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Sample records for aortoiliac aneurysm repair

  1. Endovascular repair of para-anastomotic aortoiliac aneurysms.

    LENUS (Irish Health Repository)

    Tsang, Julian S

    2009-11-01

    The purpose of this study is to evaluate the use of endovascular stent grafts in the treatment of para-anastomotic aneurysms (PAAs) as an alternative to high-risk open surgical repair. We identified all patients with previous open aortic aneurysm repair who underwent infrarenal endovascular aneurysm repair (EVAR) at our institution from June 1998 to April 2007. Patient demographics, previous surgery, and operative complications were recorded. One hundred forty-eight patients underwent EVAR during the study period and 11 patients had previous aortic surgery. Of these 11 redo patients, the mean age was 62 years at initial surgery and 71 years at EVAR. All patients were male. Initial open repair was for rupture in five (45%) patients. The average time between initial and subsequent reintervention was 9 years. All patients were ASA Grade III or IV. Fifty-five percent of the PAAs involved the iliac arteries, 36% the abdominal aorta, and 9% were aortoiliac. Ten patients had endovascular stent-grafts inserted electively, and one patient presented with a contained leak. Aorto-uni-iliac stent-grafts were deployed in seven patients, and bifurcated stent-grafts in four patients. A 100% successful deployment rate was achieved. Perioperative mortality was not seen and one patient needed surgical reintervention to correct an endoleak. Endovascular repair of PAAs is safe and feasible. It is a suitable alternative and has probably now become the treatment of choice in the management of PAAs.

  2. Non-inflammatory aortoiliac aneurysm with ureteral obstruction and consequent hydronephrosis: Case report

    Directory of Open Access Journals (Sweden)

    Babić Srđan

    2012-01-01

    Full Text Available Introduction. The natural course of abdominal aneurysms is progressive expansion, rupture, embolisation, thrombosis and compression of the visceral organs. The majority of papers report that inflammatory aortic and iliac aneurysms are associated with perianeurysmal and retroperitoneal fibrosis that ultimately results in the structural compromise of the urinary tract. Ureteral obstruction occurs in 20% to 71% of cases and approximately one half of these patients will present with obstructive uropathy. Most patients with inflammatory aneurysm are symptomatic, with elevated serum inflammatory markers, and characteristic multislice CT findings including a thickened aortic wall and a mass of periaortic inflammatory tissue. Case Outline. A 70-year-old man was admitted at the Vascular Surgery Clinic “Dedinje”, Belgrade, because of ultrasonically verified asymptomatic aortoiliac aneurysm. Multisclice CT findings showed left urethral dilatation and hydronephrosis secondary to extrinsic ureteral obstruction due to aortoiliac aneurysm. CT findings, laboratory tests and finally, histopathologic examination showed atherosclerotic aneurysm without inflammation and retroperitoneal fibrosis. The patient was successfully treated with surgical resection of the aneurysm and aortobiiliac reconstruction with “Y” prosthesis. Conclusion. We present a rare case of ureteral obstruction secondary to atherosclerotic aneurysm which, to our knowledge, has not been previously described in the domestic literature. A successful operative repair was performed. Postoperative course was uneventful and the patient was discharged on the seventh day after the surgery with normal vascular status and renal function.

  3. Brain aneurysm repair

    Science.gov (United States)

    ... aneurysm repair; Dissecting aneurysm repair; Endovascular aneurysm repair - brain; Subarachnoid hemorrhage - aneurysm ... Your scalp, skull, and the coverings of the brain are opened. A metal clip is placed at ...

  4. Endovascular Aneurysm Repair Treatment of Aortoiliac Aneurysms

    DEFF Research Database (Denmark)

    Taudorf, Mikkel; Rasmussen, John Bøje Grønvall; Schroeder, Torben V; Lönn, Lars

    2016-01-01

    , and a branch iliac device was placed in 25 limbs. Gluteal claudication developed in 38% of limbs treated withIIA exclusion but in none of the limbs treated with branch iliac devices (P < .001). Procedure time, fluoroscopy time, and use of iodine contrast material did not differ between the two groups...

  5. 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 ...

  6. Endovascular stent graft repair of multiple tuberculous thoracoabdominal aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Jung; Won, Je Hwan [Dept. of Radiology, Ajou University School of Medicine, Suwon (Korea, Republic of)

    2014-05-15

    We describe a case of multiple tuberculous aneurysms of the descending thoracic aorta and abdominal aorta repaired with endovascular stent graft. The case was a 47-year-old man who presented with three saccular pseudoaneurysms of aortoiliac bifurcation at computed tomography (CT) scan. Despite of antimycobacterial treatment, these aneurysms grew rapidly and saccular pseudoaneurysm of the descending thoracic aorta was newly seen. A bifurcated stent graft was successfully implanted in the aortoiliac bifurcation. Subsequently, endovascular stent graft was placed well in the descending thoracic aorta. Fourteen months after the procedure, the patient was stable and serial CT images showed regression of aneurysms with ongoing antimycobacterial treatment. Therefore, endovascular stent graft repair with antimycobacterial therapy may be a treatment option in patients with multiple tuberculous aneurysms.

  7. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available Aortic Aneurysm Repair May 7, 2009 Good afternoon. Welcome to the Baptist Cardiac and Vascular Institute here in Miami. My name ... our live webcast. Today we’re going to repair an abdominal aortic aneurysm using a technology called ...

  8. 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 ...

  9. 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 ...

  10. 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 ...

  11. 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 ...

  12. 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 ...

  13. 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 ...

  14. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... And one of the things that I’m learning from this movie as we looking at these ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the ...

  15. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... with such holes in the groin, this really offers the patient a tremendous advantage over having his ... a thousand aneurysms with this. So we can offer patients a very, very good integrated care with ...

  16. 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 ...

  17. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... years, and his aneurysm has now grown to 5.4 centimeters. And this is actually an important ... balloon is trying to iron out the attachment. 5 So right now we have the first half ...

  18. 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 ...

  19. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... the age of 65. It’s most common in males. There is an increasing number, due to the ... The risk factors for abdominal aortic aneurysms are males over 60, hardening of the arteries, which is ...

  20. 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 ...

  1. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... They carry oxygen and blood to various organs. These arteries have muscular walls, and when they get ... continue to expand, and they can rupture. And these aneurysms can occur in a lot of different ...

  2. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... this procedure. So let’s go back now and learn a little bit about abdominal aortic aneurysms. Great. ... And one of the things that I’m learning from this movie as we looking at these ...

  3. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... dye and also to do measurements using our computer techniques that are going on here. So what ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the ...

  4. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to do now is begin to do the process of putting an endograft in, and I’m ... that we saw, actually thrombosis. So in the process of thrombosing or clotting off the aneurysm sack, ...

  5. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to the aging baby boomers. Next slide. The risk factors for abdominal aortic aneurysms are males over 60, ... doing a good examination and also accessing for risk factors. So we have a very integrated team here, ...

  6. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... information is critical for us in terms of planning and guiding the procedure we’re going to ... be screened. In fact, patients who have a family history of aneurysm, men who are smoking over ...

  7. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... this is to prevent rupture and to prevent death from rupture. This area just underneath the renal ... Okay. Abdominal aortic aneurysms cause approximately 15,000 deaths in the United States each year. It affects ...

  8. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... past three years, and his aneurysm has now grown to 5.4 centimeters. And this is actually ... that looks like kind of railroad tracks going up and down, that’s the catheter that we’re ...

  9. 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 ...

  10. 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 ...

  11. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... an interventional radiologist. That’s a specialty many people haven’t heard of, but that’s a specialty that ... in that patient’s abdominal sack. Now remember we haven’t treated his aneurysm. We’re sort of ...

  12. 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 ...

  13. 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 ...

  14. 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 ...

  15. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... Rua, and together as a team of multidisciplinary physicians, we’re going to repair an abdominal aortic ... takes a special type of training. Both the doctors in the room are board certified and highly ...

  16. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... this is Dr. Rua, and together as a team of multidisciplinary physicians, we’re going to repair ... Institute is we have a highly- integrated multidisciplinary team; Dr. Rua and I being an example. There ...

  17. Aortoiliac aneurysm with arteriocaval fistula treated by a bifurcated endovascular stent-graft

    International Nuclear Information System (INIS)

    A 71-year-old patient with high-output cardiac failure was found to have an aneurysmal distal aorta with evidence of an arteriocaval fistula on ultrasound scanning. CT demonstrated an aneurysm of the distal aorta and right common iliac artery and an intraarterial digital subtraction angiogram confirmed an arteriocaval fistula. In view of the patient's cardiac failure and general condition an endovascular stent was considered. The right internal iliac artery was occluded with Tungsten coils prior to the insertion of a bifurcated stent-graft. This resulted in total occlusion of the aneurysm and obliteration of the arteriocaval fistula. To our knolwedge such a case has not been previously reported.

  18. Aortoiliac Aneurysm with Arteriocaval Fistula Treated by a Bifurcated Endovascular Stent-Graft

    International Nuclear Information System (INIS)

    A 71-year-old patient with high-output cardiac failure was found to have an aneurysmal distal aorta with evidence of an arteriocaval fistula on ultrasound scanning. CT demonstrated an aneurysm of the distal aorta and right common iliac artery and an intraarterial digital subtraction angiogram confirmed an arteriocaval fistula. In view of the patient's cardiac failure and general condition an endovascular stent was considered. The right internal iliac artery was occluded with Tungsten coils prior to the insertion of a bifurcated stent-graft. This resulted in total occlusion of the aneurysm and obliteration of the arteriocaval fistula. To our knowledge such a case has not been previously reported

  19. Aortoiliac Artery Reconstruction Using Bilateral Reversed Superficial Femoral Veins for an Infected Abdominal Aortic Aneurysm

    Science.gov (United States)

    Hirai, Hanako; Yasuhara, Kiyomitsu; Hatori, Kyohei; Miki, Takao; Obayashi, Tamiyuki

    2016-01-01

    Surgical treatment of an infected abdominal aortic aneurysm (IAAA) is difficult and the ideal graft material is a subject of debate. A 60-year-old man with untreated diabetes mellitus was referred to our hospital presenting with fever and left lower abdominal pain. The patient was diagnosed with an IAAA by blood culture and computed tomography. We treated the patient surgically for the IAAA using bilateral reversed superficial femoral veins which were shaped into a bifurcated graft. No signs of recurrent infection or aneurysmal dilation were observed for 3 years after the procedure. PMID:27087879

  20. 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 asymp...

  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. Bladder and rectal incontinence without paraplegia or paraparesis after endovascular aneurysm repair.

    Science.gov (United States)

    Nishioka, Naritomo; Kurimoto, Yoshihiko; Maruyama, Ryushi; Ujihira, Kosuke; Iba, Yutaka; Hatta, Eiichiro; Yamada, Akira; Nakanishi, Katsuhiko

    2016-12-01

    Spinal cord ischemia is a well-known potential complication of endovascular aneurysm repair (EVAR), and it is usually manifested by paraplegia or paraparesis. We describe a case in which spinal cord ischemia after EVAR presented by isolated bladder and rectal incontinence without other neurological deficits. A 63-year-old woman presented with intermittent claudication secondary to an infrarenal abdominal aortic aneurysm (AAA), and a left common iliac artery obstruction, for which she underwent EVAR using an aorto-uniiliac (AUI) device and ilio-femoral artery bypass. On postoperative day 3, she developed urinary and fecal incontinence without signs of paraplegia or paraparesis. Magnetic resonance imaging (MRI) showed a hyper-intense signal in the spinal cord. She received hyperbaric oxygen (HBO) therapy and was discharged after 18 days when her urinary and fecal incontinence were almost resolved. This report suggests that spinal cord ischemia after EVAR for aortoiliac occlusive disease might present as bladder and rectal incontinence without other neurological manifestations. PMID:26943687

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

    DEFF Research Database (Denmark)

    Firwana, Belal; Ferwana, Mazen; Hasan, Rim; Alpert, Martin A; Faries, Peter; Dangas, George; Gluud, Christian

    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...

  4. Potential value of aneurysm sac volume measurements in addition to diameter measurements after endovascular aneurysm repair.

    NARCIS (Netherlands)

    Keulen, J.W. van; Prehn, J. van; Prokop, M.; Moll, F.L.; Herwaarden, J.A. van

    2009-01-01

    PURPOSE:To investigate the value of aneurysm sac volume measurement in addition to diameter measurements based on computed tomographic angiography (CTA) after endovascular aneurysm repair (EVAR). METHODS:Interrogation of a vascular database identified 56 patients (51 men; median age 77 years, range

  5. Aortoiliac interventions

    International Nuclear Information System (INIS)

    Full text: Atheromatosis is a systemic disease that involves various vascular beds. The most known risk factors are smoking, diabetes mellitus, dyslipedemia, hypertension, advanced age, black gender and male sex. Occlusive aortoiliac disease is due to atheromatosis in the vast majority of cases and is a common distribution of that pathology. Historically aortoiliac occlusions were treated with surgery. Nowadays, the endovascular minimally invasive techniques have revolutionized the treatment of such lesions. The success rate is extremely high with a technical success of 96%. Long term (5 years) patency of the diseased vessel can be as high as 71%. These results combined to the advent of new materials and techniques have set the new standards for treating aortoiliac occlusive disease. The first TASC recommendations (TASC I) were recently revised (TASC II) and the new guidelines (TASC III) will be shortly published. On the other hand endovascular techniques are not always successful. Technical failure (inability to cross the lesion) is estimated to be approximately 5% in single short iliac occlusions and can rise up to 15- 20% in complex long or multiple occlusive lesions. Possible, although not very frequent, complications are dissection, rupture and distal embolization. In the case of total occlusions we can use different materials and techniques. For example in an acute or subacute total occlusion chemical (urokinase or rtPA), mechanical or aspiration thrombolysis can be implemented. These minimally invasive techniques are of the outmost importance if we consider that the majority of the patients are old with a high rate of cardiac and other co-morbidities and therefore cannot go into surgery. That is the reason why the risk of morbidity and mortality following open surgical intervention remains high (5 - 20%). In chronic lesions we can use rentry catheters, glidewires, laser or thrombolysis/thrombectomy (if the clot is not very 'old'). Nevertheless, it should

  6. 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...

  7. 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.

  8. Abdominal aortic aneurysm demonstrated on renal scintigraphy.

    Science.gov (United States)

    Phisitkul, Sorot; Brian, Susan; Rakvit, Ariwan; Jenkins, Leigh A; Bohannon, W Todd; Harris, Jennifer; Tsikouris, James; Silva, Michael B; Meyerrose, Gary E

    2003-08-01

    A 74-year-old hypertensive woman presented with abdominal discomfort and a pulsatile abdominal mass. Anterior abdominal angiography during cardiac blood pool, and renal scintigraphic imaging demonstrated a large abdominal aortic aneurysm. 1, 2 Before endovascular repair with an aortoiliac endograft, the abdominal aneurysm measured 7.5 x 7.0 cm on abdominal computed tomography. This study demonstrates that a suspected abdominal aortic aneurysm can be confirmed using the addition of anterior abdominal imaging with normal posterior imaging at the time of renal scintigraphy. PMID:12897671

  9. Successful endovascular infrarenal aneurysm repair in a patient with situs inversus totalis

    OpenAIRE

    Chan, YC; Cheng, SW; Ting, AC; Qing, KX

    2010-01-01

    Situs inversus totalis is a rare autosomal recessive developmental anomaly. There are very few reports in the published literature of abdominal aortic aneurysm in patient with situs inversus totalis, all of whom underwent open aneurysm repair. This is the first case in the world's literature to describe a patient with situs inversus totalis who had a successful endovascular infrarenal aneurysm repair. Although endovascular infrarenal aneurysm repair should not be more challenging, the endovas...

  10. 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

  11. 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.

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

    International Nuclear Information System (INIS)

    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

  13. 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

  14. 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.

  15. New insights in (acute) endovascular abdominal aneurysm repair : when fenestrated devices fall short

    NARCIS (Netherlands)

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

    2013-01-01

    The suitability for endovascular aneurysm repair (EVAR) is determined primarily by abdominal aortic aneurysm (AAA) anatomy. For patients unsuitable for standard EVAR, due to proximal neck anatomy, fenestrated aortic stent-grafting (FEVAR) is a viable alternative to open repair surgery. Initially FEV

  16. Aorto-iliac angioplasty

    International Nuclear Information System (INIS)

    This paper reports on the results and complications of aortoiliac balloon percutaneous transluminal angioplasty (PTA) and Simpson atherectomy that are compared to determine the role of the latter procedure in the management of aortoiliac disease. In 1984--1988, 92 patients underwent 126 angioplasties of the aortoiliac region. In 1986--1989, 21 patients underwent iliac artery atherectomy. Both groups had similar symptoms, risk factors, and age ranges. The overall technical success rate was 97.6or PTA and 100% for atherectomy. The initial clinical success was 92.8% for PTA and 100% for atherectomy. The 2-year clinical patency rate was 60% for PTA and 64% for artherectomy. Complications requiring surgery occurred in four of 126 (3%) PTA patients and one of 21 (5%) atherectomy patients. Groin hematomas were observed in 16% of PTA patients and 19% of atherectomy patients

  17. Endovascular Aneurysm Repair and Sealing (EVARS): A Useful Adjunct in Treating Challenging Morphology.

    Science.gov (United States)

    Harrison, Gareth J; Antoniou, George A; Torella, Francesco; McWilliams, Richard G; Fisher, Robert K

    2016-04-01

    An 81-year-old male with previous open abdominal aortic aneurysm repair presented with asymptomatic large pseudoaneurysms at both ends of an open surgical tube graft. Endovascular aneurysm sealing (EVAS) in combination with the iliac limbs of a standard endovascular aneurysm repair (EVAR) successfully excluded both pseudoaneurysms from circulation. We describe the combination of elements of EVAS and EVAR and have termed this endovascular aneurysm repair and sealing (EVARS). EVARS has the advantage of harnessing the benefits of endobag sealing in aortic necks unsuitable for standard EVAR whilst providing the security of accurate stent placement within short common iliac arteries. In conclusion, EVAS may be combined with standard endovascular iliac limbs and is a possible treatment option for pseudoaneurysm following open aneurysm repair. PMID:26493819

  18. 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)

  19. Type I Endoleak-like Phenomenon Causing Rupture of the Replaced Aneurysm Sac 12 Years after Open Repair of Abdominal Aortic Aneurysm

    OpenAIRE

    Matsushita, Masahiro; Ikezawa, Teruo; Banno, Hiroshi

    2008-01-01

    Only a few cases of endoleak following conventional abdominal aortic aneurysm repair have been reported. We treated a patient with a type I endoleak-like phenomenon occuring 12 years after conventional abdominal aortic aneurysm repair. Computed tomography demonstrated dilation of the surgically replaced, once-shrunken aneurysm sac to a diameter of 3.5 cm. Thrombus was identified between the graft and the sac. Four months later the sac ruptured, and emergency repair was performed. Dehiscence o...

  20. 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

  1. Bone marrow-derived endothelial progenitor cells are involved in aneurysm repair in rabbits.

    Science.gov (United States)

    Fang, Xinggen; Zhao, Rui; Wang, Kuizhong; Li, Zifu; Yang, Penfei; Huang, Qinghai; Xu, Yi; Hong, Bo; Liu, Jianmin

    2012-09-01

    Endothelial progenitor cells (EPC) are believed to be involved in aneurysmal repair and remodeling. The aim of this study was to test this hypothesis and, if true, explore how EPC contribute to aneurysm repair in a rabbit model of elastase-induced carotid aneurysm. Rabbits were divided randomly into an in situ carotid EPC transfusion group (ISCT group, n=5), and an intravenous EPC transfusion group (IVT group, n=5). Autologous EPC were double-labeled with Hoechst 33342 and 5,6-carboxyfluorescein diacetate succinimidyl ester before injection into the animals in either the carotid artery (ISCT group) or marginal ear veins (IVT group). Three weeks later, labeled cells in the aneurysms were observed with respect to location, adhesion, and growth to detect signs of aneurysm repair. Labeled EPC were detected within the neointima in all five aneurysms in the ISCT group and in three of the five aneurysms in the IVT group, but there was no endothelial growth in the aneurysmal neointima in either group. These results show that bone marrow-derived EPC are involved in the process of aneurysm repair in this rabbit model. PMID:22789632

  2. Improving Results of Elective Abdominal Aortic Aneurysm Repair at a Low-Volume Hospital by Risk-Adjusted Selection of Treatment in the Endovascular Era

    International Nuclear Information System (INIS)

    Several studies have observed both higher mortality rates and lower utilization of endovascular aneurysm repair (EVAR) at low-volume centers. This article presents the results of elective abdominal aortic aneurysm (AAA) repair at a low-volume center in the endovascular era and investigates whether postprocedural mortality can be improved by extension of EVAR application also in this setting. This is an 11.6-year retrospective cohort study of 132 patients undergoing elective surgical or endovascular AAA repair at a tertiary care academic hospital between 1997 and July 2008, i.e., a median volume of 12 cases per year. The study was divided into two periods of time according to the respective indications and contraindications for EVAR, which substantially changed in 2005. During period 1, only aneurysms with necks ≥20 mm long and not involving the iliac arteries were treated endoluminally. Beginning in 2005, indication for EVAR was expanded to aortoiliac aneurysms with a minimum neck length of 15 mm. Preoperative risk was assessed by the SVS/AAVS comorbidity score. During the first period (1997-2004) 18.4% (16/87) of all patients received EVAR. By extending anatomical confines and indications for EVAR in 2005, the utilization rate of EVAR increased to 40.0% (18/45) during the second period (2005-July 2008; p = 0.007). Prevalence of preoperative risk factors did not change during the two observation periods. In contrast to period 1, high-risk patients were preferentially treated endoluminally during the second period, resulting in a significantly higher median SVS/AAVS score in the EVAR group (p < 0.001). A significant decrease in median length of stay at the intensive/intermediate care unit (5 vs. 2 days; p = 0.006) and length of in-hospital stay (20 vs. 12.5 days; p < 0.001) was observed during period 2. Overall perioperative mortality was reduced from 6.9% during the first period to 2.2% during the second period (p = 0.256). EVAR mortality was 0%, mortality after

  3. Mycotic aneurysm in a child with history of coarctation of the aorta repair

    OpenAIRE

    M Santiago Restrepo; Turek, Joseph W; Benjamin Reinking; Nicholas Von Bergen

    2014-01-01

    A mycotic aneurysm is a rare condition occasionally seen in patients with a history of prior cardiac or vascular surgery. Here we report the presentation of a mycotic aneurysm in a pediatric patient at the site of prior aortic coarctation repair. This patient′s initial presentation suggested rheumatologic or oncologic disease, and after diagnosis he continued to show evidence of splenic, renal and vascular injury distal to the mycotic aneurysm site while being treated with antibiotics. We dis...

  4. 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

  5. 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

  6. 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

  7. Duplex ultrasound in aneurysm surveillance following endovascular aneurysm repair: a comparison with computed tomography aortography.

    LENUS (Irish Health Repository)

    Manning, Brian J

    2012-02-01

    OBJECTIVES: Cumulative radiation dose, cost, and increased demand for computed tomography aortography (CTA) suggest that duplex ultrasonography (DU) may be an alternative to CTA-based surveillance. We compared CTA with DU during endovascular aneurysm repair (EVAR) follow-up. METHODS: Patients undergoing EVAR had clinical and radiological follow-up data entered in a prospectively maintained database. For the purpose of this study, the gold standard test for endoleak detection was CTA, and an endoleak detected on DU alone was assumed to be a false positive result. DU interpretation was performed independently of CTA and vice versa. RESULTS: One hundred thirty-two patients underwent EVAR, of whom 117 attended for follow-up ranging from six months to nine years (mean, 32 months). Adequate aneurysm sac visualisation on DU was not possible in 1.7% of patients, predominantly due to obesity. Twenty-eight endoleaks were detected in 28 patients during follow-up. Of these, 24 were initially identified on DU (four false negative DU examinations), and eight had at least one negative CTA with a positive DU prior to diagnosis. Twenty-three endoleaks were type II in nature and three of these patients had increased sac size. There was one type I and four type III endoleaks. Two of these (both type III) had an increased sac size. Of 12 patients with increased aneurysm size of 5 mm or more at follow-up, five had an endoleak visible on DU, yet negative CTA and a further five had endoleak visualisation on both DU and CTA. Of six endoleaks which underwent re-intervention, all were initially picked up on DU. One of these endoleaks was never demonstrated on CTA and a further two had at least one negative CTA prior to endoleak confirmation. Positive predictive value for DU was 45% and negative predictive value 94%. Specificity of DU for endoleak detection was 67% when compared with CTA, because of the large number of false positive DU results. Sensitivity for DU was 86%, with all

  8. Imaging and management of complications of open surgical repair of abdominal aortic aneurysms

    International Nuclear Information System (INIS)

    Open repair is still considered the reference standard for long-term repair of abdominal aortic aneurysms (AAA). In contrast to endovascular aneurysm repair (EVAR), patients with open surgical repair of AAA are not routinely followed up with imaging. Although complications following EVAR are widely recognized and routinely identified on follow-up imaging, complications also do occur following open surgical repair. With frequent use of multi-slice computed tomography (CT) angiography (CTA) in vascular patients, there is now improved recognition of the potential complications following open surgical repair. Many of these complications are increasingly being managed using endovascular techniques. The aim of this review is to illustrate a variety of potential complications that may occur following open surgical repair and to demonstrate their management using both surgical and endovascular techniques.

  9. Imaging and management of complications of open surgical repair of abdominal aortic aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Nayeemuddin, M. [Department of Interventional Radiology, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent (United Kingdom); Pherwani, A.D. [Department of Vascular Surgery, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent (United Kingdom); Asquith, J.R., E-mail: john.asquith@uhns.nhs.uk [Department of Interventional Radiology, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent (United Kingdom)

    2012-08-15

    Open repair is still considered the reference standard for long-term repair of abdominal aortic aneurysms (AAA). In contrast to endovascular aneurysm repair (EVAR), patients with open surgical repair of AAA are not routinely followed up with imaging. Although complications following EVAR are widely recognized and routinely identified on follow-up imaging, complications also do occur following open surgical repair. With frequent use of multi-slice computed tomography (CT) angiography (CTA) in vascular patients, there is now improved recognition of the potential complications following open surgical repair. Many of these complications are increasingly being managed using endovascular techniques. The aim of this review is to illustrate a variety of potential complications that may occur following open surgical repair and to demonstrate their management using both surgical and endovascular techniques.

  10. Ductus arteriosus aneurysm presenting as hoarseness: successful repair with an endovascular approach.

    Science.gov (United States)

    De Freitas, Simon; Connolly, Caoilfhionn; Neary, Colm; Sultan, Sherif

    2016-01-01

    An aneurysm of the ductus arteriosus is a rare finding, particularly in the adult population. These saccular aneurysms arise at the site of an incompletely obliterated ductus arteriosus along the lesser curvature of the aortic arch. Left untreated, it is associated with a high risk of potentially life-threatening complications including rupture, infection and thromboembolism. As a result, surgical correction is recommended. Previously, options were limited to open repair but as endovascular experience grows, novel techniques afford safer and less invasive alternatives. In contrast, neonatal ductus arteriosus aneurysms may regress spontaneously and expectant treatment can be justified. We present the case of a 74-year-old woman who presented with hoarseness secondary to a ductus arteriosus aneurysm; a diagnosis consistent with Ortner's syndrome. The patient underwent an uncomplicated endovascular repair using the chimney-graft technique. PMID:27141045

  11. Endovascular aneurysm repair: state-of-art imaging techniques for preoperative planning and surveillance

    DEFF Research Database (Denmark)

    Truijers, M; Resch, T; Van Den Berg, J C;

    2009-01-01

    patency and locate side branch orifices. However, recent developments in cross-sectional imaging, including advanced image postprocessing, multi-modality image fusion and new contrast agents have resulted in improved spatial resolution for preoperative planning. Advanced reconstruction algorithms, like......Endovascular aneurysm repair (EVAR) represents one of the greatest advances in vascular surgery over the past 50 years. In contrast to conventional aneurysm repair, EVAR requires accurate preoperative imaging and stringent postoperative surveillance. Duplex ultrasound (DUS), transesophageal...... dynamic CTA and MRA, provide valuable information on dynamic changes in aneurysm morphology that might have an important impact on endograft selection. During follow-up, imaging of the graft and aneurysm is of utmost importance to identify patients in need of secondary intervention. This has led to...

  12. Mycotic aneurysm in a child with history of coarctation of the aorta repair

    Directory of Open Access Journals (Sweden)

    M Santiago Restrepo

    2014-01-01

    Full Text Available A mycotic aneurysm is a rare condition occasionally seen in patients with a history of prior cardiac or vascular surgery. Here we report the presentation of a mycotic aneurysm in a pediatric patient at the site of prior aortic coarctation repair. This patient′s initial presentation suggested rheumatologic or oncologic disease, and after diagnosis he continued to show evidence of splenic, renal and vascular injury distal to the mycotic aneurysm site while being treated with antibiotics. We discuss the diagnosis, treatment and management of this condition.

  13. Mycotic aneurysm in a child with history of coarctation of the aorta repair

    International Nuclear Information System (INIS)

    A mycotic aneurysm is a rare condition occasionally seen in patients with a history of prior cardiac or vascular surgery. Here we report the presentation of a mycotic aneurysm in a pediatric patient at the site of prior aortic coarctation repair. This patient's initial presentation suggested rheumatologic or oncologic disease, and after diagnosis he continued to show evidence of splenic, renal and vascular injury distal to the mycotic aneurysm site while being treated with antibiotics. We discuss the diagnosis, treatment and management of this condition

  14. Sex differences in 30-day and 5-year outcomes after endovascular repair of abdominal aortic aneurysms in the EUROSTAR study

    DEFF Research Database (Denmark)

    Grootenboer, Nathalie; Hunink, M G Myriam; Hendriks, Johanna M; van Sambeek, Marc R H M; Buth, Jaap

    2013-01-01

    The purpose of this study was to determine the effect of sex on 30-day and long-term outcomes after elective endovascular aneurysm repair.......The purpose of this study was to determine the effect of sex on 30-day and long-term outcomes after elective endovascular aneurysm repair....

  15. 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

  16. Endovascular repair of an abdominal aortic aneurysm in the presence of a hydronephrotic horseshoe kidney.

    Science.gov (United States)

    Krivoshei, Lian; Akin-Olugbade, Yemi; McWilliams, Glen; Halak, Moshe; Silverberg, Daniel

    2012-02-01

    The aim of this paper is to report an unusual case of a patient with an abdominal aortic aneurysm (AAA) and a hydronephrotic horseshoe kidney (HSK) that was repaired by endovascular means. An 81-year-old male patient with a known HSK was found to have hydronephrosis and an AAA. The patient's aneurysm was treated with an endovascular stent graft which required the covering of accessory renal arteries. He had an uneventful recovery with complete resolution of the hydronephrosis evident on a computed tomography scan performed seven months after the surgery. In conclusion, endovascular aneurysm repair is a feasible therapeutic option for an AAA coexisting with an HSK and may be considered as a valid alternative to open repair when concomitant hydronephrosis is present. PMID:22328622

  17. 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.

  18. 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.

  19. 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.

  20. Tratamento convencional e endovascular para rara associação de doenças: síndrome de veia cava superior e aneurisma aorto-ilíaco - controle após 12 meses Conventional and endovascular treatment for a rare combination of diseases: superior vena cava syndrome and aortoiliac aneurysm - control after 12 months

    Directory of Open Access Journals (Sweden)

    Gustavo Petorossi Solano

    2011-09-01

    Full Text Available A associação entre a síndrome de veia cava superior e uma dilatação aneurismática das artérias aorta e ilíacas não é comum. A abordagem de cada uma destas patologias pode ser efetuada através do modo convencional, com cirurgia aberta ou pela técnica endovascular. Neste trabalho, relatamos as duas modalidades de intervenção cirúrgica executadas e discutimos suas indicações e os resultados deste caso em particular.The association between superior vena cava syndrome and an aorto-iliac aneurysm is not common. The approach to each of theses diseases can be either by the conventional way with open surgery or by endovascular techniques. We report the two methods of surgical intervention and discuss their indications and results in this particular case.

  1. Patient Compliance with Surveillance Following Elective Endovascular Aneurysm Repair

    Energy Technology Data Exchange (ETDEWEB)

    Godfrey, Anthony D., E-mail: deangodfrey@yahoo.co.uk; Morbi, Abigail H. M., E-mail: a.morbi@soton.ac.uk; Nordon, Ian M., E-mail: ian.nordon@uhs.nhs.uk [University Hospital Southampton NHS Foundation Trust, Unit of Cardiac Vascular and Thoracic Surgery - CV& T, Department of Vascular Surgery (United Kingdom)

    2015-10-15

    PurposeIntegral to maintaining good outcomes post-endovascular aneurysm repair (EVAR) is a robust surveillance protocol. A significant proportion of patients fail to comply with surveillance, exposing themselves to complications. We examine EVAR surveillance in Wessex (UK), exploring factors that may predict poor compliance.MethodsRetrospective analysis of 179 consecutive elective EVAR cases [2008–2013] was performed. 167 patients were male, with the age range of 50–95. Surveillance was conducted centrally (tertiary referral trauma centre) and at four spoke units. Surveillance compliance and predictors of non-compliance including age, gender, co-morbid status, residential location and socioeconomic status were analysed for univariate significance.ResultsFifty patients (27.9 %) were non-compliant with surveillance; 14 (8.1 %) had no imaging post-EVAR. At 1 year, 56.1 % (of 123 patients) were compliant. At years 2 and 3, 41.5 and 41.2 % (of 65 and 34 patients, respectively) were compliant. Four years post-EVAR, only one of eight attended surveillance (12.5 %). There were no statistically significant differences in age (p = 0.77), co-morbid status or gender (p = 0.64). Distance to central unit (p = 0.67) and surveillance site (p = 0.56) was non-significant. While there was a trend towards compliance in upper-middle-class socioeconomic groups (ABC1 vs. C1C2D), correlating with >50 % of non-compliant patients living within <10 mile radius of the central unit, overall predictive value was not significant (p = 0.82).ConclusionsCompliance with surveillance post-EVAR is poor. No independent predictor of non-compliance has been confirmed, but socioeconomic status appears to be relevant. There is a worrying drop-off in attendance beyond the first year. This study highlights a problem that needs to be addressed urgently, if we are to maintain good outcomes post-EVAR.

  2. Management of multiple type Ⅱ endoleaks detected by duplex ultrasound after endovascular abdominal aneurysm repair

    Institute of Scientific and Technical Information of China (English)

    GUO Da-qiao; LI Wei-miao; JIANG Jun-hao; SHI Zhen-yu; WANG Yu-qi; FU Wei-guo

    2012-01-01

    We reported a case of multiple type Ⅱ endoleaks detected by duplex ultrasound after endovascular abdominal aneurysm repair.The patient was undergoing warfarin therapy.Duplex ultrasound was applied as the sole surveillance method during follow-up and provided the concerned information for reintervention.The endoleaks were successfully repaired by coil embolization of the collaterals from the internal iliac artery feeding the fourth lumbar artery.

  3. 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

  4. 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

  5. Are there fewer complications with third generation endografts in endovascular aneurysm repair?

    DEFF Research Database (Denmark)

    Jayia, P; Constantinou, J; Morgan-Rowe, L;

    2013-01-01

    Endovascular aneurysm repair (EVAR) is widely accepted as a safe technique for treatment of aortic diseases since the concept was first pioneered by Volodos in 1986 and Parodi in 1991. Numerous registries have shown that this minimally invasive technique is associated with lower mortality when co...

  6. Evaluation of patient renal function following endovascular aneurysm repair with suprarenal fixation

    Directory of Open Access Journals (Sweden)

    YingBin Jia

    2011-09-01

    Full Text Available This study aimed to assess the mid-term renal function of abdominal aortic aneurysm patients following suprarenal endovascular repair. From March 2005 to December 2009, 290 abdominal aortic aneurysm patients were included in the study and grouped according to whether they had received infrarenal or suprarenal endovascular aneurysm repair. Suprarenal endovascular aneurysm repair was performed in 173 patients, with a mean age of 72(±8 years (85.0% male. Infrarenal endovascular aneurysm repair was performed in 117 patients, with a mean age of 71(±9 years (90.6% male. Preoperative and one week, 1-, 3-, 6- and 12-month postoperative serum creatinine and cystatin C values were recorded. Estimated glomerular filtration rate was calculated by cystatin-based formula and Cr-based Cockcroft formula. The t-test was used to determine statistical differences between or within groups. All patients received Talent or Zenith endograft. Patients’ characteristics and operative files in the two groups were well matched. Preoperative serum creatinine and cystatin C were 82 (±8 mmol/L and 0.89 (±0.11 mg/L for suprarenal endovascular aneurysm repair, respectively, and 81 (±11 mmol/L and 0.87 (±0.15 mg/L, respectively, for infrarenal endovascular aneurysm repair; no differences were observed between the two groups. Compared to preoperative renal markers within each group, a deterioration in serum creatinine, cystatin C and estimated glomerular filtration rate values was found at one week and 12 months after surgery(P<0.05. A deterioration in cystatin C [SR:(0.93±0.17 mg/L, IR: (0.92±0.31 mg/L] and estimated glomerular filtration rate by cystatin C was also found at six months after surgery(P<0.05. However, no differences in patient serum creatinine, cystatin C and estimated glomerular filtration rate values were observed between groups at each follow-up time interval. There was no greater significant difference in the association of the use of suprarenal

  7. Percutaneous Transabdominal Approach for the Treatment of Endoleaks after Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Sun Young; Lee, Do Yun; Lee, Kwang Hun [Severance Hospital, University of Yonsei, Seoul (Korea, Republic of); Won, Jong Yun [Gangnam Severance Hospital, University of Yonsei, Seoul (Korea, Republic of); Choi, Dong Hoon; Shim, Won Heum [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    The purpose of this study was to evaluate the technical feasibility and clinical efficacy of percutaneous transabdominal treatment of endoleaks after endovascular aneurysm repair. Between 2000 and 2007, six patients with type I (n = 4) or II (n = 2) endoleaks were treated by the percutaneous transabdominal approach using embolization with N-butyl cyanoacrylate with or without coils. Five patients underwent a single session and one patient had two sessions of embolization. The median time between aneurysm repair and endoleak treatment was 25.5 months (range: 0-84 months). Follow-up CT images were evaluated for changes in the size and shape of the aneurysm sac and presence or resolution of endoleaks. The median follow-up after endoleak treatment was 16.4 months (range: 0-37 months). Technical success was achieved in all six patients. Clinical success was achieved in four patients with complete resolution of the endoleak confirmed by follow-up CT. Clinical failure was observed in two patients. One eventually underwent surgical conversion, and the other was lost to follow-up. There were no procedure-related complications. The percutaneous transabdominal approach for the treatment of type I or II endoleaks, after endovascular aneurysm repair, is an alternative method when conventional endovascular methods have failed.

