification of Diseases-9th Revision codes for a diagnosis of MFS. Aortic aneurysm (AA) with or without dissection, length of stay (LOS), and hospital charges were determined. During the study period, there were 1,978 admissions in 1,228 patients with MFS. AA was present in 217 (11%) admissions in 188 (15%) patients (63% male). Mean age of patients with AA was 13.8 ± 5.9 years. Aortic dissection or rupture was present in 15 (7% with AA) admissions in 15 (8% with AA) patients (mean age 15.7 ± 5.2 years). Other cardiac diagnoses occurred more commonly in the AA cohort (p < 0.0001), regardless of the reason for admission. Cardiothoracic surgical procedures were performed in 116 AA admissions (53%). Mean LOS, hospital charges per admission, and charges per day were significantly higher in AA cohort compared to those without AA. In-hospital mortality for AA was 2%. The presence of AA in patients with MFS increases hospital resource utilization. Cardiothoracic surgeries are commonly performed in this cohort. Other cardiovascular diagnoses are more prevalent in patients with AA suggesting a more severe phenotype.

  1. Colorectal cancer associated with abdominal aortic aneurysm: results of EVAR followed by colectomy.

    Science.gov (United States)

    Illuminati, Giulio; Ceccanei, Gianluca; Pacilè, Maria A; Pizzardi, Giulia; Palumbo, Piergaspare; Vietri, Francesco

    2013-01-01

    The association of colorectal cancer and abdominal aortic aneurysm (AAA) is infrequent but poses special problems of priority of treatment under elective circumstances. The purpose of this study was to retrospectively evaluate the outcome of 16 consecutive patients undergoing endovascular aneurysm repair (EVAR) followed by colectomy. Operative mortality was nil. Operative morbidity included two transient rise of serum creatinine level and one extraperitoneal anastomotic leakage which evolved favourably with conservative treatment. EVAR allowed a very short delay of treatment of colorectal cancer after aneurysm repair, minimizing operative complications. PMID:23151840

  2. Current endovascular treatment of infrarenal abdominal aortic aneurysms and future directions.

    Science.gov (United States)

    Kokkosis, Angela A; Abramowitz, Steven; Malik, Rajesh K; Ellozy, Sharif H; Faries, Peter L; Marin, Michael L

    2012-12-01

    The paradigm in elective surgical management of infrarenal abdominal aortic aneurysms (AAAs) has quickly shifted from major open surgical repairs to less invasive, endovascular procedures. In the last few years, there have been numerous advancements to commercially available devices making the endovascular approach more attractive and efficacious. This review serves to detail the similarities, differences, advantages, and disadvantages of currently available endovascular stent-grafts as well as preview future and emerging technologies in endovascular aortic therapies.

  3. Changes in wall shear stresses in abdominal aortic aneurysms with increasing wall stiffness

    Science.gov (United States)

    Salsac, Anne-Virginie; Fernandez, Miguel

    2006-11-01

    During the growth of abdominal aortic aneurysms, local changes occur in the composition and structure of the diseased wall, resulting in its stiffening. A numerical simulation of the fluid structure interactions is performed in idealized models of aneurysms using a finite element method. A full coupling of the equations governing the pulsatile blood flow and the deformation of the compliant wall is undertaken. The effect of the progressive stiffening of the wall is analyzed at various stages in the growth of the aneurysm. Increasing the wall stiffness alters the distribution of wall shear stresses and leads to an increase in their magnitude. The wall compliance is shown to have a more pronounced effect on non-axisymmetric aneurysms, which sustain large displacements. The overall movement of the aneurysm models increases the three-dimensionality of the flow.

  4. Anesthetic Implications of Emergent Cesarean Section in a Parturient with Marfan Syndrome Complicated by Ascending Aortic Aneurysm and Heart Failure

    Directory of Open Access Journals (Sweden)

    Young Sung Kim

    2014-07-01

    Full Text Available Cardiovascular comorbidities to the Marfan syndrome may induce hemodynamic instability especially in the parturients during labor or delivery. For anesthesiologists, it is challenging to maintain hemodynamic stability during Cesarean section in those patients with Marfan syndrome. Remifentanil is an ultra-short-acting opioid with rapid onset and offset of action which provides cardiovascular stability during surgery. Together with remifentanil, the use of a laryngeal mask airway can reduce the risk of hypertensive response followed by tracheal intubation. We describe the successful administration of remifentanil and application of laryngeal mask airway for emergent Cesarean section performed under general anesthesia in a patient with Marfan syndrome complicated by ascending aortic aneurysm and heart failure. The use of remifentanil (loading dose of 1 μg/kg for 1 min, 2 min before induction; thereafter continuous infusion dose of 0.1 μg/kg/min was useful to maintain hemodynamic stability of the parturient throughout the surgery without neonatal respiratory depression.Keywords: Ascending Aortic Aneurysm; Cesarean section; Laryngeal mask airway; Marfan syndrome; Remifentanil

  5. Simulation of bifurcated stent grafts to treat abdominal aortic aneurysms (AAA)

    Science.gov (United States)

    Egger, J.; Großkopf, S.; Freisleben, B.

    2007-03-01

    In this paper a method is introduced, to visualize bifurcated stent grafts in CT-Data. The aim is to improve therapy planning for minimal invasive treatment of abdominal aortic aneurysms (AAA). Due to precise measurement of the abdominal aortic aneurysm and exact simulation of the bifurcated stent graft, physicians are supported in choosing a suitable stent prior to an intervention. The presented method can be used to measure the dimensions of the abdominal aortic aneurysm as well as simulate a bifurcated stent graft. Both of these procedures are based on a preceding segmentation and skeletonization of the aortic, right and left iliac. Using these centerlines (aortic, right and left iliac) a bifurcated initial stent is constructed. Through the implementation of an ACM method the initial stent is fit iteratively to the vessel walls - due to the influence of external forces (distance- as well as balloonforce). Following the fitting process, the crucial values for choosing a bifurcated stent graft are measured, e.g. aortic diameter, right and left common iliac diameter, minimum diameter of distal neck. The selected stent is then simulated to the CT-Data - starting with the initial stent. It hereby becomes apparent if the dimensions of the bifurcated stent graft are exact, i.e. the fitting to the arteries was done properly and no ostium was covered.

  6. Ultrasound screening for abdominal aortic aneurysm in medicare beneficiaries.

    Science.gov (United States)

    Schermerhorn, Marc; Zwolak, Robert; Velazquez, Omaida; Makaroun, Michel; Fairman, Ronald; Cronenwett, Jack

    2008-01-01

    Ultrasound screening for abdominal aortic aneurysm (AAA) has been shown to be beneficial and cost-effective for men aged 65-74. However, most screening studies have been conducted in Europe and Australia, where attendance for screening was higher than the single large U.S. study involving only veterans. The prevalence of AAA in the U.S. general population is not well defined, nor is the best method of recruitment for screening. Letters of invitation for a free screening ultrasound for AAA were sent to 30,000 randomly selected Medicare beneficiaries from the hospital referral region of three university-affiliated hospitals without restriction by age, gender, or comorbidity. Attendance for screening was calculated by age, gender, and travel distance to the screening center. Telephone calls to a random sample of nonresponders were made to determine the reason for failure to attend. Prevalence of AAA by ultrasound and known risk factors for AAA (e.g., age, gender, smoking status) were determined. The attendance rate was 7% (2,005). Attendance was greater with male gender (p Medicare beneficiaries for ultrasound screening for AAA results in a low attendance and low yield of AAA. The prevalence estimates from this study may not reflect the entire Medicare population given the low attendance and may reflect the healthy habits of those most interested in screening. Patients should be selected for screening based on their suitability for repair if an AAA is found as well as their risk factors for AAA. The best method of recruitment for screening of those most at risk for AAA in the United States remains to be determined. PMID:18055170

  7. Ultrasound screening for abdominal aortic aneurysm in medicare beneficiaries.

    Science.gov (United States)

    Schermerhorn, Marc; Zwolak, Robert; Velazquez, Omaida; Makaroun, Michel; Fairman, Ronald; Cronenwett, Jack

    2008-01-01

    Ultrasound screening for abdominal aortic aneurysm (AAA) has been shown to be beneficial and cost-effective for men aged 65-74. However, most screening studies have been conducted in Europe and Australia, where attendance for screening was higher than the single large U.S. study involving only veterans. The prevalence of AAA in the U.S. general population is not well defined, nor is the best method of recruitment for screening. Letters of invitation for a free screening ultrasound for AAA were sent to 30,000 randomly selected Medicare beneficiaries from the hospital referral region of three university-affiliated hospitals without restriction by age, gender, or comorbidity. Attendance for screening was calculated by age, gender, and travel distance to the screening center. Telephone calls to a random sample of nonresponders were made to determine the reason for failure to attend. Prevalence of AAA by ultrasound and known risk factors for AAA (e.g., age, gender, smoking status) were determined. The attendance rate was 7% (2,005). Attendance was greater with male gender (p Medicare beneficiaries for ultrasound screening for AAA results in a low attendance and low yield of AAA. The prevalence estimates from this study may not reflect the entire Medicare population given the low attendance and may reflect the healthy habits of those most interested in screening. Patients should be selected for screening based on their suitability for repair if an AAA is found as well as their risk factors for AAA. The best method of recruitment for screening of those most at risk for AAA in the United States remains to be determined.

  8. Endovascular vs open repair for ruptured abdominal aortic aneurysm

    Science.gov (United States)

    Nedeau, April E.; Pomposelli, Frank B.; Hamdan, Allen D.; Wyers, Mark C.; Hsu, Richard; Sachs, Teviah; Siracuse, Jeffrey J.; Schermerhorn, Mark L.

    2014-01-01

    Objective Endovascular repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) has become first-line therapy at our institution and is performed under a standardized protocol. We compare perioperative mortality, midterm survival, and morbidity after EVAR and open surgical repair (OSR). Methods Records were retrospectively reviewed from May 2000 to September 2010 for repair of infrarenal rAAAs. Primary end points included perioperative mortality and midterm survival. Secondary end points included acute limb ischemia, length of stay, ventilator-dependent respiratory failure, myocardial infarction, renal failure, abdominal compartment syndrome, and secondary intervention. Statistical analysis was performed using the t-test,X2 test, the Fisher exact test, and logistic regression calculations. Midterm survival was assessed with Kaplan-Meier analysis and Cox proportional hazard models. Results Seventy-four infrarenal rAAAs were repaired, 19 by EVAR and 55 by OSR. Despite increased age and comorbidity in the EVAR patients, perioperative mortality was 15.7% for EVAR, which was significantly lower than the 49% for OSR (odds ratio, 0.19; 95% CI, 0.05-0.74; P = .008). Midterm survival also favored EVAR (hazard ratio, 0.40; 95% CI, 0.21-0.77; P = .028, adjusted for age and sex). Mean follow-up was 20 months, and 1-year survival was 60% for EVAR vs 45% for OSR. Mean length of stay for patients surviving >1 day was 10 days for EVAR and 21 days for OSR (P = .004). Ventilator-dependent respiratory failure was 5% in the EVAR group vs 42% for OSR (odds ratio, 0.08; 95% CI, 0.01-0.62; P = .001). Conclusions EVAR of rAAA has a superior perioperative survival advantage and decreased morbidity vs OSR. Although not statistically significant, overall survival favors EVAR. We recommend that EVAR be considered as the first-line treatment of rAAAs and practiced as the standard of care. PMID:22626871

  9. Percutaneous endovascular stent-graft treatment of aortic aneurysms and dissections: new techniques and initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Do Yun; Choi, Dong Hoon; Kang, Sung Gwon; Lee, Kwang Hoon; Won, Jong Yun [Yonsei University College of Medicine, Seoul (Korea, Republic of); Kang, Sung Gwon [Chosun University College of Medicine, Gwangju (Korea, Republic of); Won, Je Whan [Aju University College of Medicine, Suwon (Korea, Republic of); Song, Ho Young [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2003-01-01

    To evaluate the feasibility, safety and effectiveness of a newly designed percutaneously implanted separate stent-graft (SSG) for the treatment of aortic aneurysms and dissections. Using a percutaneous technique, SSG placement (in the descending thoracic aorta in 26 cases and infrarenal abdominal aorta in 24) was attempted in 50 patients with aortic aneurysms (n=27) or dissection (n=23). All SSGs were individually constructed using self-expandable nitinol stents and a Dacron graft, and were introduced through a 12 F sheath and expanded to a diameter of 20-34 mm. In all cases, vascular access was through the femoral artery. The clinical status of each patient was monitored, and postoperative CT was performed within one week of the procedure and at 3-6 month intervals afterwards. Endovascular stent-graft deployment was technically successful in 49 of 50 patients (98%). The one failure was due to torsion of the unsupported graft during deployment. Successful exclusion of aneurysms and the primary entry tears of dissections was achieved in all but three patients with aortic dissection. All patients in whom technical success was achieved showed complete thrombosis of the thoracic false lumen or aneurysmal sac, and the overall technique success rate was 92%. In addition, sixteen patients demonstrated complete resolution of the dissected thoracic false lumen (n=9) or aneurysmal sac (n=7). Immediate post-operative complications occurred at the femoral puncture site in one patient with an arteriovenous fistula, and in two, a new saccular aneurysm developed at the distal margin of the stent. No patients died, and there was no instance of paraplegia, stroke, side-branch occlusion or infection during the subsequent mean follow-up period of 9.4 (range, 2 to 26) months. In patients with aortic aneurysm and dissection, treatment with a separate percutaneously inserted stent-graft is technically feasible, safe, and effective.

  10. Blood flow dynamic improvement with aneurysm repair detected by a patient-specific model of multiple aortic aneurysms.

    Science.gov (United States)

    Sughimoto, Koichi; Takahara, Yoshiharu; Mogi, Kenji; Yamazaki, Kenji; Tsubota, Ken'ichi; Liang, Fuyou; Liu, Hao

    2014-05-01

    Aortic aneurysms may cause the turbulence of blood flow and result in the energy loss of the blood flow, while grafting of the dilated aorta may ameliorate these hemodynamic disturbances, contributing to the alleviation of the energy efficiency of blood flow delivery. However, evaluating of the energy efficiency of blood flow in an aortic aneurysm has been technically difficult to estimate and not comprehensively understood yet. We devised a multiscale computational biomechanical model, introducing novel flow indices, to investigate a single male patient with multiple aortic aneurysms. Preoperative levels of wall shear stress and oscillatory shear index (OSI) were elevated but declined after staged grafting procedures: OSI decreased from 0.280 to 0.257 (first operation) and 0.221 (second operation). Graftings may strategically counter the loss of efficient blood delivery to improve hemodynamics of the aorta. The energy efficiency of blood flow also improved postoperatively. Novel indices of pulsatile pressure index (PPI) and pulsatile energy loss index (PELI) were evaluated to characterize and quantify energy loss of pulsatile blood flow. Mean PPI decreased from 0.445 to 0.423 (first operation) and 0.359 (second operation), respectively; while the preoperative PELI of 0.986 dropped to 0.820 and 0.831. Graftings contributed not only to ameliorate wall shear stress or oscillatory shear index but also to improve efficient blood flow. This patient-specific modeling will help in analyzing the mechanism of aortic aneurysm formation and may play an important role in quantifying the energy efficiency or loss in blood delivery. PMID:23852404

  11. Endovascular treatment of aortic pathologies - State of the art. Part 1 - Aneurysms of abdominal aorta

    International Nuclear Information System (INIS)

    Endovascular treatment of aortic pathologies is actually an alternative to open surgery. It has proven to be safe, showing similar or better results to those achieved by surgery. In this article, treatment of aortic pathologies by means of endoprosthesis is presented, as well as its indications, contraindications and future treatment with this kind of devices

  12. Abdominal aortic aneurysm: Treatment options, image visualizations and follow-up procedures

    Institute of Scientific and Technical Information of China (English)

    Zhong-Hua Sun

    2012-01-01

    Abdominal aortic aneurysm is a common vascular disease that affects elderly population.Open surgical repair is regarded as the gold standard technique for treatment of abdominal aortic aneurysm,however,endovaseular aneurysm repair has rapidly expanded since its first introduction in 1990s.As a less invasive technique,endovascular aneurysm repair has been confirmed to be an effective alternative to open surgical repair,especially in patients with co-morbid conditions.Computed tomography (CT) angiography is currently the preferred imaging modality for both preoperative planning and post-operative follow-up.2D CT images are complemented by a number of 3D reconstructions which enhance the diagnostic applications of CT angiography in both planning and follow-up of endovascular repair.CT has the disadvantage of high cummulative radiation dose,of particular concern in younger patients,since patients require regular imaging follow-ups after endovascular repair,thus,exposing patients to repeated radiation exposure for life.There is a trend to change from CT to ultrasound surveillance of endovascular aneurysm repair.Medical image visualizations demonstrate excellent morphological assessment of aneurysm and stent-grafts,but fail to provide hemodynamic changes caused by the complex stent-graft device that is implanted into the aorta.This article reviews the treatment options of abdominal aortic aneurysm,various image visualization tools,and follow-up procedures with use of different modalities including both imaging and computational fluid dynamics methods.Future directions to improve treatment outcomes in the follow-up of endovascular aneurysm repair are outlined.

  13. The same sequence variant on 9p21 associates with myocardial infarction, abdominal aortic aneurysm and intracranial aneurysm

    DEFF Research Database (Denmark)

    Helgadottir, Anna; Thorleifsson, Gudmar; Magnusson, Kristinn P;

    2008-01-01

    . Here we report that rs10757278-G is associated with, in addition to CAD, abdominal aortic aneurysm (AAA; odds ratio (OR) = 1.31, P = 1.2 x 10(-12)) and intracranial aneurysm (OR = 1.29, P = 2.5 x 10(-6)), but not with T2D. This variant is the first to be described that affects the risk of AAA...... and intracranial aneurysm in many populations. The association of rs10811661-T to T2D replicates in our samples, but the variant does not associate with any of the five arterial diseases examined. These findings extend our insight into the role of the sequence variant tagged by rs10757278-G and show...