  8. 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

  9. Recurrent focal segmental glomerulosclerosis apparently resistant to plasmapheresis improves after surgical repair of arteriovenous fistula aneurysms.

    Science.gov (United States)

    Ding, Yanli; Francis, Jean; Kalish, Jeffrey; Deshpande, Anita; Quillen, Karen

    2016-06-01

    Focal segmental glomerulosclerosis (FSGS) is a leading cause of end-stage renal disease and has a high recurrence rate after kidney transplantation, attributed to a circulating permeability factor. Plasmapheresis is the treatment of choice after recurrence to remove the circulating factor. We present a case of recurrent FSGS 6 years after transplantation. It is instructive because proteinuria did not respond to intensive plasmapheresis-combined with rituximab-until the possibility of ineffective apheresis secondary to multiple aneurysms in the arteriovenous fistula (AVF) was considered. Proteinuria improved soon after alternative access for plasmapheresis was secured and AVF aneurysms were surgically repaired. PMID:27274825

  10. 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

  11. Impact of graft composition on the systemic inflammatory response after an elective repair of an abdominal aortic aneurysm

    OpenAIRE

    Baek, Jong Kwan; Kwon, Hyunwook; Ko, Gi-Young; Kim, Min Joo; Han, Youngjin; Chung, Young Soo; Park, Hojong; Kwon, Tae-Won; Cho, Yong-Pil

    2014-01-01

    Purpose The present study aimed to evaluate the risk factors and the role of graft material in the development of an acute phase systemic inflammatory response, and the clinical outcome in patients who undergo endovascular aneurysm repair (EVAR) or open surgical repair (OSR) of an abdominal aortic aneurysm (AAA). Methods We retrospectively evaluated the risk factors and the role of graft material in an increased risk of developing systemic inflammatory response syndrome (SIRS), and the clinic...

  12. 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

  13. 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.

  14. Endovascular Treatment of an Aortoiliac Tuberculous Pseudoaneurysm

    International Nuclear Information System (INIS)

    We report a rare case of a tuberculous mycotic aortoiliac pseudoaneurysm treated with an endovascular procedure and follow-up of 36 months. The patient was a white 72-year-old man with pulmonary tuberculosis and a former smoker with hypertension, chronic renal failure, and dyslipidemia. A computed tomographic scan of the abdomen and pelvis revealed a left paravertebral cavity with fluid content and involvement of vertebrae L2–L4. After a surgical repair attempt, the patient was treated with the implant of a bifurcated endoprosthesis. Because it is unlikely that any center has extensive experience in the management of this rare manifestation of the disease, we reviewed the literature for similar cases.

  15. Endovascular Treatment of an Aortoiliac Tuberculous Pseudoaneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Villegas, Miguel O.; Mereles, Alberto Perez; Tamashiro, Gustavo A.; Dini, Andres E.; Mollon, Ana P.; De Candido, Laura V.; Zelaya, Denis A.; Soledispa-Suarez, Carlos I.; Denato, Sergio; Tamashiro, Alberto; Diaz, Jose A., E-mail: joseantoniodiaz@hotmail.com [Hospital Nacional Prof. Alejandro Posadas, Department of Cardiology, Section of Hemodinamia (Argentina)

    2013-04-15

    We report a rare case of a tuberculous mycotic aortoiliac pseudoaneurysm treated with an endovascular procedure and follow-up of 36 months. The patient was a white 72-year-old man with pulmonary tuberculosis and a former smoker with hypertension, chronic renal failure, and dyslipidemia. A computed tomographic scan of the abdomen and pelvis revealed a left paravertebral cavity with fluid content and involvement of vertebrae L2-L4. After a surgical repair attempt, the patient was treated with the implant of a bifurcated endoprosthesis. Because it is unlikely that any center has extensive experience in the management of this rare manifestation of the disease, we reviewed the literature for similar cases.

  16. 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...

  17. How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair

    OpenAIRE

    Setacci, Carlo; Chisci, Emiliano; Setacci, Francesco; Ercolini, Leonardo; de Donato, Gianmarco; Troisi, Nicola; Galzerano, Giuseppe; Michelagnoli, Stefano

    2014-01-01

    The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a...

  18. Failure of aneurysm sac shrinkage after endovascular repair; the effect of mural calcification

    Energy Technology Data Exchange (ETDEWEB)

    Love, M. [Department of Radiology, Royal Victoria Hospital, Belfast (United Kingdom)]. E-mail: mark.love@royalhospitals.n-i.nhs.uk; Wray, A. [Department of Radiology, Royal Victoria Hospital, Belfast (United Kingdom); Worthington, M. [Department of Radiology, Royal Victoria Hospital, Belfast (United Kingdom); Ellis, P. [Department of Radiology, Royal Victoria Hospital, Belfast (United Kingdom)

    2005-12-15

    AIM: To evaluate the effect of abdominal aortic aneurysm wall calcification on subsequent sac shrinkage after endovascular repair. MATERIALS AND METHODS: Seventy-three patients underwent endovascular aneurysm repair. The degree of sac wall calcification on pre-procedural computed tomography (CT) examination was graded from 1 to 4 according to the degree of circumferential involvement. On follow-up CT imaging, the maximum transverse diameter (MTD) of the sac was recorded, as well as the presence or absence of endoleak. In those patients with a non-shrinking aneurysm, but no CT evidence of endoleak, contrast-enhanced ultrasound (USS) was performed. Any patient with an endoleak, however diagnosed, was excluded from the study. Kruskal-Wallis and Spearman's rank correlation coefficient testing was applied to compare the degree of calcification and change in MTD. RESULTS: Sixty-three pre-procedural CT images were available for calcification grading. Six of this group had endoleaks resulting in 57 sets of data being available for the study. A reduction in MTD occurred in 68.25% of these patients by 1 year post-procedure. Our figures show aortic calcification is inversely associated with MTD reduction at 6 months (p=0.01), 1 year (p=0.05) and 2 years (p=0.05). CONCLUSION: This study indicates that the degree of aortic wall calcification is significant in predicting MTD reduction post-endovascular repair. The possible mechanisms and implications of this are discussed.

  19. 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.

  20. 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.)

  1. 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.)

  2. GIA-Aneurysmorrhaphy and Dermal Detachment: A Novel Technique to Repair Arteriovenous Fistula Aneurysms.

    Science.gov (United States)

    Chang, Jason; Prema, Jateen; Pedersen, Rose; Li, Yiping; Liebl, Max; Patel, Kaushal; Mueller, Mark

    2016-05-01

    This report describes a simplified technique for management of aneurysmal arteriovenous fistulas along with results of initial clinical experience in 12 patients. Various techniques have been described which seek to repair the arteriovenous fistula and lengthen its duration of use. Here, we introduce the GIA-aneurysmorrhaphy and dermal detachment (GADD) procedure, a novel technique which requires minimal dissection to decompress tension on the overlying skin. Transverse incisions were made proximally and distally to the aneurysmal segment, which was then bluntly dissected along its length on either side. A GIA stapler is then fired along the longitudinal axis, narrowing the lumen of the fistula and separating the aneurysm from the skin. After the operation, the arteriovenous fistulae were used continuously until death (1 patient for 12 months), until thrombosis (1 patient for 13 months), or continue to be in use (9 patients, mean patency 18 months). One patient underwent conversion to open aneurysmorrhaphy due to intraoperative fistula occlusion. Five patients resumed hemodialysis immediately, while the remaining resumed hemodialysis within 3 months. The most common complication was cellulitis (3 patients). The GADD procedure as described in this report offers an effective and low-risk option for the management of venous aneurysms with threatened skin in hemodialysis patients. PMID:26965822

  3. CT Study of the Relationship Between the Common Iliac Artery and Vein and Their Juxtaposition: Implications for Conduit Construction Prior to Endosvascular Stent-Graft Repair of Aortic Aneurysms

    International Nuclear Information System (INIS)

    The objective of this study was to determine the anatomical relationship and juxtaposition between the common iliac artery and vein in a population of patients with aortic aneurysmal disease and a population clinically and radiologically free of atheroma. It was a retrospective study of 100 consecutive patients undergoing computed tomographic assessment of abdominal aortic aneurysm prior to endovascular or open surgical repair and 100 patients undergoing computed tomographic assessment for other pathologies who did not have clinical or imaging signs of aorto-iliac atheroma. In both groups the anatomical relationship between the right and left iliac artery and vein was studied, and the thickness of the fat plane separating the artery from the vein measured. The right iliac vein was posterolateral to the artery at the level of the common iliac artery bifurcation in 95% of patients in both groups. At the same level the left iliac vein was posterior in 23% (p ≤ 0.001). Eighty-three percent of patients in the aneurysm group had a fat plane between the right artery and vein that measured 0 mm (no visible fat plane = 52%) to 1 mm (= 31%). Ninety-eight percent of patients in the aneurysm group had a measurable fat plane between the left iliac artery and vein of up to 5 mm (p = 0.001). Six percent of the control group demonstrated no visible fat plane between the right iliac artery and vein (p ≤ 0.001), while the fat plane measured more than 1 mm (1-5 mm) on the left in 100%. We conclude that in patients where conduit construction is required for aortic stent-graft access, the anatomical configuration and intimate relationship of the iliac arteries and veins should be assessed and taken into account at CT scan evaluation. The distal right common iliac artery should not be used, as venous damage can be predicted from the anatomical and intimate relationship of the iliac artery and vein at this level in patients with atheroma and the difficulties this relationship

  4. 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.

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

    International Nuclear Information System (INIS)

    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

  6. Contemporary management of the demanding infra-renal neck in abdominal aortic aneurysm repair.

    Science.gov (United States)

    Mees, B M; Peppelenbosch, A G; De Haan, M W; Jacobs, M J; Schurink, G W

    2015-04-01

    Proximal infrarenal neck anatomy is a crucial factor in determining outcome of abdominal aortic aneurysm (AAA) repair. Unfavorable or demanding infrarenal neck anatomy significantly increases the complexity of both standard endovascular and open repair resulting in increased rates of morbidity and mortality. While technological improvements and expanding institutional experience have resulted in an increased proportion of patients with an AAA with unfavorable infrarenal neck treated by (fenestrated) endovascular techniques, open repair has also remained a valid technique. The purpose of this manuscript was to describe the wide array of endovascular and open techniques in use to treat patients with an AAA with a demanding infrarenal neck and discuss their results and indications. PMID:25592277

  7. Multivariate Analysis of Risk Factors of Cerebral Infarction in 439 Patients Undergoing Thoracic Endovascular Aneurysm Repair

    Science.gov (United States)

    Kanaoka, Yuji; Ohki, Takao; Maeda, Koji; Baba, Takeshi; Fujita, Tetsuji

    2016-01-01

    Abstract The aim of the study is to identify the potential risk factors of cerebral infarction associated with thoracic endovascular aneurysm repair (TEVAR). TEVAR was developed as a less invasive surgical alternative to conventional open repair for thoracic aortic aneurysm treatment. However, outcomes following TEVAR of aortic and distal arch aneurysms remain suboptimal. Cerebral infarction is a major concern during the perioperative period. We included 439 patients who underwent TEVAR of aortic aneurysms at a high-volume teaching hospital between July 2006 and June 2013. Univariate and multivariate logistic regression analyses were performed to identify perioperative cerebral infarction risk factors. Four patients (0.9%) died within 30 days of TEVAR; 17 (3.9%) developed cerebral infarction. In univariate analysis, history of ischemic heart disease and cerebral infarction and concomitant cerebrovascular disease were significantly associated with cerebral infarction. “Shaggy aorta” presence, left subclavian artery coverage, carotid artery debranching, and pull-through wire use were identified as independent risk factors of cerebral infarction. In multivariate analysis, history of ischemic heart disease (odds ratio [OR] 6.49, P = 0.046) and cerebral infarction (OR 43.74, P = 0.031), “shaggy aorta” (OR 30.32, P < 0.001), pull-through wire use during surgery (OR 7.196, P = 0.014), and intraoperative blood loss ≥800 mL (OR 24.31, P = 0.017) were found to be independent risk factors of cerebral infarction. This study identified patient- and procedure-related risk factors of cerebral infarction following TEVAR. These results indicate that patient outcomes could be improved through the identification and management of procedure-related risk factors. PMID:27082585

  8. 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

  9. Endovascular Aneurysm Repair: Is Imaging Surveillance Robust, and Does It Influence Long-term Mortality?

    Energy Technology Data Exchange (ETDEWEB)

    Waduud, Mohammed Abdul, E-mail: m.a.waduud@doctors.org.uk [Glasgow Royal Infirmary, Department of Surgery (United Kingdom); Choong, Wen Ling, E-mail: wenlingchoong@nhs.net [Aberdeen Royal Infirmary, NHS Grampian, Department of Surgery (United Kingdom); Ritchie, Moira, E-mail: moirasim9@gmail.com; Williams, Claire, E-mail: c.williams.3@research.gla.ac.uk [University of Glasgow, Institute of Health and Wellbeing Glasgow (United Kingdom); Yadavali, Reddi, E-mail: reddi.yadavali@nhs.net [Aberdeen Royal Infirmary, NHS Grampian, Department of Radiology (United Kingdom); Lim, Shueh, E-mail: s.lim.06@aberdeen.ac.uk [Royal Infirmary of Edinburgh, NHS Lothian, Department of Radiology (United Kingdom); Buchanan, Fraser, E-mail: f.buchanan.11@aberdeen.ac.uk [University of Aberdeen, The School of Medicine and Dentistry (United Kingdom); Bhat, Raj, E-mail: raj.bhat@nhs.net [Ninewells Hospital, NHS Tayside, Department of Radiology (United Kingdom); Ramanathan, Krishnappan, E-mail: k.ramanathan@dundee.ac.uk [University of Dundee, School of Medicine (United Kingdom); Ingram, Susan, E-mail: susan.ingram@luht.scot.nhs.uk; Cormack, Laura, E-mail: lgcormack@googlemail.com [Royal Infirmary of Edinburgh, NHS Lothian, Department of Radiology (United Kingdom); Moss, Jonathan G., E-mail: jon.moss@ggc.scot.nhs.uk [Gartnavel General Hospital, Department of Radiology (United Kingdom)

    2015-02-15

    PurposeEndovascular aneurysm repair (EVAR) is the dominant treatment strategy for abdominal aortic aneurysms. However, as a result of uncertainty regarding long-term durability, an ongoing imaging surveillance program is required. The aim of the study was to assess EVAR surveillance in Scotland and its effect on all-cause and aneurysm-related mortality.MethodsA retrospective analysis of all EVAR procedures carried out in the four main Scottish vascular units. The primary outcome measure was the implementation of post-EVAR imaging surveillance across Scotland. Patients were identified locally and then categorized as having complete, incomplete, or no surveillance. Secondary outcome measures were all-cause mortality and aneurysm-related mortality. Cause of death was obtained from death certificates.ResultsData were available for 569 patients from the years 2001 to 2012. All centers had data for a minimum of 5 contiguous years. Surveillance ranged from 1.66 to 4.55 years (median 3.03 years). Overall, 53 % had complete imaging surveillance, 43 % incomplete, and 4 % none. For the whole cohort, all-cause 5-year mortality was 33.5 % (95 % confidence interval 28.0–38.6) and aneurysm-related mortality was 4.5 % (.8–7.3). All-cause mortality in patients with complete, incomplete, and no imaging was 49.9 % (39.2–58.6), 19.1 % (12.6–25.2), and 47.2 % (17.7–66.2), respectively. Aneurysm-related mortality was 3.7 % (1.8–7.4), 4.4 % (2.2–8.9), and 9.5 % (2.5–33.0), respectively. All-cause mortality was significantly higher in patients with complete compared to incomplete imaging surveillance (p < 0.001). No significant differences were observed in aneurysm-related mortality (p = 0.2).ConclusionOnly half of EVAR patients underwent complete long-term imaging surveillance. However, incomplete imaging could not be linked to any increase in mortality. Further work is required to establish the role and deliverability of EVAR imaging surveillance.

  10. Transretroperitoneal CT-guided Embolization of Growing Internal Iliac Artery Aneurysm after Repair of Abdominal Aortic Aneurysm: A Transretroperitoneal Approach with Intramuscular Lidocaine Injection Technique

    International Nuclear Information System (INIS)

    This study was designed to evaluate the efficacy and safety of CT-guided embolization of internal iliac artery aneurysm (IIAA) after repair of abdominal aortic aneurysm by transretroperitoneal approach using the lidocaine injection technique to iliacus muscle, making window for safe needle path for three patients for whom CT-guided embolization of IIAA was performed by transretroperitoneal approach with intramuscular lidocaine injection technique. Transretroperitoneal access to the IIAA was successful in all three patients. In all three patients, the IIAA was first embolized using microcoils. The aneurysmal sac was then embolized with glue and coils without complication. With a mean follow-up of 7 months, the volume of the IIAAs remained stable without residual endoleaks. Transretroperitoneal CT-guided embolization of IIAA using intramuscular lidocaine injection technique is effective, safe, and results in good outcome

  11. Transretroperitoneal CT-guided Embolization of Growing Internal Iliac Artery Aneurysm after Repair of Abdominal Aortic Aneurysm: A Transretroperitoneal Approach with Intramuscular Lidocaine Injection Technique

    Energy Technology Data Exchange (ETDEWEB)

    Park, Joon Young, E-mail: pjy1331@hanmail.net; Kim, Shin Jung, E-mail: witdd2@hanmail.net; Kim, Hyoung Ook, E-mail: chaos821209@hanmail.net [Chonnam National University Hospital, Department of Radiology (Korea, Republic of); Kim, Yong Tae, E-mail: mono-111@hanmail.net [Chonnam National University Hwasun Hospital, Department of Radiology (Korea, Republic of); Lim, Nam Yeol, E-mail: apleseed@hanmail.net; Kim, Jae Kyu, E-mail: kjkrad@jnu.ac.kr [Chonnam National University Hospital, Department of Radiology (Korea, Republic of); Chung, Sang Young, E-mail: sycpvts@jnu.ac.kr; Choi, Soo Jin Na, E-mail: choisjn@jnu.ac.kr; Lee, Ho Kyun, E-mail: mhaha@hanmail.net [Chonnam National University Hospital, Department of Surgery (Korea, Republic of)

    2015-02-15

    This study was designed to evaluate the efficacy and safety of CT-guided embolization of internal iliac artery aneurysm (IIAA) after repair of abdominal aortic aneurysm by transretroperitoneal approach using the lidocaine injection technique to iliacus muscle, making window for safe needle path for three patients for whom CT-guided embolization of IIAA was performed by transretroperitoneal approach with intramuscular lidocaine injection technique. Transretroperitoneal access to the IIAA was successful in all three patients. In all three patients, the IIAA was first embolized using microcoils. The aneurysmal sac was then embolized with glue and coils without complication. With a mean follow-up of 7 months, the volume of the IIAAs remained stable without residual endoleaks. Transretroperitoneal CT-guided embolization of IIAA using intramuscular lidocaine injection technique is effective, safe, and results in good outcome.

  12. Computer-supported diagnosis for endotension cases in endovascular aortic aneurysm repair evolution.

    Science.gov (United States)

    García, G; Tapia, A; De Blas, M

    2014-06-01

    An abdominal aortic aneurysm (AAA) is a localized abnormal enlargement of the abdominal aorta with fatal consequences if not treated on time. The endovascular aneurysm repair (EVAR) is a minimal invasive therapy that reduces recovery times and improves survival rates in AAA cases. Nevertheless, post-operation difficulties can appear influencing the evolution of treatment. The objective of this work is to develop a pilot computer-supported diagnosis system for an automated characterization of EVAR progression from CTA images. The system is based on the extraction of texture features from post-EVAR thrombus aneurysm samples and on posterior classification. Three conventional texture-analysis methods, namely the gray level co-occurrence matrix (GLCM), the gray level run length matrix (GLRLM), the gray level difference method (GLDM), and a new method proposed by the authors, the run length matrix of local co-occurrence matrices (RLMLCM), were applied to each sample. Several classification schemes were experimentally evaluated. The ensembles of a k-nearest neighbor (k-NN), a multilayer perceptron neural network (MLP-NN), and a support vector machine (SVM) classifier fed with a reduced version of texture features resulted in a better performance (Az=94.35±0.30), as compared to the classification performance of the other alternatives. PMID:24721658

  13. 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.)

  14. Provider volume and outcomes for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures.

    LENUS (Irish Health Repository)

    Killeen, Shane D

    2012-02-03

    BACKGROUND: Intuitively, vascular procedures performed by high-volume vascular subspecialists working at high-volume institutions should be associated with improved patient outcome. Although a large number of studies assess the relationship between volume and outcome, a single contemporary compilation of such studies is lacking. METHODS: A review of the English language literature was performed incorporating searches of the Medline, EMBASE, and Cochrane collaboration databases for abdominal aortic aneurysm repair (elective and emergent), carotid endarterectomy, and arterial lower limb procedures for any volume outcome relationship. Studies were included if they involved a patient cohort from 1980 onwards, were community or population based, and assessed health outcomes (mortality and morbidity) as a dependent variable and volume as an independent variable. RESULTS: We identified 74 relevant studies, and 54 were included. All showed either an inverse relationship of variable magnitude between provider volume and mortality, or no volume-outcome effect. The reduction in the risk-adjusted mortality rate (RAMR) for high-volume providers was 3% to 11% for elective abdominal aortic aneurysm (AAA) repair, 2.5 to 5% for emergent AAA repair, 0.7% to 4.7% carotid endarterectomy, and 0.3% to 0.9% for lower limb arterial bypass procedures. Subspeciality training also conferred a considerable morbidity and mortality benefit for emergent AAA repair, carotid endarterectomy, and lower limb arterial procedures. CONCLUSION: High-volume providers have significantly better outcomes for vascular procedures both in the elective and emergent setting. Subspeciality training also has a considerable impact. These data provide further evidence for the specialization of vascular services, whereby vascular procedures should generally be preformed by high-volume, speciality trained providers.

  15. Endovascular aneurysm repair (EVAR) follow-up imaging: the assessment and treatment of common postoperative complications

    International Nuclear Information System (INIS)

    Endovascular abdominal aortic aneurysm repair (EVAR) is a well-established procedure, which has long-term mortality rates similar to that of open repair. It has the additional benefit of being less invasive, making it the favoured method of treating abdominal aortic aneurysms in elderly and high-risk patients with multiple co-morbidities. The main disadvantage of EVAR is the higher rate of re-intervention, due to device-related complications, including endoleaks, limb occlusion, stent migration, kinking, and infection. As a result lifelong surveillance is required. In order to avoid missing these complications, intricate knowledge of stent graft design, good-quality diagnostic ultrasound skills, multiplanar reformatting of CT images, and reproducible investigations are important. Most of these complications can be treated via an endovascular approach using cuff extensions, uncovered stents, coils, and liquid embolic agents. Open surgery is reserved for complex complications, where an endovascular approach is not feasible. - Highlights: • Comprehensive pictorial review of EVAR related complications. • Importance of life-long EVAR surveillance, to prevent aortic rupture or lower limb ischaemia. • Identification and management of endoleaks, rupture, migration, kink/infolding, occlusion and infection

  16. PCA-induced respiratory depression simulating stroke following endoluminal repair of abdominal aortic aneurysm: a case report

    OpenAIRE

    Ahmad Javed; Riley Richard; Sieunarine Kishore

    2007-01-01

    Abstract Aim To report a case of severe respiratory depression with PCA fentanyl use simulating stroke in a patient who underwent routine elective endoluminal graft repair for abdominal aortic aneurysm (AAA) Case presentation A 78-year-old obese lady underwent routine endoluminal graft repair for AAA that was progressively increasing in size. Following an uneventful operation postoperative analgesia was managed with a patient-controlled analgesia (PCA) device with fentanyl. On the morning fol...

  17. AORTOILIAC AND AORTOFEMORAL RECONSTRUCTION OF OBSTRUCTIVE DISEASE

    NARCIS (Netherlands)

    VANDENAKKER, PJ; VANSCHILFGAARDE, R; BRAND, R; VANBOCKEL, JH; TERPSTRA, JL

    1994-01-01

    This retrospective study evaluates our strategy to limit prosthetic reconstructions for aortoiliac obstructive disease to the diseased segments in 518 patients. There were 363 (70%) reconstructions without femoral anastomotic sites (FEM-0), 107 (21%) reconstructions with one femoral anastomotic site

  18. Study Design of PROCEDURE Study. A Randomized Comparison of the Dose-Dependent Effects of Pitavastatin in Patients with Abdominal Aortic Aneurysm with Massive Aortic Atheroma: Prevention of Cholesterol Embolization during Endovascular and Open Aneurysm Repair with Pitavastatin (PROCEDURE) Study

    OpenAIRE

    Hoshina, Katsuyuki; Nemoto, Masaru; Hashimoto, Takuya; Miura, Sumio; Urabe, Go; Nakazawa, Tatsu; Hosaka, Akihiro; Kato, Masaaki; Ohkubo, Nobukazu; Miyairi, Takeshi; Okamoto, Hiroyuki; Shigematsu, Kunihiro; Miyata, Tetsuro

    2013-01-01

    Outcomes of abdominal aortic aneurysm (AAA) repair have improved in the 2 decades since the emergence of endovascular aneurysm repair (EVAR). However, EVAR is considered a contraindication for shaggy aorta because of the high risk of shower embolization. Recently, statins have been implicated in preventing embolization in patients with shaggy aorta via its pleiotropic effects, including atheroma reduction and coronary artery stabilization. We selected pitavastatin, a statin with potent effect...

  19. Patient-specific simulation of endovascular repair surgery with tortuous aneurysms requiring flexible stent-grafts.

    Science.gov (United States)

    Perrin, David; Badel, Pierre; Orgeas, Laurent; Geindreau, Christian; du Roscoat, Sabine Rolland; Albertini, Jean-Noël; Avril, Stéphane

    2016-10-01

    The rate of post-operative complications is the main drawback of endovascular repair, a technique used to treat abdominal aortic aneurysms. Complex anatomies, featuring short aortic necks and high vessel tortuosity for instance, have been proved likely prone to these complications. In this context, practitioners could benefit, at the preoperative planning stage, from a tool able to predict the post-operative position of the stent-graft, to validate their stent-graft sizing and anticipate potential complications. In consequence, the aim of this work is to prove the ability of a numerical simulation methodology to reproduce accurately the shapes of stent-grafts, with a challenging design, deployed inside tortuous aortic aneurysms. Stent-graft module samples were scanned by X-ray microtomography and subjected to mechanical tests to generate finite-element models. Two EVAR clinical cases were numerically reproduced by simulating stent-graft models deployment inside the tortuous arterial model generated from patient pre-operative scan. In the same manner, an in vitro stent-graft deployment in a rigid polymer phantom, generated by extracting the arterial geometry from the preoperative scan of a patient, was simulated to assess the influence of biomechanical environment unknowns in the in vivo case. Results were validated by comparing stent positions on simulations and post-operative scans. In all cases, simulation predicted stents deployed locations and shapes with an accuracy of a few millimetres. The good results obtained in the in vitro case validated the ability of the methodology to simulate stent-graft deployment in very tortuous arteries and led to think proper modelling of biomechanical environment could reduce the few local discrepancies found in the in vivo case. In conclusion, this study proved that our methodology can achieve accurate simulation of stent-graft deployed shape even in tortuous patient specific aortic aneurysms and may be potentially helpful to

  20. 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

  1. Internal Iliac Artery Embolization during an Endovascular Aneurysm Repair with Detachable Interlock Microcoils

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Woo ChuL; Jeon, Yong Sun; Hong, Kee Chun; Cho, Soon Gu; Park, Jae Young [Inha University Hospital, Inha University School of Medicine, Incheon (Korea, Republic of); Kim, Jang Yong [Dept. of Vascular and Endovascular Surgery, The Catholic University of Korea School of Medicine, Seoul (Korea, Republic of)

    2014-10-15

    The purpose of this study was to evaluate the effectiveness of detachable interlock microcoils for an embolization of the internal iliac artery during an endovascular aneurysm repair (EVAR). A retrospective review was conducted on 40 patients with aortic aneurysms, who had undergone an EVAR between January 2010 and March 2012. Among them, 16 patients were referred for embolization of the internal iliac artery for the prevention of type II endoleaks. Among 16 patients, 13 patients underwent embolization using detachable interlock microcoils during an EVAR. Computed tomographic angiographies and clinical examinations were performed during the follow-up period. Technical success, clinical outcome, and complications were reviewed. Internal iliac artery embolizations using detachable interlock microcoils were technically successful in all 13 patients, with no occurrence of procedure-related complications. Follow-up imaging was accomplished in the 13 cases. In all cases, type II endoleak was not observed with computed tomographic angiography during the median follow-up of 3 months (range, 1-27 months) and the median clinical follow-up of 12 months (range, 1-27 months). Two of 13 (15%) patients had symptoms of buttock pain, and one patient died due to underlying stomach cancer. No significant clinical symptoms such as bowel ischemia were observed. Internal iliac artery embolization during an EVAR using detachable interlock microcoils to prevent type II endoleaks appears safe and effective, although this should be further proven in a larger population.

  2. Internal Iliac Artery Embolization during an Endovascular Aneurysm Repair with Detachable Interlock Microcoils

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the effectiveness of detachable interlock microcoils for an embolization of the internal iliac artery during an endovascular aneurysm repair (EVAR). A retrospective review was conducted on 40 patients with aortic aneurysms, who had undergone an EVAR between January 2010 and March 2012. Among them, 16 patients were referred for embolization of the internal iliac artery for the prevention of type II endoleaks. Among 16 patients, 13 patients underwent embolization using detachable interlock microcoils during an EVAR. Computed tomographic angiographies and clinical examinations were performed during the follow-up period. Technical success, clinical outcome, and complications were reviewed. Internal iliac artery embolizations using detachable interlock microcoils were technically successful in all 13 patients, with no occurrence of procedure-related complications. Follow-up imaging was accomplished in the 13 cases. In all cases, type II endoleak was not observed with computed tomographic angiography during the median follow-up of 3 months (range, 1-27 months) and the median clinical follow-up of 12 months (range, 1-27 months). Two of 13 (15%) patients had symptoms of buttock pain, and one patient died due to underlying stomach cancer. No significant clinical symptoms such as bowel ischemia were observed. Internal iliac artery embolization during an EVAR using detachable interlock microcoils to prevent type II endoleaks appears safe and effective, although this should be further proven in a larger population.

  3. Risk-adjusted outcome analysis of endovascular abdominal aortic aneurysm repair in a large population: how do stent-grafts compare?

    NARCIS (Netherlands)

    Marrewijk, C.J. van; Leurs, L.J.; Vallabhaneni, S.R.; Harris, P.L.; Buth, J.; Laheij, R.J.F.

    2005-01-01

    PURPOSE: To compare differences in the applicability and incidence of postoperative adverse events among stent-grafts used for repair of infrarenal aortic aneurysms. METHODS: An analysis of 6787 patients from the EUROSTAR Registry database was conducted to compare aneurysm morphological features, pa

  4. Embolisation of a Proximal Type I Endoleak Post-Nellix Aortic Aneurysm Repair Complicated by Reflux of Onyx into the Nellix Endograft Limb

    Energy Technology Data Exchange (ETDEWEB)

    Ameli-Renani, S., E-mail: seyedameli@doctors.org.uk; Das, R., E-mail: raj.das@stgeorges.nhs.uk; Weller, A., E-mail: alweller@gmail.com; Chung, R., E-mail: rchung@doctors.org.uk; Morgan, R. A., E-mail: robert.Morgan@stgeorges.nhs.uk [St George’s Hospital, Department of Radiology (United Kingdom)

    2015-06-15

    We report the first case of intervention for a proximal type 1 endoleak following Nellix endovascular aneurysm sealing repair of an aortic aneurysm. This was complicated by migration of Onyx into one of the Nellix graft limbs causing significant stenosis. Subsequent placement of a covered stent to affix the Onyx between the stent and the wall of the Nellix endograft successfully restored stent patency.

  5. 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

  6. Endovascular Aneurysm Repair Using a Reverse Chimney Technique in a Patient With Marfan Syndrome and Contained Ruptured Chronic Type B Dissection

    International Nuclear Information System (INIS)

    We report endovascular thoracic and abdominal aneurysm repair (EVAR) with reverse chimney technique in a patient with contained ruptured type B dissection. EVAR seems feasible as a bailout option in Marfan patients with acute life-threatening disease.

  7. Follow-up of endovascular aortic aneurysm repair: Preliminary validation of digital tomosynthesis and contrast enhanced ultrasound in detection of medium- to long-term complications

    OpenAIRE

    Mazzei, Maria Antonietta; Guerrini, Susanna; Mazzei, Francesco Giuseppe; Cioffi Squitieri, Nevada; Notaro, Dario; de Donato, Gianmarco; Galzerano, Giuseppe; Sacco, Palmino; Setacci, Francesco; Volterrani, Luca; Setacci, Carlo

    2016-01-01

    AIM: To validate the feasibility of digital tomosynthesis of the abdomen (DTA) combined with contrast enhanced ultrasound (CEUS) in assessing complications after endovascular aortic aneurysm repair (EVAR) by using computed tomography angiography (CTA) as the gold standard.

  8. Type II Endoleak Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm: Innovative Transgraft Approach to Contemporary Management

    Directory of Open Access Journals (Sweden)

    M. Fuad Jan

    2015-08-01

    Full Text Available Elective endovascular aneurysm repair (EVAR is the first-line therapeutic option for patients with infrarenal abdominal aortic aneurysm. However, endoleaks –– persistent blood flow outside the lumen of the stent graft (or endograft but within the aneurysm sac or adjacent vascular segment being treated by the graft –– continue to be a persistent problem in the post-EVAR setting. The type II endoleak is the most common of these and can be a demanding challenge to address by standard endovascular techniques. Currently, two prominent endovascular techniques exist for the management of type II endoleaks: direct translumbar embolization and transarterial embolization. Both of these are fraught with their own limitations and complications. In this review, we describe the contemporary trends in management of type II endoleaks and introduce a novel endovascular technique to treat this challenging and common EVAR complication.

  9. 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.

  10. 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.

  11. Surgical repair for giant ascending aortic aneurysm to superior vena cava fistula with positive syphilitic test.

    Science.gov (United States)

    Sekine, Yuji; Yamamoto, Shin; Fujikawa, Takuya; Oshima, Susumu; Ono, Makoto; Sasaguri, Shiro

    2015-10-01

    Syphilitic aortitis is usually associated with thoracic aortic saccular aneurysm, aortic regurgitation and coronary ostial stenosis. However, syphilitic aneurysms have rarely been reported today. Here, we report a patient with ascending aortic aneurysm with aorta-superior vena cava (SVC) fistula with positive syphilitic test. A 52-year-old man was admitted to our institution with a giant ascending aortic aneurysm complicated with SVC syndrome. Computed tomography revealed a giant ascending aneurysm 79 mm in diameter. The result of serodiagnostic tests for syphilis had not been judged yet preoperatively. Total arch replacement concomitant with elephant trunk was performed. Intraoperatively, we detected the ascending aorta to SVC fistula. Postoperatively, we suspected the syphilitic aneurysm strongly, because preoperative serodiagnostic test was concluded to be positive. However, histological examination did not show typical syphilitic features. The patient remains asymptomatic 1 year later. Although extremely rarely today, syphilitic aneurysm should be still considered in the differential diagnosis of ascending aortic aneurysm. PMID:24000069

  12. Severe tracheobronchial compression in a patient with Turner's syndrome undergoing repair of a complex aorto-subclavian aneurysm: anesthesia perspectives.

    Science.gov (United States)

    Hudson, Christopher C C; Stewart, Jeremie; Dennie, Carole; Malas, Tarek; Boodhwani, Munir

    2014-01-01

    We present a case of severe tracheobronchial compression from a complex aorto-subclavian aneurysm in a patient with Turner's syndrome undergoing open surgical repair. Significant airway compression is a challenging situation and requires careful preoperative preparation, maintenance of spontaneous breathing when possible, and consideration of having an alternative source of oxygenation and circulation established prior to induction of general anesthesia. Cardiopulmonary monitoring is essential for safe general anesthesia and diagnosis of unexpected intraoperative events. PMID:25281630

  13. Early prediction of acute kidney injury biomarkers after endovascular stent graft repair of aortic aneurysm: a prospective observational study

    OpenAIRE

    Ueta, Kazuyoshi; Watanabe, Michiko; Iguchi, Naoya; Uchiyama, Akinori; Shirakawa, Yukitoshi; Kuratani, Toru; Sawa, Yoshiki; Fujino, Yuji

    2014-01-01

    Background Acute kidney injury (AKI) is a common and serious condition usually detected some time after onset by changes in serum creatinine (sCr). Although stent grafting to repair aortic aneurysms is associated with AKI caused by surgical procedures or the use of contrast agents, early biomarkers for AKI have not been adequately examined in stent graft recipients. We studied biomarkers including urinary neutrophil gelatinase-associated lipocalin (NGAL), blood NGAL, N-acetyl-β-d-glucosaminid...