  14. Cost-effectiveness and cost-utility of endovascular versus open repair of ruptured abdominal aortic aneurysm in the Amsterdam Acute Aneurysm Trial

    NARCIS (Netherlands)

    Kapma, M. R.; Dijksman, L. M.; Reimerink, J. J.; de Groof, A. J.; Zeebregts, C. J.; Wisselink, W.; Balm, R.; Dijkgraaf, M. G. W.; Vahl, A. C.

    2014-01-01

    Background: Minimally invasive endovascular aneurysm repair (EVAR) could be a surgical technique that improves outcome of patients with ruptured abdominal aortic aneurysm (rAAA). The aim of this study was to analyse the cost-effectiveness and cost-utility of EVAR compared with standard open repair (

  15. 腹主动脉瘤围手术期管理%Perioperative management for abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    赵渝; 李凤贺

    2012-01-01

    腹主动脉瘤(abdominal aortic aneurysm,AAA)是人体最常见的主动脉瘤,多见于老年人,65岁以上人群患病率高达5%~9%,如果合并高血压等高危因素,其发病率则更高.AAA有自发破裂倾向,一旦发生破裂,其病死率可达80%~90%.目前主要有动脉瘤切除-人工血管置换未及腔内修复术两种手术方式.从AAA的病因筛查、相关基础疾病的控制到手术方式的选择,再到术后相关并发症的处理等围手术期的管理尤为重要,从一定意义上可以决定治疗的效果.%Abdominal aortic aneurysm (AAA) is the most common aneurysm in human, especially among old patients. It was reported that the incidence of AAA was as high as 5% ~ 9% among patients older than 65 yeas. If complicated with risk factors, such as hypertension, the incidence was even higher. The morbidity was as high as 80%-90% if the AAA ruptured. Now there are two main kinds of treatment for AAA. One is the classical open surgery, which includes resection of the aneurysm and then reconstruction of the vascular tone. The other kind of treatment is endovascular therapy. The management for AAA during the perioperative period such as screening the etiology of the disease, manipulation of basic disease, selection of the treatment method and the treatment some complications after operation is very important for the prognosis of AAA.

  16. Endovascular Treatment of a Symptomatic Thoracoabdominal Aortic Aneurysm by Chimney and Periscope Techniques for Total Visceral and Renal Artery Revascularization

    Energy Technology Data Exchange (ETDEWEB)

    Cariati, Maurizio, E-mail: cariati.maurizio@sancarlo.mi.it [San Carlo Borromeo Hospital, Department of Diagnostic Sciences (Italy); Mingazzini, Pietro; Dallatana, Raffaello [San Carlo Borromeo Hospital, Department of Vascular Surgery (Italy); Rossi, Umberto G. [San Carlo Borromeo Hospital, Department of Diagnostic Sciences (Italy); Settembrini, Alberto [San Carlo Borromeo Hospital, Università degli Studi di Milano (Italy); Santuari, Davide [San Carlo Borromeo Hospital, Department of Vascular Surgery (Italy)

    2013-05-02

    Conventional endovascular therapy of thoracoabdominal aortic aneurysm with involving visceral and renal arteries is limited by the absence of a landing zone for the aortic endograft. Solutions have been proposed to overcome the problem of no landing zone; however, most of them are not feasible in urgent and high-risk patients. We describe a case that was successfully treated by total endovascular technique with a two-by-two chimney-and-periscope approach in a patient with acute symptomatic type IV thoracoabdominal aortic aneurysm with supra-anastomotic aneurysm formation involving the renal and visceral arteries and a pseduaneurismatic sac localized in the left ileopsoas muscle.

  17. Limitations of Online Information on Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Carolyn G. Goldberg

    2010-01-01

    Full Text Available Background. Patients with AAA face a complex decision, and knowledge of the risks and benefits of each treatment option is essential to informed decision-making. Here we assess the current information on the internet accessible to patients regarding the management of AAA. Study Design. We performed a search on Google using the keywords “abdominal aortic aneurysm” and reviewed the top 50 web sites. We focused on information related to treatment options and alternatives to treatment and the risks of each option. Results. Twenty-seven websites were included in the study. Nearly 30% of websites discussed the risk of mortality and myocardial infarction after open surgery, compared to only 7.4% for both risks after EVAR. Other complications were listed by fewer websites. Fifty-five percent of websites reported that patients had a faster recovery following EVAR, but only 18.5% mentioned the risk of reintervention after EVAR or the need for long-term surveillance with CT scans. Conclusions. While most websites included descriptive information on AAA and mentioned the potential treatment options available to patients, the discussion of the risks of open surgery and EVAR was inadequate. These results suggest that websites frequently accessed by patients lack important information regarding surgical risk.

  18. Mutations in the TGF-beta repressor SKI cause Shprintzen-Goldberg syndrome with aortic aneurysm

    NARCIS (Netherlands)

    Doyle, A.J.; Doyle, J.J.; Bessling, S.L.; Maragh, S.; Lindsay, M.E.; Schepers, D.; Gillis, E.; Mortier, G.; Homfray, T.; Sauls, K.; Norris, R.A.; Huso, N.D.; Leahy, D.; Mohr, D.W.; Caulfield, M.J.; Scott, A.F.; Destree, A.; Hennekam, R.C.; Arn, P.H.; Curry, C.J.; Laer, L. van; McCallion, A.S.; Loeys, B.L.; Dietz, H.C.

    2012-01-01

    Elevated transforming growth factor (TGF)-beta signaling has been implicated in the pathogenesis of syndromic presentations of aortic aneurysm, including Marfan syndrome (MFS) and Loeys-Dietz syndrome (LDS). However, the location and character of many of the causal mutations in LDS intuitively imply

  19. Low-dose aspirin and rupture of abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Wemmelund, Holger; Jørgensen, Trine M M; Høgh, Annette;

    2016-01-01

    OBJECTIVE: The use of low-dose aspirin (acetylsalicylic acid [ASA]) has been suggested to attenuate growth of abdominal aortic aneurysms (AAAs), yet solid clinical evidence of this hypothesis is still missing. This study aimed to investigate whether preadmission ASA use influenced the risk of...

  20. Surgical Treatment of a Voluminous Infrarenal Abdominal Aortic Aneurysm with Horseshoe Kidney: Tips and Tricks

    OpenAIRE

    De Caridi, Giovanni; Massara, Mafalda; Greco, Michele; Mastrojeni, Claudio; Serra, Raffaele; Salomone, Ignazio; La Spada, Michele

    2015-01-01

    Horseshoe kidney is a common urology anomaly, while its association with infrarenal abdominal aortic aneurysm represents a very rare condition. Surgical approach remains controversial however, we believe that the left retroperitoneal approach should be preferred in order to avoid isthmus resection with any subsequent renal infarction, urinary tract damage and to facilitate renal arteries reimplantation, when required.

  1. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in patients with abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Kristensen, Karl Emil; Torp-Pedersen, Christian; Gislason, Gunnar Hilmar;

    2015-01-01

    OBJECTIVE: The renin-angiotensin system is thought to play a pivotal role in the pathogenesis of abdominal aortic aneurysms (AAAs). However, effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs) on human AAAs remain unclear. We therefore ex...

  2. Abdominal aortic aneurysm in a premature neonate with disseminated candidiasis: Ultrasound and angiography

    International Nuclear Information System (INIS)

    When using ultrasound for detection of kidney enlargement, we found an acute abdominal aortic aneurysm secondary to aortitis arising from umbilical artery catheterisation in a premature neonate with systemic candidiasis. Aortography was performed to provide vascular details such as involvement of celiac, renal, iliac and femoral arteries. (orig.)

  3. Embolization with Histoacryl Glue of an Anastomotic Pseudoaneurysm following Surgical Repair of Abdominal Aortic Aneurysm

    Science.gov (United States)

    Walid, Ayesha; Ul Haq, Tanveer; Ur Rehman, Zia

    2013-01-01

    We report a 62-year-old female who had surgical repair of abdominal aortic aneurysm with a bifurcated graft 2 years ago. She presented with a distal anastomotic pseudoaneurysm which was successfully embolized with histoacryl glue. Only one such similar case has been reported in the literature so far (Yamagami et al. (2006)). PMID:23476883

  4. Abdominal aortic aneurysm in a premature neonate with disseminated candidiasis: Ultrasound and angiography

    Energy Technology Data Exchange (ETDEWEB)

    Khoss, A.E.; Ponhold, W.; Pollak, A.; Schlemmer, M.; Weninger, M.

    1985-09-01

    When using ultrasound for detection of kidney enlargement, we found an acute abdominal aortic aneurysm secondary to aortitis arising from umbilical artery catheterisation in a premature neonate with systemic candidiasis. Aortography was performed to provide vascular details such as involvement of celiac, renal, iliac and femoral arteries.

  5. Mortality of ruptured abdominal aortic aneurysm with selective use of endovascular repair

    NARCIS (Netherlands)

    Verhoeven, E. L. G.; Kapma, M. R.; Bos, W. T. G. J.; Vourliotakis, G.; Bracale, U. M.; Bekkema, F.; Vahl, A. C.; Van den Dungen, J. J. A. M.

    2009-01-01

    The aim of this review was to examine the results over a seven-year period of treatment for ruptured abdominal aortic aneurysm (RAAA). From 2002 on, our tertiary referral centre offered both open and endovascular (EVAR) treatment modalities for RAAA. All patients with a proven RAAA who were admitted

  6. Combination of traumatic thoracic aortic pseudoaneurysm and myocardial contusion leading to left ventricular aneurysm

    International Nuclear Information System (INIS)

    The combination of thoracic aortic pseudoaneurysm and left ventricular aneurysm resulting from a single traumatic incident is an exceedingly rare occurrence. We present a case of a 10-year-old girl who sustained significant blunt trauma to the chest after being involved in a rollover motor vehicle accident. The child underwent immediate repair of a transected aortic arch. An inferior wall left ventricular aneurysm developed 3 weeks later, and the patient underwent successful repair of the left ventricular aneurysm and a damaged mitral valve. The use of fast multidetector row CT, cardiac MRI, and echocardiography have improved our ability to diagnose these types of injuries and accurately image their anatomic relationships in the acute and perioperative settings. (orig.)

  7. Through-Plane Movement at Multiple Aortic Levels on Dynamic Computed Tomography Angiography Is Limited in Patients With an Abdominal Aortic Aneurysm

    NARCIS (Netherlands)

    de Jonge, Jeroen C; Zandvoort, Herman J A; Vonken, Evert-Jan P A; Moll, Frans L; van Herwaarden, JA

    2015-01-01

    PURPOSE: To analyze the movement of the aorta in the craniocaudal direction (through-plane movement) during the cardiac cycle at several levels to determine any potential impact on endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). METHODS: For this study, 30 patients (median ag

  8. Aortic valve surgery: what is the future?

    Science.gov (United States)

    Hudorović, Narcis

    2008-04-01

    Modern surgical treatment for aortic valve disease has undergone significant improvements in all areas of this procedure. Successful treatment strategies for cardiovascular diseases have often been initiated and driven by surgeons. Radical excision of diseased tissue, repair and replacement strategies lead to long-term successful treatment of the underlying diseases and clearly improved patient outcome. In highly developed nations, valve surgery will be increasing applied in older people, with more co-morbidities and a higher incidence of concomitant coronary artery disease. Cardiovascular surgeons will be facing increased competition from the catheter-based procedures; these are already applied clinically, and their numbers will rise in near future. Right now interventional cardiologists supported by some cardiac surgeons are on their way to transform some conventional open surgical procedures into catheter-based less invasive interventions, such as valve repair and replacement. Cardiovascular surgery is undergoing a rapid transformation; socio-economic factors and recent advances in medical technology contribute to these changes. Further developments will come, and surgeons with all their expertise in the treatment of valvular heart disease need to be part of it. Cardiovascular surgeons have to adapt the exciting new approaches of transapical and transfemoral transcatheter valve implantation techniques. PMID:17573248

  9. Quantification of aortic distensibility in abdominal aortic aneurysm using ECG-gated multi-detector computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Ganten, Maria-Katharina [Deutsches Krebsforschungszentrum, Department of Radiology, Medical Physics in Radiology, Heidelberg (Germany); Ruprecht-Karls-University of Heidelberg, Department of Diagnostic Radiology, Heidelberg (Germany); Krautter, Ute; Tengg-Kobligk, Hendrik von; Delorme, Stefan; Kauczor, Hans-Ulrich [Deutsches Krebsforschungszentrum, Department of Radiology, Medical Physics in Radiology, Heidelberg (Germany); Boeckler, Dittmar; Schumacher, Hardy [Ruprecht-Karls-University of Heidelberg, Department of Vascular and Endovascular Surgery, Heidelberg (Germany); Stiller, Wolfram; Bock, Michael [Deutsches Krebsforschungszentrum, Department of Medical Physics in Radiology, Medical Physics in Radiology, Heidelberg (Germany); Kauffmann, Guenter W. [Ruprecht-Karls-University of Heidelberg, Department of Diagnostic Radiology, Heidelberg (Germany)

    2008-05-15

    To detect distensibility changes that might be an indicator for an increased risk of rupture, cross-sectional area changes of abdominal aortic aneurysms (AAA) have been determined using ECG-gated CT. Distensibility measurements of the aorta were performed in 67 patients with AAA. Time-resolved images were acquired with a four detector-row CT system using a modified CT-angiography protocol. Pulsatility-related cross-sectional area changes were calculated above and at AAA level by semiautomatic segmentation; distensibility values were obtained using additional systemic blood pressure measurements. Values were compared for small Oe< 5 cm (n=44) and large Oe> 5 cm (n = 23) aneurysms. The aorta could be segmented successfully in all patients. Upstream AAA distensibility D was significantly higher than at AAA level for both groups: means above AAA (at AAA) D{sub above} = (1.3 {+-}0.8) .10 {sup -5} Pa {sup -1} (D{sub AAA} = (0.6 {+-}0.5) .10 {sup -5} Pa {sup -1}) t-test p{sub D}<0.0001. Differences of the distensibility between smaller and larger aneurysms were not found to be significant. Distensibility can be measured non-invasively with ECG-gated CT. The reduction of distensibility within aneurysms compared to normal proximal aorta is subtle; the lack of difference between both small and large aneurysms suggests that this reduction occurs early in the aneurysm's development. Hence, reduced distensibility might be a predictive parameter in patients with high risk of aortic disease. (orig.)

  10. [The role of intraoperative flowmetry in surgery of cerebral aneurysms].

    Science.gov (United States)

    Shekhtman, O D; Éliava, Sh Sh; Shakhnovich, V A; Pilipenko, Iu V

    2011-01-01

    Aim of the study was to assess the capabilities of intraoperative ultrasonic flowmetry in cerebral aneurysm surgery for prevention and immediate correction of cerebral ischemia. Ultrasonic flowmeter (Model HT313/323, "ransonic Systems Inc.", USA) was used during surgery in patients with complicated, large and giant aneurysms for evaluation of cerebral blood flow in main arteries (internal carotid, anterior and middle cerebral) and their branches (branches of M2-M3 and A2 segments). The series included 20 adult patients (13 male and 7 female) operated in Burdenko Moscow Neurosurgery Institute during 2008-2011 years. Mean age was 47.4 +/- 8.6 years. Giant aneurysms (> 2.5 cm) were present in 12 (60%) patients, large (1.5-2.5 cm)--in 5 (25%). Aneurysms of internal carotid artery were found in 8 cases. 1 female patient was operated on giant aneurysm of anterior cerebral--anterior communicating artery. In 4 (20%) cases significant alterations of blood flow were registered after clipping (> 25% according to initial), the changes were not visible. This allowed to correct the position of clips. In 2 surgeries ('low' paraclinoid aneurysms) the collateral flow was sufficient during temporary clipping, this allowed trapping of aneurysms with good neurological outcome. In 3 cases flowmeter was used to evaluate blood flow after extracranial-intracranial bypass. Ultrasonic flowmetry is a simple, reproducible and safe technique for intraoperative assessment of blood flow. Despite visual sufficiency of arteries flowmetry allows detection of surgically significant alterations of blood flow after clipping. PMID:22066255

  11. Device-specific outcomes after endovascular abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    F.B. Gonçalves (Frederico Bastos); E.V. Rouwet (Ellen); R. Metz (Roderik); J.M. Hendriks (Joke); M.P.F.V. Peeters; B.E. Muhs (Bart); H.J.M. Verhagen (Hence)

    2010-01-01

    textabstractOver the last decade, endovascular aneurysm repair (EVAR) has been used extensively for the elective treatment of infra-renal abdominal aneurysms. However, it remains unclear how specific devices perform and how they compare to others. We provide an overview of currently used endografts,

  12. A comparison of modelling techniques for computing wall stress in abdominal aortic aneurysms

    Directory of Open Access Journals (Sweden)

    McGloughlin Timothy M

    2007-10-01

    Full Text Available Abstract Background Aneurysms, in particular abdominal aortic aneurysms (AAA, form a significant portion of cardiovascular related deaths. There is much debate as to the most suitable tool for rupture prediction and interventional surgery of AAAs, and currently maximum diameter is used clinically as the determining factor for surgical intervention. Stress analysis techniques, such as finite element analysis (FEA to compute the wall stress in patient-specific AAAs, have been regarded by some authors to be more clinically important than the use of a "one-size-fits-all" maximum diameter criterion, since some small AAAs have been shown to have higher wall stress than larger AAAs and have been known to rupture. Methods A patient-specific AAA was selected from our AAA database and 3D reconstruction was performed. The AAA was then modelled in this study using three different approaches, namely, AAA(SIMP, AAA(MOD and AAA(COMP, with each model examined using linear and non-linear material properties. All models were analysed using the finite element method for wall stress distributions. Results Wall stress results show marked differences in peak wall stress results between the three methods. Peak wall stress was shown to reduce when more realistic parameters were utilised. It was also noted that wall stress was shown to reduce by 59% when modelled using the most accurate non-linear complex approach, compared to the same model without intraluminal thrombus. Conclusion The results here show that using more realistic parameters affect resulting wall stress. The use of simplified computational modelling methods can lead to inaccurate stress distributions. Care should be taken when examining stress results found using simplified techniques, in particular, if the wall stress results are to have clinical importance.