  14. Endovascular Repair of a Type III Thoracoabdominal Aortic Aneurysm in a Patient with Occlusion of Visceral Arteries

    International Nuclear Information System (INIS)

    The successful endovascular repair of a type III thoracoabdominal aortic aneurysm (TAAA) with the use of a tube endograft is reported. A 56-year-old male with a 6.4-cm type III TAAA, a 4.2-cm infrarenal abdominal aortic aneurysm, and chronic renal insufficiency presented with flank pain, nausea, acute anuria, and serum creatinine of 6.1 mg/dl. Acute occlusion of the left solitary renal artery was diagnosed and emergent recanalization with percutaneus transluminal angioplasty and stenting was performed successfully, with reversal of the serum creatinine level at 1.6 mg/dl. Further imaging studies for TAAA management revealed ostial occlusion of both the celiac artery (CA) and the superior mesenteric artery (SMA) but a hypertrophic inferior mesenteric artery (IMA) providing retrograde flow to the aforementioned vessels. This rare anatomic serendipity allowed us to repair the TAAA simply by using a two-component tube endograft without fenestrations (Zenith; William Cook, Bjaeverskov, Denmark) that covered the entire length of the aneurysm, including the CA and SMA origins, since a natural arterial bypass from the IMA to the CA and SMA already existed, affording protection from gastrointestinal ischemic complications. The patient had a fast and uneventful recovery and is currently doing well 6 months after the procedure. To our knowledge, this is the first report in the English literature of successful endovascular repair of a TAAA involving visceral arteries with the simple use of a tube endograft

  15. Surgical repair of an aberrant splenic artery aneurysm: report of a case.

    Science.gov (United States)

    Illuminati, Giulio; LaMuraglia, Glenn; Nigri, Giuseppe; Vietri, Francesco

    2007-03-01

    Aneurysms of the splenic artery are the most common splanchnic aneurysms. Aneurysms of a splenic artery with an anomalous origin from the superior mesenteric artery are however rare, with eight previously reported cases. Their indications for treatment are superposable to those of aneurysms affecting an orthotopic artery. Methods of treatment of this condition include endovascular, minimally invasive techniques and surgical resection. We report one more case of aneurysm of an aberrant splenic artery, treated with surgical resection, and preservation of the spleen. PMID:17349366

  16. A special type of endovascular stent repair with complicated thoracic aneurysm and chronic type B dissection aligned in tandem: double perfusion in true and false distal aorta lumen

    Institute of Scientific and Technical Information of China (English)

    GAN Hui-li; ZHANG Jian-qun

    2008-01-01

    @@ Aortic dissection and aortic aneurysm are two of the most common catastrophic events involving the aorta. Thoracic endovascular aortic repair is now considered as a promising alternative to open surgical graft replacement, The aim of endovascular repair of a thoracic aneurysm is to exclude, and thus depressurize, the aneurismal wall and the aim of the endovascular repair of type B aortic dissection is to obliterate all of the false lumen through thrombosis after sealing the primary entry tears, thus to ensure the true lumen perfusion.

  17. How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair.

    Science.gov (United States)

    Setacci, Carlo; Chisci, Emiliano; Setacci, Francesco; Ercolini, Leonardo; de Donato, Gianmarco; Troisi, Nicola; Galzerano, Giuseppe; Michelagnoli, Stefano

    2014-12-01

    The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a correct diagnosis. There is no good evidence to guide management so far. In the case of active gastrointestinal bleeding, pseudoaneurysm, or extensive perigraft purulence involving adjacent organs, an invasive treatment should always be attempted. In the other cases (the majority), when there is not an immediate danger to the patient's life, a conservative management is started with a proper antimicrobial therapy. Any infectious cavity can be percutaneously drained. Management depends on the patient's condition and a tailored approach should always be offered. In the case of a patient who is young, has a good life expectancy, or in whom there is absence of significant comorbidities, a surgical attempt can be proposed. Surgical techniques favor, in terms of mortality, patency, and reinfection rate, the in situ reconstruction. Choice of technique relies on the center and the operator's experience. Long-term antibiotic therapy is always required in all cases, with close monitoring of the C-reactive protein. PMID:26798744

  18. Antiplatelet treatment and prothrombotic diathesis following endovascular abdominal aortic aneurysm repair.

    Science.gov (United States)

    Trellopoulos, G; Georgiadis, G S; Nikolopoulos, E S; Kapoulas, K C; Georgakarakos, E I; Lazarides, M K

    2014-10-01

    Prothrombotic diathesis expressed by elevated levels of coagulation-specific biomarkers has been reported in patients with abdominal aortic aneurysm (AAA) and after AAA endovascular repair (EVAR). This study investigates the effect of antiplatelet agents (APLs) on the prothrombotic diathesis in the post-EVAR period. Forty elective EVAR patients had thrombin-antithrombin complex, d-dimer, fibrinopeptide A, and high-sensitivity C-reactive protein measured before, at 24 hours, 1 month, and 6 months after EVAR. Patients receiving APLs postoperatively were compared with those not receiving APLs. All biomarkers were above the normal limits preoperatively and increased significantly 24 hours postoperatively followed by a drop at 1 and 6 months. No statistically significant changes were noted among patients receiving APLs in comparison with those not receiving APLs. The preoperative and postoperative prothrombotic diathesis of AAA following EVAR was confirmed in line with other reports. There was however no significant alteration of the examined biomarkers in patients receiving APLs. PMID:24101707

  19. How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair

    Science.gov (United States)

    Setacci, Carlo; Chisci, Emiliano; Setacci, Francesco; Ercolini, Leonardo; de Donato, Gianmarco; Troisi, Nicola; Galzerano, Giuseppe; Michelagnoli, Stefano

    2014-01-01

    The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a correct diagnosis. There is no good evidence to guide management so far. In the case of active gastrointestinal bleeding, pseudoaneurysm, or extensive perigraft purulence involving adjacent organs, an invasive treatment should always be attempted. In the other cases (the majority), when there is not an immediate danger to the patient's life, a conservative management is started with a proper antimicrobial therapy. Any infectious cavity can be percutaneously drained. Management depends on the patient's condition and a tailored approach should always be offered. In the case of a patient who is young, has a good life expectancy, or in whom there is absence of significant comorbidities, a surgical attempt can be proposed. Surgical techniques favor, in terms of mortality, patency, and reinfection rate, the in situ reconstruction. Choice of technique relies on the center and the operator's experience. Long-term antibiotic therapy is always required in all cases, with close monitoring of the C-reactive protein. PMID:26798744

  20. 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

  1. Endovascular repair as a sole treatment in multiple aneurysms in patient with SLE

    International Nuclear Information System (INIS)

    Full text: Introduction: Most aneurysms are local manifestations of systemic disease. For patients over 65 years the incidence of aneurysm of the abdominal aorta (AAA) is approximately 5-6% in men and 1-2 % for women. The presence of both the AAA and aneurysms in other location is even rarer, and this percentage is likely increase further in patients with systemic lupus erythematosus (SLE). What you will learn: We present a rare clinical case of endovascular treatment of multifocal aneurysm including post catheterization pseudoaneurysm. The patient is a 73 years old woman with a history of SLE and age-related comorbidity. Originally an endovascular treatment of aneurysms of the abdominal aorta and right common iliac artery was used. Two years later a successfully endovascular treatment of aneurysm of the right renal artery was conducted, which however is complicated by the formation of a pseudoaneurysm in access through the left femoral artery. The late one is again treated endovascular by placement of a covered stent after failure of percutaneous injection of 1000 UI thrombin. Discussion: Adult patients with a long history of SLE are unsuitable candidates for surgical treatment of aneurysmal disease, especially in its multifocal form. In our case we have taken multistep successful endovascular procedures, including technically hard placing of the stent at the site of the right renal aneurysms, and post catheterization pseudoaneurysm. Conclusion: Multifocal aneurysmal vascular changes due to macroangiopathia in SLE can be treated alone by endovascular means in multi-stages procedures

  2. Effects of postimplantation systemic inflammatory response on long-term clinical outcomes after endovascular aneurysm repair of an abdominal aortic aneurysm.

    Science.gov (United States)

    Kwon, Hyunwook; Ko, Gi-Young; Kim, Min-Ju; Han, Youngjin; Noh, Minsu; Kwon, Tae-Won; Cho, Yong-Pil

    2016-08-01

    The aim of this study was to determine the association between postimplantation syndrome (PIS) and long-term clinical outcomes after elective endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm.In this single-center, observational cohort study, a total of 204 consecutive patients undergoing EVAR were included. Primary outcome was long-term mortality from any cause; secondary outcomes included long-term mortality, systemic or implant-related complications, and secondary therapeutic procedures.The diagnosis of PIS was established in 64 patients (31.4%). PIS patients were more likely to receive woven polyester endografts and have a longer postoperative hospital stay and lower incidence of type II endoleaks. In multivariate analysis, PIS was significantly associated with a decreased risk of developing type II endoleaks (P = 0.044). During follow-up period of 44 months, clinical outcomes showed no significant differences in mortality (P = 0.876), systemic (P = 0.668), or implant-related complications (P = 0.847), although rates of secondary therapeutic procedure were significantly higher in non-PIS patients (P = 0.037). The groups had similar rates of overall survival (P = 0.761) and other clinical outcomes (P = 0.562).Patients with and without PIS had similar long-term overall survival rates and other clinical outcomes. PIS was beneficial in preventing type II endoleaks during postoperative period. PMID:27512875

  3. Seventeen Years’ Experience of Late Open Surgical Conversion after Failed Endovascular Abdominal Aortic Aneurysm Repair with 13 Variant Devices

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Ziheng, E-mail: wuziheng303@hotmail.com [Zhejiang University, Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine (China); Xu, Liang, E-mail: maxalive@163.com [Zhejiang University, Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine (China); Qu, Lefeng, E-mail: qulefeng@gmail.com [The Second Military Medical University, Department of Vascular and Endovascular Surgery, Changzheng Hospital (China); Raithel, Dieter, E-mail: dieter.raithel@rzmail.uni-erlangen.de [Nuremberg Southern Hospital, Department of Vascular and Endovascular Surgery (Germany)

    2015-02-15

    PurposeTo investigate the causes and results of late open surgical conversion (LOSC) after failed abdominal aortic aneurysm repair (EVAR) and to summarize our 17 years’ experience with 13 various endografts.MethodsRetrospective data from August 1994 to January 2011 were analyzed at our center. The various devices’ implant time, the types of devices, the rates and causes of LOSC, and the procedures and results of LOSC were analyzed and evaluated.ResultsA total of 1729 endovascular aneurysm repairs were performed in our single center (Nuremberg South Hospital) with 13 various devices within 17 years. The median follow-up period was 51 months (range 9–119 months). Among them, 77 patients with infrarenal abdominal aortic aneurysms received LOSC. The LOSC rate was 4.5 % (77 of 1729). The LOSC rates were significantly different before and after January 2002 (p < 0.001). The reasons of LOSC were mainly large type I endoleaks (n = 51) that were hard to repair by endovascular techniques. For the LOSC procedure, 71 cases were elective and 6 were emergent. The perioperative mortality was 5.2 % (4 of 77): 1 was elective (due to septic shock) and 3 were urgent (due to hemorrhagic shock).ConclusionLarge type I endoleaks were the main reasons for LOSC. The improvement of devices and operators’ experience may decrease the LOSC rate. Urgent LOSC resulted in a high mortality rate, while selective LOSC was relatively safe with significantly lower mortality rate. Early intervention, full preparation, and timely LOSC are important for patients who require LOSC.

  4. Seventeen Years’ Experience of Late Open Surgical Conversion after Failed Endovascular Abdominal Aortic Aneurysm Repair with 13 Variant Devices

    International Nuclear Information System (INIS)

    PurposeTo investigate the causes and results of late open surgical conversion (LOSC) after failed abdominal aortic aneurysm repair (EVAR) and to summarize our 17 years’ experience with 13 various endografts.MethodsRetrospective data from August 1994 to January 2011 were analyzed at our center. The various devices’ implant time, the types of devices, the rates and causes of LOSC, and the procedures and results of LOSC were analyzed and evaluated.ResultsA total of 1729 endovascular aneurysm repairs were performed in our single center (Nuremberg South Hospital) with 13 various devices within 17 years. The median follow-up period was 51 months (range 9–119 months). Among them, 77 patients with infrarenal abdominal aortic aneurysms received LOSC. The LOSC rate was 4.5 % (77 of 1729). The LOSC rates were significantly different before and after January 2002 (p < 0.001). The reasons of LOSC were mainly large type I endoleaks (n = 51) that were hard to repair by endovascular techniques. For the LOSC procedure, 71 cases were elective and 6 were emergent. The perioperative mortality was 5.2 % (4 of 77): 1 was elective (due to septic shock) and 3 were urgent (due to hemorrhagic shock).ConclusionLarge type I endoleaks were the main reasons for LOSC. The improvement of devices and operators’ experience may decrease the LOSC rate. Urgent LOSC resulted in a high mortality rate, while selective LOSC was relatively safe with significantly lower mortality rate. Early intervention, full preparation, and timely LOSC are important for patients who require LOSC

  5. 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

  6. Antithrombin can modulate coagulation, cytokine production, and expression of adhesion molecules in abdominal aortic aneurysm repair surgery.

    Science.gov (United States)

    Nishiyama, Tomoki

    2006-04-01

    We investigated the effects of antithrombin on coagulation, fibrinolysis, and production of cytokines and adhesion molecules in abdominal aortic aneurysm repair surgery. Sixteen patients for Y-shaped graft replacement of abdominal aortic aneurysm were divided into an antithrombin group and a control group. In the antithrombin group, 3000 U antithrombin was infused over 30 min before heparin administration and 24 h later. White blood cell counts, platelet counts, prothrombin time ratio, and serum concentrations of antithrombin, polymorphonuclear leukocyte elastase, interleukin (IL)-1beta, IL-6, IL-8, tumor necrosis factor-alpha, and adhesion molecules, and variables of coagulation and fibrinolysis were measured before surgery, at the end of surgery, and 1 and 2 days after surgery. The antithrombin concentration decreased in the control group, whereas it increased in the antithrombin group with significant differences between the groups. Prothrombin time ratio, concentrations of d-dimer, thrombin-antithrombin complex, and intercellular adhesion molecule-1 increased only in the control group and polymorphonuclear leukocyte elastase, IL-6, tumor necrosis factor-alpha, and vascular cell adhesion molecule-1 increased in both groups. They were significantly less in the antithrombin group except for intercellular adhesion molecule-1. In conclusion, antithrombin could decrease hypercoagulation and inflammatory activation during abdominal aortic aneurysm surgery, which may decrease adverse events. PMID:16551889

  7. Cell washing versus immediate reinfusion of intraoperatively shed blood during abdominal aortic aneurysm repair.

    Science.gov (United States)

    Long, G W; Glover, J L; Bendick, P J; Brown, O W; Kitzmiller, J W; Lombness, P; Hanson, D

    1993-08-01

    Significant hematologic changes are known to occur following intraoperative autotransfusion of shed blood, but the clinical importance of cell washing prior to reinfusion has not been substantiated. To evaluate these changes and their relationship to the use of blood bank products and postoperative morbidity, 26 patients undergoing elective abdominal aortic aneurysm repair were prospectively randomized to reinfusion with washed shed blood or to the use of a collection system in which filtered, but unwashed, whole blood was reinfused intraoperatively. Each patient was evaluated with respect to standard metabolic and hematologic laboratory parameters preoperatively, immediately postoperatively, and 12 to 18 hours postoperatively. Patient demographic data were similar for both groups. Perioperative survival was 100% for both groups. Total blood loss and blood volume autotransfused were significantly greater in the unwashed cell group compared with the washed cell group (p = 0.00014 and p = 0.00011, respectively). Hemoglobin, fibrinogen, prothrombin time, and partial thromboplastin time levels were not significantly different between the two groups at any time perioperatively; fibrin split product and d-dimer levels were significantly higher in the unwashed cell group postoperatively (p = 0.016 and p < 0.001, respectively). Serum free hemoglobin levels were significantly higher in the immediate postoperative period in the unwashed cell group compared with the washed cell group (p = 0.0013); by 12 to 18 hours postoperatively, this difference was not significant. Haptoglobin levels were significantly lower in the unwashed cell group at both postoperative times (123 +/- 86 mg/dL versus 41 +/- 50 mg/dL, p = 0.0086; 102 +/- 66 mg/dL versus 24 +/- 36 mg/dL, p = 0.0001); however, there was no perioperative renal failure in either group. Furthermore, homologous blood product use was not significantly different between the two groups, with an average of 1.5 +/- 2.5 units of

  8. 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...

  9. A mycotic aneurysm of the abdominal aorta in a child

    NARCIS (Netherlands)

    W. Suijker (W.); J.H.L.J. Bergmeijer (Jan Hein); J.J. Hamming (J.); J.C. Molenaar

    1991-01-01

    textabstractA 6-year-old boy with a previous history of intracardiac correction of a partial atrioventricular canal defect presented with infective endocarditis. Despite antibiotic therapy and reoperation, he developed a mycotic abdominal aneurysm. In situ aortoiliac reconstruction with a prosthesis

  10. Bilateral prevascular herniae – A rare complication of aorto-uniiliac endovascular abdominal aortic aneurysm repair and femoro-femoral bypass

    Directory of Open Access Journals (Sweden)

    Obinna Obinwa

    2015-01-01

    Full Text Available A case of a 78-year-old female with bilateral groin prevascular herniae following an emergency aorto-uniiliac EVAR and femoro-femoral bypass for a ruptured abdominal aortic aneurysm is presented. Primary repair of the herniae was achieved using a preperitoneal approach. The case emphasises a safe approach to dealing with this rare complication.

  11. Successful repair of a syphilitic aortic arch aneurysm accompanied by serious cerebral infarction.

    Science.gov (United States)

    Sato, Katsutoshi; Chiba, Kiyoshi; Koizumi, Nobusato; Ogino, Hitoshi

    2014-01-01

    We present a 52-year-old male with a syphilitic aortic arch aneurysm accompanied by relevant extensive cerebral infarction. He was admitted to a local hospital for sudden loss of consciousness, where he was diagnosed with serious cerebral infarction. During his treatment, a multilocular aortic arch aneurysm involving the arch vessels was found incidentally. He was transferred to our hospital for surgical treatment. A preoperative routine laboratory test for syphilis was highly positive, which suggested that the aneurysm was likely caused by syphilis and the cerebral infarction was also induced by the involvement of syphilitic aortitis or arteritis. After 2 weeks of antibiotic therapy for syphilis, total arch replacement was performed successfully using meticulous brain protection with antegrade selective cerebral perfusion and deep hypothermia. He recovered without any further cerebral deficits. The pathological examination of the surgical specimen showed some characteristic changes of syphilitic aortitis. PMID:24492165

  12. Using a Surgeon-modified Iliac Branch Device to Preserve the Internal Iliac Artery during Endovascular Aneurysm Repair: Single-center Experiences and Early Results

    Institute of Scientific and Technical Information of China (English)

    Wei-Wei Wu; Chen Lin; Bao Liu; Chang-Wei Liu

    2015-01-01

    Background:To evaluate the feasibility of a new surgeon-modified iliac branch device (IBD) technique to maintain pelvic perfusion in the management of common iliac artery (CIA) aneurysm during endovascular aneurysm repair (EVAR).Methods:From January 2011 to December 2013,a new surgeon-modified IBD technique was performed in department of vascular surgery of Peking Union Medical College Hospital in five patients treated for CIA aneurysm with or without abdominal aortic aneurysm.A stent-graft limb was initially deployed in vitro,anastomosed with vascular graft,creating a modified IBD reloaded into a larger sheath,with or without a guidewire preloaded into the side branch.The reloaded IBD was then placed in the iliac artery,with a covered stent bridging internal iliac artery and the branch.Finally,a bifurcated stent-graft was deployed,and a limb device was used to connect the main body and IBD.Results:Technical successes were obtained in all patients.The mean follow-up length was 24 months (range:6-38 months).All grafts remained patent without any sign of endoleaks.There were no aneurysm ruptures,deaths,or other complications related to pelvic flow.Conclusions:Using the surgeon-modified IBD to preserve pelvic flow is a feasible endovascular technique and an appealing solution for personalized treatment of CIA aneurysm during EVAR.

  13. Repair of an Atherosclerotic Coronary Artery Aneurysm by Implantation of a Coronary Covered Stent

    Directory of Open Access Journals (Sweden)

    Antenor Portela

    2002-05-01

    Full Text Available An atherosclerotic aneurysm of the right coronary artery complicated by a recent myocardial infarction was successfully treated with coronary artery stenting, using a device consisting of 2 stents with a layer of expandable polytetrafluorethylene (PTFE placed between them. A follow-up angiograph 5 months after the procedure showed sustained initial results.

  14. Endovascular Aortic Aneurysm Repair with the Talent Stent-Graft: Outcomes in Patients with Large Iliac Arteries

    International Nuclear Information System (INIS)

    The purpose of this study is to report outcomes following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) in patients with ectatic common iliac arteries (CIAs). Of 117 AAA patients treated by EVAR between 1998 and 2005, 87 (74%) had CIAs diameters 18 but <25 mm. All patients were treated with Talent stent-grafts, 114 bifurcated and 3 AUI devices. Departmental databases and patient records were reviewed to assess outcomes. Technical success, iliac-related outcome, and iliac-related reintervention (IRSI) were analyzed. Patients with EVAR extending into the external iliac artery were excluded. Median (range) follow-up for the study group was 24 (1-84) months. Initial technical success was 98% for CIAs <18 mm and 100% for CIAs ≥18 mm (p = 0.551). There were three distal type I endoleaks (two in the ectatic group) and six iliac limb occlusions (one in an ectatic patient); there were no statistically significant differences between groups (p = 0.4). There were nine IRSIs (three stent-graft extensions, six femorofemoral crossover grafts); three of these patients had one or both CIAs ≥18 mm (p = 0.232). One-year freedom from IRSI was 92% ± 3% and 84% ± 9% for the <18-mm and ≥18-mm CIA groups, respectively (p = 0.232). We conclude that the treatment of AAA by EVAR in patients with CIAs 18-24 mm appears to be safe and effective, however, it may be associated with more frequent reinterventions.

  15. Can Surgeons Assess CT Suitability for Endovascular Repair (EVAR) in Ruptured Abdominal Aortic Aneurysm? Implications for a Ruptured EVAR Trial

    International Nuclear Information System (INIS)

    The purpose of this study was to determine whether surgeons without formal radiological training are able to assess suitability of patients with ruptured abdominal aortic aneurysms (AAA) for EVAR. The CT scans of 20 patients with AAA were reviewed under timed conditions by six vascular surgeons. Twenty minutes was allocated per scan. They were asked to determine if each aneurysm would be treatable by EVAR in the emergency setting and, if so, to measure for device selection. The results were then compared with those of a vascular radiologist. Six surgeons agreed on the suitability of endovascular repair in 45% of cases (95% CI, 23.1-68.5%; 9/20 scans; κ = 0.41 [p = 0.01]) and concurred with the radiologist in eight of these. Individually, agreement ranged from 13 to 16 of the 20 scans, 65-80% between surgeons. The kappa value for agreement between all the surgeons and the radiologist was 0.47 (p = 0.01, moderate agreement). For the individual surgeons, this ranged from 0.3 to 0.6 (p = 0.01). In conclusion, while overall agreement was moderate between the surgeons and the radiologist, it is clear that if surgeons are to assess patients for ruptured EVAR in the future, focused training of surgical trainees is required.

  16. Dual-energy computed tomography after endovascular aortic aneurysm repair: The role of hard plaque imaging for endoleak detection

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Wille, R.; Borgmann, T.; Wohlgemuth, W.A.; Jung, E.M.; Heiss, P.; Schreyer, A.G.; Stroszczynski, C.; Dornia, C. [Institute of Radiology, University Medical Center Regensburg, Regensburg (Germany); Zeman, F. [University Medical Center Regensburg, Center for Clinical Studies, Regensburg (Germany); Pfister, K. [University Medical Center Regensburg, Department of Surgery, Regensburg (Germany); Krauss, B. [Siemens AG, Healthcare Sector, Forchheim (Germany)

    2014-10-15

    To assess the diagnostic accuracy of dual-energy computed tomography (DECT) for detection of endoleaks and aneurysm sac calcifications after endovascular aneurysm repair (EVAR) using hard plaque imaging algorithms. One hundred five patients received 108 triple-phase contrast-enhanced CT (non-contrast, arterial and delayed phase) after EVAR. The delayed phase was acquired in dual-energy and post-processed using the standard (HPI-S) and a modified (HPI-M) hard plaque imaging algorithm. The reference standard was determined using the triple-phase CT and contrast-enhanced ultrasound. All images were analysed separately for the presence of endoleaks and calcifications by two independent readers; sensitivity, specificity and interobserver agreement were calculated. Endoleaks and calcifications were present in 25.9 % (28/108) and 20.4 % (22/108) of images. The HPI-S images had a sensitivity/specificity of 54 %/100 % (reader 1) and 57 %/99 % (reader 2), the HPI-M images of 93 %/92 % (reader 1) and 96 %/92 % (reader 2) for detection of endoleaks. For detection of calcifications HPI-S had a sensitivity/specificity of 91 %/99 % (reader 1) and 95 %/97 % (reader 2), the HPI-M images of 91 %/99 % (reader 1) and 91 %/99 % (reader 2), respectively. Using HPI-M, DECT enables an accurate diagnosis of endoleaks after EVAR and allows distinguishing between endoleaks and calcifications with high diagnostic accuracy. (orig.)

  17. Graft Distortion After Endovascular Repair of Abdominal Aortic Aneurysm: Association with Sac Morphology and Mid-Term Complications

    International Nuclear Information System (INIS)

    Purpose: To investigate the incidence, significance, and mechanism of stent-graft distortion after endovascular repair (EVR) of abdominal aortic aneurysm.Methods: EVR of abdominal aortic aneurysm was performed in 51 cases (49 modular, bifurcated; 2 tube). Thirty-two patients were followed for 6 or more months and had equivalent baseline and follow-up images which could be used to determine changes in graft configuration. Sac dimensions were measured using computed tomographic (CT) images and graft-related complications were recorded.Results: Amongst 32 patients evaluated on follow-up, there was graft distortion in 24. Distorted grafts were significantly (p= 0.002) associated with sac diameter reduction (mean 5 mm) and sac length reduction (mean 8.1 mm). All graft-related complications occurred in the limbs of eight distorted grafts, with a mean reduction of sac length in this group of 7.8 mm on reformatted CT images.Conclusion: There was a highly significant association between graft distortion and limb complications, and reduced sac dimensions

  18. 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

  19. Multimodality Imaging Approach towards Primary Aortic Sarcomas Arising after Endovascular Abdominal Aortic Aneurysm Repair: Case Series Report.

    Science.gov (United States)

    Kamran, Mudassar; Fowler, Kathryn J; Mellnick, Vincent M; Sicard, Gregorio A; Narra, Vamsi R

    2016-06-01

    Primary aortic neoplasms are rare. Aortic sarcoma arising after endovascular aneurysm repair (EVAR) is a scarce subset of primary aortic malignancies, reports of which are infrequent in the published literature. The diagnosis of aortic sarcoma is challenging due to its non-specific clinical presentation, and the prognosis is poor due to delayed diagnosis, rapid proliferation, and propensity for metastasis. Post-EVAR, aortic sarcomas may mimic other more common aortic processes on surveillance imaging. Radiologists are rarely knowledgeable about this rare entity for which multimodality imaging and awareness are invaluable in early diagnosis. A series of three pathologically confirmed cases are presented to display the multimodality imaging features and clinical presentations of aortic sarcoma arising after EVAR. PMID:26721588

  20. Medium-Term Outcomes Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms with an Unfavourable Proximal Neck

    Energy Technology Data Exchange (ETDEWEB)

    Saha, Prakash, E-mail: prakash.2.saha@kcl.ac.uk; Hughes, John, E-mail: johnhughes387@rocketmail.com; Patel, Ashish S., E-mail: ashish.s.patel@kcl.ac.uk; Donati, Tommaso, E-mail: tommaso.donati@gstt.nhs.uk; Sallam, Morad, E-mail: morad.sallam@gstt.nhs.uk; Patel, Sanjay D., E-mail: sanjay.patel@gstt.nhs.uk; Bell, Rachel E. [King’s Health Partners, Department of Vascular Surgery, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr [King’s Health Partners, Department of Interventional Radiology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Modarai, Bijan, E-mail: bijan.modarai@kcl.ac.uk; Zayed, Hany A., E-mail: hany.zayed@gstt.nhs.uk [King’s Health Partners, Department of Vascular Surgery, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom)

    2015-08-15

    PurposeThe purpose of this study was to evaluate medium-term outcomes following endovascular repair of abdominal aortic aneurysms (EVAR) with unfavourable neck anatomy using stent grafts with a 36 mm or larger proximal diameter.Materials and MethodsA retrospective review of 27 patients who underwent elective EVAR between 2006 and 2008 using a stent graft with a 36 mm or larger proximal diameter was carried out. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. Patients were followed up with CTA at 3 and 12 months and annual duplex thereafter.ResultsThe median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Cook Zenith stent grafts were used in all patients, with a proximal diameter of 36 mm (n = 25) and 40 mm (n = 2). Primary and assisted primary technical success rates were 74 and 93 %, respectively. The follow-up period ranged from 62 to 84 months, with a median of 72 months. 15 patients died during follow-up. Two patients died from aortic rupture, and the remaining patients died from cardiac disease (n = 4), chest sepsis (n = 6), cancer (n = 2) and renal failure (n = 1). Complications included type I endoleak (n = 5), limb occlusion (n = 2), limb stenosis (n = 2), limb kinking (n = 1), dissection of an artery (n = 1), occlusion of a femorofemoral cross-over graft (n = 1) and poor attachment of a distal limb (n = 1).ConclusionsEVAR using stent grafts in the presence of an unfavourable neck has a high risk of complications. Medium-term survival in this group is low but mainly due to patient co-morbidities.

  1. Medium-Term Outcomes Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms with an Unfavourable Proximal Neck

    International Nuclear Information System (INIS)

    PurposeThe purpose of this study was to evaluate medium-term outcomes following endovascular repair of abdominal aortic aneurysms (EVAR) with unfavourable neck anatomy using stent grafts with a 36 mm or larger proximal diameter.Materials and MethodsA retrospective review of 27 patients who underwent elective EVAR between 2006 and 2008 using a stent graft with a 36 mm or larger proximal diameter was carried out. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. Patients were followed up with CTA at 3 and 12 months and annual duplex thereafter.ResultsThe median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Cook Zenith stent grafts were used in all patients, with a proximal diameter of 36 mm (n = 25) and 40 mm (n = 2). Primary and assisted primary technical success rates were 74 and 93 %, respectively. The follow-up period ranged from 62 to 84 months, with a median of 72 months. 15 patients died during follow-up. Two patients died from aortic rupture, and the remaining patients died from cardiac disease (n = 4), chest sepsis (n = 6), cancer (n = 2) and renal failure (n = 1). Complications included type I endoleak (n = 5), limb occlusion (n = 2), limb stenosis (n = 2), limb kinking (n = 1), dissection of an artery (n = 1), occlusion of a femorofemoral cross-over graft (n = 1) and poor attachment of a distal limb (n = 1).ConclusionsEVAR using stent grafts in the presence of an unfavourable neck has a high risk of complications. Medium-term survival in this group is low but mainly due to patient co-morbidities

  2. Study Design of PROCEDURE Study. A Randomized Comparison of the Dose-Dependent Effects of Pitavastatin in Patients with Abdominal Aortic Aneurysm with Massive Aortic Atheroma: Prevention of Cholesterol Embolization during Endovascular and Open Aneurysm Repair with Pitavastatin (PROCEDURE) Study

    Science.gov (United States)

    Nemoto, Masaru; Hashimoto, Takuya; Miura, Sumio; Urabe, Go; Nakazawa, Tatsu; Hosaka, Akihiro; Kato, Masaaki; Ohkubo, Nobukazu; Miyairi, Takeshi; Okamoto, Hiroyuki; Shigematsu, Kunihiro; Miyata, Tetsuro

    2013-01-01

    Outcomes of abdominal aortic aneurysm (AAA) repair have improved in the 2 decades since the emergence of endovascular aneurysm repair (EVAR). However, EVAR is considered a contraindication for shaggy aorta because of the high risk of shower embolization. Recently, statins have been implicated in preventing embolization in patients with shaggy aorta via its pleiotropic effects, including atheroma reduction and coronary artery stabilization. We selected pitavastatin, a statin with potent effects, discovered and developed by a Japanese company because it has shown excellent pleiotropic effects on atheromatous arteries in the Japanese population. A randomized comparison study of dose-dependent effects of pitavastatin in patients with AAA with massive atheromatous aortic thrombus (PROCEDURE study) has begun. PROCEDURE has an enrollment goal of up to 80 patients with AAA with massive aortic atheroma (excluding intrasac atheroma), randomly allocated into 2 groups receiving pitavastatin at a dose of 1 or 4 mg/day. The endpoints of the PROCEDURE study include change in atheroma volume, major adverse events related to shower embolization after aneurysm repair, and lipid-lowering effects. When complete, results of the PROCEDURE study should provide objective evidence to use statins preoperatively for AAA with massive aortic atheroma. PMID:23641286

  3. Aneurysm Complications

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  4. PCA-induced respiratory depression simulating stroke following endoluminal repair of abdominal aortic aneurysm: a case report

    Directory of Open Access Journals (Sweden)

    Ahmad Javed

    2007-07-01

    Full Text Available Abstract Aim To report a case of severe respiratory depression with PCA fentanyl use simulating stroke in a patient who underwent routine elective endoluminal graft repair for abdominal aortic aneurysm (AAA Case presentation A 78-year-old obese lady underwent routine endoluminal graft repair for AAA that was progressively increasing in size. Following an uneventful operation postoperative analgesia was managed with a patient-controlled analgesia (PCA device with fentanyl. On the morning following operation the patient was found to be unusually drowsy and unresponsive to stimuli. Her GCS level was 11 with plantars upgoing bilaterally. A provisional diagnosis of stroke was made. Urgent transfer to a high-dependency unit (HDU was arranged and she was given ventilatory support with a BiPap device. CT was performed and found to be normal. Arterial blood gas (ABG analysis showed respiratory acidosis with PaCO2 81 mmHg, PaO2 140 mmHg, pH 7.17 and base excess -2 mmol/l. A total dose of 600 mcg of fentanyl was self-administered in the 16 hours following emergence from general anaesthesia. Naloxone was given with good effect. There was an increase in the creatinine level from 90 μmol/L preoperatively to 167 μmol/L on the first postoperative day. The patient remained on BiPap for two days that resulted in marked improvement in gas exchange. Recovery was complete.

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

    Directory of Open Access Journals (Sweden)

    Marković Miroslav

    2004-01-01

    Full Text Available Ruptured abdominal aortic aneurysm is one of the most urgent surgical conditions with high mortality that has not been changed in decades. Between 1991-2001 total number of 1058 patients was operated at the Institute for Cardiovascular Diseases of Clinical Center of Serbia due to abdominal aortic aneurysm. Of this number, 288 patients underwent urgent surgical repair because of ruptured abdominal aortic aneurysm. The aim of this retrospective study was to show results of the early outcome of surgical treatment of patients with ruptured abdominal aortic aneurysm, and to define relevant intraoperative factors that influence their survival. There were 83% male and 17% female patients in the study, mean aged 67 years. Mean duration of surgical procedure was 190 minutes (75-420 min. Most common localization of aneurysm was infrarenal - in 74% of patients, then juxtarenal (12.3%. Suprarenal aneurysm was found in 6.8% of patients, as well as thoracoabdominal aneurysm (6.8%. Retroperitoneal rupture of aortic aneurysm was most common - in 65% of patients, then intraperotineal in 26%. Rare finding such as chronic rupture was found in 3.8%, aortocaval fistula in 3.2% and aorto-duodenal fistula in 0.6% of patients. Mean aortic cross-clamping time was 41.7 minutes (10-150 min. Average intraoperative systolic pressure in patients was 106.5 mmHg (40-160 mmHg. Mean intraoperative blood loss was 3700 ml (1400-8500 ml. Mean intraoperative diuresis was 473 ml (0-2100 ml. Tubular graft was implanted in 53% of patients, aortoiliac bifurcated graft in 32.8%. Aortobifemoral reconstruction was done in 14.2% of patients. These data refer to the patients that survived surgical procedure. Intrahospital mortality that included intraoperative and postoperative deaths was 53.7%. Therefore, 46.3% patients survived surgical treatment and were released from the hospital. Intraoperative mortality was 13.5%. Type of aneurysm had no influence on outcome of patients (p>0.05, as

  6. Emergency Abdominal Aortic Aneurysm Repair in a Patient with Failing Heart: Axillofemoral Bypass Using a Centrifugal Pump Combined with Levosimendan for Inotropic Support

    Directory of Open Access Journals (Sweden)

    Pavel Michalek

    2011-01-01

    Full Text Available We describe the case of an 83-year-old patient requiring repair of a large symptomatic abdominal aortic aneurysm (AAA. The patient was known to have coronary artery disease (CAD with symptoms and signs of significant myocardial dysfunction, left-heart failure, and severe aortic insufficiency. The procedure was performed with the help of both mechanical and pharmacological circulatory support. Distal perfusion was provided by an axillofemoral bypass with a centrifugal pump, with dobutamine and levosimendan administered as pharmacological inotropic support. The patient's hemodynamic status was monitored with continuous cardiac output monitoring and transesophageal echocardiography. No serious circulatory complications were recorded during the perioperative and postoperative periods. This paper suggests a potential novel approach to combined circulatory support in patients with heart failure, scheduled for open abdominal aortic aneurysm repair.

  7. Severe tracheobronchial compression in a patient with Turner′s syndrome undergoing repair of a complex aorto-subclavian aneurysm: Anesthesia perspectives

    Directory of Open Access Journals (Sweden)

    Christopher C .C. Hudson

    2014-01-01

    Full Text Available We present a case of severe tracheobronchial compression from a complex aorto-subclavian aneurysm in a patient with Turner′s syndrome undergoing open surgical repair. Significant airway compression is a challenging situation and requires careful preoperative preparation, maintenance of spontaneous breathing when possible, and consideration of having an alternative source of oxygenation and circulation established prior to induction of general anesthesia. Cardiopulmonary monitoring is essential for safe general anesthesia and diagnosis of unexpected intraoperative events.

  8. 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...

  9. Severe tracheobronchial compression in a patient with Turner′s syndrome undergoing repair of a complex aorto-subclavian aneurysm: Anesthesia perspectives

    OpenAIRE

    Hudson, Christopher C. C.; Jeremie Stewart; Carole Dennie; Tarek Malas; Munir Boodhwani

    2014-01-01

    We present a case of severe tracheobronchial compression from a complex aorto-subclavian aneurysm in a patient with Turner′s syndrome undergoing open surgical repair. Significant airway compression is a challenging situation and requires careful preoperative preparation, maintenance of spontaneous breathing when possible, and consideration of having an alternative source of oxygenation and circulation established prior to induction of general anesthesia. Cardiopulmonary monitoring is essentia...

  10. Heat shock proteins HSP70 and HSP27 in the cerebral spinal fluid of patients undergoing thoracic aneurysm repair correlate with the probability of postoperative paralysis

    OpenAIRE

    Hecker, James G.; Sundram, Hari; Zou, Shaomin; Praestgaard, Amy; Bavaria, Joseph E.; Ramchandren, Sindhu; McGarvey, Michael

    2008-01-01

    An understanding of the time course and correlation with injury of heat shock proteins (HSPs) released during brain and/or spinal cord cellular stress (ischemia) is critical in understanding the role of the HSPs in cellular survival, and may provide a clinically useful biomarker of severe cellular stress. We have analyzed the levels of HSPs in the cerebrospinal fluid (CSF) from patients who are undergoing thoracic aneurysm repair. Blood and CSF samples were collected at regular intervals, and...

  11. Noninvasive vascular ultrasound elastography applied to the characterization of experimental aneurysms and follow-up after endovascular repair

    International Nuclear Information System (INIS)

    Experimental and simulation studies were conducted to noninvasively characterize abdominal aneurysms with ultrasound (US) elastography before and after endovascular treatment. Twenty three dogs having bilateral aneurysms surgically created on iliac arteries with venous patches were investigated. In a first set of experiments, the feasibility of elastography to differentiate vascular wall elastic properties between the aneurismal neck (healthy region) and the venous patch (pathological region) was evaluated on six dogs. Lower strain values were found in venous patches (p < 0.001). In a second set of experiments, 17 dogs having endovascular repair (EVAR) by stent graft (SG) insertion were examined three months after SG implantation. Angiography, color Doppler US, examination of macroscopic sections and US elastography were used. The value of elastography was validated with the following end points by considering a solid thrombus of a healed aneurysm as a structure with small deformations and a soft thrombus associated with endoleaks as a more deformable tissue: (1) the correlation between the size of healed organized thrombi estimated by elastography and by macroscopic examinations; (2) the correlation between the strain amplitude measured within vessel wall elastograms and the leak size; and (3) agreement on the presence and size of endoleaks as determined by elastography and by combined reference imaging modalities (angiography + Doppler US). Mean surfaces of solid thrombi estimated with elastography were found correlated with those measured on macroscopic sections (r = 0.88, p < 0.001). Quantitative strain values measured within the vessel wall were poorly linked with the leak size (r = 0.12, p = 0.5). However, the qualitative evaluation of leak size in the aneurismal sac was very good, with a Kappa agreement coefficient of 0.79 between elastography and combined reference imaging modalities. In summary, complementing B-scan and color Doppler, noninvasive US

  12. CT evaluation of anastomotic aneurysms following vascular reconstructive procedures

    International Nuclear Information System (INIS)

    Despite improved surgical techniques, anastomotic aneurysms continue to complicate vascular reconstructive procedures. The role of CT in this condition has not been previously emphasized. Twenty-one patients with 31 anastomotic aneurysms following aortofemoral or aortoiliac graft placement were evaluated by CT and angiography and four by CT alone. CT contributed significant addiitional information affecting the surgical approach to the lesion in six patients. CT was superior in defining local complications, the longitudinal extent of the aneurysms, and in demonstrating mural thrombus, which occurred at 13 anastomoses. CT should be performed in conjunction with angiography in the evaluation of this condition

  13. 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...

  14. [Novel strategy for thoracoabdomianl aortic aneurysm repair; intraoperative selective perfusion of the Adamkiewicz artery].

    Science.gov (United States)

    Ohtsubo, S; Furukawa, K; Rikitake, K; Okazaki, Y; Sato, M; Natsuaki, M; Matsumoto, K; Kato, A; Kudo, S; Itoh, T

    2004-04-01

    We report our method for delineating the Adamkiewicz artery using multidetector row computed tomography (MDCT) with selective perfusion using a distal perfusion cannula that is clinically available for off-pump coronary artery bypass (OPCAB). The tip of a distal perfusion catheter (Medtronic Quickflow, Minneapolis) designed for OPCAB was applicable for selective perfusion of the segmental arteries. The femoro-femoral venoarterial bypass was branched off into selective perfusion of the segmental arteries, using an independent roller pump and heat exchanger. Our method of visualization of the Adamkiewicz artery was MDCT scanning with injection of contrast medium directly into the proximal descending aorta: namely, "CT during aortography". Lower descending aorta to abdominal aorta (the range involving the aneurysm) was scanned in a cephalad-to-caudal direction using a detector collimation of 4 x 1.25 mm with a table speed of 9.4 mm/sec, pitch of 6, and image thickness of 1.25 mm. All images were reviewed on a workstation to investigate the continuity between the Adamkiewicz artery and its proximal segmental artery with paging, mulitplanar reformation and curved planar reformation. Distal perfusion cannulae of 2.0 mm in diameter were inserted into the respective intercostal arteries. 4-0 polyethylene sutures were placed to tourniquet the catheters. Segmental arteries were perfused with total flow of approximately 80 ml/min at a circuit pressure of 120 mmHg. Reattachment of the ninth intercostal arteries related to the Adamkiewicz artery was carried out. A total of 6 consecutive 6 patients with thoracoabdominal aortic aneurysm (TAAA) have undergone graft replacement by the methods described, since April 2002. All patients survived surgery without any neurological complications. This method is expected to minimize the ischemic time of the spinal cord and attenuate the reperfusion injury. PMID:15071861

  15. Indications for and outcome of open AAA repair in the endovascular era.

    Science.gov (United States)

    Wieker, Carola M; Spazier, Max; Böckler, Dittmar

    2016-04-01

    The benefits, safety and efficacy of endovascular aortic aneurysm repair (EVAR) is well documented and intensively reported in multiple randomized trials and meta-analysis. Therefore, EVAR became the first choice of abdominal aortic aneurysms (AAA) treatment in almost 70-100% of patients. Consecutively, open repair (OR) is performed less frequently in morphologically preselected patients. Anatomical condition remains the most important factor for indication for OR. Especially unfavorable intrarenal landing zone based on difficult neck anatomy like very short neck or excessive neck angulation is still the most predictive factor. Furthermore, patients presenting additional iliac aneurysms, aortoiliac occlusive disease or variations of renal arteries are recommended for OR. Randomized trials like EVAR 1, DREAM and OVER from the year 2004/2005 and 2009 showed lower 30-day mortality rates in EVAR compared to OR. However, the late mortality rates after two years became equal in both treatment options. Furthermore, reinterventions after EVAR occur more frequently than after OR. Analysis from our own data showed a higher 30-day mortality in the patients who underwent OR in the endovascular era (15% vs. 2.5%), however the number of emergency open AAA repair because of ruptured aneurysms was much higher in the endovascular era (32.5% vs. 5%). In conclusion, treatment of AAA has changed in the past decade. Nevertheless OR of AAA still remains as a safe and durable method in experienced surgeons, even in the endovascular era. High volume centres are needed to offer the best patients' treatment providing the best postoperative outcome. Therefore OR must remain a part of fellowship training in the future. To decide the best treatment option many facts like patients' fitness and preference or finally the anatomic suitability for endovascular repair have to be considered. PMID:26822580

  16. Predictive Factors for Mortality and Morbidity of Ruptured Abdominal Aortic Aneurysm Repair

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    Manabu Shiraishi

    2012-04-01

    Conclusions: Emergency open repair can be safely performed in patients for infrarenal rAAA. In particular, we identified specific independent predictive factors of clinical examination and laboratory studies for mortality, major morbidity and renal insufficiency. [Arch Clin Exp Surg 2012; 1(2.000: 94-101

  17. Perioperative changes in coagulative and fibrinolytic function during surgical treatment of abdominal aortic aneurysm and arteriosclerosis obliterans.

    Science.gov (United States)

    Aramoto, H; Shigematsu, H; Muto, T

    1994-12-01

    To determine the factors which influence perioperative coagulative and fibrinolytic function, we studied 41 patients who underwent surgical repair of unruptured abdominal aortic aneurysm (AAA) and 30 patients who underwent arterial reconstruction for arteriosclerosis obliterans (ASO). In patients with AAA, the levels of fibrin/fibrinogen degradation products (FDP) (11.4 +/- 20.1 micrograms/ml), thrombin-antithrombin III complex (TAT) (22.0 +/- 21.8 micrograms/l), plasmin-alpha 2 plasmin inhibitor complex (PIC) (2.6 +/- 2.9 micrograms/ml) and d-dimer of cross-linked fibrin degradation products (D-D) (8.4 +/- 10.8 micrograms/ml) were elevated, particularly when the AAAs had a large mural thrombus surface area or were accompanied by aneurysm of the iliac or femoral artery. In arterial aneurysms, blood coagulability and secondary fibrinolytic activity were believed to be enhanced. In patients with ASO, the level of TAT (17.2 +/- 24.8 micrograms/l) was so elevated that they were considered to show chronic hypercoagulability. Among the ASO patients with aorto-iliac lesions, those with concomitant graft occlusion or anastomotic aneurysm had significantly elevated levels of TAT. Proximal arterial occlusion or accompanying aneurysm in the ASO patients was associated with increased levels of PIC and D-D. Postoperative fluctuations in conventional hematological variables did not differ significantly among the surgical procedures. Conventional markers showed a transient decrease due to consumption during surgery, and a subsequent recovery or an actual increase within several days after surgery.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7737753

  18. Predictors of Outcome after Open Repair of Ruptured Abdominal Aortic Aneurysms

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    Hao-Jui Li

    2011-10-01

    Full Text Available Background: To determine predictors associated with early hospital death, 30-day mortality, and long-term survival after open surgical treatment of ruptured abdominal aortic aneurysms (RAAAs.Methods: A retrospective chart review of 127 consecutive patients who received opensurgical treatment of a RAAA at Chang Gung Memorial Hospital, Taiwan,from February 1994 to May 2007. Data recorded included patient characteristics, medical history, perioperative variables, and outcomes.Results: There were 104 men and 23 women with a mean age of 70Ų12 years in theanalysis. Patients with RAAAs were classified into two groups; 100 (78.7%patients were classified as group I (hemodynamically stable, and 27 (21.3%patients were classified as group II (hemodynamically unstable at arrival.T h e 3 0 - d a y mo r t a l i t y wa s 2 2% f o r g r o u p I a n d 7 4 . 1% f o r g r o u p I I .Multivariate analysis identified age > 75 years old (odds ratio [OR], 0.083;95% confidence interval [CI] 0.02-0.36, hemodynamically unstable state(OR, 0.081; 95% CI 0.016-0.4, blood transfusion > 5 L (OR, 0.14; 95% CI0.038-0.54, intraperitoneal rupture (OR, 7.2; 95% CI 1.4-36, urine output 75 years old, intraperitoneal rupture, lowintraoperative urine output, and suprarenal cross-clamping.

  19. Coagulation and fibrinolysis after open infrarenal abdominal aortic aneurysm repair in a long-term perspective.

    Science.gov (United States)

    Holmberg, A; Bergqvist, D; Siegbahn, A

    1999-10-15

    In patients with abdominal aortic aneurysms (AAA) the coagulation and fibrinolytic systems have been found to be activated preoperatively. Does the increased activity of the coagulation and fibrinolytic systems persist after AAA surgery in a long-term perspective? Prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), tissue plasminogen activator (tPA), human plasminogen activator inhibitor type 1, and human cross-linked fibrin degradation product (D-dimer) were analysed in 18 patients after open AAA surgery (postop-AAA). The median time between surgery and blood sampling was 19 months (range, 5-37 months). Comparisons were made with both preoperative values of 23 patients with AAA (preop-AAA) as well as 20 age-matched healthy controls (AMC). F1+2, TAT, and D-dimer in preop-AAA were significantly higher compared to AMC (pD-dimer). However, TAT and D-dimer levels were still higher in postop-AAA than in AMC (paneurysmal sac but still higher than in a nonaneurysmal aorta. PMID:10574587

  20. Predictive Factor for Mortality and Morbidity of Abdominal Aortic Aneurysm Repair

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    Manabu Shiraishi

    2013-02-01

    Conclusions: Open repair and EVAR can both be safely performed in patients treated for elective and emergency infrarenal AAA. EVAR has perioperative advantages of reduced blood loss and blood transfusion, as well as decreased mortality and duration of post-operative hospital stay. In particular, we identified specific independent predictive factors of serum chemistry values for mortality and renal insufficiency. [Arch Clin Exp Surg 2013; 2(1.000: 8-15

  1. 腹主动脉瘤开放手术时机选择%Opportunity of open surgical repair in abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    梁卫; 张纪蔚

    2012-01-01

    It is the core concept to exclude aneurysm and reconstruct the abdominal aorta for abdominal aortic aneurysm (AAA) treatment. The purpose of the treatment is to prevent aneurysm rupture. Evaluation of the risk of AAA rupture and the patients' condition are the key for the indication of operation. Open surgical repair (OR) and endovascular aneurysm repair (EVAR) are two treatments for AAA. Though the early result of the EVAR is better than that of the OR according to the multi-center clinical studies, the mid-result and long-result are the same between two treatments. For the hostile anatomy, OR is better than EVAR for AAA treatment. The OR still has the applicability for the AAA treatment.%腹主动脉瘤瘤腔隔绝和动脉血管的重建是治疗腹主动脉瘤的核心概念,治疗的根本目的在于防止动脉瘤的破裂.手术指征的关键在于术前评估动脉瘤破裂危险性和病人全身状况.目前的治疗方法有传统的开放手术和近年迅速发展的腔内修复术.国外多中心研究发现虽然腔内治疗的近期效果较传统开放手术好,但两种治疗方法的中远期结果差异并无统计学意义.同时,对于特殊解剖形态的腹主动脉瘤,传统开放手术更具优势.因此,传统的开放手术治疗腹主动脉瘤仍具有临床应用的价值.

  2. Should Endovascular Repair Be Reimbursed for Low Risk Abdominal Aortic Aneurysm Patients? Evidence from Ontario, Canada

    Directory of Open Access Journals (Sweden)

    Jean-Eric Tarride

    2011-01-01

    Full Text Available Background. This paper presents unpublished clinical and economic data associated with open surgical repair (OSR in low risk (LR patients and how it compares with EVAR and OSR in high risk (HR patients with an AAA > 5.5 cm. Design. Data from a 1-year prospective observational study was used to compare EVAR in HR patients versus OSR in HR and LR patients. Results. Between 2003 and 2005, 140 patients were treated with EVAR and 195 with OSR (HR: 52; LR: 143. The 1-year mortality rate with EVAR was statistically lower than HR OSR patients and comparable to LR OSR patients. One-year health-related quality of life was lower in the EVAR patients compared to OSR patients. EVAR was cost-effective compared to OSR HR but not when compared to OSR LR patients. Conclusions. Despite a similar clinical effectiveness, these results suggest that, at the current price, EVAR is more expensive than open repair for low risk patients.

  3. “Open” repair of ruptured thoracoabdominal aortic aneurysm (experience of 51 cases)

    Science.gov (United States)

    Zanetti, Piero Paolo; Walas, Ryszard; Cebotaru, Theodor; Popa, Calin; Vintila, Bogdan; Steiu, Flaviu

    2015-01-01

    Introduction Surgical treatment of toracoabdominal aortic aneurysms (TAAA) represents a difficult problem for the vascular surgeon and may become a formidable challenge in an emergency procedure. In patient with hemodynamic instability, protective measures as cerebral spinal fluid drainage and bio-pump against spinal cord, visceral and renal ischemia, may be ineffective or impracticable. Material and methods We report our experience of 51 emergency-operated patients with TAAA out of 660 treated between 1994 and 2014; 48 patients (94%) were hemodynamically unstable, 3 (6%) were hemodynamically stable. The TAAA patients were evaluated, according to Crawford classification, as: 18 type I, 13 type II, 15 type III, 5 type IV. Results Overall mortality was 23 cases out of 51 (43.1%); 8 deaths occurred during the surgical procedure and 14 in the postoperative period. Early deaths, subdivided by Crawford TAAA classification, were: type I 9/18 (50%), type II 9/13 (69.2%), type III 7/15 (46.6%), type IV 3/5 (60%). Paraplegia-paraparesis developed in 6 cases out of 43 (16.2%), excluding 8 deaths during the operative procedure. Acute renal failure was observed in 8 out of 43 patients (18.6%). Dialysis was found to be a risk factor for hospital mortality (p = 0.03). Pulmonary insufficiency was diagnosed in 15 patients out of 43 (34.8%), and 5 patients (15.5%) needed tracheostomy, out of whom 3 died (p = 0.04%). Postoperative bleeding was present in 8 cases out of 43 (18.6%). Inferior laryngeal nerve palsy was present in 6 cases out of 43 (13.5%). The follow-up period comprised 1-3-5-10 years postoperative follow-up. The actuarial survival rate of patients discharged from hospital was respectively 75%, 63%, 48%, 35%. Conclusions In the literature there are very few studies published on emergency treatment for TAAA. Having usually low numbers of patients in the groups wider experiences are still needed to give more light on the pathophysiology and surgical treatment of this type

  4. 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.

  5. Sealing zones have a greater influence than iliac anatomy on the occurrence of limb occlusion following endovascular aortic aneurysm repair.

    Science.gov (United States)

    Daoudal, Anne; Cardon, Alain; Verhoye, Jean-Philippe; Clochard, Elodie; Lucas, Antoine; Kaladji, Adrien

    2016-06-01

    Limb occlusion is a well-known complication following endovascular aortic aneurysm repair (EVAR), and it very often leads to reoperation. The aim of this study is to identify predictive factors for limb occlusion following EVAR. Two hundred and twenty-four patients undergoing EVAR between 2004 and 2012 were included in this retrospective study. Demographics, anatomic, and follow-up data were compared between two groups (with or without thrombosis). Preoperative anatomy was analyzed with a dedicated workstation, using the Society of Vascular Surgery reporting standards. Eleven (4.9%) patients presented with a limb occlusion during follow-up (46 ± 12 months). Univariate analyses were first performed to investigate the influence of preoperative variables on limb occlusion. Then, variables with a p value <0.1 were included in the multivariate analysis and showed that in the occlusion group there was a greater rate of chronic renal failure (18.2% vs. 3.8%, p = 0.012), a more frequent occurrence of distal landing zones in the external iliac artery (15.4% vs. 2.1%, p = 0.006), and a smaller aortic neck diameter (21.0 ± 2.9 mm vs. 23.6 ± 3.3 mm, p = 0.014). Although iliac anatomy does not appear to have a significant influence on limb occlusion rate in the multivariate analysis, proximal and distal sealing zones appear to be involved in this complication. PMID:26084467

  6. Buttock Claudication and Erectile Dysfunction After Internal Iliac Artery Embolization in Patients Prior to Endovascular Aortic Aneurysm Repair

    International Nuclear Information System (INIS)

    Coil embolization of the internal iliac artery (IIA) is used to extend the application of endovascular aneurysm repair (EVAR) in cases of challenging iliac anatomy. Pelvic ischemia is a complication of the technique, but reports vary as to the rate and severity. This study reports our experience with IIA embolization and compares the results to those of other published series. The vascular unit database of the Leicester Royal Infirmary was used to identify patients who had undergone IIA coil embolization prior to EVAR. Data were collected from hospital case notes and by telephone interviews. Thirty-eight patients were identified; 29 of these were contactable by telephone. A literature search was performed for other studies of IIA embolization and the results were pooled. In this series buttock claudication occurred in 55% (16 of 29 patients) overall: in 52% of unilateral embolizations (11 of 21) and 63% of bilateral embolizations (5 of 8). New erectile dysfunction occurred in 46% (6 of 13 patients) overall: in 38% of unilateral embolizations (3 of 8) and 60% of bilateral embolizations (3 of 5). The literature review identified 18 relevant studies. The results were pooled with our results, to give 634 patients in total. Buttock claudication occurred in 28% overall (178 of 634 patients): in 31% of unilateral embolizations (99 of 322) and 35% of bilateral embolizations (34 of 98) (p = 0.46, Fisher's exact test). New erectile dysfunction occurred in 17% overall (27 of 159 patients): in 17% of unilateral embolizations (16 of 97) and 24% of bilateral embolizations (9 of 38) (p = 0.33). We conclude that buttock claudication and erectile dysfunction are frequent complications of IIA embolization and patients should be counseled accordingly.

  7. Efficacy and Safety of Augmenting the Preclose Technique with a Collagen-Based Closure Device for Percutaneous Endovascular Aneurysm Repair

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Rafiuddin, E-mail: rafiuddin.patel@ouh.nhs.uk [Oxford University Hospitals NHS Trust, Department of Radiology, John Radcliffe Hospital (United Kingdom); Juszczak, Maciej T. [Oxford University Hospitals NHS Trust, Department of Vascular Surgery, John Radcliffe Hospital (United Kingdom); Bratby, Mark J. [Oxford University Hospitals NHS Trust, Department of Radiology, John Radcliffe Hospital (United Kingdom); Sideso, Ediri [Oxford University Hospitals NHS Trust, Department of Vascular Surgery, John Radcliffe Hospital (United Kingdom); Anthony, Susan; Tapping, Charles R. [Oxford University Hospitals NHS Trust, Department of Radiology, John Radcliffe Hospital (United Kingdom); Handa, Ashok; Darby, Christopher R.; Perkins, Jeremy [Oxford University Hospitals NHS Trust, Department of Vascular Surgery, John Radcliffe Hospital (United Kingdom); Uberoi, Raman [Oxford University Hospitals NHS Trust, Department of Radiology, John Radcliffe Hospital (United Kingdom)

    2015-08-15

    PurposeTo report our experience of selectively augmenting the preclose technique for percutaneous endovascular aneurysm repair (p-EVAR) with an Angio-Seal device as a haemostatic adjunct in cases of significant bleeding after tensioning the sutures of the suture-mediated closure devices.Materials and MethodsProspectively collected data for p-EVAR patients at our institute were analysed. Outcomes included technical success and access site complications. A logistic regression model was used to analyse the effects of sheath size, CFA features and stent graft type on primary failure of the preclose technique necessitating augmentation and also on the development of complications.Resultsp-EVAR was attempted via 122 CFA access sites with a median sheath size of 18-French (range 12- to 28-French). Primary success of the preclose technique was 75.4 % (92/122). Angio-Seal augmentation was utilised as an adjunct to the preclose technique in 20.5 % (25/122). The overall p-EVAR success rate was 95.1 % (116/122). There was a statistically significant relationship (p = 0.0093) between depth of CFA and primary failure of preclose technique. CFA diameter, calcification, type of stent graft and sheath size did not have significant effects on primary preclose technique failure. Overall 4.9 % (6/122) required surgical conversion but otherwise there were no major complications.ConclusionAugmentation with an Angio-Seal device is a safe and effective adjunct to increase the success rate of the preclose technique in p-EVAR.

  8. Near-infrared spectroscopy assessed cerebral oxygenation during open abdominal aortic aneurysm repair

    DEFF Research Database (Denmark)

    Sørensen, Henrik; Nielsen, H B; Secher, N H

    2016-01-01

    not prevent an increase in ScO2 by 2 % (-1 to 4; P < 0.001) as EtCO2 increased 0.5 kPa (0.1-1.0; P < 0.001) despite an increase in ventilation by 1.8 l min(-1) (0.9-2.7; P < 0.001). Changes in ScO2 related to those in EtCO2 (r = 0.41; P = 0.0001) and cerebral deoxygenation (-15 %) was noted in three......During open abdominal aortic aneurism (AAA) repair cerebral blood flow is challenged. Clamping of the aorta may lead to unintended hyperventilation as metabolism is reduced by perfusion of a smaller part of the body and reperfusion of the aorta releases vasodilatory substances including CO2. We...... intend to adjust ventilation according end-tidal CO2 tension (EtCO2) and here evaluated to what extent that strategy maintains frontal lobe oxygenation (ScO2) as determined by near infrared spectroscopy. For 44 patients [5 women, aged 70 (48-83) years] ScO2, mean arterial pressure (MAP), EtCO2, and...

  9. Influence of endoleaks on aneurysm volume and hemodynamics after endovascular aneurysm repair; Einfluss von Typ-II-Endoleaks auf die Groessenaenderung und Haemodynamik experimenteller Aortenaneurysmen nach endovaskulaerer Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, M.B.; Welter, B.; Schmenger, P.; Thelen, M. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Dueber, C. [Universitaetsklinikum Mannheim gGmbH (Germany). Inst. fuer Diagnostische Radiologie; Neufang, A. [Mainz Univ. (Germany). Klinik fuer Herz-, Thorax- und Gefaesschirurgie

    2003-12-01

    Purpose: To evaluate the aneurysm volume and the intra-aneurysmatic pressure and maximal pressure pulse (dp/dtmax) in completely excluded aneurysms and cases with endoleaks. Materials and Methods: In 36 mongrel dogs, experimental autologous aneurysms were treated with stent-grafts. All aortic side branches were ligated in 18 cases (group I) but were preserved in group II (n=18). Aneurysm volumes were calculated from CT scans before and after intervention, and from follow-up CT scans at 1 week, 6 weeks and 6 months. Finally, for hemodynamic measurements, manometer-tipped catheters were introduced into the excluded aneurysm sac (group I and II), selectively in endoleaks (group II), and intraluminally for aortic reference measurement. Systemic hypertension was induced by volume load and pharmacologic stress. Pressure curves and dp/dt were simultaneously recorded and the ratios of aneurysm pressure to systemic reference pressure calculated. Results: At follow-up, type-II, endoleaks were excluded in all cases of group I by selective angiography. In contrast, endoleaks were evident in all cases of group II. Volumetric analysis of the aneurysms showed a benefit for group I with an improved aneurysm shrinkage: {delta}Volume +0.08%, -1.62% and -9.76% at 1 week, 6 weeks and 6 months follow-up (median, group I), compared to +1.43%, +0.67%, and -4.04% (group II), p<0.05. In case of complete aneurysm exclusion the ratio of systolic aneurysm pressure to systemic reference pressure was 0.662, 0.575 and 0.385 (median) at 1 week, 6 weeks and 6 months. The corresponding dp/dtmax ratios were 0.12, 0.07 and 0.04, respectively. However, within endoleaks selective measurements showed significantly increased pressure load: the ratios of systolic endoleak pressure to systemic reference pressure and the corresponding ratios for dp/dtmax were 0.882 and 0.913 (median), respectively. These hemodynamic findings were linear from hypotension, physiologic blood pressure to hypertension. (orig

  10. A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms

    Institute of Scientific and Technical Information of China (English)

    HAN Yan-shuo; ZHANG Jian; XIA Qian; LIU Zhi-min; ZHANG Xiao-yu; WU Xiao-yu; LUN Yu

    2013-01-01

    Background Although it is generally acknowledged that patients with ruptured abdominal aortic aneurysm (rAAA)obtain the greatest benefit from endovascular repair (EVAR),convincing evidence on the medium-long term effect is lacking.The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair (OSR).Methods A search of publicly published literature was performed.Based on an inclusion and exclusion criteria,a systematic meta-analysis was undertaken to compare patient characteristics,complications,short term mortality and medium-long term outcomes.A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences.A quantitative method was used to analyze the differences between these two methods.Results A search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA (435 EVAR and 778 OSR) would be suitable for this study.Furthermore,13 Chinese studies were included,including 267 patients with rAAA totally,among which 238 patients received operation.The endovascular method was associated with more respiratory diseases before treatment (OR=1.81,P=0.01),while there are more patients with hemodynamic instability before treatment in OSR group (OR=1.53,P=0.031).Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR (weighted mean difference (WMD) 1500 ml,P=0.014).The endovascular method was associated with a shorter stay in intensive care (WMD 2.34 days,P <0.001) and a shorter total postoperative stay (WMD 6.27 days,P <0.001).The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group (OR=0.48,P <0.001 and OR=0.28,P=0.043,respectively).The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR,and the odds ratio was 0.53 (95% confidence interval (CI) 0.41-0.70,P <0.001).There was not,however,any significant reduction in

  11. 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

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

    International Nuclear Information System (INIS)

    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.

  13. 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.

  14. Six years' experience with prostaglandin I2 infusion in elective open repair of abdominal aortic aneurysm: a parallel group observational study in a tertiary referral vascular center.

    LENUS (Irish Health Repository)

    Beirne, Chris

    2008-11-01

    The prostaglandin I(2) (PGI(2)) analogue iloprost, a potent vasodilator and inhibitor of platelet activation, has traditionally been utilized in pulmonary hypertension and off-label use for revascularization of chronic critical lower limb ischemia. This study was designed to assess the effect of 72 hr iloprost infusion on systemic ischemia post-open elective abdominal aortic aneurysm (EAAA) surgery. Between January 2000 and 2007, 104 patients undergoing open EAAA were identified: 36 had juxtarenal, 15 had suprarenal, and 53 had infrarenal aneurysms, with a mean maximal diameter of 6.9 cm. The male-to-female ratio was 2.5:1, with a mean age of 71.9 years. No statistically significant difference was seen between the study groups with regard to age, sex, risk factors, American Society of Anesthesiologists (ASA) grade, or diameter of aneurysm repaired. All emergency, urgent, and endovascular procedures for aneurysms were excluded. Fifty-seven patients received iloprost infusion for 72 hr in the immediate postoperative period compared with 47 patients who did not. Patients were monitored for signs of pulmonary, renal, cardiac, systemic ischemia, and postoperative intensive care unit (ICU) morbidity. Statistically significantly increased ventilation rates (p=0.0048), pulmonary complication rates (p=0.0019), and myocardial ischemia (p=0.0446) were noted in those patients not receiving iloprost. These patients also had significantly higher renal indices including estimate glomerular filtration rate changes (p=0.041) and postoperative urea level rises (p=0.0286). Peripheral limb trashing was noted in five patients (11.6%) in the non-iloprost group compared with no patients who received iloprost. Increased rates of transfusion requirements and bowel complications were noted in those who did not receive iloprost, with their ICU stay greater than twice that of iloprost patients. All-cause morbidity affected 67% of patients not receiving iloprost compared to 40% who did

  15. 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

  16. True aneurysm of brachial artery.

    Science.gov (United States)

    Hudorović, Narcis; Lovričević, Ivo; Franjić, Dario Bjorn; Brkić, Petar; Tomas, Davor

    2010-10-01

    True upper extremity peripheral artery aneurysms are a rarely encountered arterial disorder. Following computer-tomography angiographic (CT-a) imaging examination, true saccular aneurysm, originating from the left brachial artery was diagnosed in the 77-year-old female without history of trauma. The aneurysm was resected by surgical intervention, and primary repair of the brachial artery was performed by interposition of a part of great saphenous vein harvested from the left groin and creation of two end-to-end anastomoses between interposition graft and previously resected part of brachial artery. No complication was observed during the follow-up. Surgical intervention for upper extremity aneurysms should be initiated without delay. Factors combined with minimal morbidity associated with repair suggest that surgical repair should be performed routinely for true upper extremity arterial aneurysms. PMID:20865459

  17. Innovation in aortoiliac stenting: an in vitro comparison

    Science.gov (United States)

    Groot Jebbink, E.; Goverde, P. C. J. M.; van Oostayen, J. A.; Reijnen, M. M. P. J.; Slump, C. H.

    2014-03-01

    Aortoiliac occlusive disease (AIOD) may cause disabling claudicatio, due to progression of atherosclerotic plaque. Bypass surgery to treat AIOD has unsurpassed patency results, with 5-year patency rates up to 86%, at the expense of high complication rates (local and systemic morbidity rate of 6% and 16%). Therefore, less invasive, endovascular treatment of AOID with stents in both iliac limbs is the first choice in many cases, however, with limited results (average 5-year patency: 71%, range: 63-82%). Changes in blood flow due to an altered geometry of the bifurcation is likely to be one of the contributing factors. The aim of this study is to compare the geometry and hemodynamics of various aortoiliac stent configurations in vitro. Transparent vessel phantoms mimicking the anatomy of the aortoiliac bifurcation are used to accommodate stent configurations. Bare Metal Kissing stents (BMK), Kissing Covered (KC) stents and the Covered Endovascular Reconstruction of the Aortic Bifurcation (CERAB) configuration are investigated. The models are placed inside a flow rig capable of simulating physiologic relevant flow in the infrarenal area. Dye injection reveals flow disturbances near the neobifurcation of BMK and KC stents as well. At the radial mismatch areas of the KC stents recirculation zones are observed. With the CERAB configuration no flow reversal or large disturbances are observed. In conclusion, dye injection reveals no significant flow disturbances with the new CERAB configuration as seen with the KC and BMK stents.

  18. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... these microchips and the sort of next generation nanotechnology, so to speak. So I think what we’ ... with a little bit of injection of dye material. And I don’t have a way to ...

  19. Aortic Aneurysm Repair

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    Full Text Available ... as an important landmark in this procedure. So let’s go back now and learn a little bit about ... re going to do is actually deploy this. Let’s go ahead and record it while we’re working, ...

  20. Aortic Aneurysm Repair

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    Full Text Available ... the Institute and in other places around the world is the less invasive treatment of this type ... that goes down to the right leg and one that goes down to the left leg. These ...

  1. Aortic Aneurysm Repair

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    Full Text Available ... get for other reasons, but we use three-dimensional reconstruction and we can reconstruct all the blood ... actually participated in a lot of the original research that was done to get these devices approved. ...

  2. Aortic Aneurysm Repair

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    Full Text Available ... is a CT scan that we performed several days ago. So having this type of information is ... this patient will go home likely in two days time. Come back to me. The patient will ...

  3. Aortic Aneurysm Repair

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    Full Text Available ... the officer and we follow the patient with CAT scan. Is that right, Ignacio? Yeah. Usually we ... about the second year, it’s usually an annual CAT scan just to check position of the endograft. ...

  4. Aortic Aneurysm Repair

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    Full Text Available ... the way to screen is with a simple ultrasound. But sometimes a CT scan can show that, ... can integrate CAT scan imaging. We can integrate ultrasound imaging, the patient’s blood pressure, and so it’s ...

  5. Aortic Aneurysm Repair

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    Full Text Available ... what we’re doing is we’re actually reading that signal. And you can see our monitor ... institute, one of our main goals is advancing research in endovascular therapy. And to do this we’ ...

  6. Aortic Aneurysm Repair

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    Full Text Available ... microchip that acts a little bit like a cell phone technology. We’ll show you how that ... a little radio transmitter signal just like a cell phone might. And what we’re doing is ...

  7. Aortic Aneurysm Repair

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    Full Text Available ... you may get for other reasons, but we use three-dimensional reconstruction and we can reconstruct all ... What we’re going to do is just use this image where we can see everything superimposed ...

  8. Aortic Aneurysm Repair

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    Full Text Available ... saw, that big bubble that we saw, actually thrombosis. So in the process of thrombosing or clotting ... up being good candidates for this type of therapy. We would encourage you to seek the least ...

  9. Aortic Aneurysm Repair

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    Full Text Available ... And what’s happening right now is for all practical purposes, the procedure itself, the treatment of this ... institute, one of our main goals is advancing research in endovascular therapy. And to do this we’ ...

  10. Aortic Aneurysm Repair

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    Full Text Available ... that because we’re doing this with such holes in the groin, this really offers the patient a tremendous advantage over having his bellow open. The recovery time for what we’re doing here is going ...

  11. Aortic Aneurysm Repair

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    Full Text Available ... is that those of us that do image-guided therapy depend on all these sophisticated ways of ... that we have when we do these image-guided therapies and treatment of stent graft. So I ...

  12. Aortic Aneurysm Repair

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    Full Text Available ... experience here. We have been part of a number of the clinical trials that have been run through the FDA to get these devices approved. Yeah, I do that. Let me have the dilator first. Dilator first. Jim? Yes, Barry. So what we’ ...

  13. Aortic Aneurysm Repair

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    Full Text Available ... red tube that represents an artery. The arteries carry blood in your body. They carry oxygen and blood to various organs. These arteries ... with such holes in the groin, this really offers the patient a tremendous advantage over having his ...

  14. Aortic Aneurysm Repair

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  15. Aortic Aneurysm Repair

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  16. Aortic Aneurysm Repair

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    Full Text Available ... the less invasive treatment of this type of problem with something called “stent grafts.” The next slide ... quick procedure to replace a major life-threatening problem in the patient’s abdomen. So you can see ...

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  19. Aortic Aneurysm Repair

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  20. Aortic Aneurysm Repair

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  1. Aortic Aneurysm Repair

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    Full Text Available ... for all of you listening, you can ask online. Just click the “Ask a question” button, and ... we’re just looking, we’re trying to measurement. We’re actually doing measurements inside of these ...

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    Full Text Available ... this a little bit. You can see that large sheathe come down. I’m just going to ... patient. And now look, we have this very large device inside the patient, and it went in ...