  13. The Impact of Endovascular Repair of Ruptured Abdominal Aortic Aneurysm on the Gastrointestinal and Renal Function

    Directory of Open Access Journals (Sweden)

    R. R. Makar

    2014-01-01

    Full Text Available Introduction. Systemic effects of ruptured abdominal aortic aneurysm (rAAA may be altered by the mode of surgery. This study aimed to determine systemic effects of endovascular aneurysm repair (EVAR compared to open repair (OR. Patients and Methods. Consecutive patients with rAAA were repaired by OR or EVAR according to computerised tomographic (CT findings. Renal function was monitored by estimated glomerular filtration rate (eGFR, serum urea and creatinine, and urinary albumin creatinine ratio (ACR. Hepatic function was assessed postoperatively for 5 days. Intestinal function was determined by the paracetamol absorption test. Intestinal permeability was assessed by urinary lactulose/mannitol ratio. Results. 30 rAAA patients were included. Fourteen had eEVAR and sixteen eOR. Serum urea were higher in eOR, while creatinine was similar between groups. Hepatic function showed no intergroup difference. Paracetamol absorption was increased in eEVAR group at day 3 compared to day 1 (P=0.03, with no similar result in eOR (P=0.24. Peak lactulose/mannitol ratio was higher in eOR (P=0.03, with higher urinary L/M ratio in eOR at day 3 (P=0.02. Clinical intestinal function returned quicker in eEVAR (P=0.02. Conclusion. EVAR attenuated the organ dysfunction compared to open repair. However, a larger comparative trial would be required to validate this. The clinical trial is registered with reference number EUDRACT: 2013-003373-12.

  14. Precision medical and surgical management for thoracic aortic aneurysms and acute aortic dissections based on the causative mutant gene.

    Science.gov (United States)

    Milewicz, Dianna; Hostetler, Ellen; Wallace, Stephanie; Mellor-Crummey, Lauren; Gong, Limin; Pannu, Hariyadarshi; Guo, Dong-chuan; Regalado, Ellen

    2016-04-01

    Almost one-quarter of patients presenting with thoracic aortic aneurysms (TAAs) or acute aortic dissections (TAADs) have an underlying mutation in a specific gene. A subset of these patients will have systemic syndromic features, for example, skeletal features in patients with Marfan Syndrome. It is important to note that the majority of patients with thoracic aortic disease will not have these syndromic features but many will have a family history of the disease. The genes predisposing to these thoracic aortic diseases are inherited in an autosomal dominant manner, and thirteen genes have been identified to date. As the clinical phenotype associated with each specific gene is defined, the data indicate that the underlying gene dictates associated syndromic features. More importantly, the underlying gene also dictates the aortic disease presentation, the risk for dissection at a given range of aortic diameters, the risk for additional vascular diseases and what specific vascular diseases occur associated with the gene. These results lead to the recommendation that the medical and surgical management of these patients be dictated by the underlying gene, and for patients with mutations in ACTA2, the specific mutation in the gene. PMID:26837258

  15. A prospective clinical, economic, and quality-of-life analysis comparing endovascular aneurysm repair (EVAR), open repair, and best medical treatment in high-risk patients with abdominal aortic aneurysms suitable for EVAR: the Irish patient trial.

    LENUS (Irish Health Repository)

    Hynes, Niamh

    2007-12-01

    To report the results of a trial comparing endovascular aneurysm repair (EVAR) to open repair (OR) and best medical therapy (BMT) involving high-risk patients with abdominal aortic aneurysms (AAA) suitable for EVAR.

  16. SOMATOSENSORY EVOKED-POTENTIALS IN CEREBRAL ANEURYSM SURGERY

    NARCIS (Netherlands)

    BUCHTHAL, A; BELOPAVLOVIC, M

    1992-01-01

    Monitoring of median nerve somatosensory evoked potentials (SSEP) during surgery for a basilar artery aneurysm under moderate hypothermia revealed an unexpected loss of the first cortical peak. This was due to compression of the middle cerebral artery under the retractor during the surgical approach

  17. Blood transfusion requirement in surgery for femoral artery aneurysms

    DEFF Research Database (Denmark)

    Levi, N; Schroeder, T V

    1997-01-01

    Audit of blood usage in various surgical specialities have shown that over-ordering of blood is widespread, causing unnecessary pressure on the transfusion facilities and giving growing concern over the expense of cross-matching blood. The aim of this study was to assess the blood transfusion req...... requirement in patients undergoing surgery for femoral artery aneurysms....

  18. The murine angiotensin II-induced abdominal aortic aneurysm model: rupture risk and inflammatory progression patterns

    Directory of Open Access Journals (Sweden)

    Richard Y Cao

    2010-07-01

    Full Text Available An abdominal aortic aneurysm (AAA is an enlargement of the greatest artery in the body defined as an increase in diameter of 1.5-fold. AAAs are common in the elderly population and thousands die each year from their complications. The most commonly used mouse model to study the pathogenesis of AAA is the angiotensin II (Ang II infusion method delivered via osmotic mini-pump for 28 days. Here, we studied the site-specificity and onset of aortic rupture, characterized three-dimensional (3D images and flow patterns in developing AAAs by ultrasound imaging, and examined macrophage infiltration in the Ang II model using 65 apolipoprotein E deficient mice. Aortic rupture occurred in 16 mice (25 % and was nearly as prevalent at the aortic arch (44 % as it was in the suprarenal region (56 % and was most common within the first seven days after Ang II infusion (12 of 16; 75 %. Longitudinal ultrasound screening was found to correlate nicely with histological analysis and AAA volume renderings showed a significant relationship with AAA severity index. Aortic dissection preceded altered flow patterns and macrophage infiltration was a prominent characteristic of developing AAAs. Targeting the inflammatory component of AAA disease with novel therapeutics will hopefully lead to new strategies to attenuate aneurysm growth and aortic rupture.

  19. Developing a new endograft for the treatment of juxtarenal aortic aneurysms: definition and experimentation

    Directory of Open Access Journals (Sweden)

    Sergio Q. Belczak

    2015-06-01

    Full Text Available OBJECTIVES: To analyze angiotomographic parameters of juxtarenal aneurysms to assess the applicability of an endograft model to patients and to create in vitro and in vivo models to assess the new endograft. METHODS: A total of 49 patients with juxtarenal aneurysms were submitted to angiotomographic evaluation, and parameters such as the aortic diameter, the length of the neck, and the angulations of the celiac trunk, superior mesenteric artery and renal arteries; the distances between them; and anatomic variations were analyzed. Based on these parameters, an endograft model was developed and tested in a newly created in vitro model of juxtarenal aneurysm. An experimental model of juxtarenal aneurysm was then established in six pigs weighing 50-60 kg to assess the new endograft model. RESULTS: The angiotomographic parameters of juxtarenal aneurysm measured in this study were similar to those reported in the literature and allowed the development of an endograft based on the hourglass concept, which was applicable to 85.8% of the patients. The in vitro model of juxtarenal aneurysm evidenced good radiopacity and functionality and permitted adjustments in the new device and technical improvements in the procedures for treating these aneurysms. In addition, the porcine model of juxtarenal aneurysm was successfully created in all six animals using a bovine pericardial patch, and use of the new endograft in three pilot procedures evidenced its feasibility. CONCLUSIONS: The Hourglass endograft was rendered applicable to treatment of the majority of patients with juxtarenal aneurysms simply by changing its diameter. Moreover, the new in vitro and in vivo models were shown to be effective for assessing both the presented endograft and experiments assessing the endovascular treatment of juxtarenal aneurysms.

  20. Cranio-orbital approach for complex aneurysmal surgery.

    LENUS (Irish Health Repository)

    Kelleher, M O

    2012-02-03

    Certain aneurysms of the anterior circulation continue to offer a technical challenge for safe exposure and clipping. The purpose of this paper was to describe the cranio-orbital approach for surgical clipping of complex aneurysms and to evaluate prospectively the associated complications of this approach. Prospective audit of all patients undergoing cranio-orbital approach for aneurysm surgery from 1997 to 2004 by the senior author. Twenty-five patients, eight male and 17 female, median age of 52 years, range 28-73. All patients had a standard pterional approach supplemented by an orbital osteotomy. In the 7-year period 367 patients underwent treatment for their aneurysms (169 clipped and 198 coiled). Of the 169 patients who were operated on, 29 had a skull base approach, of which 25 were cranio-orbital. The aneurysm location was as follows: 16 middle cerebral artery (MCA), three carotid bifurcation, four anterior communicating artery (ACOMM), one ophthalmic and one basilar. There were no approach-related complications. The cranio-orbital craniotomy can be a useful adjunct in the surgical treatment of giant or complex aneurysms. It offers the following advantages over a standard pterional approach: reduces operative distance; allows easy splitting of the sylvian fissure; and provides a wide arc of exposure with multiple working corridors.

  1. Results of surgery for aortic regurgitation due to aortic valve prolapse.

    Directory of Open Access Journals (Sweden)

    Shigenobu,Masaharu

    1988-12-01

    Full Text Available The clinical, hemodynamic and pathological findings of 13 patients with aortic regurgitation due to aortic valve prolapse caused by advanced myxomatous degeneration were evaluated. Eleven patients showed a favorable outcome with no complications resulting from surgery. One patient died from aortic dissection, and another died suddenly from an unknown cause. Five patients had mitral valve prolapse as a complication. Ten patients (77% had a long-standing history of hypertension. Twelve patients (92% were male. None of the patients had the stigmata of Marfan's syndrome. All patients had marked myxomatous degeneration of the aortic valves without any inflammatory changes. Two patients showed microcalcification; 7 demonstrated moderate fibrosis. Five patients showed severe fragility of the cusps which appeared redundant, gelatinous and softened by degenerative changes. Myxomatous degeneration of the aortic valve is not rare, and, in fact, it may be one of the most common pathologic and clinical entities associated with pure aortic insufficiency.

  2. Technical and clinical success of infrarenal endovascular abdominal aortic aneurysm repair: A 10-year single-center experience

    Energy Technology Data Exchange (ETDEWEB)

    Steingruber, I.E. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria)]. E-mail: iris.steingruber@uibk.ac.at; Neuhauser, B. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Seiler, R. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Greiner, A. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Chemelli, A. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Kopf, H. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Walch, C. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Waldenberger, P. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Jaschke, W. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Czermak, B. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria)

    2006-09-15

    Objective: The aim of our retrospective study was to review our single-center experience with aortic abdominal aneurysm (AAA) repair retrospectively. Material and methods: From 1995 to 2005, 70 consecutive patients affected by AAA were treated by endovascular stent-graft repair. Mean follow-up was 23.9 months. Follow-up investigations were performed at 6 and 12 months and yearly thereafter. Five different stent-graft designs were compared to each other. Primary technical success (PTS), assisted primary technical success (APTS), primary clinical success (PCS) and secondary clinical success (SCS) were evaluated. Results: All over PTS was achieved in 94.3%, APTS in 97.1%, PCS in 61.4%, APCS in 64.3% and SCS in 70%. There were 3 type I endoleaks, 25 type II endoleaks, 4 type III endoleaks, 8 limb problems, 5 conversions to open surgery, 10 aneurysm sac expansions and 14 device migrations. Patients with newer generation devices showed better results than patients with first generation prosthesis. In addition results were better for grafts with suprarenal fixation (versus infrarenal fixation) and grafts with barbs and hooks (versus grafts without barbs and hooks). Patients with bad anatomic preconditions showed a higher complication rate. Conclusion: Contrary to first generation products, new stent-graft designs show acceptable technical and clinical results in endovascular AAA aneurysm repair. However, this therapy still should be reserved only for patients with significant comorbities and suitable anatomic conditions.

  3. Family history of atherosclerotic vascular disease is associated with the presence of abdominal aortic aneurysm.

    Science.gov (United States)

    Ye, Zi; Bailey, Kent R; Austin, Erin; Kullo, Iftikhar J

    2016-02-01

    We investigated whether family history (FHx) of atherosclerotic cardiovascular disease (ASCVD) was associated with presence of abdominal aortic aneurysm (AAA). The study cohort comprised of 696 patients with AAA (70±8 years, 84% men) and 2686 controls (68±10 years, 61% men) recruited from noninvasive vascular and stress electrocardiogram (ECG) laboratories at Mayo Clinic. AAA was defined as a transverse diameter of abdominal aorta ⩾ 3 cm or history of AAA repair. Controls were not known to have AAA. FHx was defined as having at least one first-degree relative with aortic aneurysm or with onset of ASCVD (coronary, cerebral or peripheral artery disease) before age 65 years. FHx of aortic aneurysm or ASCVD were each associated with presence of AAA after adjustment for age, sex, conventional risk factors and ASCVD: adjusted odds ratios (OR; 95% confidence interval): 2.17 (1.66-2.83, p aneurysm: adjusted OR: 1.27 (1.05-1.55, p = 0.01). FHx of ASCVD in multiple arterial locations was associated with higher odds of having AAA: the adjusted odds were 1.23 times higher for each additionally affected arterial location reported in the FHx (1.08-1.40, p = 0.01). Our results suggest both unique and shared environmental and genetic factors mediating susceptibility to AAA and ASCVD. PMID:26566659

  4. Recurrent Rare Genomic Copy Number Variants and Bicuspid Aortic Valve Are Enriched in Early Onset Thoracic Aortic Aneurysms and Dissections

    Science.gov (United States)

    Prakash, Siddharth; Kuang, Shao-Qing; Regalado, Ellen; Guo, Dongchuan; Milewicz, Dianna

    2016-01-01

    Thoracic Aortic Aneurysms and Dissections (TAAD) are a major cause of death in the United States. The spectrum of TAAD ranges from genetic disorders, such as Marfan syndrome, to sporadic isolated disease of unknown cause. We hypothesized that genomic copy number variants (CNVs) contribute causally to early onset TAAD (ETAAD). We conducted a genome-wide SNP array analysis of ETAAD patients of European descent who were enrolled in the National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC). Genotyping was performed on the Illumina Omni-Express platform, using PennCNV, Nexus and CNVPartition for CNV detection. ETAAD patients (n = 108, 100% European American, 28% female, average age 20 years, 55% with bicuspid aortic valves) were compared to 7013 dbGAP controls without a history of vascular disease using downsampled Omni 2.5 data. For comparison, 805 sporadic TAAD patients with late onset aortic disease (STAAD cohort) and 192 affected probands from families with at least two affected relatives (FTAAD cohort) from our institution were screened for additional CNVs at these loci with SNP arrays. We identified 47 recurrent CNV regions in the ETAAD, FTAAD and STAAD groups that were absent or extremely rare in controls. Nine rare CNVs that were either very large (>1 Mb) or shared by ETAAD and STAAD or FTAAD patients were also identified. Four rare CNVs involved genes that cause arterial aneurysms when mutated. The largest and most prevalent of the recurrent CNVs were at Xq28 (two duplications and two deletions) and 17q25.1 (three duplications). The percentage of individuals harboring rare CNVs was significantly greater in the ETAAD cohort (32%) than in the FTAAD (23%) or STAAD (17%) cohorts. We identified multiple loci affected by rare CNVs in one-third of ETAAD patients, confirming the genetic heterogeneity of TAAD. Alterations of candidate genes at these loci may contribute to the pathogenesis of TAAD. PMID:27092555

  5. Vertebral Bone Erosions Due to Aortic Abdominal Aneurysm: A Case Report

    Directory of Open Access Journals (Sweden)

    Jamal Hossin

    2009-01-01

    Full Text Available   "nOsteolytic aortic abdominal aneurysm has rarely been reported as the cause of spinal lesions. Patients presenting with pain secondary to an abdominal aortic aneurysm demands prompt attention. Such cases could be encountered in a neurosurgical field such as a lumbar disc disease, spondylosis, or a cauda equina tumor. "nWe represent a 65-year-old male who was referred by a neurosurgeon for lumbosacral MRI due to new onset low back pain since a week ago with extension of the radiculer pain to the left lower extremity. MRI revealed erosions on the left anterior border with sclerotic changes in the body of L4 and the left psoas muscle appeared wider than the right psoas muscle with a non homogeneous signal intensity. Follow-up multi slice CT revealed a 6.5 cm diameter saccular abdominal aortic aneurysm 5.5 cm beneath the origin of the left renal artery and just before the bifurcation of the abdominal aorta with aortic wall calcifications and a large retroperitoneal hematoma.  

  6. Novel endovascular procedures and new developments in aortic surgery.

    Science.gov (United States)

    Cheng, S W K

    2016-09-01

    Endovascular repair has evolved to become a viable mainstream treatment for aortic pathology in both acute and elective settings. As technology advanced, traditional anatomical barriers were progressively tackled using new devices and novel procedures, and there are now multiple options available to the vascular surgeon. In the abdominal aorta, advances in endovascular aneurysm repair have been in the treatment of hostile aortic necks using new sealing concepts and ancillary procedures, and in branch preservation using fenestrations and snorkels. Access challenges have been met with a percutaneous approach and low-profile devices, and standard protocols have improved mortality for ruptured aneurysms. In the thoracic aorta, more invasive hybrid procedures have given way gradually to branched endografts. Particular challenges to the anaesthetist include blood pressure control and the prevention of stroke and paraplegia. Current focus in the thoracic aorta is in treating aortic arch pathology and in optimal management of acute and chronic dissections. This review describes the latest trends in the endovascular treatment of aortic diseases and examines the current evidence for different modalities of management. PMID:27566806

  7. Dutch experience with the fenestrated Anaconda endograft for short-neck infrarenal and juxtarenal abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    Dijkstra, Martijn L.; Tielliu, Ignace F. J.; Meerwaldt, Robbert; Pierie, Maurice; van Brussel, Jerome; Schurink, Geert Willem H.; Lardenoye, Jan-Willem; Zeebregts, Clark J.

    2014-01-01

    Objective: In the past decennium, the management of short-neck infrarenal and juxtarenal aortic aneurysms with fenestrated endovascular aneurysm repair (FEVAR) has been shown to be successful, with good early and midterm results. Recently, a new fenestrated device, the fenestrated Anaconda (Vascutek

  8. Aneurysm of the left aortic sinus causing acute myocardial infarction

    International Nuclear Information System (INIS)

    This report describes the findings and management of a young male who presented with an acute ST-segment elevation myocardial infarction due to compression of the circumflex coronary artery by a large aneurysm of left sinus of Valsalva

  9. Aneurysm of the left aortic sinus causing acute myocardial infarction

    OpenAIRE

    Jan-Peter Smedema; Vernon Freeman; Johan Brink

    2011-01-01

    This report describes the findings and management of a young male who presented with an acute ST-segment elevation myocardial infarction due to compression of the circumflex coronary artery by a large aneurysm of left sinus of Valsalva.