  13. Aortic Aneurysm Repair

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    Full Text Available ... using to inject dye and also to do measurements using our computer techniques that are going on here. So what I’m going to do now is using the fluoroscopy, using the X-ray fluoro, I’m going to unsheathe this a ...

  14. Aortic Aneurysm Repair

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    Full Text Available ... the ability to be shaped differently at different temperatures, so we can make it very, very small. ... we’re just looking, we’re trying to measurement. We’re actually doing measurements inside of these ...

  15. Aortic Aneurysm Repair

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    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 ...

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  17. Aortic Aneurysm Repair

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    Full Text Available ... be done -- this takes a lot of real skill with your hands and your hand/eye coordination. ... here, including our anesthesia teams, all of our nurses and our technologists and a lot of people ...

  18. Aortic Aneurysm Repair

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  19. Aortic Aneurysm Repair

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  20. Aortic Aneurysm Repair

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  1. Aortic Aneurysm Repair

    Science.gov (United States)

    ... invasive treatment of this type of problem with something called “stent grafts.” The next slide shows how ... So, again, to show you, how does this something that big -- how does something as big as ...

  2. Aortic Aneurysm Repair

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    Full Text Available ... into the patient’s body through a tiny little hole? Well this device, as you saw, is actually ... and we can introduce it through this small hole. Now the device is actually made of -- this ...

  3. Aortic Aneurysm Repair

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    Full Text Available ... in Miami. My name is Dr. James Benenati. I’m an interventional radiologist here at the Institute, and I want to become you to our live webcast. ... endograft,” which is sometimes called the “stent graft.” I want to introduce to you two of my ...

  4. Aortic Aneurysm Repair

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    Full Text Available ... one more reason before we’re ready to employee. Okay. Apnea, please. What I’m doing is ... devices in 1999, and then other devices, next-generation devices such as this subsequently. So we’re ...

  5. Aortic Aneurysm Repair

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    Full Text Available ... of this slide, you can see a smooth red tube that represents an artery. The arteries carry ... wave form is what we started with. The red one, just below it, is what happened after ...

  6. Aortic Aneurysm Repair

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  7. Aortic Aneurysm Repair

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    Full Text Available ... here, including our anesthesia teams, all of our nurses and our technologists and a lot of people ... seek the least invasive therapy for your own care as long as you’re an appropriate patient. ...

  8. Aortic Aneurysm Repair

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  9. Aortic Aneurysm Repair

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    Full Text Available ... stent grafts.” The next slide shows how this works. Here you can see the artery that’s diseased ... this you’ll start and see as we work through the skin into the abdomen, you can ...

  10. Aortic Aneurysm Repair

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    Full Text Available ... catheters and our wires and do everything. We leave the sheathe in the artery, and that’s what ... constantly taking things in and out. But we leave this one conduit, this one small tubing in ...

  11. Aortic Aneurysm Repair

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    Full Text Available ... I’m learning from this movie as we looking at these images is that the device is ... this and everyone is watching this, you’re looking on a TV screen inside the patient’s body, ...

  12. Aortic Aneurysm Repair

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    Full Text Available ... dye and also to do measurements using our computer techniques that are going on here. So what ... I’m going to show a very important part of the procedure where we actually use a ...

  13. Aortic Aneurysm Repair

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    Full Text Available ... be done -- this takes a lot of real skill with your hands and your hand/eye coordination. ... about two inches. Dr. Rua did an incredible job with those. And he has hardly anything we ...

  14. Aortic Aneurysm Repair

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    Full Text Available ... re just dilating this to just get very good attachment of the device to the wall, and now we’re deflating the balloon. Barry, as you do that, one thing I think we failed to mention, it’s very ...

  15. Aortic Aneurysm Repair

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    Full Text Available ... placing that paperclip-shaped sensor, which is really nano or micro technology that will stay in the ... is with a simple ultrasound. But sometimes a CT scan can show that, which is how most ...

  16. Aortic Aneurysm Repair

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  17. Aortic Aneurysm Repair

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    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. ...

  18. Aortic Aneurysm Repair

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  19. Aortic Aneurysm Repair

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    Full Text Available ... dye and also to do measurements using our computer techniques that are going on here. So what ... of see it. It’s not exactly X-ray vision, but it’s something similar to X-ray vision ...

  20. Aortic Aneurysm Repair

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    Full Text Available ... Is that right, Ignacio? Yeah. Usually we do serial surveillance every three to six months, depending on ... here is this collaborative effort using the best medical specialists we have. We have interventional radiology, vascular ...

  1. Aortic Aneurysm Repair

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    Full Text Available ... training. Both the doctors in the room are board certified and highly trained to do just this ... we have. We have interventional radiology, vascular surgeons, board certified and highly trained. And one of the ...

  2. Aortic Aneurysm Repair

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    Full Text Available ... Vascular Institute is that we have a very level of expertise. We’ve done almost a thousand ... possible results for our patients with the least level of invasiveness. So here you can see the ...

  3. Aortic Aneurysm Repair

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    Full Text Available ... it actually has the ability to be shaped differently at different temperatures, so we can make it ... that all of you have been able to learn something from this experience. Certainly our principle focus ...

  4. Aortic Aneurysm Repair

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    Full Text Available ... left side you can see this tube-like structure. This is a main blood vessel that runs ... treat conservatively and we’ll just watch them. But the two most important factors in terms of ...

  5. Aortic Aneurysm Repair

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    Full Text Available ... each year. It affects eight percent of the population over the age of 65. It’s most common in males. There is an increasing number, due to the aging baby boomers. Next slide. The risk factors for ...

  6. Aortic Aneurysm Repair

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    Full Text Available ... sure those barbs and everything else are very well seated. Okay. Somebody needs to be grabbing images. Now for those of you just ... Okay? And in doing this, this has to be done -- this takes a lot of real skill with ... surgeon, very well trained, and it takes very special training. It’s ...

  7. Aortic Aneurysm Repair

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    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 ...

  8. Aortic Aneurysm Repair

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    Full Text Available ... watch just one second here. Oh, it looks beautiful. Very nice. So you can breathe. Yeah. So ... now we can have apnea, please. That’s really beautiful, Barry. Now we don’t see that sack ...

  9. Aortic Aneurysm Repair

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    Full Text Available ... Institute here in Miami. My name is Dr. James Benenati. I’m an interventional radiologist here at ... arteries carry blood in your body. They carry oxygen and blood to various organs. These arteries have ...

  10. Aortic Aneurysm Repair

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    Full Text Available ... pen is here, he’s placing that paperclip-shaped sensor, which is really nano or micro technology that ... no reaction, no allergic reaction. It’s inert. But sensor will allow us to always come back and ...

  11. Aortic Aneurysm Repair

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    Full Text Available ... getting that set up, for all of you listening, you can ask online. Just click the “Ask ... be done -- this takes a lot of real skill with your hands and your hand/eye coordination. ...

  12. Aortic Aneurysm Repair

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  13. Aortic Aneurysm Repair

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    Full Text Available ... places around the world is the less invasive treatment of this type of problem with something called “ ... what we’re going to demonstrate today in treatment of this patient. So why don’t we ...

  14. Aortic Aneurysm Repair

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    Full Text Available ... dye and also to do measurements using our computer techniques that are going on here. So what ... ten, okay. Twelve, okay. Let me have the super stiff. Okay. Jim, what we’re doing is ...

  15. Aortic Aneurysm Repair

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    Full Text Available ... two different components, and essentially we place a new tube inside the patient’s diseased tubing. And this ... really very exciting, Barry, because this is a new technology that really makes follow up for the ...

  16. Aortic Aneurysm Repair

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    Full Text Available ... is nickel titanium, and it actually has the ability to be shaped differently at different temperatures, so ... actually participated in a lot of the original research that was done to get these devices approved. ...

  17. Aortic Aneurysm Repair

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    Full Text Available ... black marks on the screen. And I’m positioning the graft on the patient’s tummy here to ... we have right here. Okay. And all that positioning he was doing was just to make sure ...

  18. Aortic Aneurysm Repair

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    Full Text Available ... very well trained, and it takes very special training. It’s not just any type of surgeon. So Dr. Rua has done special type of training in vascular surgery, and Dr.. Katsen is an ...

  19. Aortic Aneurysm Repair

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    Full Text Available ... ask a question. You can just click the tab “Ask a question.” The other thing I wanted ... that all of you have been able to learn something from this experience. Certainly our principle focus ...

  20. Aortic Aneurysm Repair

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    Full Text Available ... have been part of a number of the clinical trials that have been run through the FDA ... device, we are part of a number of clinical trials looking at more difficult types of anatomy. ...

  1. Aortic Aneurysm Repair

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    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 ...

  2. Aortic Aneurysm Repair

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    Full Text Available ... can see, to the audience that there’s a paper clip. If we can show monitor camera number four, you can see all the wires curled around. But just to your left when you’re looking at the screen is something that looks like a little paperclip ...

  3. Aortic Aneurysm Repair

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    Full Text Available ... small incisions where we can kind of get access. Okay. Apnea, please. Apnea. We’re just going ... re doing right now is our sheathe, our access, our tube has sort of come back a ...

  4. Aortic Aneurysm Repair

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    Full Text Available ... 7, 2009 Good afternoon. Welcome to the Baptist Cardiac and Vascular Institute here in Miami. My name ... who is a medical director of the Baptist Cardiac and Vascular Institute, and Dr. Ignacio Rua, who ...

  5. Aortic Aneurysm Repair

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    Full Text Available ... the ability to be shaped differently at different temperatures, so we can make it very, very small. ... pen is here, he’s placing that paperclip-shaped sensor, which is really nano or micro technology that ...

  6. Aortic Aneurysm Repair

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    Full Text Available ... really makes follow up for the patients very easy. So people frequently ask after you treat a ... that all of you have been able to learn something from this experience. Certainly our principle focus ...

  7. Aortic Aneurysm Repair

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    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. ...

  8. Aortic Aneurysm Repair

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    Full Text Available ... What we’re going to do today in concept and what was really pioneered here at the ... tube inside the patient’s diseased tubing. And this concept is what we’re going to demonstrate today ...

  9. Aortic Aneurysm Repair

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    Full Text Available ... a very minimum injection of contrast just to test injection if we can get apnea for a ... seek the least invasive therapy for your own care as long as you’re an appropriate patient. ...

  10. Aortic Aneurysm Repair

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    Full Text Available ... actually participated in a lot of the original research that was done to get these devices approved. ... way in 1990 in an experimental and a research way. And we started this Cardiac and Vascular ...

  11. Aortic Aneurysm Repair

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    Full Text Available ... You can probably see that there’s a little gold ring there that shows up on the X- ... trying to get a wire directly into that gold ring, which can be a little tricky. Watch ...

  12. Aortic Aneurysm Repair

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    Full Text Available ... see that I’ve got this kind of tennis racquet device here that’s sitting on the patient’s ... needle, no contact or anything. And from this tennis racquet, you can now come over to the ...

  13. Aortic Aneurysm Repair

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    Full Text Available ... catheters and our wires and do everything. We leave the sheathe in the artery, and that’s what he’s working right 14 now to secure. And that’s what the device went through a sheathe like this. The balloons go through a ... in and out. But we leave this one conduit, this one small tubing in ...

  14. Aortic Aneurysm Repair

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    Full Text Available ... the patient’s body through a tiny little hole? Well this device, as you saw, is actually wrapped ... sure those barbs and everything else are very well seated. Okay. Somebody needs to be grabbing images. ...

  15. Aortic Aneurysm Repair

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    Full Text Available ... And one of the things that I’m learning from this movie as we looking at these ... quick procedure to replace a major life-threatening problem in the patient’s abdomen. So you can see ...

  16. Aortic Aneurysm Repair

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    Full Text Available ... Jim mentioned, most of them are detected by accident. But many times when you go to your ... issues because most of these are detected by accident. So if you happen to have a family ...

  17. Aortic Aneurysm Repair

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    Full Text Available ... re coming near the end of our presentation today. Dr. Rua, as you can see, is putting some stitches in. I’d like to thank my partner, Dr. Jim Benenati, who shared so much ...

  18. Aortic Aneurysm Repair

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    Full Text Available ... do by showing a little bit of graphic information about the device and the procedure. Jim, would ... several days ago. So having this type of information is critical for us in terms of planning ...

  19. Aortic Aneurysm Repair

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    Full Text Available ... we placed a combination of graft fabric and metal. It’s called a “stent graft” because there are ... jacket might be made out of, and the metal framework that Dr. Katsen alluding to is a ...

  20. Aortic Aneurysm Repair

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    Full Text Available ... going to -- try not the lean on the controls. Okay. What you’re going to see now ... something. We have a little bit of a control issue here. What we’re doing right now ...

  1. Aortic Aneurysm Repair

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    Full Text Available ... be done -- this takes a lot of real skill with your hands and your hand/eye coordination. ... in that these devices will last the patient’s life. They will be free of risk of rupture ...

  2. Aortic Aneurysm Repair

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    Full Text Available ... of these devices is basically sized for the individual, so we don’t just take any old ... where we go from here, we know several factors. One is that from the picture point of ...

  3. Aortic Aneurysm Repair

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    Full Text Available ... being monitored mostly by sort of X-ray vision where we’re using this X-ray equipment ... of see it. It’s not exactly X-ray vision, but it’s something similar to X-ray vision ...

  4. Aortic Aneurysm Repair

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    Full Text Available ... groin, this really offers the patient a tremendous advantage over having his bellow open. The recovery time ... just this type of work. One of the advantages we have at the Baptist Cardiac and Vascular ...

  5. Aortic Aneurysm Repair

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    Full Text Available ... placed a combination of graft fabric and metal. It’s called a “stent graft” because there are two ... runs through abdomen. At about the belly button, it divides into a vessel that goes down to ...

  6. Aortic Aneurysm Repair

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    Full Text Available ... the background, so we can see everything for orientation. And now we’ve released everything, and I’ ... that long marker that we were using for orientation, you can see that long marker came out ...

  7. Aortic Aneurysm Repair

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    Full Text Available ... exactly, the patient can breathe. So that was forward on the injector. What we’re going to ... can reduce the need for CAT scans moving forward, because this is the way we use to ...

  8. Aortic Aneurysm Repair

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    Full Text Available ... I’m just going to inject a little dye that you’re going to see. And you ... the catheter that we’re using to inject dye and also to do measurements using our computer ...

  9. Aortic Aneurysm Repair

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    Full Text Available ... of my partners who are in the room working on the patient, Dr. Barry Katsen, who is ... stent grafts.” The next slide shows how this works. Here you can see the artery that’s diseased ...

  10. Aortic Aneurysm Repair

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    Full Text Available ... And one of the things that I’m learning from this movie as we looking at these ... still doing research here to improve devices, improve outcomes, and to get the best possible results for ...

  11. Aortic Aneurysm Repair

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    Full Text Available ... can offer this patient a much less invasive therapy. This gentleman is going to be out of ... up being good candidates for this type of therapy. We would encourage you to seek the least ...

  12. Aortic Aneurysm Repair

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    Full Text Available ... now is do an angiographic run or an injection of contrast, and you’ll see that. If ... to see, I’m going to do anther injection of dye material so everyone can see better, ...

  13. Aortic Aneurysm Repair

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    Full Text Available ... Apnea, please. Okay, now what’s happening is that diagnostic catheter is coming down. I don’t want ... days, end up being good candidates for this type of therapy. We would encourage you to seek ...

  14. Aortic Aneurysm Repair

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    Full Text Available ... Apnea, please. Okay, now what’s happening is that diagnostic catheter is coming down. I don’t want ... here is this collaborative effort using the best medical specialists we have. We have interventional radiology, vascular ...

  15. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... devices in 1999, and then other devices, next-generation devices such as this subsequently. So we’re ... use these microchips and the sort of next generation nanotechnology, so to speak. So I think what ...

  16. Aortic Aneurysm Repair

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    Full Text Available ... microchip that acts a little bit like a cell phone technology. We’ll show you how that works. ... a little radio transmitter signal just like a cell phone might. And what we’re doing is we’ ...

  17. Aortic Aneurysm Repair

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    Full Text Available ... ray. And so if you show camera number one please, you’ll be able to see a number of black marks on the screen. And I’m positioning the graft on the patient’s tummy here to orient things, and you can see if ... long black marker and a short one. Perhaps you can see that a little bit ...

  18. Aortic Aneurysm Repair

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    Full Text Available ... in on this very small tube that we call a “catheter.” So Barry, where are you right ... referral to any of our physicians you can call (786) 596-2700. Or if you’re outside ...

  19. Aortic Aneurysm Repair

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    Full Text Available ... have been part of a number of the clinical trials that have been run through the FDA to ... device, we are part of a number of clinical trials looking at more difficult types of anatomy. If ...

  20. Brain aneurysm repair - discharge

    Science.gov (United States)

    ... will tell you when your dressing should be changed. DO NOT take a bath or swim for ... vomiting Eye pain Problems with your eyesight (from blindness to peripheral vision problems to double vision) Speech ...

  1. Aortic Aneurysm Repair

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    Full Text Available ... drop in the sack. Let me have a real wire quick. There you go. I’m just ... to be done -- this takes a lot of real skill with your hands and your hand/eye ... your hand there. Let me have a wire real quick. Now to go back to what you’ ...

  2. Aortic Aneurysm Repair

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    Full Text Available ... real skill with your hands and your hand/eye coordination. I just wanted to mention that the ... kinds of things, but it’s very much an eye/hand coordination. And what we’re doing here -- ...

  3. Why routine intensive care unit admission after elective open infrarenal Abdominal Aortic Aneurysm repair is no longer an evidence based practice.

    LENUS (Irish Health Repository)

    Ryan, David

    2012-01-31

    BACKGROUND: Elective open infrarenal Abdominal Aortic Aneurysm (AAA) repair is major surgery performed on high-risk patients. Routine ICU admission postoperatively is the current accepted standard of care. Few of these patients actually require a level of care that cannot be provided just as effectively in a surgical high dependency unit (HDU). Our aim was to determine, \\'can high risk patients that will require ICU admission postoperatively be reliably identified preoperatively?\\'. METHODS: A retrospective analysis of all elective open infrarenal AAA repairs in our institution over a 3-year period was performed. The Estimation of Physiological Ability and Surgical Stress (E-PASS) model was used as our risk stratification tool for predicting post-operative morbidity. Renal function was also considered as a predictor of outcome, independent of the E-PASS. RESULTS: 80% (n = 16) were admitted to ICU. Only 30% (n = 6) of the total study population necessitated intensive care. There were 9 complications in 7 patients in our study. The E-PASS comprehensive risk score (CRS)\\/Surgical stress score (SSS) were found to be significantly associated with the presence of a complication (p = 0.009)\\/(p = 0.032) respectively. Serum creatinine (p = 0.013) was similarly significantly associated with the presence of a complication. CONCLUSIONS: The E-PASS model possessing increasing external validity is an effective risk stratification tool in safely deciding the appropriate level of post-operative care for elective infrarenal AAA repairs.

  4. Resultados da cirurgia do aneurisma da aorta abdominal em pacientes jovens Outcomes after surgical repair of abdominal aortic aneurysms in young patients

    Directory of Open Access Journals (Sweden)

    Telmo P. Bonamigo

    2009-06-01

    Full Text Available CONTEXTO: A presença de aneurisma da aorta abdominal (AAA é rara em pacientes jovens. OBJETIVO: Avaliar os resultados da cirurgia do AAA em pacientes com idade BACKGROUND: Abdominal aortic aneurysms (AAA are rare in young patients. OBJECTIVE: To evaluate outcomes after AAA repair in patients aged < 50 years. METHODS: Between June 1979 and January 2008, 946 patients underwent elective repair for an infrarenal AAA performed by the first author. Of these, 13 patients (1.4% were < 50 years old at surgery. Demographic characteristics and surgical data were analyzed, as well as early and late outcomes after surgical intervention. RESULTS: Mean age was 46±3.4 years (ranging from 43 to 50 years. Most patients were men (76.9%, hypertensive (76.9% and smokers (61.5%. Perioperative morbidity and mortality rates were low (15.4% and 0%, respectively; one patient had respiratory infection and another patient had unstable angina. Median follow-up was 85.5 months, and two patients died due to ischemic cardiopathy and cerebrovascular accident during the follow-up period. CONCLUSION: AAA repair in young patients is a safe procedure, with good long-term results. In our study, there were no perioperative deaths, and a good long-term survival was observed.

  5. Clinical experience in 1040 patients with double-velour knitted Dacron vascular prostheses: With particular reference to dilatation and aneurysm formation

    OpenAIRE

    Cooley, Denton A.; Subram, Aswath; Houchin, Dena P.

    1981-01-01

    Recent reports of dilatation and aneurysm formation in Dacron fabric grafts have prompted us to review our experience with 1040 patients who received Meadox-Cooley double-velour knitted grafts over a 47-month period. Bifurcation grafts were used in 398 patients with aorto-femoral occlusive disease and in 203 patients with aortoiliac occlusive disease. Straight tube grafts were implanted in 310 patients with abdominal aortic aneurysms. Small caliber straight tube grafts were used for femoral-f...

  6. Unruptured Brain Aneurysms

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  7. Brain Aneurysm: Treatment Options

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  8. Saphenous vein graft true aneurysms: Report of nine cases and review of the literature

    Directory of Open Access Journals (Sweden)

    Davidović Lazar B.

    2004-01-01

    Full Text Available INTRODUCTION The true aneurysm formation of the autogenous saphenous vein graft (ASVG is a very rare complication after bypass surgery [1 -5]. In 1969 Pillet [1] first described a true fusiform aneurysm formation of the ASVG which had been used as a replacement of the iwured superficial femoral artery in 26-year-old male patient. We present nine cases. CASE!. A 71-year-old man with previous history of arterial hypertension and higher serum lipid level, was admitted with an asymptomatic pulsating swelling of the medial portion on the thigh. Five years ago the bellow knee F-P bypass with ASVG due to occlusive disease has been performed. The transfemoral angiography (Figure 1 showed patent graft with fusiform true aneurysm formation at its mid portion. This aneurysm has been replaced with PTFE graft. The pathohistological examination showed an atherosclerotic origin of the aneurysm. This patient died four years after operation due to myocardial infarction with patent graft. CASE 2. A 57-year-old female with previous history of arterial hypertension and higher serum lipid level, had an elective resection and replacement of the superficial femoral artery aneurysm. For the reconstruction an ASVG was used. The saphenous vein showed postflebitic changes. Four years later she was admitted with asymptomatic pulsating mass of the mid portion of the thigh. The control transfemoral angiography showed patent graft with fusiform aneurysm formation of its mid portion. After aneurismal resection, an above knee F-P bypass with 8 mm PTFE graft was performed. A pathohistological examination showed a partially degenerated elastic membrane with fragmentation and disruption, without atherosclerosis (Figure 2. During the follow up period an elective resection of the subclavian artery aneurysm as well as abdominal aortic aneurysm, were performed. CASE3. A subclavian artery aneurysm caused by TOS has been repaired with sapehnous vein graft at 40-year-old female patient

  9. New Technique for the Preservation of the Left Common Carotid Artery in Zone 2a Endovascular Repair of Thoracic Aortic Aneurysm

    International Nuclear Information System (INIS)

    To describe a technique for the preservation of the left common carotid artery (CCA) in zone 2 endovascular repair of thoracic aortic aneurysm. This technique involves the placement of a guide wire into the left CCA via the right brachial artery before stent graft deployment to enable precise visualization and protection of the left CCA during the whole procedure. Of the 107 patients with thoracic endovascular aortic repair in our study, 32 (30%) had the left subclavian artery intentionally covered (landing zone 2). Eight (25%) of those 32 had landing zone 2a—the segment distally the origin of the left CCA, halfway between the origin of the left CCA and the left subclavian artery. In all patients, a guide wire was positioned into the left CCA via the right brachial artery before stent graft deployment. It is a retrospective study in design. In seven patients, stent grafts were positioned precisely. In the remaining patient, the positioning was imprecise; the origin of the left CCA was partially covered by the graft. A stent was implanted into the left CCA to restore the flow into the vessel. All procedures were performed successfully. The technique of placing a guide wire into the left CCA via the right brachial artery before stent graft deployment is a safe and effective method that enables the precise visualization of the left CCA during the whole procedure. Moreover, in case of inadvertent complete or partial coverage of the origin of the left CCA, it supplies safe and quick access to the artery for stent implantation.

  10. Enhanced recovery after elective open surgical repair of abdominal aortic aneurysm: a complementary overview through a pooled analysis of proportions from case series studies.

    Directory of Open Access Journals (Sweden)

    Sanderland J T Gurgel

    Full Text Available 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 only one randomized controlled trial was found, a pooled analysis of proportions from case series was conducted, considering it a complementary overview of the topic. Inclusion criteria were case series with more than five cases reported, adult patients who underwent an elective OSR of AAA and use of an ERAS program. ERAS was compared to conventional perioperative care. The pooled proportion and the confidence interval (CI are shown for each outcome. The overlap of the CI suggests similar effect of the interventions studied. RESULTS: Thirteen case series studies with ERAS involving 1,250 patients were compared to six case series with conventional care with a total of 1,429 patients. The pooled, respective proportions for ERAS and conventional care were: mortality, 1.51% [95% CI: 0.0091, 0.0226] and 3.0% [95% CI 0.0183, 0.0445]; and incidence of complications, 3.82% [95% CI 0.0259, 0.0528] and 4.0% [95% CI 0.03, 0.05]. CONCLUSION: This review shows that ERAS and conventional care therapies have similar mortality and complication rates in OSR of AAA.

  11. Implementation of the Continuous AutoTransfusion System (C.A.T.S) in open abdominal aortic aneurysm repair: an observational comparative cohort study.

    LENUS (Irish Health Repository)

    Tawfick, Wael A

    2008-01-01

    The use of the Continuous AutoTransfusion System (C.A.T.S; Fresenius Hemotechnology, Bad Homburg v.d.H., Germany), which conserves allogenic blood, is reported in 187 patients having abdominal aortic aneurysm repair during a 9-year period. Patients were allocated to C.A.T.S if a Haemovigilance technician was available. A mean of 685 mL of retrieved blood was reinfused in 101 patients receiving C.A.T.S; 61% required 2 U or less. All control patients required 3 U or more of allogenic blood. Allogenic transfusion in C.A.T.S patients decreased significantly (P < .0001). Mean intensive care unit stay was significantly reduced in C.A.T.S patients (P = .042). Mean postoperative hospital stay was 18 days for C.A.T.S group and 25 days in control patients (P = .014). The respective 30-day mortality was 12% versus 19% (P = .199). The C.A.T.S markedly reduced the amount of blood transfused, was associated with reduced intensive care unit and postoperative hospital stay, and was cost-effective.

  12. Follow-up of endovascular aortic aneurysm repair: Preliminary validation of digital tomosynthesis and contrast enhanced ultrasound in detection of medium- to long-term complications

    Science.gov (United States)

    Mazzei, Maria Antonietta; Guerrini, Susanna; Mazzei, Francesco Giuseppe; Cioffi Squitieri, Nevada; Notaro, Dario; de Donato, Gianmarco; Galzerano, Giuseppe; Sacco, Palmino; Setacci, Francesco; Volterrani, Luca; Setacci, Carlo

    2016-01-01

    AIM: To validate the feasibility of digital tomosynthesis of the abdomen (DTA) combined with contrast enhanced ultrasound (CEUS) in assessing complications after endovascular aortic aneurysm repair (EVAR) by using computed tomography angiography (CTA) as the gold standard. METHODS: For this prospective study we enrolled 163 patients (123 men; mean age, 65.7 years) referred for CTA for EVAR follow-up. CTA, DTA and CEUS were performed at 1 and 12 mo in all patients, with a maximum time interval of 2 d. RESULTS: Among 163 patients 33 presented complications at CTA. DTA and CTA correlated for the presence of complications in 32/33 (96.96%) patients and for the absence of complications in 127/130 (97.69%) patients; the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of DTA were 97%, 98%, 91%, 99%, and 98%, respectively. CEUS and CTA correlated for the presence of complications in 19/33 (57.57%) patients and for the absence of complications in 129/130 (99.23%) patients; the sensitivity, specificity, PPV, NPV and accuracy of CEUS were 58%, 99%, 95%, 90%, and 91%, respectively. Sensitivity, specificity and accuracy of combining DTA and CEUS together in detecting EVAR complications were 77%, 98% and 95%, respectively. CONCLUSION: Combining DTA and CEUS in EVAR follow-up has the potential to limit the use of CTA only in doubtful cases. PMID:27247719

  13. Typical exposure parameters, organ doses and effective doses for endovascular aortic aneurysm repair: Comparison of Monte Carlo simulations and direct measurements with an anthropomorphic phantom

    International Nuclear Information System (INIS)

    Radiation exposure of patients during endovascular aneurysm repair (EVAR) procedures ranks in the upper sector of medical exposure. Thus, estimation of radiation doses achieved during EVAR is of great importance. Organ doses (OD) and effective doses (ED) administered to 17 patients receiving EVAR were determined (1) from the exposure parameters by performing Monte Carlo simulations in mathematical phantoms and (2) by measurements with thermoluminescent dosimeters in a physical anthropomorphic phantom. The mean fluoroscopy time was 26 min, the mean dose area product was 24995 cGy cm2. The mean ED was 34.8 mSv, ODs up to 626 mSv were found. Whereas digital subtraction angiographies (DSA) and fluoroscopies each contributed about 50 % to the cumulative ED, the ED rates of DSAs were found to be ten times higher than those of fluoroscopies. Doubling of the field size caused an ED rate enhancement up to a factor of 3. EVAR procedures cause high radiation exposure levels that exceed the values published thus far. As a consequence, (1) DSAs should be only performed when necessary and with a low image rate, (2) fluoroscopies should be kept as short as possible, and (3) field sizes should be minimized. (orig.)

  14. Typical exposure parameters, organ doses and effective doses for endovascular aortic aneurysm repair: Comparison of Monte Carlo simulations and direct measurements with an anthropomorphic phantom

    Energy Technology Data Exchange (ETDEWEB)

    Foerth, Monika; Treitl, Karla Maria; Treitl, Marcus [Ludwig Maximilians University of Munich, Institute for Clinical Radiology, Munich (Germany); Seidenbusch, Michael C. [Ludwig Maximilians University of Munich, Institute for Clinical Radiology, Munich (Germany); Clinical Centre of the Ludwig Maximilian University of Munich, Institute for Clinical Radiology, Munich (Germany); Sadeghi-Azandaryani, Mojtaba [Clinical Centre of the County of Erding, Department of Vascular Surgery, Erding (Germany); Lechel, Ursula [Federal Office for Radiation Protection, Department of Medical and Occupational Radiation Protection, Oberschleissheim (Germany)

    2015-09-15

    Radiation exposure of patients during endovascular aneurysm repair (EVAR) procedures ranks in the upper sector of medical exposure. Thus, estimation of radiation doses achieved during EVAR is of great importance. Organ doses (OD) and effective doses (ED) administered to 17 patients receiving EVAR were determined (1) from the exposure parameters by performing Monte Carlo simulations in mathematical phantoms and (2) by measurements with thermoluminescent dosimeters in a physical anthropomorphic phantom. The mean fluoroscopy time was 26 min, the mean dose area product was 24995 cGy cm2. The mean ED was 34.8 mSv, ODs up to 626 mSv were found. Whereas digital subtraction angiographies (DSA) and fluoroscopies each contributed about 50 % to the cumulative ED, the ED rates of DSAs were found to be ten times higher than those of fluoroscopies. Doubling of the field size caused an ED rate enhancement up to a factor of 3. EVAR procedures cause high radiation exposure levels that exceed the values published thus far. As a consequence, (1) DSAs should be only performed when necessary and with a low image rate, (2) fluoroscopies should be kept as short as possible, and (3) field sizes should be minimized. (orig.)

  15. Brain Aneurysm

    Science.gov (United States)

    A brain aneurysm is an abnormal bulge or "ballooning" in the wall of an artery in the brain. They are sometimes called berry aneurysms because they ... often the size of a small berry. Most brain aneurysms produce no symptoms until they become large, ...

  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. Automatic pose initialization for accurate 2D/3D registration applied to abdominal aortic aneurysm endovascular repair

    Science.gov (United States)

    Miao, Shun; Lucas, Joseph; Liao, Rui

    2012-02-01

    Minimally invasive abdominal aortic aneurysm (AAA) stenting can be greatly facilitated by overlaying the preoperative 3-D model of the abdominal aorta onto the intra-operative 2-D X-ray images. Accurate 2-D/3-D registration in 3-D space makes the 2-D/3-D overlay robust to the change of C-Arm angulations. By far, the 2-D/3-D registration methods based on simulated X-ray projection images using multiple image planes have been shown to be able to provide satisfactory 3-D registration accuracy. However, one drawback of the intensity-based 2-D/3-D registration methods is that the similarity measure is usually highly non-convex and hence the optimizer can easily be trapped into local minima. User interaction therefore is often needed in the initialization of the position of the 3-D model in order to get a successful 2-D/3-D registration. In this paper, a novel 3-D pose initialization technique is proposed, as an extension of our previously proposed bi-plane 2-D/3-D registration method for AAA intervention [4]. The proposed method detects vessel bifurcation points and spine centerline in both 2-D and 3-D images, and utilizes landmark information to bring the 3-D volume into a 15mm capture range. The proposed landmark detection method was validated on real dataset, and is shown to be able to provide a good initialization for 2-D/3-D registration in [4], thus making the workflow fully automatic.

  18. Isolated common femoral artery aneurysm: a case report

    OpenAIRE

    Sharma, Saurabh; Nalachandran, Sanjay

    2009-01-01

    Introduction Isolated aneurysm of common femoral artery is a rare occurrence. They may mimic other common conditions like groin lymph nodes or groin hernia. Case presentation Here we present a case of 61-years-old Chinese gentleman who presented with a right groin lump, which was suspected to be groin hernia but turned out common femoral artery aneurysm. The aneurysm was surgically excised and a prosthetic vascular repair was done. Conclusion Isolated common femoral artery aneurysms are rare ...

  19. RARE PRESENTATION OF SYMPTOMATIC BILATERAL PROXIMAL POPLITEAL ARTERY ANEURYSM

    Directory of Open Access Journals (Sweden)

    Thulasikumar Ganapathy

    2016-07-01

    Full Text Available True Popliteal artery aneurysm is the most common of all the peripheral artery aneurysms. We present a case of proximal popliteal artery aneurysm involvement both lower limb presented with gangrene in one lower limb and incapacitating claudication pain on the other lower limb. We have successfully repaired both sides aneurysm in the same sitting with Poly Tetra Fluro Ethylene (PTFE graft, as the patient also had multiple venous perforators’ involvement on both sides, which left us only with synthetic graft repair option rather than venous graft repair.

  20. Relationship between acute kidney injury before thoracic endovascular aneurysm repair and in-hospital outcomes in patients with type B acute aortic dissection

    Institute of Scientific and Technical Information of China (English)

    Hong-Mei REN; Xiao WANG; Chun-Yan HU; Bin QUE; Hui AI; Chun-Mei WANG; Li-Zhong SUN; Shao-Ping NIE

    2015-01-01

    Objective Acute kidney injury (AKI) frequently occurs after catheter-based interventional procedures and increases mortality. How-ever, the implications of AKI before thoracic endovascular aneurysm repair (TEVAR) of type B acute aortic dissection (AAD) remain un-clear. This study evaluated the incidence, predictors, and in-hospital outcomes of AKI before TEVAR in patients with type B AAD. Meth-ods Between 2009 and 2013, 76 patients were retrospectively evaluated who received TEVAR for type B AAD within 36 h from symptom onset. The patients were classified into no-AKI vs. AKI groups, and the severity of AKI was further staged according to kidney disease:im-proving global outcomes criteria before TEVAR. Results The incidence of preoperative AKI was 36.8%. In-hospital complications was significantly higher in patients with preoperative AKI compared with no-AKI (50.0%vs. 4.2%, respectively;P<0.001), including acute renal failure (21.4%vs. 0, respectively;P<0.001), and they increased with severity of AKI (P<0.001). The maximum levels of body tem-perature and white blood cell count were significantly related to maximum serum creatinine level before TEVAR. Multivariate analysis showed that systolic blood pressure on admission (OR:1.023;95%CI:1.003–1.044;P=0.0238) and bilateral renal artery involvement (OR:19.076;95%CI:1.914–190.164;P=0.0120) were strong predictors of preoperative AKI. Conclusions Preoperative AKI frequently oc-curred in patients with type B AAD, and correlated with higher in-hospital complications and enhanced inflammatory reaction. Systolic blood pressure on admission and bilateral renal artery involvement were major risk factors for AKI before TEVAR.

  1. Tratamento do aneurisma da aorta toracoabdominal com endoprótese ramificada para as artérias viscerais Branched endovascular stent graft for thoracoabdominal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    André Simi

    2007-03-01

    AATA com endoprótese ramificada é factível. A melhora dos recursos técnicos e da qualidade dos materiais poderá ampliar a indicação desse procedimento como alternativa à cirurgia aberta.We report a case of branched stent graft system for endovascular repair of thoracoabdominal aortic aneurysm (TAAA. A 68-year-old female patient, smoker, hypertensive, with a large TAAA and multiple comorbid conditions that restricted indication for conventional surgery. The aneurysm originated from the descending thoracic aorta, extending until the infrarenal abdominal aorta, involving the emergence of visceral arteries, celiac trunk, superior and renal mesenteric arteries. The TAAA was treated with the endovascular technique using a branched stent graft. This stent graft was customized based on the anatomical characteristics of the aorta and on the position of visceral branches, which were obtained by tomographic angiography, with the aim of excluding the aneurysm and maintaining perfusion of visceral arteries. The procedure was performed under regional and general anesthesia in the surgical room, preceded by cerebrospinal fluid drainage under fluoroscopic guidance. The femoral arteries, which were previously dissected, were used to implement the branched stent graft and for radiological control. Through the stent graft branches, secondary extensions were implanted, with covered stents, to the respective visceral arteries, which were approached via left axillary artery. Total operative time was 14 hours, 4 hours and 30 minutes of fluoroscopy time and 120 mL of iodinated contrast. The patient became hemodynamically unstable after the surgery. Transesophageal echocardiogram showed a type A retrograde dissection of the thoracic aorta, followed by spontaneous thrombosis of the false lumen. Control tomography showed exclusion of the TAAA and patency of the bypasses to visceral branches, with no endoleaks. The patient was discharged on the 13th postoperative day. Branched

  2. Endovascular treatment for long-segment aortoiliac arterial occlusion:its technical skill and therapeutic effect

    International Nuclear Information System (INIS)

    Aortoiliac arterial occlusion is the most common arterial occlusive disease. The therapeutic options include the basic treatment with the medication as the principal part, the establishment of a bypass through an open surgery and the newly-developed endovascular revascularization technique. With the advantages of endovascular management being deeply understood by the clinicians and patients, the endovascular revascularization technique has become the therapy of first choice for long-segment aortoiliac arterial occlusion. This paper aims to make a comprehensive review about the technical skill and therapeutic effect of the newly-developed endovascular revascularization technique. (authors)

  3. Current technology for the treatment of infection following abdominal aortic aneurysm (AAA) fixation by endovascular repair (EVAR).

    Science.gov (United States)

    Capoccia, L; Mestres, G; Riambau, V

    2014-06-01

    In recent years, in parallel with the increase of endovascular aortic repair (EVAR) procedures performances, a rise of late open surgical removal of EVAR implants has been observed, due to non-endovascularly correctable graft complications. Among them endograft infection is a rare but devastating occurrence, accounting for an incidence ranging from 0.2% to 0.7% in major series, and almost 1% of all causes of endograft explantations. However, a real estimation of the incidence of the problem respect to the number of EVAR implantations is difficult to obtain. Time to infection is usually defined as the period between EVAR and presentation of symptoms that leads to the infection diagnosis. It can be extremely variable, depending on bacterial virulence and host conditions. The diagnosis of an endograft infection is usually based on a combination of clinical symptoms, imaging studies and microbial cultures whenever possible. If computed tomography (CT) scan is employed in almost 100% of infection diagnosis, a combination of fluorodeoxyglucose-positron emission tomography (FDG-PET) and CT scan is nowadays used with increasing frequency in order to rise the likelihood of detecting a graft infection, since even cultures of blood or samples collected from the infected field can sometimes be negative. Complete graft excision seems the best approach whenever a surgical reconstruction could be attempted. In situ reconstruction can be performed by the interposition of an autologous vein, a cryopreserved allograft or a rifampin-soaked Dacron graft. The so-called conventional treatment contemplates the re-establishment of vascularization through extranatomical routes, thus preserving the new graft material from possible contamination by the surgical field just cleaned. When severe comorbid conditions did not allow graft excision, a conservative treatment should be taken into account. It is mainly based on broad-spectrum or culture-specific antibiotic therapy combined, whenever

  4. Brain Aneurysm Statistics and Facts

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  5. Internal thoracic artery collateral to the external iliac artery in chronic aortoiliac occlusive disease

    International Nuclear Information System (INIS)

    To evaluate the incidence and angiographic findings of the collateral pathway involving the internal thoracic artery in patients with chronic aortoiliac occlusive disease. Between March 2000 and Februrary 2001, 124 patients at our hospital underwent angiographic evaluation of chronic aortoiliac occlusive disease, and in 15 of these complete obstruction or severe stenosis of the aortoiliac artery was identified. The aortograms and collateral arteriograms obtained, including internal thoracic arteriograms, as well as the medical records of the patients involved, were evaluated. In nine patients there was complete occlusion of the infrarenal aorta, or diffuse stenosis of 75% or more in the descending thoracic aorta, and in the other six, a patent aorta but complete occlusion or stenosis of 75% or more of the common iliac artery was demonstrated. Collateral perfusion via hypertrophied internal thoracic arteries and rich anastomoses between the superior and inferior epigastric arteries, reconstituting the external iliac artery, were noted in all fifteen patients, regardless of symptom duration, which ranged from six months to twelve years. In patients with chronic aortoiliac occlusive disease, the internal thoracic artery, along with visceral collaterals and those from the contralateral side, is one of the major parietal collateral pathways

  6. Endoluminal embolization of bilateral atherosclerotic common iliac aneurysms with fibrin tissue glue (Beriplast)

    International Nuclear Information System (INIS)

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

  7. 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

  8. Use of multi-detector CT angiography in identification and classification of aorto-iliac diseases; clinical and surgical application

    Directory of Open Access Journals (Sweden)

    Reda Abdelsamie Alarabawy

    2016-03-01

    Conclusions: MDCT angiography is excellent noninvasive scanning technique for patients suspected of having aorto-iliac occlusive disease, with higher spatial resolution and faster acquisition times, allowing assessment of the aorta and its branches with greater accuracy than other modalities.

  9. Risk–benefit analysis of the treatment of unruptured intracranial aneurysms

    Science.gov (United States)

    Vindlacheruvu, R; Mendelow, A; Mitchell, P

    2005-01-01

    Objectives: To determine under what circumstances repair of unruptured intracranial aneurysms may be beneficial. Methods: A life expectancy analysis of patients with unruptured aneurysms with and without repair based on prospective data from the International Study of Unruptured Intracranial Aneurysms (ISUIA). Results: Life years are lost at all ages by repairing anterior circulation aneurysms under 7 mm in diameter in patients with no history of a subarachnoid haemorrhage from another aneurysm (incidental). For all other aneurysms the number of life years saved by repair is dependent on the patient's age at the time when repair is undertaken. Between 2 and 40 years are saved by repairing aneurysms in patients aged 20 years. These benefits fall to 0 when remaining life expectancy falls below 15–35 years, corresponding to the age range of 45–70 years. Conclusions: Repair of unruptured aneurysms benefits patients harbouring them by improving life expectancy except in certain circumstances. The exceptions are patients with remaining life expectancy less than 15–35 years or aged 45–70 (depending on aneurysm size and location) and patients with aneurysms of the anterior circulation under 7 mm in diameter with no history of a previous subarachnoid haemorrhage. These results are based on the findings of the ISUIA and are dependent on their accuracy. PMID:15654039

  10. Advances in endovascular aneurysm treatment: are we making a difference?

    International Nuclear Information System (INIS)

    Recent advancements in endovascular aneurysm repair, including bioactive and expansile coils and intracranial stents, hold promise for improved aneurysm occlusion rates. We report the immediate and midterm clinical and angiographic outcomes of a consecutive series of patients treated since the advent of these technologies. Clinical and radiological records of 134 patients with 142 aneurysms treated between 2001 and 2004 were retrospectively evaluated by an independent neurologist. Endovascular procedures were analyzed by an independent neuroradiologist blinded to all clinical information. Seventy-two ruptured and 60 un-ruptured saccular aneurysms, nine fusiform and one post-traumatic aneurysm were treated. Matrix coils were used in 53% of saccular aneurysms and HydroCoils in 13% of all aneurysms. Neuroform stents were deployed in 19% of aneurysms. Angiographic total or subtotal occlusion was achieved in 76% of cases and in 96% at last follow-up. Aneurysm recanalization was observed in 14% over a mean follow-up of 12 months, and 18% of aneurysms were retreated. Clinically relevant complications occurred in 6.0%, resulting in procedure-related morbidity of 0.6% and 0.6% mortality at 6 months. No aneurysm bled over a cumulative 1,347 months of observation. Newer embolization technologies can be exploited successfully even in more complex aneurysms with very low morbidity and mortality. (orig.)

  11. First-pass radionuclide angiography in the diagnosis of aortoiliac thromboembolism in a horse

    International Nuclear Information System (INIS)

    First-pass radionuclide angiography of the terminal aorta was performed in 3 normal horses and a 6-year-old Standardbred intact male with aortoiliac thromboembolism. Thromboembolism caused chronic bilateral hind limb lameness, more severe in the right hind limb, was detected by rectal examination, and confirmed using transrectal ultrasonography. Using 99mTc-HDP, first-pass radionuclide angiography was combined with hind limb and pelvis bone (delayed) scintigraphy and revealed marked reduction in blood flow through both external iliac arteries and absence of blood flow in the internal iliac arteries. Quantitative analysis showed a decreased activity in the right iliac vessels in the clinic patient consistent with reduced blood flow when compared to control horses. First-pass radionuclide angiography provided a method to obtain diagnostic images of the terminal aorta and branches and a method to diagnose aortoiliac thromboembolism in the horse

  12. Posterior tibial artery aneurysm: a case report with review of literature

    OpenAIRE

    Sagar, Jayesh; Button, Mathew

    2014-01-01

    Background Aneurysms infra-patellar region are uncommon. Of them, true aneurysms are very rare and that of posterior tibial artery are extremely rare. The more common, pseudoaneurysms are commonly associated with trauma whereas the true ones are linked with either inflammatory or mycotic origins. Case Presentation We reported another case of true aneurysm of posterior tibial artery without any evident aetiology. This was repaired with resection of aneurysm followed by interposition vein graft...

  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. Visceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the Bentall procedure with the elephant trunk technique: A case report

    Directory of Open Access Journals (Sweden)

    Marjanović Ivan

    2014-01-01

    Full Text Available Introduction. Reconstruction of chronic type B dissection and thoracoabdominal aortic aneurysm (TAAA remaining after the emergency reconstruction of the ascending thoracic aorta and aortic arch for acute type A dissection represents one of the major surgical challenges. Complications of chronic type B dissection are aneurysmal formation and rupture of an aortic aneurysm with a high mortality rate. We presented a case of visceral hybrid reconstruction of TAAA secondary to chronic dissection type B after the Bentall procedure with the elephant trunk technique due to acute type A aortic dissection in a high-risk patient. Case report. A 62 year-old woman was admitted to our institution for reconstruction of Crawford type I TAAA secondary to chronic dissection. The patient had had an acute type A aortic dissection 3 years before and undergone reconstruction by the Bentall procedure with the elephant trunk technique with valve replacement. On admission the patient had coronary artery disease (myocardial infarction, two times in the past 3 years, congestive heart disease with ejection fraction of 25% and chronic obstructive pulmonary disease. On computed tomography (CT of the aorta TAAA was revealed with a maximum diameter of 93 mm in the descending thoracic aorta secondary to chronic dissection. All the visceral arteries originated from the true lumen with exception of the celiac artery (CA, and the end of chronic dissection was below the origin of the superior mesenteric artery (SMA. The patient was operated on using surgical visceral reconstruction of the SMA, CA and the right renal artery (RRA as the first procedure. Postoperative course was without complications. Endovascular TAAA reconstruction was performed as the second procedure one month later, when the elephant trunk was used as the proximal landing zone for the endograft, and distal landing zone was the level of origin of the RRA. Postoperatively, the patient had no neurological deficit and

  15. Therapeutic algorithm to treat common iliac artery aneurysms by endovascular means.

    Science.gov (United States)

    Panuccio, Giuseppe; Torsello, Giovanni F; Torsello, Giovanni B; Donas, Konstantinos P

    2016-10-01

    Use of endovascular means is gaining ever greater acceptance in the treatment of aorto-iliac aneurysms. Especially, the treatment of patients with common iliac aneurysms (CIAs) may be very challenging due to the complexity of the underlying disease with often involvement of the hypogastric artery. Additionally, the variety of endovascular therapeutic options such as the use of iliac branch devices, parallel grafts, the bell-bottom technique or coil embolization of the hypogastric artery and overstenting of the origin represents significant limitation regarding the presentation of a clear and robust endovascular therapeutic algorithm. Aim of the present article was the demonstration of the institutional experience with the endovascular management of CIAs in order to provide a clinical recommendation and algorithm. PMID:27406396

  16. 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.

  17. Novel Molecular Imaging Approaches to Abdominal Aortic Aneurysm Risk Stratification.

    Science.gov (United States)

    Toczek, Jakub; Meadows, Judith L; Sadeghi, Mehran M

    2016-01-01

    Selection of patients for abdominal aortic aneurysm repair is currently based on aneurysm size, growth rate, and symptoms. Molecular imaging of biological processes associated with aneurysm growth and rupture, for example, inflammation and matrix remodeling, could improve patient risk stratification and lead to a reduction in abdominal aortic aneurysm morbidity and mortality. (18)F-fluorodeoxyglucose-positron emission tomography and ultrasmall superparamagnetic particles of iron oxide magnetic resonance imaging are 2 novel approaches to abdominal aortic aneurysm imaging evaluated in clinical trials. A variety of other tracers, including those that target inflammatory cells and proteolytic enzymes (eg, integrin αvβ3 and matrix metalloproteinases), have proven effective in preclinical models of abdominal aortic aneurysm and show great potential for clinical translation. PMID:26763279

  18. Perigraft Plug Embolization of the Internal Iliac Artery and Implantation of a Bifurcated Stentgraft: One Treatment Option for Insufficient Tubular Stentgraft Repair of a Common Iliac Artery Aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Goltz, Jan Peter, E-mail: janpeter.goltz@uksh.de; Loesaus, Julia; Frydrychowicz, Alex; Barkhausen, Jörg [University Hospital of Schleswig-Holstein, Department for Radiology and Nuclear Medicine (Germany); Wiedner, Marcus [University Hospital of Schleswig-Holstein, Clinic for Surgery (Germany)

    2016-02-15

    We report an endovascular technique for the treatment of type Ia endoleak after a plain tubular stentgraft had been implanted for a large common iliac artery aneurysm with an insufficient proximal landing zone and without occlusion of the hypogastric in another hospital. CT follow-up showed an endoleak with continuous sac expansion over 12 months. This was classified as type Ia by means of dynamic contrast-enhanced MRI. Before a bifurcated stentgraft was implanted to relocate the landing zone more proximally, the still perfused ipsilateral hypogastric artery was embolized to prevent a type II endoleak. A guidewire was manipulated alongside the indwelling stentgraft. The internal iliac artery could then be selectively intubated followed by successful plug embolization of the vessel’s orifice despite the stentgraft being in place.

  19. Brain Aneurysm: Early Detection and Screening

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  20. Brain Aneurysm Warning Signs/Symptoms

    Science.gov (United States)

    ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ... Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History ...

  1. Cardiovascular and Interventional Radiological Society of Europe Guidelines on Endovascular Treatment in Aortoiliac Arterial Disease

    International Nuclear Information System (INIS)

    PurposeThese guidelines are intended for use in assessing the standard for technical success and safety in aorto-iliac percutaneous endovascular interventions.MethodsAny recommendation contained in the text comes from the highest level and extension of literature review available to date.ResultsThe success of endovascular procedures is strictly related to an accurate planning based mainly on CT- or MR-angiography. TASC II A through C lesions have an endovascular-first option Pre-procedure ASA antiplatelet therapy is advisable in all cases. The application of stents improves the immediate hemodynamic and most likely long-term clinical results. Cumulative mean complication rate is 7.51 % according to the most relevant literature. Most of the complications can be managed by means of percutaneous techniques.ConclusionThe design and quality of devices, as well as the easy and accuracy of performing these procedures, have improved over the last decades, leading to the preferential treatment of aorto-iliac steno-obstructive disease via endovascular means, often as first-line therapy, with high technical success rate and low morbidity. This is mirrored by the decreasing number of patients undergoing surgical grafts over the last years with patency, limb salvage, and survival rates equivalent to open reconstruction

  2. Identification of predictive CT angiographic factors in the development of high-risk type 2 endoleaks after endovascular aneurysm repair in patients with infrarenal aortic aneurysms; Identifikation praediktiver CT-angiographischer Faktoren fuer die Entstehung eines Hochrisiko Typ-2 Endoleaks nach endovaskulaerem Aortenrepair bei Patienten mit infrarenalen Bauchaortenaneurysmen

    Energy Technology Data Exchange (ETDEWEB)

    Loewenthal, D.; Herzog, L.; Rogits, B.; Bulla, K.; Pech, M.; Ricke, J.; Dudeck, O. [Magdeburg Univ. (Germany). Radiology and Nuclear Medicine; Weston, S. [Magdeburg Univ. (Germany). Biometry and Medical Informatics; Meyer, F.; Halloul, Z. [Magdeburg Univ. (Germany). General, Visceral and Vascular Surgery

    2015-01-15

    An extensive analysis of the value of computed tomography (CT) parameters as potential predictors of the clinical outcome of type 2 endoleaks after endovascular aortic aneurysm repair (EVAR). Initial CT scans of 130 patients with abdominal aortic aneurysms (AAAs) were retrospectively reviewed. On the basis of postoperative CT scans and angiographies, patients were stratified into a low-risk group (LRG; without or transient type 2 endoleak; n = 80) and a high-risk group (HRG, persistent type 2 endoleak or need for reintervention; n = 50). Statistical analysis comprised a univariate and multivariate analysis. Anatomical, thrombus-specific, as well as aortic side branch parameters were assessed on the initial CT scan. Of all anatomical parameters, the diameter of the immediate infrarenal aorta was significantly different in the univariate analysis (LRG 22.4 ± 3.8 mm; HRG 23.6 ± 2.5 mm; p = 0.03). The investigation of the thrombus-specific parameters showed a trend towards statistical significance for the relative thrombus load (LRG 31.7 ± 18.0 %; HRG 25.3 ± 17.5 %; p = 0.09). Assessment of aortic side branches revealed only for the univariate analysis significant differences in the patency of the inferior mesenteric artery (LRG 71.3 %; HRG 92.0 %; p = 0.003) and their diameter (LRG 3.3 ± 0.7 mm; HRG 3.8 ± 0.9 mm; p = 0.004). In contrast, the number of lumbar arteries (LAs; LRG 2.7 ± 1.4; HRG 3.6 ± 1.2; univariate: p = 0.01; multivariate: p = 0.006) as well as their diameter (LRG 2.1 ± 0.4 mm; HRG 2.4 ± 0.4 mm; univariate: p < 0.001; multivariate: p = 0.006) were highly significantly associated with the development of type 2 endoleaks of the HRG. The most important predictive factors for the development of high-risk type 2 endoleaks were mainly the number and the diameter of the LAs which perfused the AAA.

  3. Cerebral Aneurysms Fact Sheet

    Science.gov (United States)

    ... cerebral aneurysm from forming. People with a diagnosed brain aneurysm should carefully control high blood pressure, stop smoking, and avoid cocaine use or other stimulant drugs. They should also ...

  4. 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 ...

  5. Cerebral aneurysms and inflammation

    Directory of Open Access Journals (Sweden)

    Toshihiro Yokoi

    2015-06-01

    Full Text Available Multiple inflammatory factors, playing a crucial role in cerebral aneurysm formation, have been identified. tumor necrosis factor-alpha (TNF-α has been revealed to have a close connection with several risk factors that affect aneurysm formation. Remarkable expression in aneurysm walls of mRNA for TNF-α has been observed in humans. Possible therapeutic interventions to reduce the formation of cerebral aneurysms may include the inhibition of mediators of inflammation.

  6. [False aneurysm on dacron prosthesis, 20 years after aortofemoral bypass].

    Science.gov (United States)

    Illuminati, G; Bertagni, A; Nasti, A G; Montesano, G

    2001-10-01

    A 85-year-old male developed a false, non septic, non anastomotic aneurysm, 20 years after right aorto-femoral Dacron grafting for claudication. On account of the proximity to the femoral anastomosis, and the association with a profunda femoris stenosis, a conventional surgical repair was preferred to an endovascular treatment. The patient underwent a successful aneurysm resection followed by PTFE interposition between the primary graft and the profunda femoris artery, with uneventful recovery. PMID:11692765

  7. 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...

  8. Paediatric intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    A A Wani

    2006-01-01

    Full Text Available Intracranial aneurysms in childhood account for 1-2% of intracranial aneurysms.[1],[2] These aneurysms have unique characteristics that make them different from those in adults. These differences are evident in their epidemiology, location, clinical spectrum, association with trauma and infection, complications and outcome.

  9. Ruptured ileocolic artery aneurysm: An unusual cause of hemoperitoneum

    Directory of Open Access Journals (Sweden)

    Zakaur R Siddiqui

    2012-01-01

    Full Text Available Ruptured aneurysm of a branch of ileocolic artery is a rare finding and is an unusual cause of haemoperitoneum. Rapid diagnosis, and surgical or endovascular intervention are necessary to avoid devastating consequences and high mortality rates following an emergency operation after rupture. Resection is a good choice for surgical intervention for some aneurysms that are not suitable for endovascular repair. This report describes the case of a middle-aged man with a ruptured superior mesenteric artery branch aneurysm and his subsequent surgical management.

  10. Ruptured Ileocolic Artery Aneurysm: An Unusual Cause of Hemoperitoneum

    Science.gov (United States)

    Siddiqui, Zakaur R.; Yousif, Omer F.; Halliday, Mark W.; Hubaishah, Nasser A.; Adam, Khalid A.

    2012-01-01

    Ruptured aneurysm of a branch of ileocolic artery is a rare finding and is an unusual cause of haemoperitoneum. Rapid diagnosis, and surgical or endovascular intervention are necessary to avoid devastating consequences and high mortality rates following an emergency operation after rupture. Resection is a good choice for surgical intervention for some aneurysms that are not suitable for endovascular repair. This report describes the case of a middle-aged man with a ruptured superior mesenteric artery branch aneurysm and his subsequent surgical management. PMID:23006464

  11. Balloon Occlusion of the Contralateral Iliac Artery to Assist Recanalization of the Ipsilateral Iliac Artery in Total Aortoiliac Occlusion: A Technical Note

    OpenAIRE

    Abdel Aziz A. Jaffan

    2013-01-01

    Endovascular recanalization of chronic total aortoiliac occlusion is technically challenging. Inability to reenter the true aortic lumen, following retrograde iliac recanalization, is one of the most common causes of failure. We describe a case of a total aortoiliac occlusion where balloon occlusion of the right common iliac artery, following its recanalization from a brachial approach, was used to facilitate antegrade recanalization of the occluded contralateral left common iliac artery.

  12. Outcome and survival of patients aged 75 years and older compared to younger patients after ruptured abdominal aortic aneurysm repair: do the results justify the effort?

    DEFF Research Database (Denmark)

    Shahidi, S; Schroeder, T Veith; Carstensen, M.;

    2009-01-01

    were also performed with the variables that were found to be significant in the univariate analysis. Health economy and cost analysis for the two groups were estimated. Out of 72 open repairs of RAAA, 44 patients (61%) were under 75 years of age and 28 (39%) were 75 years or older. The average age of...... elderly because of the increased incidence of surgical risk factors and hospital mortality in this subset of patients (cut-off age). Demographic, clinical, and operative factors were analyzed together with 30-day mortality. Univariate analysis was performed with the chi-squared test. Multivariate analyses......%-33%) of 44 younger patients (p < 0.001). An age of 75 years or older and a serum creatinine >or=0.150 mmol/L in elderly patients with RAAA (p < 0.01) were identified to be significant risk factors for operative mortality. We did not encounter significant differences in the distribution of other risk...

  13. Correção cirúrgica de aneurismas saculares de fístula arteriovenosa para hemodiálise utilizando a técnica de aneurismorrafia Surgical repair of saccular aneurysms of an arteriovenous fistula for hemodialysis using aneurismorraphy technique

    Directory of Open Access Journals (Sweden)

    Ricardo Wagner da Costa Moreira

    2011-06-01

    Full Text Available Uma das complicações mais frequentes da fístula arteriovenosa (FAV para hemodiálise é o desenvolvimento de um aneurisma. A formação de aneurismas geralmente decorre de um enfraquecimento da parede venosa devido às repetidas punções, e sua rotura causa hemorragia intensa que pode levar à morte. Descrevemos o caso de uma paciente com dois aneurismas saculares de FAV, tratados através de aneurismorrafia, detalhando a técnica cirúrgica utilizada e a evolução pós-operatória. A técnica de rafia simples da parede constitui uma boa alternativa no reparo da parede da FAV quando o aneurisma é de curta extensão, evitando a colocação de um material protético e a confecção de duas anastomoses.One of the most common complications of arteriovenous fistulas (AVF is aneurysm formation due to weakening of the venous wall after repeated punctures. Its rupture causes severe bleeding that can lead to death. We report the case of a patient with two AVF saccular aneurysms treated by aneurysmorrhaphy. The technique and the postoperative follow-up are presented in detail. Aneurysmorrhaphy is a good option to repair the AVF wall when the aneurysmal segment is short, thus avoiding the placement of prosthetic grafts and the performance of two anastomoses.

  14. Successful endovascular treatment for high take off aorto-iliac occlusive disease.

    Science.gov (United States)

    Nomura, Akihiro; Nagashima, Michio; Tomoi, Yusuke; Tosaka, Atsushi; Soga, Yoshimitsu

    2015-01-01

    A 73-year-old man with a history of intermittent claudication for the previous six years visited our hospital. His ankle-brachial index (ABI) was very low on both sides, and computed tomography (CT) indicated bilateral aorto-iliac occlusive disease (AIOD). As he refused to undergo open surgery, endovascular treatment (EVT) was administered. After the first and second EVT sessions, the intermittent claudication improved completely. In addition, the ABI normalized (right: 1.01, left: 0.99), and CT demonstrated full expansion of the stents. His post-EVT course was uneventful for 18 months. The use of EVT to treat AIOD is technically feasible and may serve as a potential treatment option for patients with an inoperable condition. PMID:25876573

  15. Congenital Circumflex Coronary Arteriovenous Fistula with Aneurysmal Termination in the Pulmonary Artery

    OpenAIRE

    Darwazah, Ahmad K.; Hussein, Izzedein H.; Hawari, Mohammad H.

    2005-01-01

    Coronary arteriovenous fistula is a rare congenital anomaly that is seen in 0.1% to 0.2% of coronary angiograms. Aneurysmal formation in the fistula is even rarer. We report a case of congenital circumflex arteriovenous fistula with aneurysmal formation just near its termination in the pulmonary artery, associated with atherosclerotic left anterior descending coronary artery. The anomaly was successfully repaired.

  16. 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

    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. Thoraci...

  17. A case of syphilitic aortic aneurysm with sternal erosion and impending rupture.

    Science.gov (United States)

    Mohamed Sarjun Basha, Khadhar; Raman, Karthik; Ahmed, Sheriff Ejaz; Latchumanadoss, Kalidoss; Rajan, Sethuratnam

    2016-02-01

    Syphilitic aortic aneurysm is a rare occurrence in the current antibiotic era. Cardiovascular syphilis has nearly disappeared in developed countries, although it remains a factor in differential diagnosis in developing nations. We report a case of syphilitic aortic aneurysm eroding through the sternum in a 52-year-old man who underwent successful surgical repair. PMID:25344618

  18. Endovascular treatment of abdominal aortic aneurysms.

    Science.gov (United States)

    Buck, Dominique B; van Herwaarden, Joost A; Schermerhorn, Marc L; Moll, Frans L

    2014-02-01

    Patients with abdominal aortic aneurysms (AAAs) are usually treated with endovascular aneurysm repair (EVAR), which has become the standard of care in many hospitals for patients with suitable anatomy. Clinical evidence indicates that EVAR is associated with superior perioperative outcomes and similar long-term survival compared with open repair. Since the randomized, controlled trials that provided this evidence were conducted, however, the stent graft technology for infrarenal AAA has been further developed. Improvements include profile downsizing, optimization of sealing and fixation, and the use of low porosity fabrics. In addition, imaging techniques have improved, enabling better preoperative planning, stent graft placement, and postoperative surveillance. Also in the past few years, fenestrated and branched stent grafts have increasingly been used to manage anatomically challenging aneurysms, and experiments with off-label use of stent grafts have been performed to treat patients deemed unfit or unsuitable for other treatment strategies. Overall, the indications for endovascular management of AAA are expanding to include increasingly complex and anatomically challenging aneurysms. Ongoing studies and optimization of imaging, in addition to technological refinement of stent grafts, will hopefully continue to broaden the utilization of EVAR. PMID:24343568

  19. 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

  20. 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.)

  1. Interventional therapy of huge aneurysm

    International Nuclear Information System (INIS)

    Objective: To evaluate the methods and the efficacy of interventional therapy for huge aneurysm. Methods: Seven patients with huge aneurysm including 2 with pulmonary aneurysm, 2 with renal aneurysm, 1 with humeral artery aneurysm, 1 with right common iliac artery aneurysm, 1 with right internal iliac artery aneurysm. Among these, 5 were true aneurysm, and 2 were pseudoaneurysms caused by congenital, trauma, arteriosclerosis. Three patients were treated with endovascular covered stent graft and 2 patients with embolization containing metallic coils. Two patients were treated with partial aneurysm and feeding artery trunk embolization with metallic coils. Results: All 7 patients were successful carried out the interventional therapy with successful rate of 100%. Six aneurysms were completely obstructed with disappearance of symptoms and signs. One died of aneurysm rupture. No other complication occurred. Conclusion: Interventional therapy for huge aneurysm is an effective method. (authors)

  2. Brain Aneurysm Statistics and Facts

    Science.gov (United States)

    ... Statistics and Facts A- A A+ Brain Aneurysm Statistics and Facts An estimated 6 million people in ... Understanding the Brain Warning Signs/ Symptoms Brain Aneurysm Statistics and Facts Seeking Medical Attention Risk Factors Aneurysm ...

  3. 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.

  4. 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. PMID:26522587

  5. Pediatric cerebral artery aneurysms

    OpenAIRE

    Koroknay-Pál, PÀivi

    2012-01-01

    Objectives. Intracranial aneurysms in children are rare and population-based long-term follow-up studies are limited. In this study, a large clinical and angiographic long-term follow-up was carried out. The special characteristics of the patients and their aneurysms were assessed together with factors affecting early and long-term morbidity and mortality. Materials and Methods. All pediatric (≀18 years) aneurysm patients treated at the Department of Neurosurgery in Helsinki during 193...

  6. 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

  7. Ruptured hepatic artery aneurysm precipitated by gangrenous perforated appendicitis: a case report.

    Science.gov (United States)

    Snow, Alec F; Vannahme, Milena; Kettley, Laura; Pullyblank, Anne

    2016-01-01

    Hepatic artery aneurysms are among the most common visceral artery aneurysms although still relatively rare. Repair of aneurysms >2 cm in diameter is important due to the high rate of rupture and associated mortality. Here, we present a case of a sudden rupture of a hepatic artery aneurysm after presentation with a perforated gangrenous appendicitis. There is increasing evidence that expansion and rupture of abdominal aortic aneurysm is related to degradation of elastin and collagen by matrix metalloproteinases (MMPs). Elastin degradation leads to expansion, while collagen degradation leads to rupture. The activity of MMPs has been shown to be upregulated by both sepsis and peritonitis. Here, we suggest that the inflammation from sepsis and peritonitis led to the activation and/or upregulation of MMPs, which precipitated aneurysm rupture via collagenase activity. PMID:27173883

  8. Ruptured hepatic artery aneurysm precipitated by gangrenous perforated appendicitis: a case report

    Science.gov (United States)

    Snow, Alec F.; Vannahme, Milena; Kettley, Laura; Pullyblank, Anne

    2016-01-01

    Hepatic artery aneurysms are among the most common visceral artery aneurysms although still relatively rare. Repair of aneurysms >2 cm in diameter is important due to the high rate of rupture and associated mortality. Here, we present a case of a sudden rupture of a hepatic artery aneurysm after presentation with a perforated gangrenous appendicitis. There is increasing evidence that expansion and rupture of abdominal aortic aneurysm is related to degradation of elastin and collagen by matrix metalloproteinases (MMPs). Elastin degradation leads to expansion, while collagen degradation leads to rupture. The activity of MMPs has been shown to be upregulated by both sepsis and peritonitis. Here, we suggest that the inflammation from sepsis and peritonitis led to the activation and/or upregulation of MMPs, which precipitated aneurysm rupture via collagenase activity. PMID:27173883

  9. Creation of a neo-aortoiliac system from lower extremity deep and superficial veins.

    Science.gov (United States)

    Clagett, G P; Bowers, B L; Lopez-Viego, M A; Rossi, M B; Valentine, R J; Myers, S I; Chervu, A

    1993-01-01

    OBJECTIVE: This study evaluated the morbidity, mortality, and intermediate term follow-up of patients undergoing replacement of their aortoiliac-femoral systems with lower extremity deep and superficial veins. SUMMARY BACKGROUND DATA: The most commonly used treatment for aortic prosthetic infection is ectopic bypass and removal of the prosthesis. The overall mortality rate with this approach is approximately 20%, with an amputation rate of 10% to 14%. Other limitations include thrombosis of the ectopic bypass leading to limb loss, reinfection of the ectopic bypass, and aortic stump blowout. Dissatisfaction with this approach has led the authors to develop the following. METHODS: A neo-aortoiliac system (NAIS) was fashioned from lower extremity deep veins (DV), greater saphenous veins (GSV), or both in patients with infected aortobifemoral prosthesis (n = 17) and other complex aortic problems (n = 3). Removal of infected prosthetic material, harvest of vein, and creation of NAIS was performed as a single-staged procedure. RESULTS: The in-hospital mortality and amputation rates were 10% each. The mean (+/- standard deviation [SD]) operative time was 6.5 +/- 1.8 hours and the blood transfusion requirement was 4 +/- 3 units. Four patients experienced postoperative gastrointestinal complications with peritonitis and sepsis; NAIS vein graft resisted infection and remained intact. The mean follow-up time was 22.5 +/- 16 months. NAISs constructed from GSVs were prone to the development of focal stenoses requiring intervention or diffuse neointimal hyperplasia leading to occlusion. In contrast, all NAISs from larger caliber DVs have remained widely patent. The failure rate of GSV NAISs was 64%, compared to 0% for DV NAISs (p = 0.006). Despite the high failure rate in patients with GSV NAISs, none has required amputation. In patients who had DVs harvested for NAIS reconstruction, limb edema and other signs of venous hypertension have been minimal. CONCLUSION: NAIS

  10. Intraorbital ophthalmic artery aneurysm associated with basilar tip saccular aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Dehdashti, A.R.; Tribolet, N. de [Department of Neurosurgery, HUG, Geneva (Switzerland); Safran, A.B. [Department of Ophthalmology, HUG, Geneva (Switzerland); Martin, J.B.; Ruefenacht, D.A. [Division of Neuroradiology, HUG, Geneva (Switzerland)

    2002-07-01

    We present a rare case of intraorbital ophthalmic artery aneurysm found incidentally, together with a ruptured aneurysm of the tip of the basilar artery. The intraorbital aneurysm was asymptomatic, and no treatment was offered. Angiographic control was recommended to detect any progression. Treatment may be indicated for documented enlargement or significant mass effect of the aneurysm. (orig.)

  11. Intraorbital ophthalmic artery aneurysm associated with basilar tip saccular aneurysm

    International Nuclear Information System (INIS)

    We present a rare case of intraorbital ophthalmic artery aneurysm found incidentally, together with a ruptured aneurysm of the tip of the basilar artery. The intraorbital aneurysm was asymptomatic, and no treatment was offered. Angiographic control was recommended to detect any progression. Treatment may be indicated for documented enlargement or significant mass effect of the aneurysm. (orig.)

  12. Open and Endovascular Treatment of Trans-Atlantic Inter-Society Consensus Ⅱ D Aortoiliac Occlusive Lesions: What Determines the Rate of Restenosis?

    Institute of Scientific and Technical Information of China (English)

    Chen-Yang Shen; Yun-Feng Liu; Qing-Le Li; Yong-Bao Zhang; Yang Jiao; Miltiadis E Krokidis; Xiao-Ming Zhang

    2015-01-01

    Background: Open surgery is the preferred approach for the treatment of type D lesions according to the Trans-Atlantic Inter-Society Consensus (TASC) Ⅱ guideline, but endovascular solutions also appear to be a valid option in selected patients.The study aimed to identify the risk factors of restenosis after open and endovascular reconstruction of symptomatic TASC Ⅱ D aortoiliac occlusive lesions (AIOLs).Methods: Fifty-six patients (82 limbs) who underwent open repair and endovascular treatment (ET) for symptomatic TASC ⅡD AIOLs between March 2005 and December 2012 were retrospectively reviewed.Baseline characteristics, preoperative and postoperative imaging,and operation procedure reports were reviewed and analyzed.Restenosis after revascularization was assessed by duplex ultrasound or computed tomography angiogram.Kaplan-Meier survival analysis, Log-rank test, and multivariate Cox regression were used to evaluate the relevance between risk factors and patency.Results: The mean duration of follow-up was 42.8 ± 23.5 months (ranging from 3 to 90 months).Primary patency rates at 1-, 3-, 5-,and 7-year were 93.6%, 89.3%, 87.0%, and 70.3%, respectively.Restenosis after revascularization occurred in 11 limbs.Kaplan-Meier survival analysis and the Log-rank test revealed that diabetes, Rutherford classification ≥5th and concurrent femoropopliteal TASC Ⅱ type C/D lesions were significantly related to the duration of primary patency.According to the result of Cox regression, diabetes and femoropopliteal TASC Ⅱ type C/D lesions were identified as the risk factors for restenosis after revascularization.Conclusion: This study demonstrated that diabetes and femoropopliteal TASC Ⅱ type C/D lesions are risk factors associated with restenosis after open and ET of TASC Ⅱ D AIOLs.