  10. A case of acute ischemic colitis after endovascular abdominal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Grigorios Voulalas

    2016-01-01

    Full Text Available Colonic ischemia is a recognized complication of either open or endovascular abdominal aortic aneurysm repair. The clinical difficulty in establishing the diagnosis, the severity of this complication and the patient's poor physiological status may lead to a fatal outcome. We presented a case of ischemic colitis in a patient with patent hypogastric arteries that occurred after an endovascular abdominal aortic aneurysm repair as well as a review of the available literature. The patient's preoperative, intraoperative and postoperative data were recorded. A thorough search through the Google data and Medline to review similar cases or any analyses that referred to ischemic colitis after endovascular abdominal aneurysm repair was conducted. A 76-year-old male was admitted to our department for an elective endovascular repair of an 8 cm in diameter abdominal aortic aneurysm. A Zenith bifurcation graft was implanted. The whole procedure was uneventful and the final angiogram showed an accurate deployment of the endograft without endoleaks and patency of both hypogastric arteries. During the 1st postoperative day, the patient developed symptoms of acute abdomen in combination with metabolic acidosis and oliguria. He underwent an exploratory laparotomy, which revealed necrosis of the sigmoid. A Hartmann's procedure was performed; the patient was transferred to the intensive care unit where he deceased after 24 h. Postoperative ischemic colitis has been described after open abdominal aneurysm repair. The description of this complication has been reported since the early phase of endovascular abdominal aneurysm repair development with a current incidence of 1.5%–3.0%. Possible mechanisms that may contribute to ischemic colitis in spite of the presence of patent hypogastric arteries include atheroembolization, shock, vasopressive drugs and inferior mesenteric artery occlusion.

  11. A case of acute ischemic colitis after endovascular abdominal aortic aneurysm repair

    Institute of Scientific and Technical Information of China (English)

    Grigorios Voulalas; Chrisostomos Maltezos

    2016-01-01

    Colonic ischemia is a recognized complication of either open or endovascular abdominal aortic aneurysm repair. The clinical difficulty in establishing the diagnosis, the severity of this complication and the patient's poor physiological status may lead to a fatal outcome. We presented a case of ischemic colitis in a patient with patent hypogastric arteries that occurred after an endovascular abdominal aortic aneurysm repair as well as a review of the available literature. The patient's preoperative, intraoperative and postoperative data were recorded. A thorough search through the Google data and Medline to review similar cases or any analyses that referred to ischemic colitis after endovascular abdominal aneurysm repair was conducted. A 76-year-old male was admitted to our department for an elective endovascular repair of an 8 cm in diameter abdominal aortic aneurysm. A Zenith bifurcation graft was implanted. The whole procedure was uneventful and the final angiogram showed an accurate deployment of the endograft without endoleaks and patency of both hypogastric arteries. During the 1st postoperative day, the patient developed symptoms of acute abdomen in combination with metabolic acidosis and oliguria. He underwent an exploratory laparotomy, which revealed necrosis of the sig-moid. A Hartmann's procedure was performed;the patient was transferred to the intensive care unit where he deceased after 24 h. Postoperative ischemic colitis has been described after open abdominal aneurysm repair. The description of this complication has been reported since the early phase of endovascular abdominal aneurysm repair development with a current incidence of 1.5%–3.0%. Possible mechanisms that may contribute to ischemic colitis in spite of the presence of patent hypogastric arteries include athe-roembolization, shock, vasopressive drugs and inferior mesenteric artery occlusion.

  12. Successful reversal of recurrent spinal cord ischemia following endovascular repair of a descending thoracic aortic aneurysm

    OpenAIRE

    Appoo, J J; Gregory, H D; Toeg, H D; Prusinkiewicz, C A; Kent, W D T; Ferland, A; Ha, D V

    2012-01-01

    Despite recent advances in technique, spinal cord ischemia remains one of the most dreaded complications of thoracic aortic surgery. Recently, it has been suggested that thoracic endovascular aortic repair may decrease the risk of paraplegia. We present a case of delayed paraplegia following thoracic endovascular aortic repair that was successfully reversed on 3 separate occasions in the same patient. This highlights the importance of vigilant clinical assessments, efficient multidisciplinary...

  13. Risk Stratification of Patients with Peripheral Arterial Disease and Abdominal Aortic Aneurysm Using Aortic Augmentation Index

    Science.gov (United States)

    Beckmann, Marianne; Husmann, Marc

    2015-01-01

    Background Central augmentation index (cAIx) is an indicator for vascular stiffness. Obstructive and aneurysmatic vascular disease can affect pulse wave propagation and reflection, causing changes in central aortic pressures. Aim To assess and compare cAIx in patients with peripheral arterial disease (PAD) and / or abdominal aortic aneurysm (AAA). Methods cAIx was assessed by radial applanation tonometry (Sphygmocor) in a total of 184 patients at a tertiary referral centre. Patients were grouped as having PAD only, AAA only, or both AAA and PAD. Differences in cAIx measurements between the three patient groups were tested by non-parametric tests and stepwise multivariate linear regression analysis to investigate associations with obstructive or aneurysmatic patterns of vascular disease. Results In the study sample of 184 patients, 130 had PAD only, 20 had AAA only, and 34 patients had both AAA and PAD. Mean cAIx (%) was 30.5 ± 8.2 across all patients. It was significantly higher in females (35.2 ± 6.1, n = 55) than males (28.4 ± 8.2, n = 129), and significantly higher in patients over 80 years of age (34.4 ± 6.9, n = 22) than in those under 80 years (30.0 ± 8.2, n = 162). Intergroup comparison revealed a significant difference in cAIx between the three patient groups (AAA: 27.3 ± 9.5; PAD: 31.4 ± 7.8; AAA & PAD: 28.8 ± 8.5). cAIx was significantly lower in patients with AAA, higher in patients with both AAA and PAD, and highest in patients with PAD only (beta = 0.21, p = 0.006). Conclusion Non-invasive assessment of arterial stiffness in high-risk patients indicates that cAIx differs according to the pattern of vascular disease. Measurements revealed significantly higher cAIx values for patients with obstructive peripheral arterial disease than for patients with aneurysmatic disease. PMID:26452151

  14. Studying the interaction of stent-grafts and treated abdominal aortic aneurysms: time to move caudally!

    Science.gov (United States)

    Georgakarakos, Efstratios; Raptis, Anastasios; Schoretsanitis, Nikolaos; Bisdas, Theodosios; Beropoulis, Efthymios; Georgiadis, George S; Matsagkas, Miltiadis; Xenos, Michalis

    2015-06-01

    Since the advent of endovascular repair of aortic aneurysms (EVAR), clinical focus has been on preventing loss of sealing at the level of the infrarenal neck, which leads to type I endoleak and repressurization of the aneurysm sac. Enhanced mechanisms for central fixation and seal have consequently lowered the incidence of migration and endoleaks. However, endograft limb thrombosis and its causal mechanisms have not been addressed adequately in the literature. This article reviews the pathophysiological mechanisms associated with limb thrombosis in order to facilitate better clinical judgment to prevent iliac adverse effects. PMID:25991770

  15. Preliminary ten year results from a randomised single centre mass screening trial for abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Lindholt, Jes S.; Juul, Svend; Fasting, Helge;

    2006-01-01

    BACKGROUND: At present, several regions and countries are considering screening for abdominal aortic aneurysm (AAA). However, The Chichester Aneurysms Screening Trial has reported poor long term benefit of screening for AAA. We therefore supplement previously published data with a preliminary......,333 were invited to an abdominal ultrasound scan at their district hospital. Information on all deaths until 15.3.2005 was obtained from the Office of Civil Registration. Information on AAA related deaths was obtained from the national registry of Causes of Deaths from 1.4.1994 to 31...

  16. Surgical repair of ruptured abdominal aortic aneurysm with non-bleeding aortocaval fistula.

    Science.gov (United States)

    Unosawa, Satoshi; Kimura, Haruka; Niino, Tetsuya

    2013-01-01

    We present a case of an aortocaval fistula (ACF) without bleeding because a clot was covering the fistula. A 60-year-old man was diagnosed as having a ruptured abdominal aortic aneurysm (AAA) and an aortocaval fistula, by enhanced computed tomography (CT). After the aneurysm had been opened, the fistula was detected, but there was no bleeding because it was covered with clot. After graft repair, bleeding from the fistula occurred when the clot was removed by suction. Direct closure of the fistula was achieved after bleeding was controlled by digital compression. PMID:23825505

  17. Antibody directs properdin-dependent activation of the complement alternative pathway in a mouse model of abdominal aortic aneurysm.

    Science.gov (United States)

    Zhou, Hui-Fang; Yan, Huimin; Stover, Cordula M; Fernandez, Tamara Montes; Rodriguez de Cordoba, Santiago; Song, Wen-Chao; Wu, Xiaobo; Thompson, Robert W; Schwaeble, Wilhelm J; Atkinson, John P; Hourcade, Dennis E; Pham, Christine T N

    2012-02-14

    Abdominal aortic aneurysm (AAA) is a complex inflammatory vascular disease. There are currently limited treatment options for AAA when surgery is inapplicable. Therefore, insights into molecular mechanisms underlying AAA pathogenesis may reveal therapeutic targets that could be manipulated pharmacologically or biologically to halt disease progression. Using an elastase-induced AAA mouse model, we previously established that the complement alternative pathway (AP) plays a critical role in the development of AAA. However, the mechanism by which complement AP is initiated remains undefined. The complement protein properdin, traditionally viewed as a positive regulator of the AP, may also initiate complement activation by binding directly to target surfaces. In this study, we sought to determine whether properdin serves as a focal point for the initiation of the AP complement activation in AAA. Using a properdin loss of function mutation in mice and a mutant form of the complement factor B protein that produces a stable, properdin-free AP C3 convertase, we show that properdin is required for the development of elastase-induced AAA in its primary role as a convertase stabilizer. Unexpectedly, we find that, in AAA, natural IgG antibodies direct AP-mediated complement activation. The absence of IgG abrogates C3 deposition in elastase-perfused aortic wall and protects animals from AAA development. We also determine that blockade of properdin activity prevents aneurysm formation. These results indicate that an innate immune response to self-antigens activates the complement system and initiates the inflammatory cascade in AAA. Moreover, the study suggests that properdin-targeting strategies may halt aneurysmal growth.

  18. Valve-sparing aortic root replacement and aortic valve repair in a patient with acromegaly and aortic root dilatation

    Directory of Open Access Journals (Sweden)

    Karel Van Praet

    2015-07-01

    Full Text Available Aortic regurgitation and dilatation of the aortic root and ascending aorta are severe complications of acromegaly. The current trend for management of an aortic root aneurysm is valve-sparing root replacement as well as restoring the diameter of the aortic sinotubular junction (STJ and annulus. Our case report supports the recommendation that in patients with acromegaly, severe aortic root involvement may indicate the need for surgery.

  19. Optimising stroke volume and oxygen delivery in abdominal aortic surgery

    DEFF Research Database (Denmark)

    Bisgaard, J; Gilsaa, T; Rønholm, E;

    2012-01-01

    BACKGROUND: Post-operative complications after open elective abdominal aortic surgery are common, and individualised goal-directed therapy may improve outcome in high-risk surgery. We hypothesised that individualised goal-directed therapy, targeting stroke volume and oxygen delivery, can reduce...... group (P = 0.01). However, the number of complications per patient or length of stay in the intensive care unit or hospital did not differ between the groups. CONCLUSION: Perioperative individualised goal-directed therapy targeting stroke volume and oxygen delivery did not affect post...... complications and minimise length of stay in intensive care unit and hospital following open elective abdominal aortic surgery. METHODS: Seventy patients scheduled for open elective abdominal aortic surgery were randomised to individualised goal-directed therapy or conventional therapy. In the intervention...

  20. Loss of function mutation in LOX causes thoracic aortic aneurysm and dissection in humans.

    Science.gov (United States)

    Lee, Vivian S; Halabi, Carmen M; Hoffman, Erin P; Carmichael, Nikkola; Leshchiner, Ignaty; Lian, Christine G; Bierhals, Andrew J; Vuzman, Dana; Mecham, Robert P; Frank, Natasha Y; Stitziel, Nathan O

    2016-08-01

    Thoracic aortic aneurysms and dissections (TAAD) represent a substantial cause of morbidity and mortality worldwide. Many individuals presenting with an inherited form of TAAD do not have causal mutations in the set of genes known to underlie disease. Using whole-genome sequencing in two first cousins with TAAD, we identified a missense mutation in the lysyl oxidase (LOX) gene (c.893T > G encoding p.Met298Arg) that cosegregated with disease in the family. Using clustered regularly interspaced short palindromic repeats (CRISPR)/clustered regularly interspaced short palindromic repeats-associated protein-9 nuclease (Cas9) genome engineering tools, we introduced the human mutation into the homologous position in the mouse genome, creating mice that were heterozygous and homozygous for the human allele. Mutant mice that were heterozygous for the human allele displayed disorganized ultrastructural properties of the aortic wall characterized by fragmented elastic lamellae, whereas mice homozygous for the human allele died shortly after parturition from ascending aortic aneurysm and spontaneous hemorrhage. These data suggest that a missense mutation in LOX is associated with aortic disease in humans, likely through insufficient cross-linking of elastin and collagen in the aortic wall. Mutation carriers may be predisposed to vascular diseases because of weakened vessel walls under stress conditions. LOX sequencing for clinical TAAD may identify additional mutation carriers in the future. Additional studies using our mouse model of LOX-associated TAAD have the potential to clarify the mechanism of disease and identify novel therapeutics specific to this genetic cause.

  1. Loss of function mutation in LOX causes thoracic aortic aneurysm and dissection in humans.

    Science.gov (United States)

    Lee, Vivian S; Halabi, Carmen M; Hoffman, Erin P; Carmichael, Nikkola; Leshchiner, Ignaty; Lian, Christine G; Bierhals, Andrew J; Vuzman, Dana; Mecham, Robert P; Frank, Natasha Y; Stitziel, Nathan O

    2016-08-01

    Thoracic aortic aneurysms and dissections (TAAD) represent a substantial cause of morbidity and mortality worldwide. Many individuals presenting with an inherited form of TAAD do not have causal mutations in the set of genes known to underlie disease. Using whole-genome sequencing in two first cousins with TAAD, we identified a missense mutation in the lysyl oxidase (LOX) gene (c.893T > G encoding p.Met298Arg) that cosegregated with disease in the family. Using clustered regularly interspaced short palindromic repeats (CRISPR)/clustered regularly interspaced short palindromic repeats-associated protein-9 nuclease (Cas9) genome engineering tools, we introduced the human mutation into the homologous position in the mouse genome, creating mice that were heterozygous and homozygous for the human allele. Mutant mice that were heterozygous for the human allele displayed disorganized ultrastructural properties of the aortic wall characterized by fragmented elastic lamellae, whereas mice homozygous for the human allele died shortly after parturition from ascending aortic aneurysm and spontaneous hemorrhage. These data suggest that a missense mutation in LOX is associated with aortic disease in humans, likely through insufficient cross-linking of elastin and collagen in the aortic wall. Mutation carriers may be predisposed to vascular diseases because of weakened vessel walls under stress conditions. LOX sequencing for clinical TAAD may identify additional mutation carriers in the future. Additional studies using our mouse model of LOX-associated TAAD have the potential to clarify the mechanism of disease and identify novel therapeutics specific to this genetic cause. PMID:27432961

  2. The Murine Angiotensin II-Induced Abdominal Aortic Aneurysm Model: Rupture Risk and Inflammatory Progression Patterns

    OpenAIRE

    TimothySt. Amand

    2010-01-01

    An abdominal aortic aneurysm (AAA) is an enlargement of the greatest artery in the body defined as an increase in diameter of 1.5-fold. AAAs are common in the elderly population and thousands die each year from their complications. The most commonly used mouse model to study the pathogenesis of AAA is the angiotensin II (Ang II) infusion method delivered via osmotic mini-pump for 28 days. Here, we studied the site-specificity and onset of aortic rupture, characterized three-dimensional (3D) i...

  3. Suprarenal fixation resulting in intestinal malperfusion after endovascular aortic aneurysm repair.

    Science.gov (United States)

    Siani, Andrea; Accrocca, Federico; De Vivo, Gennaro; Marcucci, Giustino

    2016-05-01

    Superior mesenteric artery (SMA) and coeliac axis (CA) occlusion after endovascular abdominal aneurysm aortic repair (EVAR-AAA), using endograft with suprarenal fixation, are uncommon. However, we are reporting a case of visceral malperfusion, which occurred 7 days after successful EVAR with suprarenal fixation for symptomatic AAA. Endograft metal stent barbs caused severe stenosis of SMA and CA. A successful recovery of SMA was carried out by means of a balloon-expandable stent released through bare metal stent barbs. We believe that an unfavourable anatomy of a proximal aortic neck and visceral aorta may have caused a wrong stent strut deployment with the coverage of CA and SMA. PMID:26826712

  4. Endovascular treatment of type II endoleak following thoracic endovascular aortic repair for thoracic aortic aneurysm: Case report of squeeze technique to reach the aneurysmal sac

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Hyun Jung; Kim, Chang Won; Lee, Tae Hong; Song, Seung Hwan; Lee, Chung Won; Chung, Sung Woon [Pusan National University Hospital, School of Medicine, Pusan National University, Busan (Korea, Republic of)

    2014-12-15

    Type II endoleaks are common after thoracic endovascular aortic repair (TEVAR). Various strategies are introduced to manage type II endoleaks, such as the use of coils, plugs, or liquid embolic agents (histoacryl, thrombin, onyx, etc.) through a transarterial approach or a direct puncture of the aneurysmal sac. We herein report a case of a type II endoleak caused by reverse blood flow through intercostal artery after TEVAR which was successfully treated with n-butyl cyanoacrylate (histoacryl)-lipiodol mixture by a squeeze technique to reach the aneurismal sac using a microcatheter.

  5. Endovascular treatment of type II endoleak following thoracic endovascular aortic repair for thoracic aortic aneurysm: Case report of squeeze technique to reach the aneurysmal sac

    International Nuclear Information System (INIS)

    Type II endoleaks are common after thoracic endovascular aortic repair (TEVAR). Various strategies are introduced to manage type II endoleaks, such as the use of coils, plugs, or liquid embolic agents (histoacryl, thrombin, onyx, etc.) through a transarterial approach or a direct puncture of the aneurysmal sac. We herein report a case of a type II endoleak caused by reverse blood flow through intercostal artery after TEVAR which was successfully treated with n-butyl cyanoacrylate (histoacryl)-lipiodol mixture by a squeeze technique to reach the aneurismal sac using a microcatheter.

  6. 腹主动脉瘤破裂外科治疗的价值和预后判断%Value and prognosis judgement of ruptured abdominal aortic aneurysm surgery

    Institute of Scientific and Technical Information of China (English)

    王深明; 吕伟明; 常光其; 黄雪玲

    2001-01-01

    Objective To investigate the value and prognosis of ruptured abdominal aoritc aneurysm (RAAA) surgery.Methods Nineteen cases of RAAA undergoing surgical treatment in our hospital from June 1979 to May 2000 were studied. The value and prognosis of RAAA sugery were judged by preoperative risk factors, complicated diseases, general conditions, blood biochemistry examination and multiorgan disfunction(MOD)score.Results Ten cases survived postoperatively with operative mortality of 47.4%. Significant differences between the surviving and deceased patients were found only with regard to pre-existing coronary heart disease and myocardial infarction (P<0.05). There were significant differences between two groups in peroperative hemoglobin, RBC count, blood urea and creatinine, severe hypotension, respiratory failure, and coma(P<0.05). All patients with a postoperative 48 h MOD score equal to 5 died. The mortality of the patients with a MOD score 4 lowered down following the score decreasing, and all patients with the score 1 survived. Conclusions Surgery treatment of RAAA was the unique selection of saving these patients. Postoperative death was mainly related with multi-organ disfunction resulted from hemorragic shock. The mortality of the patients with a postoperative 48 h MOD score over 4 was so high that the value of continuous treatment should be considered.%目的 探讨腹主动脉瘤破裂外科治疗的价值和预后。方法 分析我院自1979年6月~2000年5月经外科手术治疗的腹主动脉瘤破裂19例,通过术前高危因素、合并疾病、术前状况和血液生化检查以及多器官系统功能衰竭评分(MOD Score),对腹主动脉瘤破裂外科治疗的价值和预后进行判断。结果 术后存活10例,手术死亡率47.4%。术前冠心病和心肌缺血、心肌梗死二项指标,在存活组与死亡组间比较有显著性差异(P<0.05)。在术前血红蛋白、红细胞数、血肌酐、

  7. Tissue Responses to Stent Grafts with Endo-Exo-Skeleton for Saccular Abdominal Aortic Aneurysms in a Canine Model

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Il Young; Chung, Jin Wook; Kim, Hyo Cheol [Dept. of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul (Korea, Republic of); Choi, Young Ho; So Young Ho [Dept. of Radiology, Seoul National University Boramae Hospital, Seoul (Korea, Republic of); Kim, Hyun Beom [Dept. of Radiology, National Cancer Center, Goyang (Korea, Republic of); Min, Seung Kee [Dept. of Surgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Park, Jae Hyung [Dept. of Radiology, Gachon University Gil Medical Center, Incheon (Korea, Republic of)

    2014-10-15

    We evaluated the effect of close contact between the stent and the graft on the induction of endothelial covering on the stent graft placed over an aneurysm. Saccular abdominal aortic aneurysms were made with Dacron patch in eight dogs. The stent graft consisted of an inner stent, a expanded polytetrafluoroethylene graft, and an outer stent. After sacrificing the animals, the aortas with an embedded stent graft were excised. The aortas were inspected grossly and evaluated microscopically. The animals were sacrificed at two (n = 3), six (n = 3), and eight months (n = 2) after endovascular repair. In two dogs, the aortic lumen was occluded at two months after the placement. On gross inspection of specimens from the other six dogs with a patent aortic lumen, stent grafts placed over the normal aortic wall were covered by glossy white neointima, whereas, stent grafts placed over the aneurysmal aortic wall were covered by brownish neointima. On microscopic inspection, stent grafts placed over the normal aortic wall were covered by thin neointima (0.27 ± 0.05 mm, mean ± standard deviation) with an endothelial layer, and stent grafts placed over the aneurysmal aortic wall were covered by thick neointima (0.62 ± 0.17 mm) without any endothelial lining. Transgraft cell migration at the normal aortic wall was more active than that at the aneurysmal aortic wall. Close contact between the stent and the graft, which was achieved with stent grafts with endo-exo-skeleton, could not enhance endothelial covering on the stent graft placed over the aneurysms.

  8. An Update on the Inflammatory Response after Endovascular Repair for Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Eleni Arnaoutoglou

    2015-01-01

    Full Text Available Postimplantation syndrome (PIS is the clinical and biochemical expression of an inflammatory response following endovascular repair of an aortic aneurysm (EVAR. The goal of this review is to provide an update on the inflammatory response after endovascular repair of abdominal aortic aneurysm, discussing its causes and effects on the clinical outcome of the patient. PIS concerns nearly one-third of patients after EVAR. It is generally a benign condition, although in some patients it may negatively affect outcome. The different definitions and conclusions drawn from several studies reveal that PIS needs to be redefined with standardized diagnostic criteria. The type of the endograft’s material seems to play a role in the inflammatory response. Future studies should focus on a better understanding of the underlying pathophysiology, predictors, and risk factors as well as determining whether effective preventive strategies are necessary.

  9. Influence of virtual intervention and blood rheology on mass transfer through thoracic aortic aneurysm.

    Science.gov (United States)

    Lei, Yu; Chen, Ming; Xiong, Guanglei; Chen, Jie

    2015-09-18

    Computational fluid dynamics tools have been used to investigate blood flow through the human thoracic aortic models with aneurysm before and after virtual stent graft operation. The impact of blood rheology and aortic geometry on the wall shear stress (WSS), luminal surface low-density lipoproteins (LDL) concentration, and oxygen flux along the arterial wall is investigated. The stent graft at the aneurysm has significant effects on WSS and mass transport in blood flow. Due to the low flow rate, Newtonian blood assumption generally under-estimates the WSS. The non-Newtonian blood rheology play an important role in the LDL transport as well as oxygen transport. It is found that WSS alone is insufficient to correctly predict the location with high risk of atherogenesis. The results suggest that WSS, luminal surface LDL concentration, and the oxygen flux on the wall have to be considered together to evaluate the performance of virtual operation.

  10. Fluid, solid and fluid-structure interaction simulations on patient-based abdominal aortic aneurysm models.

    Science.gov (United States)

    Kelly, Sinead; O'Rourke, Malachy

    2012-04-01

    This article describes the use of fluid, solid and fluid-structure interaction simulations on three patient-based abdominal aortic aneurysm geometries. All simulations were carried out using OpenFOAM, which uses the finite volume method to solve both fluid and solid equations. Initially a fluid-only simulation was carried out on a single patient-based geometry and results from this simulation were compared with experimental results. There was good qualitative and quantitative agreement between the experimental and numerical results, suggesting that OpenFOAM is capable of predicting the main features of unsteady flow through a complex patient-based abdominal aortic aneurysm geometry. The intraluminal thrombus and arterial wall were then included, and solid stress and fluid-structure interaction simulations were performed on this, and two other patient-based abdominal aortic aneurysm geometries. It was found that the solid stress simulations resulted in an under-estimation of the maximum stress by up to 5.9% when compared with the fluid-structure interaction simulations. In the fluid-structure interaction simulations, flow induced pressure within the aneurysm was found to be up to 4.8% higher than the value of peak systolic pressure imposed in the solid stress simulations, which is likely to be the cause of the variation in the stress results. In comparing the results from the initial fluid-only simulation with results from the fluid-structure interaction simulation on the same patient, it was found that wall shear stress values varied by up to 35% between the two simulation methods. It was concluded that solid stress simulations are adequate to predict the maximum stress in an aneurysm wall, while fluid-structure interaction simulations should be performed if accurate prediction of the fluid wall shear stress is necessary. Therefore, the decision to perform fluid-structure interaction simulations should be based on the particular variables of interest in a given

  11. Role of F-18 FDG PET/CT in the management of infected abdominal aortic aneurysm due to salmonella

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Seung Jin; Lee, Jin Soo; Cheong, Moon Hyun; Byun, Sung Su; Hyun, In Young [Inha University College of Medicine, Incheon (Korea, Republic of)

    2007-12-15

    We present a case of infected abdominal aortic aneurysm due to salmonella enteritidis. F-18 FDG PET/CT was performed to diagnosis and during follow-up after antibiotic treatment. Computed tomography (CT) is considered to be the best diagnostic imaging modality in infected aortic lesions. In this case, a combination of CT and FDG PET/CT provided accurate information for the diagnosis of infected abdominal aortic aneurysm. Moreover, FDG PET/CT made an important contribution of monitoring disease activity during antibiotic treatment.

  12. Aortic aneurysm and non-Hodgkin’s lymphoma in Marfan syndrome

    OpenAIRE

    Sujoy Ghosh; Subrata Ghosh; Sandip Kumar Ghosh

    2009-01-01

    The combination of Marfan syndrome with lymphoma is extremely rare. This report describes a case of Marfan syndrome who presented with chest discomfort and was diagnosed to have an aortic aneurysm and an additional incidental mediastinal mass that on further investigation turned out to be a diffuse large B cell lymphoma. We have suggested a hypothesis which can explain the occurrence of lymphoma in Marfan syndrome.

  13. Aortic aneurysm and non-Hodgkin’s lymphoma in Marfan syndrome

    Directory of Open Access Journals (Sweden)

    Sujoy Ghosh

    2009-03-01

    Full Text Available The combination of Marfan syndrome with lymphoma is extremely rare. This report describes a case of Marfan syndrome who presented with chest discomfort and was diagnosed to have an aortic aneurysm and an additional incidental mediastinal mass that on further investigation turned out to be a diffuse large B cell lymphoma. We have suggested a hypothesis which can explain the occurrence of lymphoma in Marfan syndrome.

  14. Doxycycline Does Not Influence Established Abdominal Aortic Aneurysms in Angiotensin II-Infused Mice

    OpenAIRE

    Xiaojie Xie; Hong Lu; Moorleghen, Jessica J.; Howatt, Deborah A.; Rateri, Debra L.; Cassis, Lisa A.; Alan Daugherty

    2012-01-01

    BACKGROUND: There is no proven medical approach to attenuating expansion and rupture of abdominal aortic aneurysms (AAAs). One approach that is currently being investigated is the use of doxycycline. Despite being primarily used as an antimicrobial drug, doxycycline has been proposed to function in reducing AAA expansion. Doxycycline is effective in reducing the formation in the most commonly used mouse models of AAAs when administered prior to the initiation of the disease. The purpose of th...

  15. Inflammatory abdominal aortic aneurysm presenting as bilateral hydroureteronephrosis: A case report and review of literature

    OpenAIRE

    Andrea Benedetto Galosi; Carlo Grilli Cicilioni; Giulia Sbrollini; Andrea Angelini; Guevar Maselli; Luciano Carbonari

    2014-01-01

    We report a case of Inflammatory Abdominal Aortic Aneurysm (IAAA) producing bilateral hydro-ureteronephrosis. A 74-year-old patient presented to urologist office for bilateral hydronephrosis detected by kidney and bladder ultrasound (US). Patient reported lower urinary tract symptoms and inconstant and slight low back pain irradiated to inguinal region dating 3 weeks. Renal function, urine analysis and abdominal examination were normal. However the repeated ultrasound in the urologist office ...

  16. Three-dimensional Ultrasound in the Management of Abdominal Aortic Aneurysms

    DEFF Research Database (Denmark)

    Lowe, C; Ghulam, Q; Bredahl, K;

    2016-01-01

    Three-dimensional (3D) ultrasound is an evolving modality that may have numerous applications in the management of abdominal aortic aneurysms. Many vascular specialists will not be familiar with the different ways in which 3D vascular ultrasound data can be acquired nor how potential applications...... is to introduce clinicians to the current concepts of 3D ultrasound, review the current literature, and highlight avenues for further research in this new and exciting field of vascular imaging....

  17. Asthma Associates With Human Abdominal Aortic Aneurysm and RuptureSignificance

    OpenAIRE

    Liu, Cong-Lin; Wemmelund, Holger; Wang, Yi; Liao, Mengyang; Jes S Lindholt; Johnsen, Søren P.; Vestergaard, Henrik; Fernandes, Cleverson; Sukhova, Galina K.; Cheng, Xiang; ZHANG, JIN-YING; Yang, Chongzhe; Huang, Xiaozhu; Daugherty, Alan; Levy, Bruce David

    2016-01-01

    Objective—Both asthma and abdominal aortic aneurysms (AAA) involve inflammation. It remains unknown whether these diseases interact. Approach and Results—Databases analyzed included Danish National Registry of Patients, a population-based nationwide case–control study included all patients with ruptured AAA and age- and sex-matched AAA controls without rupture in Denmark from 1996 to 2012; Viborg vascular trial, subgroup study of participants from the population-based randomized Viborg va...

  18. Aortoduodenal fistula and aortic aneurysm secondary to biliary stent-induced retroperitoneal perforation

    Institute of Scientific and Technical Information of China (English)

    Tae Hoon Lee; Do Hyun Park; Ji-Young Park; Suck-Ho Lee; Il-Kwun Chung; Hong Soo Kim; Sang-Heum Park; Sun-Joo Kim

    2008-01-01

    Duodenal perforations caused by biliary prostheses are not uncommon, and they are potentially life threatening and require immediate treatment. We describe an unusual case of aortic aneurysm and rupture which occurred after retroperitoneal aortoduodenal fistula formation as a rare complication caused by biliary metallic stent-related duodenal perforation. To our knowledge, this is the first report describing a lethal complication of a bleeding, aortoduodenal fistula and caused by biliary metallic stent-induced perforation.

  19. Analysis and computer program for rupture-risk prediction of abdominal aortic aneurysms

    OpenAIRE

    Li Zhonghua; Kleinstreuer Clement

    2006-01-01

    Abstract Background Ruptured abdominal aortic aneurysms (AAAs) are the 13th leading cause of death in the United States. While AAA rupture may occur without significant warning, its risk assessment is generally based on critical values of the maximum AAA diameter (>5 cm) and AAA-growth rate (>0.5 cm/year). These criteria may be insufficient for reliable AAA-rupture risk assessment especially when predicting possible rupture of smaller AAAs. Methods Based on clinical evidence, eight biomechani...

  20. Identification of rupture locations in patient-specific abdominal aortic aneurysms using experimental and computational techniques

    OpenAIRE

    Doyle, Barry J.; Cloonan, Aidan J.; Walsh, Michael T.; Vorp, David A.; McGloughlin, Timothy M

    2010-01-01

    peer-reviewed In the event of abdominal aortic aneurysm (AAA) rupture, the outcome is often death. This paper aims to experimentally identify the rupture locations of in vitro AAA models and validate these rupture sites using finite element analysis (FEA). Silicone rubber AAA models were manufactured using two different materials (Sylgard 160 and Sylgard 170, Dow Corning) and imaged using computed tomography (CT). Experimental models were inflated until rupture with high speed photograp...

  1. CFD Modelling of Abdominal Aortic Aneurysm on Hemodynamic Loads Using a Realistic Geometry with CT

    OpenAIRE

    Loong, T. H.; Maurizio Bordone; Uei Pua; Sriram Narayanan; Eduardo Soudah; E. Y. K. Ng

    2013-01-01

    The objective of this study is to find a correlation between the abdominal aortic aneurysm (AAA) geometric parameters, wall stress shear (WSS), abdominal flow patterns, intraluminal thrombus (ILT), and AAA arterial wall rupture using computational fluid dynamics (CFD). Real AAA 3D models were created by three-dimensional (3D) reconstruction of in vivo acquired computed tomography (CT) images from 5 patients. Based on 3D AAA models, high quality volume meshes were created using an optimal tetr...