  13. Estudo comparativo entre tratamento endovascular e cirurgia convencional na correção eletiva de aneurisma de aorta abdominal: revisão bibliográfica Endovascular elective treatment of the abdominal aortic aneurysm versus conventional open repair: a comparative study

    Directory of Open Access Journals (Sweden)

    Ana Carolina P. Simão

    2009-12-01

    Full Text Available O tratamento eletivo do aneurisma de aorta abdominal é recomendado pela alta morbiletalidade decorrente da eventual ruptura. O objetivo deste trabalho foi comparar o reparo endovascular eletivo com a cirurgia aberta e avaliar as mortalidades hospitalar e perioperatória, em 1 ano, por todas as causas e relacionadas ao aneurisma, a permanência hospitalar, as complicações, as taxas de sobrevida, conversão e reintervenção, a durabilidade do enxerto, o custo-benefício e a relação desses dados com o treinamento da equipe médica responsável pelo tratamento. Realizou-se uma revisão da literatura sobre reparo endovascular versus cirurgia convencional. Foram observados vantagem na sobrevivência perioperatória e menor estresse pós-cirúrgico; no entanto, os benefícios iniciais são perdidos por complicações e reintervenções tardias. Trabalhos baseados nas primeiras gerações de endopróteses superestimam as taxas de mortalidade em curto prazo, complicações e reintervenções. A durabilidade do enxerto, a real vantagem na sobrevida e o custo-benefício são incertos, e outros estudos são necessários para o seguimento em longo prazo.The elective treatment of the abdominal aortic aneurysm is recommended due to the high morbidity and mortality of a possible rupture. The objective of this study was to compare the elective endovascular aneurysm repair with open repair and to analyze the in-hospital and perioperative mortality rate during 1 year related to all causes and to the aneurysm, as well as the postoperative length of hospital stay, complications, survival rates, conversion and reintervention, graft durability, cost-benefit ratio, and relation with the medical team’s experience. A review of the scientific literature about endovascular versus open repair was carried out. We found a higher rate of perioperative survival and less postoperative stress; nevertheless, the initial benefits were lost due to late complications and

  14. Successful Surgical Treatment for Thoracoabdominal Aortic Aneurysm with Leriche Syndrome

    Science.gov (United States)

    Chong, Byung Kwon; Kim, Joon Bum

    2015-01-01

    Thoracoabdominal aortic aneurysm accompanied by Leriche syndrome is an extremely rare combination of aortic diseases, the surgical management of which has not been described to date. We report the successful treatment of one such case through open surgical repair of the thoracoabdominal aorta. PMID:25883898

  15. Surgical management of large and giant intracavernous and paraclinoid aneurysms

    Institute of Scientific and Technical Information of China (English)

    Xu Bai-nan; SUN Zheng-hui; JIANG Jin-li; WU Chen; ZHOU Ding-biao; YU Xin-guang; LI Bao-min

    2008-01-01

    Background Due to their location,large and giant intracavernous and paraclinoid aneurysms remain a challenge for vascular neurosurgeons.We identified characteristics.surgical indications and treatment strategies of large and giant intracavernous and paraclinoid aneurysms in 36 patients.Methods The pterional approach was routinely used.The cervical internal carotid artery was exposed for proximal control of parent vessel and retrograde suction decompression.Paraclinoid aneurysms were directly clipped,intracavernous pseudoaneurysm was repaired and the intracavernous aneurysms were trapped with extracranial-intracranial bypass of saphenous vein graft.Intraoperative electroencephaIogram (EEG) and somatosensory evoked potential (SSEP) monitoring were used to detect cerebral ischemia during the temporary occlusion of parent arteries.Microvascular Doppler ultrasonography was used to assess blood flow of the parent and branch vessels.Endoscopy was helpful particularly in dealing with internal carotid artery posterior wall aneurysms.Postoperative digital subtraction angiography (DSA) was performed in 33 of the 36 patients.Results Thirty-two paraclinoid aneurysms were directly clipped,1 intracavernous pseudoaneurysm was repaired and the other 3 intracavernous aneurysms were trapped with revascula rization.Except for two patients who died in the early postoperative stage,34 patients' follow-up was 6-65 months (mean 10 months)and a Glasgow Outcome Scale score of 4 to 5 at discharge.At the 6-month follow-up examination,Rankin Outcome Scale scores were 0 to 2 in 32 patients.EEG and SSEP monitoring changed in six patients.Twelve clips were readjusted when insufficient blood flow in parent and branch vessels was detected.Three posterior wall aneurysms were clipped.Conclusions Intracavernous aneurysms not amenable to endovascular treatment should be treated surgically and surgical treatment is the first option for paraclinoid aneurysms.The temporary parent vessel occlusion

  16. Abdominal aortic aneurysm repair - open - discharge

    Science.gov (United States)

    ... After spending 1 to 3 days in the intensive care unit (ICU), you spent more time recovering in a ... Call your doctor or nurse if: You have pain in your belly or back that does not go away or is very bad Your legs ...

  17. 18F-FDG PET-CT uptake is a feature of both normal diameter and aneurysmal aortic wall and is not related to aneurysm size

    International Nuclear Information System (INIS)

    Aortic metabolic activity is suggested to correlate with presence and progression of aneurysmal disease, but has been inadequately studied. This study investigates the 2-[18F] fluoro-2-deoxy-D-glucose (18F-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 (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. SUVmax 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 18F-FDG PET/CT in infra-renal AAA does not correlate with aortic size and does not differ between aneurysms and matched controls. (orig.)

  18. Tratamento endovascular do aneurisma da aorta abdominal infrarrenal em pacientes com anatomia favorável para o procedimento: experiência inicial em um serviço universitário Endovascular treatment of infrarenal abdominal aortic aneurysm in patients with favorable anatomy for the repair: initial experience in a university hospital

    Directory of Open Access Journals (Sweden)

    José Manoel da Silva Silvestre

    2011-03-01

    Full Text Available CONTEXTO: Desde sua introdução, em 1991, o reparo endovascular do aneurisma da aorta abdominal infrarrenal tem se tornado uma alternativa atraente para o tratamento dessa doença. Avaliar nossos resultados iniciais quanto à segurança e eficácia dessa técnica nos levou à realização deste estudo. OBJETIVOS: Analisar a mortalidade perioperatória, a sobrevida tardia, as reoperações, as taxas de perviedade e o comportamento do saco aneurismático em pacientes com anatomia favorável para a realização do procedimento. MÉTODOS: Trata-se de um estudo longitudinal, observacional e retrospectivo realizado entre outubro de 2004 e janeiro de 2009 com 41 pacientes que foram submetidos à correção endovascular do aneurisma de aorta abdominal infrarrenal por apresentarem anatomia favorável para o procedimento. Foram analisados os achados dos exames diagnósticos, o tratamento e o seguimento em todos os pacientes. RESULTADOS: Foram implantadas, com sucesso, 31 (75,6% próteses bifurcadas e 10 (24,5% monoilíacas, de 5 diferentes marcas. O diâmetro médio dos aneurismas fusiformes era de 62 mm. A mortalidade perioperatória foi de 4,8% e a sobrevida tardia, 90,2%. Durante o acompanhamento médio de 30 meses, 2 (4,8% pacientes necessitaram de reintervenção, um por migração da endoprótese e outro por vazamento tipo II. Dois (4,8% pacientes apresentaram oclusão de ramo da prótese. Oito (19,5% vazamentos foram diagnosticados e não houve nenhuma rotura dos aneurismas. CONCLUSÃO: Apesar do pequeno número de pacientes, os resultados observados parecem justificar a realização do procedimento endovascular nos pacientes com anatomia favorável.BACKGROUND: Since its introduction in 1991, endovascular repair of infrarenal aortic aneurysms has become an attractive option to treat this disease. The evaluation of our initial results about safety and efficacy of this technique has led us to carry out this study. OBJECTIVES: To analyze

  19. 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

  20. Popliteal vein aneurysm.

    Science.gov (United States)

    Falkowski, A; Poncyljusz, W; Zawierucha, D; Kuczmik, W

    2006-06-01

    The incidence of a popliteal vein aneurysm is extremely low. Two cases of this rare venous anomaly are described. The epidemiology, morphology, and diagnostic methods are discussed and the potentially dangerous complications and treatment methods are presented. PMID:16796307

  1. Symptomatic regrowth of a small intracranial aneurysm that had ruptured and completely thrombosed: a case report

    Directory of Open Access Journals (Sweden)

    Hidetoshi Ooigawa

    2015-06-01

    Full Text Available We report a case of small internal carotid–posterior communication artery (IC–PC aneurysm that was completely thrombosed after initial bleeding, but subsequently became symptomatic, causing a mass effect. A 54-year-old woman initially presented with grade-five subarachnoid hemorrhage from a small right IC–PC aneurysm. The aneurysm was treated conservatively and completely thrombosed within 35 days. The patient slowly recovered and remained well until 4 years later, when she developed right oculomotor nerve palsy. Imaging revealed relapse of the aneurysm, and repair led to symptom resolution. This case offers a reminder that totally thrombosed aneurysms carry a risk of regrowth if left untreated.

  2. Endoleakage after endovascular treatment of abdominal aortic aneurysms: diagnosis, significance and treatment

    International Nuclear Information System (INIS)

    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.)

  3. 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 ...

  4. Risk of Familial Intracranial Aneurysm

    OpenAIRE

    J Gordon Millichap; Millichap, John J.

    2014-01-01

    Investigators at University Medical Center Utrecht, Netherlands, studied the yield of long-term (up to 20 years) screening for intracranial aneurysms in individuals with a positive family history (2 or more first-degree relatives) of aneurysmal subarachnoid hemorrhage (aSAH) or unruptured intracranial aneurysm (1993-2013).

  5. Surgical treatment of a giant extracranial internal carotid artery aneurysm: A case report

    Directory of Open Access Journals (Sweden)

    Pasternak Janko

    2007-01-01

    Full Text Available Introduction. True aneurysms of the extracranial internal carotid artery are rare lesions. Surgical treatment is considered to be the best therapeutic option. However, the use of the intraluminal shunt remains controversial. Case report. We reported a case of a giant extracranial internal carotid artery aneurysm treated by reconstructive surgery. A 76-year-old woman was referred with a pulsatile mass inside her mouth, associated with dizziness and dysarthria. There was no history of cerebrovascular symptoms, neck pain, or cervical trauma. A magnetic resonance scan showed a 45 mm aneurysm of the internal carotid artery (ICA, and kinking of ICA. Angiography demonstrated a saccular ICA aneurysm, with a lengthening and tortuosity of the ICA. The aneurysm and the carotid artery branches were easily exposed through a standard anterior cervical incision. After resection of the aneurysm, a Javid shunt was inserted between the common and internal carotid arteries, and end-to-end repair of ICA was easily performed due to ICA redundancy. The aneurysm was of atherosclerotic origin. Four months after the operation, the patient showed a complete recovery from peripheral neurological deficit. Discussion. Our results show that surgical reconstruction is a satisfactory therapeutic choice in the management of extracranial carotid artery aneurysms in order to avoid rupture, thromboembolism and cerebrovascular insufficiency. To date, there has been little experience with endoluminal exclusion techniques and the long-term effectiveness is still uncertain. .

  6. Verminous aneurysm caused by filaria.

    Science.gov (United States)

    Toledo, F V; de Araújo, A P; da Cunha, A M; Sidow, J R; Pavão, S G; de Araújo, E D

    1983-06-01

    Aneurysms caused by atherosclerosis are relatively frequent, as a consequence of the high incidence of this degenerative disease of the arteries. Other types of aneurysm, for example, those of infectious etiology, are more uncommon. Bacterias and fungi are able to cause aneurysms in several parts of the arterial tree. Stengel et al (1943), in a review of world literature described 217 cases of mycotic aneurysms. The Stedman's Medical Dictionary refers to a special type of aneurysm observed in horses, caused by intra-vascular migration of a worm, the Strongylus vulgaris. It has been named verminous aneurysm and generally involves the mesenteric arteries. We haven't found in medical literature any similar observations refering to human cases. The purpose of this paper is to describe a case of aneurysm the etiology of which we have imputed to the filaria (Wuchereria bancrofti). This case was observed in Marcilio Dias Naval Hospital, Rio de Janeiro, Brazil. PMID:6346961

  7. Surgical treatment of complicated traumatic aneurysm and arteriovenous fistula

    Institute of Scientific and Technical Information of China (English)

    乔正荣; 时德

    2003-01-01

    Objective: To evaluate the surgical methods and the outcome of management for traumatic arterial aneurysm (TAA) and traumatic arteriovenous fistula (TAVF). Methods: A total of 121 patients with TAA or TAVF were treated by surgery. Clinical, operative and postoperative data were collected and analyzed retrospectively. Results: The surgical techniques included aneurysmectomy and arterial end-to-end anastomosis or vascular grafting or artery ligation, aneurysm ligation and bypass, vascular repair, fistula excision and vascular ligation or vascular grafting or repair and so on. One patient died (0.83%). The follow-up rates of TAA and TAVF were 65.7% and 60% respectively. Conclusions: Complicated TAA and TAVF in different sites should be treated with different methods.

  8. What You Should Know about Cerebral Aneurysms

    Science.gov (United States)

    ... T. Quiz 5 Things to Know About Stroke What You Should Know About Cerebral Aneurysms Updated:Jun ... Damage Treatments Click image to view an animation What is a cerebral aneurysm? An aneurysm is a ...

  9. 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 ...

  10. 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...

  11. Down syndrome: a risk factor for mycotic aneurysm?

    LENUS (Irish Health Repository)

    Naughton, Peter A

    2011-03-29

    Down syndrome, or trisomy 21, has a characteristic constellation of clinical findings, including various congenital heart defects. We report a case of an adult male with Down syndrome who presented with a 3-week history of lower limb pain and swelling, attributed to cellulitis. Clinical and angiographic evaluation identified a below-knee mycotic pseudoaneurysm secondary to infective endocarditis. Surgical aneurysmal repair and revascularization were performed. Various management options are outlined in this report.

  12. Multiple idiopathic arterial aneurysms masquerading as aortic dissection

    OpenAIRE

    Naha, Kushal; Vivek, G; Shetty, Ranjan K; Dias, Lorraine Simone

    2013-01-01

    We report the case of a 58-year-old lady who presented with abdominal pain and backache. Although initial evaluation was strongly suggestive of abdominal aortic dissection, she was ultimately found to have multiple arterial aneurysms. Work-up for underlying vasculitis was negative. Surgical repair was planned and the patient was referred to a cardiovascular surgeon. This case highlights the importance of careful radiological assessment in patients with suspected aortic dissection.

  13. Staged surgical repair for extensive cardiovascular damage by syphilis.

    Science.gov (United States)

    Kobayashi, Toshiro; Yagi, Takeshi; Murakami, Masanori; Jinbo, Mitsutaka; Saito, Satoshi; Takahashi, Tsuyoshi; Yamada, Takahiro; Kunichika, Hideki; Gohra, Hidenori

    2011-10-01

    A 45-year-old man had aortic regurgitation with a syphilitic true aneurysm of the ascending to transverse arch aorta and a descending aortic aneurysm from chronic Stanford type B aortic dissection. After antibiotic therapy, two-staged surgical repair was performed and there has been no evidence of recurrence in 12 months since the second stage. We describe the successful management of extensive cardiovascular syphilitic damage. PMID:21958803

  14. Case report: Varicosity of the communicating vein between the left renal vein and the left ascending lumbar vein mimicking a renal artery aneurysm: Report of an unusual site of varicose veins and a novel hypothesis to explain its association with abdominal pain

    Directory of Open Access Journals (Sweden)

    Sandeep G Jakhere

    2011-01-01

    Full Text Available A communicating vein between the left renal vein and the left ascending lumbar vein has only rarely been reported in the imaging literature. There are very few reports of varicosity of this communicating vein. Nonetheless, awareness about this communicating vein is of utmost importance for surgeons performing aortoiliac surgeries and nephrectomies as it may pose technical difficulties during surgery or cause life-threatening retroperitoneal hemorrhage. Varicosity of this venous channel may be mistaken for paraaortic lymphadenopathy, adrenal pseudo-mass, or renal artery aneurysm. We report a case of a patient with varicosity of this communicating vein, which mimicked a left renal artery aneurysm. A novel hypothesis is also proposed to explain the relationship with abdominal pain.

  15. CT features of mycotic aneurysms

    International Nuclear Information System (INIS)

    To describe CT features of mycotic aneurysms. We have retrospectively checked 10 patients diagnosed with mycotic aneurysm. Three revealed previously treated arteriosclerotic aneurysms, one was diabetic and had undergone a reno pancreatic transplant,and another presented advanced HIV infection. They al presented fever syndrome and eight exhibited leucocytosis. Mycotic aneurysm diagnosis was made by means of CT findings, clinical examination and positive hemo culture in all cases. Anatomopathological findings were available as confirmation for all four surgically treated patients. The CT scan was performed during arterial phase with spiral acquisition, without contrast and with endo venous administration of a contrast medium. Saccular aneurysms were found in seven patients (double aneurysms in the case of two), with seven of these being abdominal aneurysms (one retrocrural aortic,three infra renal aortic, and three iliac arteries) and two thoracic (aortic arch). In all three remaining patients, there was a pre-existing arteriosclerotic aneurysm (fusiform) and only incipient changes were observed in the adjacent fat. Perianeurysmatic soft-tissue was was noted in eight cases. Only two patients presented signs of tear (peri aneurysm hematoma and/or with contrast extravasation). In three cases, the calcium ring was disrupted. In two patients, absences were observed in other locations. In none of the cases was there gas in the aneurysm wall. Mycotic aneurysm is a rate entity, but must be considered in the evaluation of septic patients since it demands early diagnosis and treatment. In such patients, a CT finding of saccular aneurysm with adjacent soft-tissue mass, and associated with a positive hemo culture, is highly suggestive of this pathology. (Author) 9 refs

  16. Correção endovascular de aneurisma de aorta abdominal e artéria ilíaca comum esquerda em paciente com hemofilia C grave Endovascular repair of abdominal aortic aneurysm and left common iliac artery in a patient with severe hemophilia C

    Directory of Open Access Journals (Sweden)

    Sergio Quilici Belczak

    2012-03-01

    Full Text Available A deficiência do fator XI, também conhecida como hemofilia C, é uma doença hematológica hereditária rara, que se manifesta clinicamente com hemorragia persistente após cirurgias, traumas, menorragias e extrações dentárias. Neste artigo, relatou-se a correção endovascular de um paciente com aneurisma de aorta e de artéria ilíaca comum esquerda em um paciente portador de deficiência major do fator XI (atividade do fator XI inferior a 20%. O procedimento foi realizado com sucesso, com o manuseio do distúrbio da coagulação por meio da infusão de plasma fresco no pré-operatório imediato e no pós-operatório, e controle laboratorial da coagulação do paciente.Factor XI deficiency, also known as hemophilia C, is a rare hereditary blood disease that manifests with persistent bleeding after surgery, trauma, menorrhagia, and dental extractions. This article reports an endovascular repair of a patient diagnosed with an aortic and left common iliac aneurysm, with severe factor XI deficiency (factor XI activity below 20%. The procedure was successfully performed with management of the coagulation disorder by preoperative and postoperative infusion of plasma and laboratory control of the coagulation.

  17. Management of Unruptured Intracranial Aneurysms.

    Science.gov (United States)

    Nasr, Deena M; Brown, Robert D

    2016-09-01

    Unruptured intracranial aneurysms (UIA) occur in approximately 2-3 % of the population. Most of these lesions are incidentally found, asymptomatic and typically carry a benign course. Although the risk of aneurysmal subarachnoid hemorrhage is low, this complication can result in significant morbidity and mortality, making assessment of this risk the cornerstone of UIA management. This article reviews important factors to consider when managing unruptured intracranial aneurysms including patient demographics, comorbidities, family history, symptom status, and aneurysm characteristics. It also addresses screening, monitoring, medical management and current surgical and endovascular therapies. PMID:27443382

  18. Mycotic aneurysm in a turtle hunter: brief review and a case report

    Directory of Open Access Journals (Sweden)

    Harsha Moole

    2015-06-01

    Full Text Available Salmonella-associated mycotic aneurysm is a rare, but dreaded, complication of salmonellosis. Immunocompromised and elderly populations are more susceptible to develop this extra-intestinal complication. Salmonella is spread via fecal–oral and vehicle-borne routes. Reptiles, especially small pet turtles, have been linked with an increased risk of Salmonella infection. Diagnosis of mycotic aneurysm is a challenge due to atypical presentations. Recently, widespread use of CT scan imaging to evaluate for unexplained abdominal pain and sepsis has led to early identification of mycotic aneurysms. Antibiotic therapy and surgical intervention are the cornerstones of management. Open surgery has been the gold standard of treatment but is associated with increased morbidity and mortality. A relatively new alternative to open surgery is endovascular aneurysm repair (EVAR. It is comparatively less invasive and is associated with reduced early morbidity and mortality in the setting of mycotic aneurysm. However, there is a risk of late infection. Here, we present a patient with Salmonella mycotic aneurysm initially treated conservatively with antibiotic therapy who later underwent successful interval EVAR with no complications to date. Also included is a brief review of Salmonella-associated mycotic aneurysms.

  19. 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.

  20. 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.

  1. A large un-ruptured abdominal aortic aneurysm causing pulmonary embolism.

    Science.gov (United States)

    Sajjad, Jahangir; Ahmed, Abubakr; Coveney, Andrew; Fulton, Gregory

    2015-01-01

    A 79 years old woman presented in a peripheral hospital with dyspnea, right-sided pleuritic chest pain and cough for 3 days. On examination, she was tachycardiac and tachypneic. She had reduced air entry bilaterally on auscultation. Computed tomography-pulmonary angiogram, performed in peripheral Hospital, confirmed the diagnosis of pulmonary embolism, and she was commenced on warfarin. Ultrasonography showed no evidence of deep venous thrombosis in legs; however, ultrasound of the abdomen revealed an aortic aneurysm. She was hemodynamically stable on transfer to vascular surgery department, and her complete clinical examination revealed a pulsatile mass in the central abdomen. Computed tomography angiogram of aorta showed 8.7-cm abdominal aortic aneurysm. Venogram performed during inferior vena cava (IVC) filter insertion showed that IVC was displaced and compressed due to this large aortic aneurysm, causing thromboembolism. An open repair of the aneurysm was performed with uneventful recovery. PMID:26205717

  2. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B; Olsen, P S; Perko, M J; Agerskov, Kim; Røder, O; Lorentzen, Jørgen Ewald

    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 55......, 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.......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...

  3. Intracranial aneurysm and sildenafil.

    Science.gov (United States)

    Adiga, Avinash; Edriss, Hawa; Nugent, Kenneth

    2016-04-01

    Sildenafil is one of the most commonly used drugs for the treatment of erectile dysfunction. To date, we found five reported cases of intracerebral bleeding and two reported cases of subarachnoid hemorrhage related to sildenafil use. We report a 49-year-old hypertensive and diabetic patient who presented with acute pulmonary edema and loss of consciousness following ingestion of 100 mg of sildenafil prior to sexual intercourse. He was not previously aware of the presence of an aneurysm and had no family history of it. Computed tomography of his head revealed a subarachnoid hemorrhage due to rupture of a saccular aneurysm with subsequent repeat hemorrhage within a few hours of presentation. A sudden increase in blood pressure led to pulmonary edema. Studies have shown that sildenafil acts on phosphodiesterase-1, -2 and -5 receptors and leads to a secondary increase in intracerebral circulation and vasodilatory effects, leading to sympathetic overactivity which increases the risk for intracranial bleeding. PMID:27034561

  4. Pediatric intracranial aneurysms

    OpenAIRE

    Tripathy L; Singh S

    2009-01-01

    The incidence of subarachnoid haemorrhage from intracranial aneurysms in the paediatric age group is extremely rare. Interestingly, occurrence of vasospasm has been reported to be less in comparison to the adults. Both coiling and clipping have been advocated in selected cases. Because of the thinness of the wall of the arteries, utmost care should be taken while handling these arteries during surgery. The overall results of surgery in children have been reported to be better than their adult...

  5. 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.)

  6. Ruptured Sinus of Valsalva Aneurysm into the Left Atrium with Multiple Fistulous Communications: A Rare Cause of Heart Failure

    Directory of Open Access Journals (Sweden)

    Yashwant Agrawal

    2015-01-01

    Full Text Available Ruptured noncoronary sinus of valsalva aneurysm with fistulous connections to multiple cardiac chambers has not been reported previously. We report a 66-year-old man who presented with worsening cough and exertional dyspnea. Transesophageal echocardiogram confirmed a large aneurysm involving the noncoronary cusp of the aortic sinus with aneurysmal extension to the left atrium. There were also two fistulous communications with the left atrium and one small fistulous connection with the right atrium. Open-heart surgery with aortic root replacement and reimplantation of coronary arteries along with primary closure and repair of aorta to the left atrial fistula was performed.

  7. [Subarachnoid hemorrhage without aneurysm].

    Science.gov (United States)

    Müller-Forell, W; Welschehold, S; Köhler, J; Schicketanz, K H

    2002-11-01

    The rupture and bleeding of intracranial aneurysms is the most common cause of a spontaneous, non-traumatic subarachnoid hemorrhage (SAH). In up to 20% of these patients, no aneurysm is found, but the prognosis of these patients is known to be better than in those with aneurysms. The retrospective evaluation of the initial CT- and angiographic findings of 773 patients with spontaneous SAH, who underwent (up to three) 4-vessel DSA, brought a percentage of 12.4% with negative angiography. We found the favourable prognosis of these patients with negative angiography not only to be dependent from the distribution of the hemorrhage, with preference to perimesencephalic pattern, but the initial clinical state. 85% of our patients, who presented with perimesencephalic blood pattern and even 80% of those patients with additional intraventricular hemorrhage but the good clinical condition of Hunt-Hess I/II were discharged without neurological deficits. We recommend the obligatory 4-vessel catheter-angiography (DSA) in all patients with spontaneous SAH, independent of the blood pattern on initial CT, and one control in the presence of other than perimesencephalic subarachnoid hemorrhage, CTA might be reserved for additional controls. PMID:12458439

  8. 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.

  9. Clinical usefulness of urinary liver-type fatty-acid-binding protein as a perioperative marker of acute kidney injury in patients undergoing endovascular or open-abdominal aortic aneurysm repair

    OpenAIRE

    Obata, Yumi; Kamijo-Ikemori, Atsuko; Ichikawa, Daisuke; Sugaya, Takeshi; Kimura, Kenjiro; Shibagaki, Yugo; Tateda, Takeshi

    2015-01-01

    Purpose Acute kidney injury (AKI) is common after cardiovascular surgery and is usually diagnosed on the basis of the serum creatinine (SCr) level and urinary output. However, SCr is of low sensitivity in patients with poor renal function. Because urinary liver-type fatty-acid-binding protein (L-FABP) reflects renal tubular injury, we evaluated whether perioperative changes in urinary L-FABP predict AKI in the context of abdominal aortic repair. Methods Study participants were 95 patients who...

  10. Treatment of a Common Iliac Aneurysm by Endovascular Exclusion Using the Amplatzer Vascular Plug and Femorofemoral Crossover Graft

    International Nuclear Information System (INIS)

    We report our initial experience using the Amplatzer Vascular Plug II (AVP2) in the treatment of a left common iliac aneurysm. Following investigation by computerized tomographic angiography and catheter angiography, a 79-year-old man was found to have a markedly tortuous iliac system, with a left common iliac artery aneurysm that measured 48 mm in maximal diameter. Due to the patient's age and comorbidities the surgical opinion was that conventional open repair was not suitable. However, due to the tortuous nature of the aneurysm and iliac vessels, standard endovascular repair, using either a bifurcated or an aorto-uni-iliac stent graft, was also not possible. A combined approach was used by embolizing the ipsilateral internal iliac artery using coils and excluding the aneurysm using two AVP2 occlusion devices, followed by femorofemoral crossover grafting. Total aneurysm occlusion was achieved using this method and this allowed the patient to have a much less invasive surgical procedure than with conventional open repair of common iliac aneurysms, thus avoiding potential comorbidity and mortality.

  11. Giant superior mesenteric artery aneurysm

    OpenAIRE

    Temiz, Ahmet; Bostan, Mehmet; Şatıroğlu, Ömer; Çetin, Mustafa; Bozkurt, Engin

    2011-01-01

    Aneurysm of the superior mesenteric artery (SMA) is a rare condition and most of them are symptomatic. Gradu­ally increasing abdominal pain, intestinal ischemic symp­toms and rupture are the most common symptoms. We herein report a giant SMA aneurysm detected in a patient with complaint of abdominal discomfort.

  12. Health-related quality of life outcomes following elective open or endovascular AAA repair: a randomized controlled trial.

    NARCIS (Netherlands)

    Lottman, P.E.M.; Laheij, R.J.F.; Cuypers, P.W.; Bender, M.H.M.; Buth, J.

    2004-01-01

    PURPOSE: To assess health-related quality of life outcomes after endovascular versus open abdominal aortic aneurysm repair. METHODS: Participants were randomly assigned to receive either endovascular or open abdominal aortic aneurysm (AAA) surgery according to a rate of 3 endovascular patients to 1

  13. 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

  14. Endovascular treatment of thoracic aortic aneurysms: a review

    International Nuclear Information System (INIS)

    Open surgical repair is considered the traditional treatment for patients with thoracic aortic aneurysms (TAA). In view of the persistent perioperative mobidity and mortality, endovascular stent-graft placement as a minimally invasive and potentially safer treatment for aneurysm of the descending aorta was introduced in 1992. Since then, progress has been made and several institutions have substantiated the safety and effectiveness of stent grafts in the repair of descending TAAs or type-B aortic dissections. Currently, both custom-designed, home-made, and commercially available stent grafts are used. Prior to placement of the endoprosthesis, three major prerequisites must be considered: the localization and morphology of the aneurysm; the distal vascular access of sufficient size; and a limited tortuosity of the abdominal and thoracic aorta. Although short-term results are encouraging, severe complications, including paraplegia, cerebral strokes, and aortic rupture, have been encountered. The long-term durability of currently available stent-graft systems is nonexistent and material fatigue are of major concern to both surgeons and radiologists. Nevertheless, endovascular stent-graft placement could become the procedure of choice in a substantial number of patients with descending TAA. (orig.)

  15. Early Introduction of Everolimus Immunosuppressive Regimen in Liver Transplantation with Extra-Anatomic Aortoiliac-Hepatic Arterial Graft Anastomosis

    Directory of Open Access Journals (Sweden)

    Emanuele Felli

    2014-01-01

    Full Text Available Liver transplantation is the treatment of choice for patients with acute and chronic end-stage liver disease, when no other medical treatment is possible. Despite high rates of 1- to 5-year survival, long-term adverse effects of immunosuppressant agents remain of major concern. Current research and clinical efforts are made to develop immunosuppressant agents that minimize adverse effects along with a low rate of graft rejection. Tailoring immunosuppressive therapy to individual patients by the use of proliferation signal inhibitors seems to be the best way to minimize toxicity and increase efficacy. Recently everolimus has been introduced in clinical practice; among its adverse effects an increased incidence of arterial graft thrombosis in renal transplants, vascular anastomosis leakage, impaired wound healing, and thrombotic microangiopathy have been reported. We present the case of a 54-year-old patient submitted to liver transplantation for end-stage liver disease treated by an extra-anatomic aortoiliac-hepatic arterial graft anastomosis and early postoperative introduction of everolimus for acute renal failure. Postoperative period was characterized by two abdominal collections and reactivation of cytomegalovirus infection that were treated by percutaneous drainage and antiviral therapy, respectively; the patient is well after 8-month followup with patency of the arterial conduit and no leakage.

  16. Ruptured Mycotic Aortic Aneurysm after Bacille Calmette-Guerin Therapy.

    Science.gov (United States)

    Floros, Nikolaos; Meletiadis, Konstantinos; Kusenack, Ulrich; Zirngibl, Hubert; Kamper, Lars; Haage, Patrick; Dreger, Nici Markus

    2015-10-01

    To report a case of a ruptured mycotic abdominal aortic aneurysm (MAA) after intravesical Bacille Calmette-Guerin (BCG) therapy because of bladder carcinoma. A 57-year-old male patient was admitted to our hospital for follow-up computed tomography 14 months after transurethral resection of a papillary carcinoma of the bladder and intravesical BCG therapy. The CT scan revealed a ruptured MAA aneurysm and the patient underwent an endovascular repair with an aorto-bi-iliac stent graft. A ruptured MAA is a rare but lethal complication after BCG instillation therapy. The standard therapy is the open reconstruction but according to the literature an endovascular therapy in combination with long-term antibiotics should be considered as a bridging or a definite solution. PMID:26119640

  17. Ten-Year Follow-Up of Endovascular Aneurysm Treatment with Talent Stent-Grafts

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the clinical results, complications, and secondary interventions during long-term follow-up after endovascular aneurysm repair (EVAR) and to investigate the impact of endoleak sizes on aneurysm shrinkage. From 1997 to March 2007, 127 patients (12 female, 115 male; age, 73.0 ± 7.2 years) with abdominal aortic aneurysms were treated with Talent stent-grafts. Follow-up included clinical visits, contrast-enhanced MDCT, and radiographs at 3, 6, and 12 months and then annually. Results were analyzed with respect to clinical outcome, secondary interventions, endoleak rate and management, and change in aneurysm size. There was no need for primary conversion surgery. Thirty-day mortality was 1.6% (two myocardial infarctions). Procedure-related morbidity was 2.4% (paraplegia, partial infarction of one kidney, and inguinal bleeding requiring surgery). Mean follow-up was 47.7 ± 34.2 months (range, 0-123 months). Thirty-nine patients died during follow-up; three of the deaths were related to aneurysm (aneurysm rupture due to endoleak, n = 1; secondary surgical reintervention n = 2). During follow-up, a total of 29 secondary procedures were performed in 19 patients, including 14 percutaneous procedures (10 patients) and 15 surgical procedures (12 patients), including 4 cases with late conversion to open aortic repair (stent-graft infection, n = 1; migration, endoleak, or endotension, n = 3). Overall mean survival was 84.5 ± 4.7 months. Mean survival and freedom from any event was 66.7 ± 4.5 months. MRI depicted significantly more endoleaks compared to MDCT (23.5% vs. 14.3%; P 10% of the aneurysm area were associated with reduced aneurysm shrinkage compared to no endoleaks or <10% endoleaks (Δ at 3 years, -1.8% vs. -12.0%; P < 0.05). In conclusion, endovascular aneurysm treatment with Talent stent-grafts demonstrated encouraging long-term results with moderate secondary intervention rates. Primary occlusion of all aortic side

  18. Endovascular treatment of PICA aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Mukonoweshuro, W.; Laitt, R.D.; Hughes, D.G. [Radiology Dept., Greater Manchester Neurosciences Unit, Hope Hospital, Salford, Manchester (United Kingdom)

    2003-03-01

    Endovascular treatment of aneurysms of the posterior inferior cerebellar artery (PICA) avoids manipulation of the brainstem or lower cranial nerves and should therefore carry a lower risk of neurological morbidity than surgical clipping. We reviewed our experience of 23 patients with PICA aneurysms treated by endovascular occlusion with Guglielmi detachable coils and documented their long-term outcome on follow-up. We observed a 28 day procedure-related neurological morbidity of 13% (3/23 patients). One patient suffered permanent neurological complications. There were no procedure-related deaths. None of our patients suffered a re-bleed from their treated aneurysms. Our series shows endovascular treatment of ruptured PICA aneurysms to be safe and effective. (orig.)

  19. Thoracic aortic aneurysm and dissection.

    Science.gov (United States)

    Goldfinger, Judith Z; Halperin, Jonathan L; Marin, Michael L; Stewart, Allan S; Eagle, Kim A; Fuster, Valentin

    2014-10-21

    Aortic dissection is the most devastating complication of thoracic aortic disease. In the more than 250 years since thoracic aortic dissection was first described, much has been learned about diseases of the thoracic aorta. In this review, we describe normal thoracic aortic size; risk factors for dissection, including genetic and inflammatory conditions; the underpinnings of genetic diseases associated with aneurysm and dissection, including Marfan syndrome and the role of transforming growth factor beta signaling; data on the role for medical therapies in aneurysmal disease, including beta-blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors; prophylactic surgery for aneurysm; surgical techniques for the aortic root; and surgical and endovascular management of aneurysm and dissection for different aortic segments. PMID:25323262

  20. Tobacco smoking and aortic aneurysm

    DEFF Research Database (Denmark)

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

    2012-01-01

    from the Copenhagen City Heart Study followed for up to 34years and in 56,211 individuals from the Copenhagen General Population Study followed for up to 7years. RESULTS: During follow-up, 335 and 169 individuals developed aortic aneurysm outcomes in the Copenhagen City Heart Study and Copenhagen...... 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...

  1. Development of bilateral coronary artery aneurysms in a child with Noonan syndrome

    International Nuclear Information System (INIS)

    Noonan syndrome is a constellation of congenital malformations including heart defects, facial anomalies and short stature. The cardiovascular defects are variable and extensive, with the most common being pulmonary stenosis and hypertrophic cardiomyopathy. Coronary artery anomalies have only been reported in a few cases. We report a child with Noonan syndrome status post pulmonary stenosis and atrial septal defect repair, who developed bilateral coronary artery aneurysms. The aneurysms were diagnosed with both cardiac magnetic resonance imaging and coronary computed tomography angiography. There had been no evidence of them on a cardiac MR exam 5 years previously. (orig.)

  2. Development of bilateral coronary artery aneurysms in a child with Noonan syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Mauro, David M.; Flors, Lucia; Norton, Patrick T.; Hagspiel, Klaus D. [University of Virginia Health System, Department of Radiology and Medical Imaging, Charlottesville, VA (United States); Hoyer, Andrew W. [University of Virginia Health System, Department of Pediatrics, Division of Pediatric Cardiology, Charlottesville, VA (United States); Pediatric Cardiology Center of Oregon, Portland, OR (United States)

    2016-03-15

    Noonan syndrome is a constellation of congenital malformations including heart defects, facial anomalies and short stature. The cardiovascular defects are variable and extensive, with the most common being pulmonary stenosis and hypertrophic cardiomyopathy. Coronary artery anomalies have only been reported in a few cases. We report a child with Noonan syndrome status post pulmonary stenosis and atrial septal defect repair, who developed bilateral coronary artery aneurysms. The aneurysms were diagnosed with both cardiac magnetic resonance imaging and coronary computed tomography angiography. There had been no evidence of them on a cardiac MR exam 5 years previously. (orig.)