  2. Leukotriene B4 levels in human atherosclerotic plaques and abdominal aortic aneurysms.

    Directory of Open Access Journals (Sweden)

    Pleunie van den Borne

    Full Text Available BACKGROUND: Leukotriene B4 (LTB4 has been associated with the initiation and progression of atherosclerosis and abdominal aortic aneurysm (AAA formation. However, associations of LTB4 levels with tissue characteristics and adverse clinical outcome of advanced atherosclerosis and AAA are scarcely studied. We hypothesized that LTB4 levels are associated with a vulnerable plaque phenotype and adverse clinical outcome. Furthermore, that LTB4 levels are associated with inflammatory AAA and adverse clinical outcome. METHODS: Atherosclerotic plaques and AAA specimens were selected from two independent databases for LTB4 measurements. Plaques were isolated during carotid endarterectomy from asymptomatic (n = 58 or symptomatic (n = 317 patients, classified prior to surgery. LTB4 levels were measured without prior lipid extraction and levels were corrected for protein content. LTB4 levels were related to plaque phenotype, baseline patient characteristics and clinical outcome within three years following surgery. Seven non-diseased mammary artery specimens served as controls. AAA specimens were isolated during open repair, classified as elective (n = 189, symptomatic (n = 29 or ruptured (n = 23. LTB4 levels were measured similar to the plaque measurements and were related to tissue characteristics, baseline patient characteristics and clinical outcome. Twenty-six non-diseased aortic specimens served as controls. RESULTS: LTB4 levels corrected for protein content were not significantly associated with histological characteristics specific for vulnerable plaques or inflammatory AAA as well as clinical presentation. Moreover, it could not predict secondary manifestations independently investigated in both databases. However, LTB4 levels were significantly lower in controls compared to plaque (p = 0.025 or AAA (p = 0.017. CONCLUSIONS: LTB4 levels were not associated with a vulnerable plaque phenotype or inflammatory AAA or clinical

  3. Surgical treatment of complex aneurysms and thoracic aortic dissections with the Frozen Elephant Trunk technique

    Directory of Open Access Journals (Sweden)

    Ricardo Ribeiro Dias

    2015-04-01

    Full Text Available AbstractObjective:Report initial experience with the Frozen Elephant Trunk technique.Methods:From July 2009 to October 2013, Frozen Elephant Trunk technique was performed in 21 patients (66% male, mean age 56 ±11 years. They had type A aortic dissection (acute 9.6%, chronic 57.3%, type B (14.3%, all chronic and complex aneurysms (19%. It was 9.5% of reoperations and 38% of associated procedures (25.3% miocardial revascularization, 25.3% replacement of aortic valve and 49.4% aortic valved graft. Aortic remodeling was evaluated comparing preoperative and most recent computed tomography scans. One hundred per cent of complete follow-up, mean time of 28 months.Results:In-hospital mortality of 14.2%, being 50% in acute type A aortic dissection, 8.3% in chronic type A aortic dissection, 33.3% in chronic type B aortic dissection and 0% in complex aneurysms. Mean times of cardiopulmonary bypass (152±24min, myocardial ischemia (115±31min and selective cerebral perfusion (60±15min. Main complications were bleeding (14.2%, spinal cord injury (9.5%, stroke (4.7%, prolonged mechanical ventilation (4.7% and acute renal failure (4.7%. The need for second-stage operation was 19%. False-lumen thrombosis was obtained in 80%.Conclusion:Frozen Elephant Trunk is a feasible technique and should be considered. The severity of the underlying disease justifies high mortality rates. The learning curve is a reality. This approach allows treatment of more than two segments at once. Nonetheless, if a second stage is made necessary, it is facilitated.

  4. Optical coherence tomography assessment of vessel wall degradation in thoracic aortic aneurysms

    Science.gov (United States)

    Real, Eusebio; Eguizabal, Alma; Pontón, Alejandro; Díez, Marta Calvo; Fernando Val-Bernal, José; Mayorga, Marta; Revuelta, José M.; López-Higuera, José M.; Conde, Olga M.

    2013-12-01

    Optical coherence tomography images of human thoracic aorta from aneurysms reveal elastin disorders and smooth muscle cell alterations when visualizing the media layer of the aortic wall. These disorders can be employed as indicators for wall degradation and, therefore, become a hallmark for diagnosis of risk of aneurysm under intraoperative conditions. Two approaches are followed to evaluate this risk: the analysis of the reflectivity decay along the penetration depth and the textural analysis of a two-dimensional spatial distribution of the aortic wall backscattering. Both techniques require preprocessing stages for the identification of the air-sample interface and for the segmentation of the media layer. Results show that the alterations in the media layer of the aortic wall are better highlighted when the textural approach is considered and also agree with a semiquantitative histopathological grading that assesses the degree of wall degradation. The correlation of the co-occurrence matrix attains a sensitivity of 0.906 and specificity of 0.864 when aneurysm automatic diagnosis is evaluated with a receiver operating characteristic curve.

  5. A multidetector tomography protocol for follow-up of endovascular aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Roberto Moraes Bastos

    2011-01-01

    Full Text Available OBJECTIVE: The purpose of this study was to improve the use of 64-channel multidetector computed tomography using lower doses of ionizing radiation during follow-up procedures in a series of patients with endovascular aortic aneurysm repair. METHODS: Thirty patients receiving 5 to 29 months of follow-up after endovascular aortic aneurysm repair were analyzed using a 64-channel multidetector computed tomography device by an exam that included pre-and postcontrast with both arterial and venous phases. Leak presence and type were classified based on the exam phase. RESULTS: Endoleaks were identified in 8/30 of cases; the endoleaks in 3/8 of these cases were not visible in the arterial phases of the exams. CONCLUSION: The authors conclude that multidetector computed tomography with pre-contrast and venous phases should be a part of the ongoing follow-up of patients undergoing endovascular aortic aneurysm repair. The arterial phase can be excluded when the aneurism is stable or regresses. These findings permit a lower radiation dose without jeopardizing the correct diagnosis of an endoleak.

  6. Preoperative and postoperative evaluation of the abdominal aortic aneurysms by spiral CT

    Energy Technology Data Exchange (ETDEWEB)

    Yamazumi, Kensuke; Okumura, Hiroshi; Toshinaga, Ryuichi; Takenoshita, Mitsuru; Ojiro, Masataka; Aikou, Takashi [Kagoshima Univ. (Japan). Faculty of Medicine; Yamazumi, Mami; Makino, Masaoki

    1996-02-01

    Twenty patients with abdominal aortic aneurysm (AAA), all of which were replaced with a Y-tube graft surgically, were studied using spiral CT to evaluate its availability for the preoperative diagnosis or postoperative course. In all cases, both two-dimensional CT and three-dimensional CT angiography were obtained at a time with one spiral scan during a single breath hold. The spiral CT scanners provided not only the reliable information about AAA including the size of the aortic lumen, the amount and location of mural thrombus and extent of an aneurysm as well as ultrasound (US), but also the major aortic branches, blood flow and construct images that look like conventional angiograms. Especially, spiral CT was more useful for the diagnosis of an aneurysm or occlusive disease of the iliac artery which was accompanied with AAA, when compared with US or intra-venous digital subtraction angiograms. On the other hand, the anastomosis in all cases including the reconstruction of the inferior mesenteric artery and the grafts could be identified and evaluated by spiral CT after surgical treatment. With regard to the distal anastomosis of the graft, spiral CT was more beneficial for the images than US. These results show that spiral CT is a non-invasive and powerful modality both for the preoperative diagnosis and the postoperative follow-up. (author).

  7. SERUM MAGNESIUM LEVELS IN AORTIC AND MITRAL VALVE REPLACEMENT SURGERIES

    Directory of Open Access Journals (Sweden)

    Srinivasa Rao

    2015-08-01

    Full Text Available BACKGROUND : The purpose of the study was to analyze serum magnesium concentration in patients undergoing Aortic and Mitral Valve replacement surgeries. METHODS: This prospective study was conducted in 60 patients who underwent elective Aortic and Mitral va lve replacement surgeries. Blood samples from radial artery were collected just before induction of anesthesia and three days post - operatively for estimation of serum magnesium. RESULTS: Magnesium level was 2.02mg/dl at baseline, 2.28mg/dl, 2.08mg/dl and 1 .90mg/dl respectively on three consecutive days post - operatively. CONCLUSION: The lowering of serum magnesium in Aortic and Mitral valve replacement surgeries postoperatively recommends the use of routine serum magnesium determination and administration to prevent post - operative arrhythmias.

  8. Minimally Invasive Cardiac Surgery: Transapical Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Ming Li

    2012-01-01

    Full Text Available Minimally invasive cardiac surgery is less traumatic and therefore leads to quicker recovery. With the assistance of engineering technologies on devices, imaging, and robotics, in conjunction with surgical technique, minimally invasive cardiac surgery will improve clinical outcomes and expand the cohort of patients that can be treated. We used transapical aortic valve implantation as an example to demonstrate that minimally invasive cardiac surgery can be implemented with the integration of surgical techniques and engineering technologies. Feasibility studies and long-term evaluation results prove that transapical aortic valve implantation under MRI guidance is feasible and practical. We are investigating an MRI compatible robotic surgical system to further assist the surgeon to precisely deliver aortic valve prostheses via a transapical approach. Ex vivo experimentation results indicate that a robotic system can also be employed in in vivo models.

  9. EXPRESSION OF MATRIX METALLOPROTEINASE-9 IN HUMAN ABDOMINAL AORTIC ANEURYSMAL TISSUES

    Institute of Scientific and Technical Information of China (English)

    Ma Zhong; Wang Ling; Qi Guangyu; Joerg. Heckenkamp

    2006-01-01

    Objective To study the effects of MMP-9 (Matrix Metalloproteinase-9, MMP-9) in the pathogenesis of abdominal aortic aneurysms (AAAs) by localizing the expression of MMP-9 in the aneurysmal tissues. Methods By means of immunohistochemistry, the frozen sections (5 μm) with aneurysmal tissues (n = 10) were incubated with MMP-9 antibody-added agents, then the sections were stained and observed under the microscope to localize the expression of MMP-9, which displayed a brown precipitate within the arterial walls. The normal arterial wall tissues(n= 10)and the diseased arterial wall tissues from the arterial occlusive diseases (AODs) (n= 15) were also immunized exactly the same way as control. Results A quantity of positive granules which appeared within the aortic media showed the strong expression of MMP-9 in the AAAs, with the positive rate reaching 95%(19/20), while no expression of MMP-9 was observed in the normal artery. However, the scattered distributed positive granules were scen within the arterial wall of some cases of the AODs, implying the weak positive expression of MMP-9 in this disease with the positive rate of 26.7%(4/15). There was a significant difference of the expression of MMP-9 within the arterial wall between the AAAs and AODs(P<0. 01). Conclusion High expression of MMP-9 within the aortic media faciliatates the degradation of collagen and elastin fibres and subsequent dilation of the aortic artery , thus playing an important role in the pathogenesis of AAAs. To refrain MMP-9 from enhanced expressing within the aortic wall is of clinical significance in the prevention and treatment of AAAs.

  10. Reproducibility of aortic pulsatility measurements from ECG-gated abdominal CTA in patients with abdominal aortic aneurysms

    Science.gov (United States)

    Manduca, Armando; Fletcher, Joel G.; Wentz, Robert J.; Shields, Raymond C.; Vrtiska, Terri J.; Siddiki, Hassan; Nielson, Theresa

    2009-02-01

    Purpose: ECG-gated abdominal CT angiography with reconstruction of multiple, temporally overlapping CT angiography datasets has been proposed for measuring aortic pulsatility. The purpose of this work is to develop algorithms to segment the aorta from surrounding structures from CTA datasets across cardiac phases, calculate registered centerlines and measurements of regional aortic pulsatility in patients with AAA, and to assess the reproducibility of these measurements. Methods: ECG-gated CTA was performed with a temporal resolution of 165 ms, reconstructed to 1 mm slices ranging at 14 cardiac phase points. Data sets were obtained from 17 patients on which two such scans were performed 6 to 12 months apart. Automated segmentation, centerline generation, and registration of centerlines between phases was performed, followed by calculation of cross-sectional areas and regional and local pulsatility. Results: Pulsatility calculations for the supraceliac region were very reproducible between earlier and later scans of the same patient, with average differences less than 1% for pulsatility values ranging from 2% to 13%. Local radial pulsatilities were also reproducible to within ~1%. Aneurysm volume changes between scans can also be quantified. Conclusion: Automated segmentation, centerline generation, and registration of temporally resolved CTA datasets permit measurements of regional changes in cross-sectional area over the course of the cardiac cycle (i.e., regional aortic pulsatility). These measurements are reproducible between scans 6-12 months apart, with differences in aortic areas reflecting both aneurysm remodeling and changes in blood pressure. Regional pulsatilities ranged from 2 to 13% but were reproducible at the 1% level.

  11. Infective endarteritis and false mycotic aneurysm complicating aortic coarctation

    International Nuclear Information System (INIS)

    A 12-year-old boy with coarctation of aorta developed infective endarteritis and mycotic aneurysm at the site distal to coarctation. The computed tomography angiogram was very helpful in the diagnosis. Medical management and early surgical intervention was curative. Infective endarteritis in coarctation may be underdiagnosed

  12. Infective endarteritis and false mycotic aneurysm complicating aortic coarctation

    Directory of Open Access Journals (Sweden)

    Ziadi Jaleleddine

    2012-01-01

    Full Text Available A 12-year-old boy with coarctation of aorta developed infective endarteritis and mycotic aneurysm at the site distal to coarctation. The computed tomography angiogram was very helpful in the diagnosis. Medical management and early surgical intervention was curative. Infective endarteritis in coarctation may be underdiagnosed.

  13. Surgery of intracranial aneurysms at Yonsei University: 780 cases.

    Science.gov (United States)

    Lee, K C

    1991-03-01

    Seven hundred and eighty patients with intracranial aneurysm, which were surgically treated by the author since 1976, were analyzed. Strategies important for intracranial aneurysm surgery were the timing of surgery, preoperative preparation and intraoperative management. The best management outcome could be achieved by early operation, removal of subarachnoid blood clot, maintenance of circulating blood volume, administration of nimodipine, and meticulous surgical tactics to avoid pitfalls. Indications for aneurysm surgery in the acute phase were determined by intracerebral hematoma, angiographic findings, clinical grade, general physical status and readiness of the surgical team. Important goals to be considered during the operation were obtaining a slack brain, preparation of proximal control, protection of the brain, awareness of microsurgical anatomy, and complete dissection of the sac. The morbidity and mortality were 2.7% and 4.0%, respectively. The mortality was attributed to intracranial causes in 20 cases (poor grade, delayed ischemic deficits, rebleeding, postoperative infarction, and postoperative epidural hematoma), extracranial causes in 7 cases (pulmonary embolism, heparin induced intracerebral hemorrhage, hepatic failure, myocardial infarction, and gastrointestinal bleeding), and unknown problems in 5 cases. The postoperative intracerebral hemorrhage occurred in 16 cases and seemed to be caused by one or more of the following events: cerebral infarction developed during the preoperative period, occlusion of the cerebral veins during the Sylvian dissection, cerebral retraction and/or sudden change of intracranial hemodynamics. Hydrocephalus, almost always a communicating type as confirmed by isotope cisternography, was managed by lumboperitoneal shunt.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2046205

  14. The Potential Role of Kallistatin in the Development of Abdominal Aortic Aneurysm

    Science.gov (United States)

    Li, Jiaze; Krishna, Smriti Murali; Golledge, Jonathan

    2016-01-01

    Abdominal aortic aneurysm (AAA) is a vascular condition that causes permanent dilation of the abdominal aorta, which can lead to death due to aortic rupture. The only treatment for AAA is surgical repair, and there is no current drug treatment for AAA. Aortic inflammation, vascular smooth muscle cell apoptosis, angiogenesis, oxidative stress and vascular remodeling are implicated in AAA pathogenesis. Kallistatin is a serine proteinase inhibitor, which has been shown to have a variety of functions, potentially relevant in AAA pathogenesis. Kallistatin has been reported to have inhibitory effects on tumor necrosis factor alpha (TNF-α) signaling induced oxidative stress and apoptosis. Kallistatin also inhibits vascular endothelial growth factor (VEGF) and Wnt canonical signaling, which promote inflammation, angiogenesis, and vascular remodeling in various pre-clinical experimental models. This review explores the potential protective role of kallistatin in AAA pathogenesis. PMID:27529213

  15. Mutations in smooth muscle alpha-actin (ACTA2) lead to thoracic aortic aneurysms and dissections.

    Science.gov (United States)

    Guo, Dong-Chuan; Pannu, Hariyadarshi; Tran-Fadulu, Van; Papke, Christina L; Yu, Robert K; Avidan, Nili; Bourgeois, Scott; Estrera, Anthony L; Safi, Hazim J; Sparks, Elizabeth; Amor, David; Ades, Lesley; McConnell, Vivienne; Willoughby, Colin E; Abuelo, Dianne; Willing, Marcia; Lewis, Richard A; Kim, Dong H; Scherer, Steve; Tung, Poyee P; Ahn, Chul; Buja, L Maximilian; Raman, C S; Shete, Sanjay S; Milewicz, Dianna M

    2007-12-01

    The major function of vascular smooth muscle cells (SMCs) is contraction to regulate blood pressure and flow. SMC contractile force requires cyclic interactions between SMC alpha-actin (encoded by ACTA2) and the beta-myosin heavy chain (encoded by MYH11). Here we show that missense mutations in ACTA2 are responsible for 14% of inherited ascending thoracic aortic aneurysms and dissections (TAAD). Structural analyses and immunofluorescence of actin filaments in SMCs derived from individuals heterozygous for ACTA2 mutations illustrate that these mutations interfere with actin filament assembly and are predicted to decrease SMC contraction. Aortic tissues from affected individuals showed aortic medial degeneration, focal areas of medial SMC hyperplasia and disarray, and stenotic arteries in the vasa vasorum due to medial SMC proliferation. These data, along with the previously reported MYH11 mutations causing familial TAAD, indicate the importance of SMC contraction in maintaining the structural integrity of the ascending aorta.

  16. The Potential Role of Kallistatin in the Development of Abdominal Aortic Aneurysm.

    Science.gov (United States)

    Li, Jiaze; Krishna, Smriti Murali; Golledge, Jonathan

    2016-01-01

    Abdominal aortic aneurysm (AAA) is a vascular condition that causes permanent dilation of the abdominal aorta, which can lead to death due to aortic rupture. The only treatment for AAA is surgical repair, and there is no current drug treatment for AAA. Aortic inflammation, vascular smooth muscle cell apoptosis, angiogenesis, oxidative stress and vascular remodeling are implicated in AAA pathogenesis. Kallistatin is a serine proteinase inhibitor, which has been shown to have a variety of functions, potentially relevant in AAA pathogenesis. Kallistatin has been reported to have inhibitory effects on tumor necrosis factor alpha (TNF-α) signaling induced oxidative stress and apoptosis. Kallistatin also inhibits vascular endothelial growth factor (VEGF) and Wnt canonical signaling, which promote inflammation, angiogenesis, and vascular remodeling in various pre-clinical experimental models. This review explores the potential protective role of kallistatin in AAA pathogenesis. PMID:27529213

  17. [Ruptured abdominal aortic aneurysm. A rare form of presentation].

    Science.gov (United States)

    Rettedal, E A; Vennesland, O

    1993-05-10

    In most cases a ruptured abdominal aortic aneurism is dramatic, with rapid deterioration of the clinical condition of the patient. With abdominal and back pain, pulsatile tumour, and development of bleeding shock the diagnosis is obvious. In some cases the symptoms are not clear and the condition can be misinterpreted. The authors describe a case to illustrate this. A 74 year-old male was admitted to hospital with vague abdominal pain and left inguinal hernia. It later turned out that a ruptured abdominal aortic aneurism was the reason for his symptoms and signs. 14 similar cases are reported in the literature. PMID:8332976

  18. RUPTURE OF ABDOMINAL AORTIC ANEURYSM IN RENAL TRANSPLANT PATIENT

    Directory of Open Access Journals (Sweden)

    B. V. Fadin

    2012-01-01

    Full Text Available The purpose of this article was to report our first experience in surgical treatment of aortic aneurism rupture in patient of 55 years old with renal transplant. Aortic aneurism rupture always associated with high mortality, and urgent operative procedure is also rather complicative and has also in bad anatomical conditions. The expectation of good collateral circulation for renal transplant, quick cross-clamp time and easy graft replacement may not always be the case. We believe that trans- planted kidney should be protected when ever feasible, especially in urgent procedure. 

  19. EXPRESSION OF MATRIX METALLOPROTEINASE-9 IN HUMANABDOMINAL AORTIC ANEURYSMAL TISSUES

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Abdominal aortic aneuryzms(AAAs)are char-acterized by the degradation of structural proteins,including both collagen and elastin and remodelingof the extracellular matrix(ECM).The matrixmetalloproteinases(MMPs)are responsible for col-lagen and elastin degradation withinthe aortic wall.Up to date,14MMPs have beenidentified.Amongthem,in particular,MMP-9(92-kDtypeⅣcolla-genase)shows strong elastinolytic activity[1].Recentstudies showedthat elevated plasmalevel of MMP-9wasassociated with AAAs,i mplicating its p...

  20. Elastic fiber regeneration in vitro and in vivo for treatment of experimental abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    XIONG Jiang; GUO Wei; WEI Ren; ZUO Shang-wei; LIU Xiao-ping; ZHANG Tao

    2013-01-01

    Background The pathological characteristics of abdominal aortic aneurysm (AAA) involved the regression of extracellular matrix (ECM) in aortic walls,especially elastic structure in medial layer.As the major structural protein of aorta,elastin contributes to the extensibility and elastic recoil of the vessels.We hypothesized that overexpression of elastin in vessel walls might regenerate the elastic structure of ECM,restore the elastic structure of the aneurysmal wall,and eventually lead to a reduction of aortic diameters (ADs) in an experimental model of AAA.Methods Tropoelastin (TE) of Sprague Dawley (SD) rat was synthesized by reverse transcription polymerase chain reaction and used to construct adneviral vectors containing elastin precursor protein (AdTE-GFP).Cultured vascular smooth muscle cells (VSMCs) from aortas of male SD rats were transfected with AdTE-GFP,AdGFP,adenoviral vector (AdNull),and phosphate buffered saline (PBS).Immunofluorescence staining was performed to determine the expression of elastin in transfected cells.The expression of elastic fibers in ECM of VSMCs transfected with AdTE-GFP were detected by fluorescence microscopy and transmission electron microscopy (TEM) at 1,3,and 5 days following gene transfer.The AAA vessel walls were infused with AdTE-GFP or an empty AdNull,or PBS directly into the aneurysmal lumen.ADs of the aneurysms were compared in infused aortas.Formation of new elastic fibers in vivo was assessed by hematoxylin and eosin,and elastic von-Giesson staining.Recombinant elastin-GFP in vivo was identified by immunohistochemical staining.Results Elastic fibers were increased both in ECM of VSMC and in vessel walls after gene transfer.Histological studies revealed that the AdTE-GFP-transduced aortas had elastic fiber regeneration in the aneurysmal walls.The AdTE-GFP-transduced aortas showed a decreased AD (23.04%±14.49%,P <0.01) in AAA vessel walls.Conclusions Elastic fibers have been successfully overexpressed both in

  1. 3D visualization of strain in abdominal aortic aneurysms based on navigated ultrasound imaging

    Science.gov (United States)

    Brekken, Reidar; Kaspersen, Jon Harald; Tangen, Geir Arne; Dahl, Torbjørn; Hernes, Toril A. N.; Myhre, Hans Olav

    2007-03-01

    The criterion for recommending treatment of an abdominal aortic aneurysm is that the diameter exceeds 50-55 mm or shows a rapid increase. Our hypothesis is that a more accurate prediction of aneurysm rupture is obtained by estimating arterial wall strain from patient specific measurements. Measuring strain in specific parts of the aneurysm reveals differences in load or tissue properties. We have previously presented a method for in vivo estimation of circumferential strain by ultrasound. In the present work, a position sensor attached to the ultrasound probe was used for combining several 2D ultrasound sectors into a 3D model. The ultrasound was registered to a computed-tomography scan (CT), and the strain values were mapped onto a model segmented from these CT data. This gave an intuitive coupling between anatomy and strain, which may benefit both data acquisition and the interpretation of strain. In addition to potentially provide information relevant for assessing the rupture risk of the aneurysm in itself, this model could be used for validating simulations of fluid-structure interactions. Further, the measurements could be integrated with the simulations in order to increase the amount of patient specific information, thus producing a more reliable and accurate model of the biomechanics of the individual aneurysm. This approach makes it possible to extract several parameters potentially relevant for predicting rupture risk, and may therefore extend the basis for clinical decision making.

  2. Lower Extremity Microembolism in Open vs. Endovascular Abdominal Aortic Aneurysm Repair

    Science.gov (United States)

    Toursavadkohi, Shahab; Kakkos, Stavros K.; Rubinfeld, Ilan; Shepard, Alexander

    2016-01-01

    Although previous studies have documented the occurrence of microembolization during abdominal aortic aneurysm (AAA) repair by both open and endovascular approaches, no study has compared the downstream effects of these two repair techniques on lower extremity hemodynamics. In this prospective cohort study, 20 patients were treated with endovascular aneurysm repair (EVAR) (11 Zenith, 8 Excluder, and 1 Medtronic) and 18 patients with open repair (OR) (16 bifurcated grafts, 2 tube grafts). Pre- and postoperative ankle-brachial indices (ABIs) and toe-brachial indices (TBIs) were measured preoperatively and on postoperative day (POD) 1 and 5. Demographics and preoperative ABIs/TBIs were identical in EVAR (0.97/0.63) and OR (0.96/0.63) patients (p = 0.21). There was a significant decrease in ABIs/TBIs following both EVAR (0.83/0.52, p = 0.01) and OR (0.73/0.39, p = 0.003) on POD #1, although this decrease was greater following OR than EVAR (p = 0.002). This difference largely resolved by POD #5 (p = 0.41). In the OR group, TBIs in the limb in which flow was restored first was significantly reduced compared to the contralateral limb (0.50 vs. 0.61, p = 0.03). In the EVAR group, there was also a difference in TBIs between the main body insertion side and the contralateral side (0.50 vs. 0.59, p = 0.02). Deterioration of lower extremity perfusion pressures occurs commonly after AAA repair regardless of repair technique. Toe perfusion is worse in the limb opened first during OR and on the main body insertion side following EVAR, suggesting that microembolization plays a major role in this deterioration. The derangement following OR is more profound than after EVAR on POD #1, but recovers rapidly. This finding suggests that microembolizarion may be worse with OR or alternatively that other factors associated with OR (e.g., the hemodynamic response to surgery with redistribution of flow to vital organs peri-operatively) may play a role. PMID

  3. Lower Extremity Microembolism in Open vs. Endovascular Abdominal Aortic Aneurysm Repair

    Directory of Open Access Journals (Sweden)

    Shahab eToursavadkohi

    2016-03-01

    Full Text Available Abstract:Although previous studies have documented the occurrence of microembolization during abdominal aortic aneurysm (AAA repair by both open and endovascular approaches, no study has compared the downstream effects of these two repair techniques on lower extremity hemodynamics .In this prospective cohort study, 20 patients were treated with endovascular aneurysm repair (EVAR (11 Zenith, 8 Excluder 1 Medtronic and 18 patients with open repair (OR (16 bifurcated grafts, 2 tube grafts. Pre- and post-operative ankle-brachia! indices (ABls and toe-brachia! indices (TBls were measured pre-operatively and on post­ operative day (POD 1 and 5.Demographics and pre-op ABls/TBls were identical in EVAR (0.97/0.63 and OR (0.96/0.63 patients (p=0.21. There was a significant decrease in ABls/TBls following both EVAR (0.83/0.52, p=0.01 and OR (0.73/0.39, p=0.003 on POD#1, although this decrease was greater following OR than EVAR (p=0.002. This difference largely resolved by POD #5 (p=0.41. In the OR group, TBls in the limb in which flow was restored first was significantly reduced compared to the contralateral limb (0.50 vs 0.61, p=0.03. In the EVAR group there was also a difference in TBls between the main body insertion side and the contralateral side (0.50 vs 0.59, p=0.02.Deterioration of lower extremity perfusion pressures occurs commonly after AAA repair regardless of repair technique. Toe perfusion is worse in the limb opened first during OR and on the main body insertion side following EVAR suggesting that microembolization plays a major role in this deterioration ..The derangement following OR is more profound than after EVAR on POD#1, but recovers rapidly. This finding suggests that microembolizarion may be worse with OR or alternatively that other factors associated with OR (e.g. the hemodynamic response to surgery with redistribution of flow to vital organs peri-operatively may play a role

  4. The use of selective cerebral perfusion through right axillary artery cannulation in aortic aneurysm surgery%经右侧腋动脉插管选择性单侧脑灌注在主动脉瘤手术中的应用

    Institute of Scientific and Technical Information of China (English)

    姚昊; 王强; 骆璇; 王喆妍; 陈杨

    2011-01-01

    Objective To summarize the experiences of selective cerebral perfusion through right axillary artery cannulation in aortic aneurysm surgery. Methods Methods Retrospectively analyzed 105 cases ( from May 2009 to May 2011 ) of aortic aneurysm surgery with deep hypothermic circulatory arrest ( DHCA ). 78 cases were male and 27 cases were female. The operation procedure included Bentall procedure and semi arch replacement in 6 cases, ascending aorta replacement and semi arch replacement in 5 cases, Bentall procedure and elephant trunk technique in 61 cases, ascending aorta replacement and elephant trunk technique in 33 cases. Combined operations included coronery artery bypass grafting ( 10 cases ), mitral valve replacement or mitral valve repair ( 24 cases ) and tricuspid valve repair ( 11 cases ). Results Average cardiopulmonary bypass time was 81 -374 ( 178. 6 ±41. 5 ) min, average DHCA time was 8 - 36 ( 23.2 ± 10. 1 ) min, average selective cerebral perfusion time was 8 - 46 ( 30. 4 ± 12. 4 ) min, nasopharynx temperature during DHCA was 15. 5 -23. 5 ( 19. 5 ± 1. 7 )℃ , rectal temperature during DHCA was 18.0-25.6 ( 20.6 ± 1. 6 )℃. 89 patients'hearts automaticly reheated and 16 reheated after defibrillation. 5 cases died postoperatively. The complications included mul-tiorgan failure for 3 cases, malignant arrhythmia for 1 case and sudden bleeding for 1 case. Conclusion The use of selective cerebral perfusion through right axillary artery cannulation in aortic aneurysm surgery can get effective brain protection and reduce the postoperative nervous system complications with acceptable results.%目的 总结经右侧腋动脉插管选择性脑灌注(SCP)在主动脉瘤手术中应用的经验.方法 回顾性分析我院2009年5月至2011年5月期间采用深低温停循环(DHCA)SCP的手术方式治疗的105例主动脉瘤患者.男78例,女27例.行Bentall+次全弓置换6例,行升主动脉置换+次全弓置换5例,行Bentall+全弓置换+降主

  5. Clinical trial of doxycycline for matrix metalloproteinase-9 inhibition in patients with an abdominal aneurysm doxycycline selectively depletes aortic wall neutrophils and cytotoxic t cells

    NARCIS (Netherlands)

    Lindeman, J.H.N.; Abdul-Hussien, H.; Bockel, J.H. van; Wolterbeek, R.; Kleemann, R.

    2009-01-01

    Background-Doxycycline has been shown to effectively inhibit aneurysm formation in animal models of abdominal aortic aneurysm. Although this effect is ascribed to matrix metalloproteinase-9 inhibition, such an effect is unclear in human studies. We reevaluated the effect of doxycycline on aortic wal

  6. Impaired results of a randomised double blinded clinical trial of propranolol versus placebo on the expansion rate of small abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Henneberg, E W; Juul, Søren;

    1999-01-01

    To study the propranolol treatment of small abdominal aortic aneurysms (AAA) concerning intention to treat, side effects, and inhibition of expansion.......To study the propranolol treatment of small abdominal aortic aneurysms (AAA) concerning intention to treat, side effects, and inhibition of expansion....

  7. Concepts to optimize stent-grafting of abdominal aortic aneurysms based on results of experimental studies

    International Nuclear Information System (INIS)

    Purpose. In the endoluminal therapy of abdominal aortic aneurysms, a short proximal aneurysm neck, endoleaks and the large size and stiffness of the introducer systems are responsible for many of the complications and sub-optimal outcomes. The purpose of the present review article is to to suggest strategies to minimize these complications based on the results of experimental studies in animals. Material and methods. After implanting various types of stents across the renal artery origins, the functional and morphological changes in the kidneys and renal vessels were studied by various authors. In order to prevent progressive widening of the proximal aneurysmal neck and graft dislocation, Sonesson et al. performed a laparoscopic banding around the proximal neck in pigs. To study the effects of endoleaks, Marty, Schurink and Pitton carried out pressure measurements in experimental aneurysms with and without endoleaks. Sakaguchi and Pavcnik developed the 'Twin-tube endografts' (TTEG) and the 'Bifurcated drum occluder endografts' (BDOEG) and tested them in dogs. Results. Up to 3 months after suprarenal stent placement, Chavan et al. detected no significant fall in the mean inulin clearance in sheep (140±46 ml/min before, 137±58 ml/min after). Nasim et al. and Malina et al. reported similar observations with respect to renal function. Suprarenal fixation may result in isolated thrombotic occlusions of the renal arteries and microinfarcts in the kidneys. Mean aortic diameters at the level of banding were significantly smaller in the animals with aortic banding as opposed to those in the control group without banding (8 mm vs 11 mm, p=0.004). The banding caused a secure proximal fixation of the stent-graft. Persistent endoleaks resulted in significantly higher intraaneurysmal pressures. Although the TTEG and the BDOEG stent-grafts required smaller sheaths, occlusions were observed in 8% (TTEG) and 60% (BDOEG) of the graft limbs. (orig.)

  8. Mutations in a TGF-β Ligand, TGFB3, Cause Syndromic Aortic Aneurysms and Dissections

    Science.gov (United States)

    Bertoli-Avella, Aida M.; Gillis, Elisabeth; Morisaki, Hiroko; Verhagen, Judith M.A.; de Graaf, Bianca M.; van de Beek, Gerarda; Gallo, Elena; Kruithof, Boudewijn P.T.; Venselaar, Hanka; Myers, Loretha A.; Laga, Steven; Doyle, Alexander J.; Oswald, Gretchen; van Cappellen, Gert W.A.; Yamanaka, Itaru; van der Helm, Robert M.; Beverloo, Berna; de Klein, Annelies; Pardo, Luba; Lammens, Martin; Evers, Christina; Devriendt, Koenraad; Dumoulein, Michiel; Timmermans, Janneke; Bruggenwirth, Hennie T.; Verheijen, Frans; Rodrigus, Inez; Baynam, Gareth; Kempers, Marlies; Saenen, Johan; Van Craenenbroeck, Emeline M.; Minatoya, Kenji; Matsukawa, Ritsu; Tsukube, Takuro; Kubo, Noriaki; Hofstra, Robert; Goumans, Marie Jose; Bekkers, Jos A.; Roos-Hesselink, Jolien W.; van de Laar, Ingrid M.B.H.; Dietz, Harry C.; Van Laer, Lut; Morisaki, Takayuki; Wessels, Marja W.; Loeys, Bart L.

    2015-01-01

    Background Aneurysms affecting the aorta are a common condition associated with high mortality as a result of aortic dissection or rupture. Investigations of the pathogenic mechanisms involved in syndromic types of thoracic aortic aneurysms, such as Marfan and Loeys-Dietz syndromes, have revealed an important contribution of disturbed transforming growth factor (TGF)-β signaling. Objectives This study sought to discover a novel gene causing syndromic aortic aneurysms in order to unravel the underlying pathogenesis. Methods We combined genome-wide linkage analysis, exome sequencing, and candidate gene Sanger sequencing in a total of 470 index cases with thoracic aortic aneurysms. Extensive cardiological examination, including physical examination, electrocardiography, and transthoracic echocardiography was performed. In adults, imaging of the entire aorta using computed tomography or magnetic resonance imaging was done. Results Here, we report on 43 patients from 11 families with syndromic presentations of aortic aneurysms caused by TGFB3 mutations. We demonstrate that TGFB3 mutations are associated with significant cardiovascular involvement, including thoracic/abdominal aortic aneurysm and dissection, and mitral valve disease. Other systemic features overlap clinically with Loeys-Dietz, Shprintzen-Goldberg, and Marfan syndromes, including cleft palate, bifid uvula, skeletal overgrowth, cervical spine instability and clubfoot deformity. In line with previous observations in aortic wall tissues of patients with mutations in effectors of TGF-β signaling (TGFBR1/2, SMAD3, and TGFB2), we confirm a paradoxical up-regulation of both canonical and noncanonical TGF-β signaling in association with up-regulation of the expression of TGF-β ligands. Conclusions Our findings emphasize the broad clinical variability associated with TGFB3 mutations and highlight the importance of early recognition of the disease because of high cardiovascular risk. PMID:25835445

  9. Open conversion after endovascular aortic aneurysm repair with the Ovation Prime™ endograft.

    Science.gov (United States)

    Georgiadis, George S; Charalampidis, Dimitrios; Georgakarakos, Efstratios I; Antoniou, George A; Trellopoulos, George; Vogiatzaki, Theodosia; Lazarides, Miltos K

    2014-02-01

    Advances in abdominal aortic aneurysm (AAA) endograft device technology have contributed to improved outcomes and durability of endovascular aortic aneurysm repair (EVAR), even in complex infrarenal aortic anatomies. However, stent graft failure secondary to endoleaks, migration, endotension and sac enlargement are persistent problems that can result in aneurysm rupture following EVAR.A symptomatic infrarenal AAA (4mm proximal neck) was treated initially with an Ovation Prime™ device (TriVascular, Inc., Santa Rosa, CA) in an off-label fashion, leading to type Ia endoleak moderately reduced by additional proximal neck ballooning. A failed Chimney technique to the single patent, but severely stenosed, right renal artery preceded the use of this device. A large type Ia endoleak was evident at 6-month follow-up, but following a failed supplementary endovascular intervention with coils to seal the endoleak, the patient presented with hemorrhagic shock from AAA rupture, requiring urgent open conversion. Intraoperatively it was impossible to explant this new type of endograft. Circumferential tying of the infrarenal aorta with a Teflon band was unable to stop the bleeding. However, after dividing the body of the stent-graft below the two proximal polymer rings, the endoleak was successfully treated by suturing the graft with the proximal aortic neck. The procedure was completed with extension of the stump to the common femoral arteries using a bifurcated Dacron prosthesis.The body of an Ovation Prime™ endograft may be impossible to explant in open conversion conditions. Large prospective studies with longer follow-up are required to adequately reflect the behavior of this particular device. PMID:24619891

  10. Induction of histone deacetylases (HDACs in human abdominal aortic aneurysm: therapeutic potential of HDAC inhibitors

    Directory of Open Access Journals (Sweden)

    María Galán

    2016-05-01

    Full Text Available Clinical management of abdominal aortic aneurysm (AAA is currently limited to elective surgical repair because an effective pharmacotherapy is still awaited. Inhibition of histone deacetylase (HDAC activity could be a promising therapeutic option in cardiovascular diseases. We aimed to characterise HDAC expression in human AAA and to evaluate the therapeutic potential of class I and IIa HDAC inhibitors in the AAA model of angiotensin II (Ang II-infused apolipoprotein-E-deficient (ApoE−/− mice. Real-time PCR, western blot and immunohistochemistry evidenced an increased expression of HDACs 1, 2 (both class I, 4 and 7 (both class IIa in abdominal aorta samples from patients undergoing AAA open repair (n=22 compared with those from donors (n=14. Aortic aneurysms from Ang-II-infused ApoE−/− mice exhibited a similar HDAC expression profile. In these animals, treatment with a class I HDAC inhibitor (MS-275 or a class IIa inhibitor (MC-1568 improved survival, reduced the incidence and severity of AAA and limited aneurysmal expansion evaluated by Doppler ultrasonography. These beneficial effects were more potent in MC-1568-treated mice. The disorganisation of elastin and collagen fibres and lymphocyte and macrophage infiltration were effectively reduced by both inhibitors. Additionally, HDAC inhibition attenuated the exacerbated expression of pro-inflammatory markers and the increase in metalloproteinase-2 and -9 activity induced by Ang II in this model. Therefore, our data evidence that HDAC expression is deregulated in human AAA and that class-selective HDAC inhibitors limit aneurysm expansion in an AAA mouse model. New-generation HDAC inhibitors represent a promising therapeutic approach to overcome human aneurysm progression.

  11. 18F-FDG PET-CT uptake is a feature of both normal diameter and aneurysmal aortic wall and is not related to aneurysm size

    Energy Technology Data Exchange (ETDEWEB)

    Barwick, Tara D. [Imperial College Healthcare NHS Trust, Charing Cross Hospital, Department of Radiology/Nuclear Medicine, London (United Kingdom); Hammersmith Hospital, Department of Surgery and Cancer, Imperial College London, London (United Kingdom); Lyons, O.T.A.; Waltham, M. [King' s College London, BHF Centre of Research Excellence and NIHR Biomedical Research Centre at King' s Health Partners, Academic Department of Surgery, London (United Kingdom); Mikhaeel, N.G. [Guy' s and St Thomas' Foundation NHS Trust, Department of Oncology, London (United Kingdom); O' Doherty, M.J. [King' s Health Partners, Clinical PET Centre, St Thomas' Hospital, London (United Kingdom)

    2014-12-15

    Aortic metabolic activity is suggested to correlate with presence and progression of aneurysmal disease, but has been inadequately studied. This study investigates the 2-[{sup 18}F] fluoro-2-deoxy-D-glucose ({sup 18}F-FDG) uptake in a population of infra-renal abdominal aortic aneurysms (AAA), compared to a matched non-aneurysmal control group. The Positron Emission Tomography - Computed Tomography (PET/CT) database was searched for infra-renal AAA. Exclusion criteria were prior repair, vasculitis, and saccular/mycotic thoracic or thoraco-abdominal aneurysms. Matching of 159 non-aneurysmal (<3 cm diameter) controls from the same population was assessed. Infra-renal aortic wall FDG uptake was assessed using visual analysis; maximum standardized uptake value (SUV{sub max}) and target to background mediastinal blood pool ratio (TBR) were documented. Predictors of FDG uptake (age, sex, aortic diameter, hypertension, statin use, and diabetes) were assessed using univariate analysis. Follow-up questionnaires were sent to referring clinicians. Aneurysms (n = 151) and controls (n = 159) were matched (p > 0.05) for age, sex, diabetes, hypertension, smoking status, statin use, and indication for PET/CT. Median aneurysm diameter was 5.0 cm (range 3.2-10.4). On visual analysis there was no significant difference in the overall numbers with increased visual uptake 24 % (36/151) in the aneurysm group vs. 19 % (30/159) in the controls, p = ns. SUV{sub max} was slightly lower in the aneurysm group vs. controls (mean (2 SD) 1.75(0.79) vs. 1.84(0.58), p = 0.02). However there was no difference in TBR between the AAA group and controls (mean (2 SD) 1.03 (0.46) vs. 1.05(0.31), p = 0.36). During a median 18 (interquartile range 8-35) months' follow-up 20 were repaired and four were confirmed ruptured. The level of metabolic activity as assessed by {sup 18}F-FDG PET/CT in infra-renal AAA does not correlate with aortic size and does not differ between aneurysms and matched controls

  12. Correlations of perioperative coagulopathy, fluid infusion and blood transfusions with survival prognosis in endovascular aortic repair for ruptured abdominal aortic aneurysm

    OpenAIRE

    Kawatani, Yohei; Nakamura, Yoshitsugu; Kurobe, Hirotsugu; Suda, Yuji; Hori, Takaki

    2016-01-01

    Background Factors associated with survival prognosis among patients who undergo endovascular aortic repair (EVAR) for ruptured abdominal aortic aneurysms (rAAA) have not been sufficiently investigated. In the present study, we examined correlations between perioperative coagulopathy and 24-h and 30-day postoperative survival. Relationships between coagulopathy and the content of blood transfusions, volumes of crystalloid infusion and survival. Methods This was a retrospective study of the me...

  13. Multiple aneurysms due to intimomedial mucoid degeneration: a short presentation

    Directory of Open Access Journals (Sweden)

    H Gajjar

    2009-11-01

    Full Text Available A 17 year-old female presented with abdominal pain, due to contained rupture of a left common iliac artery aneurysm. This was accompanied by abdominal aortic and superior mesenteric artery aneurysms. Despite emergency vascular surgery, the patient died a week later. Post-mortem examination revealed intimomedial mucoid degeneration. This rare condition has been described predominantly in South African black patients especially females, and occurs at a younger age than degenerative aortic aneurysms.

  14. [Minimally invasive cardiac surgery for aortic valve disease].

    Science.gov (United States)

    Fujimura, Y; Katoh, T; Hamano, K; Gohra, H; Tsuboi, H; Esato, K

    1998-12-01

    Recent surgical advances leading to good operative results have contributed to the trend to useminimally invasive approaches, even in cardiac surgery. Smaller incisions are clearly more cosmetically acceptable to patients. When using a minimally invasive approach, it is most important to maintain surgical quality without jeopardizing patients. A good operative visual field leads to good surgical results. In the parasternal approach, we use a retractor to harvest an internal thoracic artery in coronary artery bypass surgery. Retracting the sternum upward allows for a good surgical view and permits the use of an arch cannula rather than femoral cannulation. When reoperating for aortic valve repair, the j-sternotomy approach requires less adhesiolysis compared with the traditional full sternotomy. No special technique is necessary to perform aortic valve surgery using the j-sternotomy approach. However, meticulous attention must be paid to avoiding left ventricular air embolisms to prevent postoperative stroke or neurocognitive deficits, especially when utilizing a minimally invasive approach. Transesophageal echo is useful not only for monitoring cardiac function but also for monitoring the persence of air in the left ventricle and atrium. This paper compare as the degree of invasion of minimally invasive cardiac surgery and the traditional full sternotomy. No differences were found in the occurrence of systemic inflammatory response syndrome between patients undergoing minimally invasive cardiac surgery and the traditional technique. Therefore it is concluded that minimally invasive surgery for patients with aortic valve disease may become the standard approach in the near future.

  15. Endovascular stent graft repair for thoracic aortic aneurysms: the history and the present in Japan.

    Science.gov (United States)

    Kawaguchi, Satoshi; Shimizu, Hideyuki; Yoshitake, Akihiro; Shimazaki, Taro; Iwahashi, Toru; Ogino, Hitoshi; Ishimaru, Shin; Shigematsu, Hiroshi; Yozu, Ryohei

    2013-01-01

    Stent-grafts for endovascular repair of thoracic aortic aneurysms have been commercially available for more than ten years in the West, whereas, in Japan, a manufactured stent-graft was not approved for the use until March 2008. Nevertheless, endovascular thoracic intervention began to be performed in Japan in the early 1990s, with homemade devices used in most cases. Many researchers have continued to develop their homemade devices. We have participated in joint design and assessment efforts with a stent-graft manufacturer, focusing primarily on fenestrated stent-grafts used in repairs at the distal arch, a site especially prone to aneurysm. In March 2008, TAG (W.L. Gore & Associates, Inc., Flagstaff, Arizona, USA) was approved as a stent graft for the thoracic area first in Japan, which was major turning point in treatment for thoracic aortic aneurysms. Subsequently, TALENT (Medtronic, Inc., Minneapolis, Minnesota, USA) was approved in May 2009, and TX2 (COOK MEDICAL Inc., Bloomington, Indiana, USA) in March 2011. Valiant as an improved version of TALENT was approved in November 2011, and TX2 Proform as an improved version of TX2 began to be supplied in October 2012. These stent grafts are excellent devices that showed good results in Western countries, and marked effectiveness can be expected by making the most of the characteristics of each device. A clinical trial in Japan on Najuta (tentative name) (Kawasumi Labo., Inc., Tokyo, Japan) as a line-up of fenestrated stent grafts that can be applied to distal arch aneurysms showing a high incidence, and allow maintenance of blood flow to the arch vessel was initiated. This trial was completed, and Najuta has just been approved in January of 2013 in Japan, and further development is expected. In the U.S., great efforts have recently been made to develop and manufacture excellent stent grafts for thoracic aneurysms, and rapid progress has been achieved. In particular, in the area of the aortic arch, in which we

  16. Aneurisma de la aorta abdominal: Tratamiento endovascular con una endoprótesis fenestrada Abdominal aortic aneurysm: Endovascular treatment with fenestrated endoprothesis

    Directory of Open Access Journals (Sweden)

    Román Rostagno

    2008-12-01

    Full Text Available El tratamiento endovascular de los aneurismas de aorta abdominal es una alternativa a la cirugía abierta para pacientes de alto riesgo. Consiste en la exclusión del saco aneurismático mediante la interposición de una endoprótesis colocada por vía femoral. El tratamiento endovascular no puede ser utilizado en todos los pacientes. Una limitación frecuente la constituye el nacimiento de una arteria visceral desde el saco aneurismático. Para contrarrestar esta limitación recientemente se han desarrollado endoprótesis fenestradas que presentan orificios que se corresponden con el nacimiento de las arterias involucradas en el aneurisma evitando su oclusión, permitiendo de esta manera el tratamiento endovascular. En esta comunicación se presenta un caso de tratamiento endovascular de un aneurisma de aorta abdominal mediante la colocación de una endoprótesis fenestrada en un paciente cuya arteria renal izquierda nacía directamente del saco aneurismático.Endovascular treatment of the abdominal aortic aneurysm is consider an alternative to open surgery for high risk patients. Its goal is to exclude the aneurysm from the circulation by using an endoprothesis introduced from a femoral approach. Patients must be strictly selected to avoid possible complications. The most frequent limitation is related to anatomic contraindications such as visceral arteries involved in the aneurysm. Fenestrated endograft have been recently developed to allow endovascular treatment when anatomic features contraindicate classic endovascular procedures. Fenestrated endograft have holes that match with the origin of the visceral arteries maintaining its potency. In this paper we report the endovascular treatment of an abdominal aortic aneurysm by using a fenestrated endoprothesis in a patient whose left renal artery is originated from the aneurysm.

  17. Risk assessment and risk scores in the management of aortic aneurysms.

    Science.gov (United States)

    Von Meijenfeldt, Gerdine C I; Van Der Laan, Maarten J; Zeebregts, Clark J; Balm, Ron; Verhagen, Hence J M

    2016-04-01

    The decision whether to operate a patient or not can be challenging for a clinician for both ruptured abdominal aortic aneurysms (AAAs) as well as elective AAAs. Prior to surgical intervention it would be preferable that the clinician exactly knows which clinical variables lower or increase the chances of morbidity and mortality postintervention. To help in the preoperative counselling and shared decision making several clinical variables can be identified as risk factors and with these, risk models can be developed. An ideal risk score for aneurysm repair includes routinely obtained physiological and anatomical variables, has excellent discrimination and calibration, and is validated in different geographical areas. For elective AAA repair, several risk scores are available, for ruptured AAA treatment, these scores are far less well developed. In this manuscript, we describe the designs and results of published risk scores for elective and open repair. Also, suggestions for uniformly reporting of risk factors and their statistical analyses are described. Furthermore, the preliminary results of a new risk model for ruptured aortic aneurysm will be discussed. This score identifies age, hemoglobin, cardiopulmonary resuscitation and preoperative systolic blood pressure as risk factors after multivariate regression analysis. This new risk score can help to identify patients that would not benefit from repair, but it can also potentially identify patients who would benefit and therefore lower turndown rates. The challenge for further research is to expand on validation of already existing promising risk scores in order to come to a risk model with optimal discrimination and calibration.

  18. Identifying Abdominal Aortic Aneurysm Cases and Controls using Natural Language Processing of Radiology Reports.

    Science.gov (United States)

    Sohn, Sunghwan; Ye, Zi; Liu, Hongfang; Chute, Christopher G; Kullo, Iftikhar J

    2013-01-01

    Prevalence of abdominal aortic aneurysm (AAA) is increasing due to longer life expectancy and implementation of screening programs. Patient-specific longitudinal measurements of AAA are important to understand pathophysiology of disease development and modifiers of abdominal aortic size. In this paper, we applied natural language processing (NLP) techniques to process radiology reports and developed a rule-based algorithm to identify AAA patients and also extract the corresponding aneurysm size with the examination date. AAA patient cohorts were determined by a hierarchical approach that: 1) selected potential AAA reports using keywords; 2) classified reports into AAA-case vs. non-case using rules; and 3) determined the AAA patient cohort based on a report-level classification. Our system was built in an Unstructured Information Management Architecture framework that allows efficient use of existing NLP components. Our system produced an F-score of 0.961 for AAA-case report classification with an accuracy of 0.984 for aneurysm size extraction. PMID:24303276

  19. [Ultrasound screening for abdominal aortic aneurysms - a rational measure to prevent sudden rupture].

    Science.gov (United States)

    Torsello, Giovanni; Debus, Eike Sebastian; Schmitz-Rixen, Thomas; Grundmann, Reinhart Thomas

    2016-07-01

    The ruptured abdominal aortic aneurysm (AAA) has still a high hospital mortality rate of about 50 % (intervention and non-corrective treatment combined). With an easy non-invasive and inexpensive measure such as the ultrasound screening rupture threatened aneurysms can be recognized in time and then treated prophylactically, hemorrhagic shock can be avoided. Screening programs in England and Sweden currently describe an AAA prevalence of 1.5 % among screened 65-year-old males. With an absolute risk reduction for aneurysm-related death of 15.1 per 10,000 men invited for screening and a cost of £ 7,370 per quality-adjusted life year (QALY), screening for this target group is highly cost-effective. Comprehensive AAA screening requires defined criteria for the quality of the aortic ultrasound examination and for the surgical treatment of detected large AAA. These interventions should be concentrated in centers obligated to quality registry documentation. Patients with smaller AAA, requiring no repair, should be included in a surveillance program, also with registry of their long-term data. PMID:27404935

  20. Abdominal aortic aneurysm and histological, clinical, radiological correlation.

    Science.gov (United States)

    Rodella, Luigi Fabrizio; Rezzani, Rita; Bonomini, Francesca; Peroni, Michele; Cocchi, Marco Angelo; Hirtler, Lena; Bonardelli, Stefano

    2016-04-01

    To date, the pathogenesis of abdominal aortic aneurism (AAA) still remains unclear. As such, the aim of this study was to evaluate changes of the aortic structure during AAA. We analysed the microscopic frame of vessels sections, starting from the primum movens leading to abnormal dilatation. AAA samples were collected and processed through various staining methods (Verhoeff-Van Gieson, Masson Goldner, Sirius Red). Subsequently, the vessel morphology and collagenic web of the tunica media and adventitia were determined and the amount of type I and type III collagen was measured. We also applied immune-histochemistry markers for CD34 and PGP 9.5 in order to identify vascular and nerve structures in the aorta. Immune-positivity quantification was used to calculate the percentage of the stained area. We found increasing deposition of type I collagen and reduced type III collagen in both tunica media and adventitia of AAA. The total amount of vasa vasorum, marked with CD34, and nerva vasorum, marked with PGP 9.5, was also higher in AAA samples. Cardiovascular risk factors (blood pressure, dyslipidemia, cigarette smoking) and radiological data (maximum aneurism diameter, intra-luminal thrombus, aortic wall calcification) increased these changes. These results suggest that the tunica adventitia may have a central role in the pathogenesis of AAA as clearly there are major changes characterized by rooted inflammatory infiltration. The presence of immune components could explain these modifications within the framework of the aorta. PMID:26858185