  3. Development of bilateral coronary artery aneurysms in a child with Noonan syndrome.

    Science.gov (United States)

    Mauro, David M; Flors, Lucia; Hoyer, Andrew W; Norton, Patrick T; Hagspiel, Klaus D

    2016-03-01

    Noonan syndrome is a constellation of congenital malformations including heart defects, facial anomalies and short stature. The cardiovascular defects are variable and extensive, with the most common being pulmonary stenosis and hypertrophic cardiomyopathy. Coronary artery anomalies have only been reported in a few cases. We report a child with Noonan syndrome status post pulmonary stenosis and atrial septal defect repair, who developed bilateral coronary artery aneurysms. The aneurysms were diagnosed with both cardiac magnetic resonance imaging and coronary computed tomography angiography. There had been no evidence of them on a cardiac MR exam 5 years previously. PMID:26515448

  4. Cluster headache and intracranial aneurysm

    OpenAIRE

    Valença, Marcelo Moraes; Andrade-Valença, Luciana P. A.; Martins, Carolina; de Aragão, Maria Fátima Vasco; Batista, Laécio Leitão; Peres, Mario Fernando Prieto; da Silva, Wilson Farias

    2007-01-01

    In the present study we describe the cases of two patients with cluster-like headache related to intracranial carotid artery aneurysm. One of these patients responded to verapamil prescription with headache resolution. In both cases the surgical clipping of the aneurysm resolved the cluster pain. These findings strongly suggest a pathophysiological link between the two conditions. The authors discuss the potential pathophysiological mechanisms underlying cluster-like headache due to intracran...

  5. Flow Diverters for Intracranial Aneurysms

    Directory of Open Access Journals (Sweden)

    Yazan J. Alderazi

    2014-01-01

    Full Text Available Flow diverters (pipeline embolization device, Silk flow diverter, and Surpass flow diverter have been developed to treat intracranial aneurysms. These endovascular devices are placed within the parent artery rather than the aneurysm sac. They take advantage of altering hemodynamics at the aneurysm/parent vessel interface, resulting in gradual thrombosis of the aneurysm occurring over time. Subsequent inflammatory response, healing, and endothelial growth shrink the aneurysm and reconstruct the parent artery lumen while preserving perforators and side branches in most cases. Flow diverters have already allowed treatment of previously untreatable wide neck and giant aneurysms. There are risks with flow diverters including in-stent thrombosis, perianeurysmal edema, distant and delayed hemorrhages, and perforator occlusions. Comparative efficacy and safety against other therapies are being studied in ongoing trials. Antiplatelet therapy is mandatory with flow diverters, which has highlighted the need for better evidence for monitoring and tailoring antiplatelet therapy. In this paper we review the devices, their uses, associated complications, evidence base, and ongoing studies.

  6. Clinical presentation of cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Cianfoni, Alessandro [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Pravatà, Emanuele, E-mail: emanuele.pravata@gmail.com [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); De Blasi, Roberto [Neurocentro della Svizzera Italiana, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Tschuor, Costa Silvia [Dipartimento di Radiologia, Ospedale Civico di Lugano, via Tesserete, 46, 6900 Lugano (Switzerland); Bonaldi, Giuseppe [U.O. Neuroradiologia, Ospedali Riuniti di Bergamo, Largo Barozzi, 1, 24128 Bergamo (Italy)

    2013-10-01

    Presentation of a cerebral aneurysm can be incidental, discovered at imaging obtained for unrelated causes, can occur in the occasion of imaging obtained for symptoms possibly or likely related to the presence of an unruptured aneurysm, or can occur with signs and symptoms at the time of aneurismal rupture. Most unruptured intracranial aneurysms are thought to be asymptomatic, or present with vague or non-specific symptoms like headache or dizziness. Isolated oculomotor nerve palsies, however, may typically indicate the presence of a posterior circulation aneurysm. Ruptured intracranial aneurysms are by far the most common cause of non-traumatic subarachnoid hemorrhage and represent a neurological emergency with potentially devastating consequences. Subarachnoid hemorrhage may be easily suspected in the presence of sudden and severe headache, vomiting, meningism signs, and/or altered mental status. However, failure to recognize milder and more ambiguous clinical pictures may result in a delayed or missed diagnosis. In this paper we will describe the clinical spectrum of unruptured and ruptured intracranial aneurysms by discussing both typical and uncommon clinical features emerging from the literature review. We will additionally provide the reader with descriptions of the underlying pathophysiologic mechanisms, and main diagnostic pitfalls.

  7. Clinical presentation of cerebral aneurysms

    International Nuclear Information System (INIS)

    Presentation of a cerebral aneurysm can be incidental, discovered at imaging obtained for unrelated causes, can occur in the occasion of imaging obtained for symptoms possibly or likely related to the presence of an unruptured aneurysm, or can occur with signs and symptoms at the time of aneurismal rupture. Most unruptured intracranial aneurysms are thought to be asymptomatic, or present with vague or non-specific symptoms like headache or dizziness. Isolated oculomotor nerve palsies, however, may typically indicate the presence of a posterior circulation aneurysm. Ruptured intracranial aneurysms are by far the most common cause of non-traumatic subarachnoid hemorrhage and represent a neurological emergency with potentially devastating consequences. Subarachnoid hemorrhage may be easily suspected in the presence of sudden and severe headache, vomiting, meningism signs, and/or altered mental status. However, failure to recognize milder and more ambiguous clinical pictures may result in a delayed or missed diagnosis. In this paper we will describe the clinical spectrum of unruptured and ruptured intracranial aneurysms by discussing both typical and uncommon clinical features emerging from the literature review. We will additionally provide the reader with descriptions of the underlying pathophysiologic mechanisms, and main diagnostic pitfalls

  8. Infective endocarditis of an aorto-right atrial fistula caused by asymptomatic rupture of a sinus of Valsalva aneurysm: a case report.

    Science.gov (United States)

    Ikeda, Akihiko; Nakajima, Tomomi; Konishi, Taisuke; Matsuzaki, Kanji; Sugano, Akinori; Fumikura, Yuko; Nishina, Hidetaka; Jikuya, Tomoaki

    2016-12-01

    Asymptomatic rupture of a sinus of Valsalva aneurysm is rare. A fistula following rupture of a sinus of Valsalva aneurysm may cause infective endocarditis. Here, we report a case of infective endocarditis of an aorto-right atrial fistula caused by asymptomatic rupture of a sinus of Valsalva aneurysm. A 45-year-old male, who was first diagnosed with a heart murmur at the age of 37 years, presented with fever. Blood culture was positive for Streptococcus gordonii. Ultrasound echocardiography revealed an aorto-right atrial fistula caused by rupture of a sinus of Valsalva aneurysm. After the infective endocarditis was healed by antibiotics, we successfully performed surgical repair of the aorto-right atrial fistula. Although asymptomatic rupture of a sinus of Valsalva aneurysm is uncommon, it should be recognized as a possible cause of infective endocarditis. PMID:27180251

  9. Intracranial aneurysm associated with relapsing polychondritis

    Energy Technology Data Exchange (ETDEWEB)

    Coumbaras, M.; Boulin, A.; Pierot, L. [Dept. of Neuroradiology, Hopital Foch, Suresnes (France); Piette, A.M.; Bletry, O. [Dept. of Medicine, Hopital Foch, Suresnes (France); Graveleau, P. [Dept. of Neurology, Hopital Foch, Suresnes (France)

    2001-07-01

    We describe a 50-year-old man with relapsing polychondritis (RP) involving auricular cartilage, uveitis and hearing loss, who had an aneurysm of the anterior cerebral artery. Intracranial aneurysm is a rare manifestation of RP. (orig.)

  10. Brain Aneurysm: Early Detection and Screening

    Science.gov (United States)

    ... and Screening A- A A+ Early Detection and Screening Brain aneurysms can be similar to heart attacks. ... aneurysm is about to rupture. Fortunately, through imaging screening techniques, individuals at high risk of harboring a ...

  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....

  12. Aneurysms - Multiple Languages: MedlinePlus

    Science.gov (United States)

    ... Supplements Videos & Tools You Are Here: Home → Multiple Languages → All Health Topics → Aneurysms URL of this page: https://medlineplus.gov/languages/aneurysms.html Other topics A-Z A B ...

  13. 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.)

  14. True Giant Posterior Tibial Artery Aneurysm

    OpenAIRE

    Patrizio Colotto; Gabriele Testi; Giacomo Di Iasio; Alessandro Robaldo

    2012-01-01

    We report an unusual case of true atherosclerotic posterior tibial artery (PTA) aneurysm without any apparent causative history. To our knowledge, in the English Literature only seven previously cases of true PTA aneurysms are reported. Due to its location, this lesion may require surgical intervention and removal. The presentation, the diagnostic evaluation, and the surgical management of the aneurysm are discussed.

  15. Microsurgical cerebral aneurysm training porcine model

    Directory of Open Access Journals (Sweden)

    Jon Olabe

    2011-01-01

    Full Text Available The authors developed a simple reproducible technique for aneurysm creation and adapted it to mimic intracranial dissection conditions using glue application as a pseudo-arachnoid type layer. Ten 1-2-month-old healthy domestic swine were employed under general anesthesia. A novel technique for bifurcation aneurysm creation was developed using two arteries and a vein. After aneurysm creation, diluted sulfuric acid was applied on the dome with a micropipette to increase aneurysm fragility in selected zones. The surgical field was then dried and contact glue was applied around the vascular complex in a circular manner so as to emulate arachnoidal connection fibers. Microsurgical dissection of the aneurysm and surrounding vessels was performed by delicately removing the adhesive substance. Diverse aneurysm clipping techniques, emergency rupture situations and vascular reconstruction procedures were trained. Twenty-two aneurysms were created at several vascular sites, one aneurysm dome ruptured during application of sulfuric acid, two aneurysm models were proved to be thrombosed, two aneurysms ruptured during the dissection and no intraoperative deaths occurred. All aneurysms were clipped in an acceptable manner. This bifurcation aneurysm model provides a novel training system to be used not only by neurosurgeons but also by neurovascular interventionists.

  16. Internal carotid artery bifurcation aneurysms. Surgical experience

    International Nuclear Information System (INIS)

    Internal carotid artery (ICA) bifurcation aneurysms are relatively uncommon and frequently rupture at a younger age compared to other intracranial aneurysms. We have treated a total of 999 patients for intracranial aneurysms, of whom 89 (8.9%) had ICA bifurcation aneurysms, and 42 of the 89 patients were 30 years of age or younger. The present study analyzed the clinical records of 70 patients with ICA bifurcation aneurysms treated from mid 1997 to mid 2003. Multiple aneurysms were present in 15 patients. Digital subtraction angiography films were studied in 55 patients to identify vasospasm and aneurysm projection. The aneurysm projected superiorly in most of these patients (37/55, 67.3%). We preferred to minimize frontal lobe retraction, so widely opened the sylvian fissure to approach the ICA bifurcation and aneurysm neck. Elective temporary clipping was employed before the final dissection and permanent clip application. Vasospasm was present in 24 (43.6%) of 55 patients. Forty-eight (68.6%) of the 70 patients had good outcome, 14 (20%) had poor outcome, and eight (11.4%) died. Patients with ICA bifurcation aneurysms tend to bleed at a much younger age compared to those with other intracranial aneurysms. Wide opening of the sylvian fissure and elective temporary clipping of the ICA reduces the risk of intraoperative rupture and perforator injury. Mortality was mainly due to poor clinical grade and intraoperative premature aneurysm rupture. (author)

  17. Gigantic unruptured sinus of Valsalva aneurysm presenting as an incidental murmur.

    LENUS (Irish Health Repository)

    Yagoub, Hatim

    2012-01-01

    We report a case of a 56-year-old man referred by his family physician with an asymptomatic cardiac murmur. Trans-thoracic echocardiography (TTE) suggested an unruptured right sinus of Valsalva aneurysm (SVA) causing extrinsic compression of the right ventricular outflow tract. This was confirmed with an ECG-gated cardiac CT showing a large right SVA measuring 35×37×42 mm in size. Coronary angiography demonstrated non-obstructive coronary artery disease. Ascending thoracic anterior in the right anterior oblique view delineated the right SVA. The patient underwent aortic valve sparing surgical repair of the aneurysm with an excellent result. Echocardiography confirmed obliteration of the aneurysm and normal aortic valve function postoperatively.

  18. Predictive Models with Patient Specific Material Properties for the Biomechanical Behavior of Ascending Thoracic Aneurysms.

    Science.gov (United States)

    Trabelsi, Olfa; Duprey, Ambroise; Favre, Jean-Pierre; Avril, Stéphane

    2016-01-01

    The aim of this study is to identify the patient-specific material properties of ascending thoracic aortic aneurysms (ATAA) using preoperative dynamic gated computed tomography (CT) scans. The identification is based on the simultaneous minimization of two cost functions, which define the difference between model predictions and gated CT measurements of the aneurysm volume at respectively systole and cardiac mid-cycle. The method is applied on five patients who underwent surgical repair of their ATAA at the University Hospital Center of St. Etienne. For these patients, the aneurysms were collected and tested mechanically using an in vitro bench. For the sake of validation, the mechanical properties found using the in vivo approach and the in vitro bench were compared. We eventually performed finite-element stress analyses based on each set of material properties. Rupture risk indexes were estimated and compared, showing promising results of the patient-specific identification method based on gated CT. PMID:26178871

  19. Endovascular treatment of atherosclerotic and other thoracic aortic aneurysms.

    Science.gov (United States)

    Fattori, Rossella; Russo, Vincenzo

    2007-06-01

    The incidence of thoracic aortic aneurysms (TAAs) is increasing with the present rate of occurrence at 10.9 cases per 100,000 people per year. The estimated 5-year risk of rupture of a TAA with a diameter between 4 and 5.9 cm is 16%, but it rises to 31% for aneurysms ≥ 6 cm. Despite increasing awareness of the importance of early diagnosis and treatment options, there are no clear guidelines available at the time of writing. Nor is there any clear evidence for specific pharmacological treatment able to resolve or delay the disease progression. Endovascular treatment (EVT), proposed as an alternative to surgery, has been considered a therapeutic innovation, especially because it is minimally invasive, which allows treatment even in high surgical risk patients. Vascular imaging is crucial for patient selection, endoprosthesis choice, and planning of the treatment because not all aneurysms are suitable. Early and midterm results are encouraging, but long-term results are necessary to definitively assess reliability of stent-graft materials and improvement in patient survival. In the choice between surgical or endovascular repair of TAAs, many factors must be considered, including the clinical situation, comorbidities, anatomy, choice of equipment, and last, but not less important, experience of the clinical team. PMID:21326796

  20. Aneurisma de artéria ilíaca interna roto: relato de caso Ruptured internal iliac artery aneurysm: case report

    Directory of Open Access Journals (Sweden)

    Cristina Toledo Afonso

    2009-03-01

    Full Text Available Aneurismas isolados da artéria ilíaca interna são raros, acometem 0,1% da população e correspondem a 1% dos aneurismas aorto-ilíacos. Na maioria das vezes, os pacientes são assintomáticos, mas podem apresentar dor abdominal, massa pulsátil no hipogástrio ou na fossa ilíaca, sintomas compressivos urinários, gastrointestinais ou neurológicos. Podem ocasionar quadro de abdome agudo, principalmente quando há ruptura. O diagnóstico precoce dos aneurismas isolados de artéria ilíaca interna é incomum, sendo identificados quando mais volumosos ou rotos, o que aumenta significativamente sua morbimortalidade e torna seu prognóstico mais reservado. Dessa forma, representam um desafio terapêutico. A ligadura cirúrgica tem sido o tratamento mais comum, entretanto a cirurgia endovascular tem mostrado bons resultados, inclusive nos aneurismas rotos. É relatado caso de aneurisma de artéria ilíaca interna isolado roto diagnosticado durante laparotomia para abordagem de abdome agudo.Isolated internal iliac artery aneurysms are rare. They affect 0.1% of the population, and account for 1% of aortoiliac aneurysms. Patients are mostly asymptomatic, yet they can have abdominal pain, pulsatile mass in the hypogastrium or iliac fossa, or urinary, gastrointestinal or neurological compressive symptoms. Such aneurysms are likely to course with an acute abdomen, especially when ruptured. Early diagnosis of isolated internal iliac artery aneurysms is difficult, as they are more easily detected when larger or ruptured, which significantly raises their morbidity and mortality rate and determines a poor prognosis. Therefore, they are a therapeutic challenge. Surgical ligation has been the most common treatment; however, the endovascular approach has presented good outcomes, even in the event of ruptured aneurysms. A case of ruptured isolated iliac artery aneurysm diagnosed during a laparotomy (acute abdomen approach is reported.

  1. [Subdural hemorrhage of aneurysmal origin].

    Science.gov (United States)

    Sánchez, R; Alfaro, A; Perla, C; Blasco, R; Cortés, F; Solís, P

    1994-02-01

    Although most subdural hematomas are considered to be venous in origin, they may also be of arterial origin. When subdural bleeding is due to the rupture of an intracranial aneurysm, most commonly at the middle cerebral or internal carotid arteries, the amount of subdural blood is usually small and of no clinical importance. We describe two patients with subdural hematomas secondary to rupture of an intracranial aneurysm, who needed prompt surgical treatment. The first patient had a left internal carotid artery aneurysm at the origin of the ophthalmic artery. In the second patient the aneurysm was at the anterior communicating artery and rebled into the subdural space directly through a right intraparenchymatous frontobasal hematoma. The most probable mechanism of subdural bleeding in our two patients was the existence of adhesions between the aneurysm and the arachnoid due to previous minor hemorrhages. The indication of cerebral angiography in a patient with subdural hematoma is based mainly upon the existence of meningeal signs, the presence of blood in more than one intracranial compartment or the rapid progression of bleeding. PMID:8204251

  2. Combined treatment for complex intracranial aneurysm

    Directory of Open Access Journals (Sweden)

    Chiriac A.

    2015-06-01

    Full Text Available Complex aneurysms often cannot be completely excluded by a single approaches. Today successful treatment of these lesions requires a combination between microsurgical and endovascular techniques. Planning of combined treatment require a very good understanding of aneurysm anatomy and a close collaboration between neurosurgeon and neuroendovascular interventionist. Endovascular coiling can usually be used as early treatment for a partially aneurysm occlusion including the ruptured area and followed by definitive clipping. On the other hand microsurgical clipping also can be used as first treatment for complex aneurysm neck reconstruction, allowing successful secondary placement of coils inside the remnant aneurysm sac

  3. Endovascular treatment of false-aneurysm ten years after dacron patch aortoplasty for coarctation of the aortic isthmus. Report of a case.

    Science.gov (United States)

    Illuminati, Giulio; Pacilè, Maria Antonietta; Palumbo, Piergaspare; Salvatori, Filippo Maria; Vietri, Francesco

    2013-01-01

    False aneurysm degeneration is a known complication of patch aortoplasty for coarctation of the aortic isthmus. Open surgical treatment consists of prosthetic graft repair of the involved aorta, often requires circulatory arrest to achieve a safe proximal aortic control and perform proximal anastomosis, and finally is associated with substantial perioperative morbidity. Endografting of the diseased aorta is a valuable alternative to open repair, when feasible, with good short and long term results. We now report one more case of false aneurysm ten years after Dacron patch aortoplasty for isthmic coarctation in a 26-year-old woman, successfully treated by endovascular repair via the left common iliac artery, and a complete exclusion of the aneurysm at two year follow-up. PMID:23080212

  4. Management of symptomatic venous aneurysm.

    Science.gov (United States)

    Gabrielli, Roberto; Rosati, Maria Sofia; Siani, Andrea; Irace, Luigi

    2012-01-01

    Venous aneurysms (VAs) have been described in quite of all the major veins. They represent uncommon events but often life-threatening because of pulmonary or paradoxical embolism. We describe our twelve patients' series with acute pulmonary emboli due to venous aneurysm thrombosis. Our experience underlines the importance of a multilevel case-by-case approach and the immediate venous lower limbs duplex scan evaluation in pulmonary embolism events. Our data confirm that anticoagulant alone is not effective in preventing pulmonary embolism. We believe that all the VAs of the deep venous system of the extremities should be treated with surgery as well as symptomatic superficial venous aneurysm. A simple excision can significantly improve symptoms and prevent pulmonary embolism. PMID:22566766

  5. Position dependent right ventricular dysfunction caused by a giant right coronary artery aneurysm.

    Science.gov (United States)

    Mora, Bruno; Urbanek, Bernhard; Loewe, Christian; Grimm, Michael; Dworschak, Martin

    2011-01-01

    We describe an instructive case of a 79-year-old patient with a giant coronary aneurysm and a second smaller aneurysm with an uncommon symptomatology. Giant coronary artery aneurysms (>2 cm diameter) are rare pathologic entities with a prevalence of 0.02%. They either can be congenital malformations or are atherosclerotic in origin. Although spontaneous rupture of giant coronary artery aneurysms has been reported, they generally remain silent or induce myocardial ischemia. Our patient, however, showed no signs of myocardial malperfusion but transient position-dependent pre-syncope. The cardiologic work-up and the intraoperative considerations regarding patient management are described. During surgery, manipulation of the giant coronary artery aneurysm caused impairment of right ventricular function and regional wall hypokinesia, as assessed by transesophageal echocardiography. Venous cannulation of the right atrium was thus abandoned and extracorporeal circulation was established via the femoral vein. Subsequent dissection and surgical repair were uneventful and further recovery of the elderly patient was uncomplicated. This case underlines that once the diagnosis is established, proper perioperative management enables successful surgical treatment even of patients of advanced age. PMID:21253776

  6. Natural history and surgical results in patients with unruptured intracranial aneurysms

    International Nuclear Information System (INIS)

    The management of patients with unruptured intracranial aneurysms (UIAs) is controversial. We aimed to assess the natural history of UIAs and evaluate the surgical results. We analyzed 154 patients (181 saccular UIAs) with no history of subarachnoid hemorrhage (SAH) from a different aneurysm. Aneurysms were detected by magnetic resonance angiography (MRA) or by 3-dimensional CT angiography. Although the most frequent reason for the diagnosis was routine brain examinations of healthy patients or a vague symptom such as headache or dizziness, 15 patients were symptomatic. The natural history in patients who did not have surgery (follow-up group: 76 cases, 95 aneurysms) was assessed, and the surgical outcome of UIAs (surgical group: 78 cases, 86 aneurysms) was evaluated. Among 76 patients in the follow-up group, 7 had SAH. The mean latency period to aneurysm rupture was 3.2 months. The aneurysms with subsequent bleeding ranged from 5 to 25 mm (19.3 mm on average), whereas those without ranged from 1 to 28 mm (4.5 mm on average). The rupture rates of UIAs in anterior and posterior circulation were 6.2% and 14.3%, respectively. All ruptured cases were females. Mortality and morbidity associated with UIAs in the follow-up group were 3.9% and 3.9%, respectively. In the surgical group, no mortality was noted. Permanent morbidity associated with prospective repair of UIAs was 5.1%, although the morbidity of the patients with preoperative Rankin scores of 0 or 1 was 1.3%. Transient morbidity was observed in 6 patients (7.7%) with the size of the aneurysm 19.8 mm on average. The natural history and surgical results in patients with UIAs are modified by several factors including aneurysm size and location, the patient's age and gender, the medical status and the patient's preoperative Rankin score. The present results indicated that these factors should be considered in deciding whether to treat UIAs, and that careful assessment of the surgical benefits might be essential

  7. Aneurisma ilíaco associado a fístula arteriovenosa Iliac aneurysm associated with arteriovenous fistula

    Directory of Open Access Journals (Sweden)

    Daniel Mendes Pinto

    2007-09-01

    Full Text Available A ruptura dos aneurismas aorto-ilíacos para a veia ilíaca ou veia cava é uma complicação pouco comum. A hipertensão venosa leva a vários sinais e sintomas, o que dificulta o diagnóstico pré-operatório, tais como edema do membro inferior, dispnéia, hematúria, sinais de insuficiência renal ou cardíaca. Sopro abdominal é a chave do diagnóstico clínico, associado à massa pulsátil e dor abdominal. O reconhecimento da fístula arteriovenosa no pré-operatório é importante para o planejamento cirúrgico. Relatamos um caso de aneurisma da artéria ilíaca comum e interna direita associado a fístula para veia ilíaca comum, cursando, inicialmente, com edema do membro inferior direito e dispnéia, o que levou ao diagnóstico incorreto de trombose venosa profunda.Rupture of aortoiliac aneurysms into the iliac vein or vena cava is an uncommon complication. Many signs and symptoms develop as a result of venous hypertension, which makes preoperative diagnosis difficult, such as leg edema, dyspnea, hematuria, signs of renal or cardiac insufficiency. Abdominal bruit, associated with pulsatile mass and abdominal pain, is the key for clinical diagnosis. Preoperative recognition of arteriovenous fistula is important for surgical planning. We report a case of right internal and common iliac artery aneurysm associated with fistula into the common iliac vein. Initial symptoms were right leg edema and dyspnea, which induced to the incorrect diagnosis of deep vein thrombosis.

  8. 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.

  9. Nonruptured intracranial aneurysms: therapeutic recommendations

    International Nuclear Information System (INIS)

    With the development of new diagnostic noninvasive tools an increase in the diagnosis of asymptomatic nonruptured intracranial aneurysms has been shown. Physician and patient now have to decide wether to treat or to follow-up these aneurysms. This paper trys to review and to discuss the literature and to give guidelines for therapeutic decisions. The decision to treat an unruptured intracranial aeurysm must always comprise the individuell factors such as age, life prognosis, neurological status, and the advantages and disdavantages of the considered method. (orig.)

  10. [Treatment of aneurysmal subarachnoid hemorrhage].

    Science.gov (United States)

    Proust, François; Douvrin, Françoise; Gilles-Baray, Marie; Levêque, Sophie

    2007-01-01

    The incidence of subarachnoid hemorrhages is about 10.5/100,000 persons/year. Early obliteration of the aneurysmal sac is necessary to avoid rebleeding. The neurovascular staff meeting must decide the appropriate obliteration procedure for each patient. Intraoperative morbidity is 8% after endovascular coiling and 10% after microsurgical clipping. Endovascular coiling leads to complete obliteration of the aneurysm in 60% of patients and microsurgical clipping in 95%. Delayed ischemic deficits may be prevented by volemic expansion and calcium channel blockers. Hospitalization and general prophylaxis against deep venous thrombosis, pain and seizures are essential. Curative treatment is required against common complications such as intraparenchymatous hematoma, hydrocephalus, and delayed ischemic deficit. PMID:17296483

  11. Vortex Dynamics in Cerebral Aneurysms

    CERN Document Server

    Byrne, Greg

    2013-01-01

    We use an autonomous three-dimensional dynamical system to study embedded vortex structures that are observed to form in computational fluid dynamic simulations of patient-specific cerebral aneurysm geometries. These structures, described by a vortex which is enclosed within a larger vortex flowing in the opposite direction, are created and destroyed in phase space as fixed points undergo saddle-node bifurcations along vortex core lines. We illustrate how saddle-node bifurcations along vortex core lines also govern the formation and evolution of embedded vortices in cerebral aneurysms under variable inflow rates during the cardiac cycle.

  12. Septal aneurysm with associated anomalies

    International Nuclear Information System (INIS)

    A 15-year-old boy had a history of a functional systolic murmur with systolic and diastolic murmurs and radiological evidence of left ventricular hypertrophy. The angiorcardiogram demonstrated an aneurysm of the membranous septum, bicuspid aortic valve, dilatation of the left subclavian artery and left common carotid artery. Echocardiography showed a holosystolic prolapse of the mitral valve with mitral insufficiency and a bicuspid aortic valve with insignificant incompetence of the aortic valve. Classical TM mode echocardiography did not show an aneurysm of the membranous septum. (orig.)

  13. Endovascular Treatment of a Giant Aneurysm of the Maxillary Artery

    OpenAIRE

    J. A. Stephenson; Panteleimonitis, S; E. Choke; Dennis, M.; Glasby, M.

    2012-01-01

    Aneurysms of the maxillary artery are rare and the majority of the literature refers to false aneurysms. We report the first case of what we believe to be a spontaneous true maxillary artery aneurysm and its endovascular management.

  14. Quantitative expression and localization of cysteine and aspartic proteases in human abdominal aortic aneurysms

    OpenAIRE

    Lohoefer, Fabian; Reeps, Christian; Lipp, Christina; Rudelius, Martina; Haertl, Felix; Matevossian, Edouard; Zernecke, Alma; Eckstein, Hans-Henning; Pelisek, Jaroslav

    2014-01-01

    Cysteine and aspartic proteases possess high elastolytic activity and might contribute to the degradation of the abdominal aortic aneurysm (AAA) wall. The aim of this study was to analyze, in detail, the proteases (cathepsins B, D, K, L and S, and inhibitor cystatin C) found in human AAA and healthy aortic tissue samples. The vessel walls from AAA patients (n=36) and nonaneurysmal aortae (n=10) were retrieved using conventional surgical repair and autopsy methods. Serum samples from the same ...

  15. A variant technique for the surgical treatment of left ventricular aneurysms

    OpenAIRE

    Paulo Roberto Barbosa Evora; Paulo Victor Alves Tubino; Luis Gustavo Gali; Lafaiete Alves Junior; Cesar Augusto Ferreira; Solange Bassetto; Antônio Carlos Menardi; Alfredo José Rodrigues; Walter Vilella de Andrade Vicente

    2014-01-01

    Objective: To present a surgical variant technique to repair left ventricular aneurysms. Methods: After anesthesia, cardiopulmonary bypass, and myocardial protection with hyperkalemic tepic blood cardioplegia: 1) The left ventricle is opened through the infarct and an endocardial encircling suture is placed at the transitional zone between the scarred and normal tissue; 2) Next, the scar tissue is circumferentially plicated with deep stitches using the same suture thread, taking care to elimi...

  16. Primary Infrarenal Aortic Stenting With or Without Iliac Stenting for Isolated and Aortoiliac Stenoses: Single-Centre Experience With Long-Term Follow-Up

    Energy Technology Data Exchange (ETDEWEB)

    Tapping, C. R.; Ahmed, M.; Scott, P. M.; Lakshminarayan, R.; Robinson, G. J.; Ettles, D. F.; Shrivastava, V., E-mail: vivek.shrivastava@hey.nhs.uk [Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Department of Radiology (United Kingdom)

    2013-02-15

    The purpose of this study was to evaluate the technical success, complications, long-term clinical outcome, and patency after primary infrarenal aortic stenting for aortic and aortoiliac stenosis. Between January 1999 and January 2006, 22 consecutive patients underwent endovascular treatment because of infrarenal aortic stenosis with and without common iliac stenosis (10 men; mean age 64 {+-} 14 years). Eleven (11 of 22) patients had an isolated aortic stenosis, whereas 11 of 22 had aortic stenosis that extended into the common iliac arteries (CIAs). Thirteen patients were Rutherford classification type 3, and 9 patients were type 4. Statistical analysis included paired Student t test and Kaplan-Meier life table analysis; p < 0.05 was considered significant. Technical and initial clinical success was achieved in all patients. There were three (14 %) procedure-related complications, which included two access-point pseudoaneurysms and one non-flow-limiting left external iliac dissection. Patients were followed-up for a mean period of 88 months (range 60-132). Mean preprocedure ankle brachial pressure indexes (ABPI) were 0.60 {+-} -0.15 (right) and 0.61 {+-} -0.16 (left). After the procedure they were 0.86 {+-} -0.07 (right) and 0.90 {+-} -0.09 (left). The increase in ABPI was significant (p < 0.05), and this continued throughout follow-up. Four (18 %) patients had recurrence of symptoms during follow-up. These occurred at 36, 48, 48, and 50 months after the original procedure. All four patients were successfully treated with repeat angioplasty procedures. There was a significant difference in primary patency between isolated aortic stenosis (100 %) and aortoiliac stenosis (60 %) (p = 0.031). Cumulative follow-up was 1920 months yielding a reintervention rate of 0.025/events/year. Primary stenting of infrarenal stenosis is safe and successful with a low reintervention rate. It should be considered as first-line treatment for patients with infrarenal aortic stenotic

  17. Endovascular interventions for descending thoracic aortic aneurysms: The pivotal role of the clinical nurse in postoperative care.

    Science.gov (United States)

    Dolinger, Cami; Strider, David V

    2010-12-01

    Descending thoracic aortic aneurysms (dTAA) comprise 40% of all aneurysms arising from the thoracic aorta. Because rupture of thoracic aneurysms is associated with a 94% mortality rate, timely detection, surveillance and treatment is imperative. Endovascular stent-graft repair of thoracic aneurysms was first performed in 1992 and has become an accepted treatment option for this condition in select candidates. There is an abundance of information for the care of patients after open surgical repair of dTAA. However, still relatively few written guidelines exist in the nursing literature for postoperative care and complications associated with endovascular stent-graft repair. The prevalence of aortic endografting, however, now makes it necessary for nurses to have a solid knowledge base in the operative procedure, complications and postoperative care for this patient population. Ideal candidates for aortic endografting undergo CTA or MRI preoperatively and fit a set of strict anatomic criteria to ensure proper delivery and fixation of the device. The early postoperative care focuses on minimizing pulmonary complications, paraplegia, renal failure and embolic complications such as stroke and limb ischemia through skilled nursing assessment and interventions. Late complications such as stent-graft migration, kinking, stent fracture and endoleak are often without symptoms, making it necessary for patients to be educated about these potential complications and to be encouraged to comply with lifelong follow up. This overview provides a sound cognitive framework for nurses practicing in a vascular surgery milieu. PMID:21074117

  18. Endovascular Treatment of Isolated Bilateral Internal Ili- ac Artery Aneurysms with a Branched Endograft: A Case Report

    Directory of Open Access Journals (Sweden)

    SeyedEbrahim Kassaian

    2015-10-01

    Full Text Available Isolated bilateral internal iliac artery (IIA aneurysm is a rare and potentially lethal disease. Endovascular repair of this disorder is a matter of debate. A symptomatic 68-year-old male presented with severe pelvic pains. Computed tomography revealed a leaking 46-mm aneurysm in the right IIA, a 27-mm aneurysm in the left IIA, and ectatic changes at a diameter of 31 mm in the right common iliac artery (CIA. Due to lower rates of morbidity and mortality, an endovascular approach was chosen instead of open surgical repair. However, due to anatomical constraints, an endograft had to be implanted in a healthy aorta in order to support an iliac branch endograft in the left CIA. Subsequently, following coil embolization of the left IIA, an iliac stent graft was extended to the right external iliac artery (EIA. Two-year follow-up CT imaging showed complete exclusion of all the aneurysms and patency of the pelvic visceral arteries. The patient is currently asymptomatic.Endovascular repair of bilateral isolated IIAs can be a feasible treatment option. However, due to limited availability of sizes in iliac branch devices currently on the market, a main body device is sometimes required to be deployed in a healthy aorta for additional endograft support.

  19. Infected aortic aneurysm and inflammatory aortic aneurysm. In search of an optimal differential diagnosis

    International Nuclear Information System (INIS)

    Infected aortic aneurysm and inflammatory aortic aneurysm each account for a minor fraction of the total incidence of aortic aneurysm and are associated with periaortic inflammation. Despite the similarity, infected aortic aneurysm generally shows a more rapid change in clinical condition, leading to a fatal outcome; in addition, delayed diagnosis and misuse of corticosteroid or immunosuppressing drugs may lead to uncontrolled growth of microorganisms. Therefore, it is mandatory that detection of aortic aneurysm is followed by accurate differential diagnosis. In general, infected aortic aneurysm appears usually as a saccular form aneurysm with nodularity, irregular configuration; however, the differential diagnosis may not be easy sometimes for the following reasons: symptoms, such as abdominal and/or back pain and fever, and blood test abnormalities, such as elevated C-reactive protein and enhanced erythrocyte sedimentation rate, are common in infected aortic aneurysm, but they are not found infrequently in inflammatory aortic aneurysm; some inflammatory aortic aneurysms are immunoglobulin (Ig) G4-related, but not all of them; the prevalence of IgG4 positivity in infected aortic aneurysm has not been well investigated; enhanced uptake of 18F-fluorodeoxyglucose (FDG) by 18F-FDG-positron emission tomography may not distinguish between inflammation mediated by autoimmunity and that mediated by microorganism infection. Here we discuss the characteristics of these two forms of aortic aneurysm and the points of which we have to be aware before reaching a final diagnosis. (author)

  20. The intracranial aneurysm: cost-effective of the aneurysm intra-artery GDC embolization and the aneurysm incarcerated operation

    International Nuclear Information System (INIS)

    Objective: To evaluate the cost-effectiveness of the aneurysm intra-artery GDC embolization and the aneurysm clapping of intracranial aneurysm, and to give the instruction for the clinical practice. Methods: A case control study (1 vs. 1) was developed to evaluate the cost in hospital, the cost for return visit and the Quality-adusted Life-Year (QALY) and lifetime costs of the intra-artery GDC embolization and the aneurysm clapping of intraeranial aneurysm, under the matching of the age, sex, living place, the size and place of the aneurysm, and the Hunt and Hess score. Clinically effectiveness dates were derived from the medical records. Cost dates were derived from follow-up by telephones or letters. The correlation analysis was done with the SPSS 13.0. Results: The cost in hospital in AC group was (54 945±16 946)RMBs, which was higher than the ones in AE group (63 768±12 665) RMBs, (t=1.71, P0.05). Conclusion: The results suggest that the two therapies have no difference in cost effective rate. Considering the physical and mental loss, the aneurysm intra-arteu GDC embolization was better than the aneurysm clapping for the patients with aneurysm that diameter less than 25 mm. (authors)

  1. Isolated iliac artery aneurysms with associated hydronephrosis.

    LENUS (Irish Health Repository)

    O'Driscoll, D

    2012-02-03

    An isolated iliac artery aneurysm is where there is aneurysmal dilatation of one or more branches of the iliac system, with no associated dilatation of the aorta. Such aneurysms are rare and comprise 1% of all intra-abdominal aneurysms. The signs and symptoms of such an aneurysm are influenced by its concealed location within the bony pelvis. Awareness of these special characteristics improves the chances of early diagnosis and proper treatment before possible rupture. We present the clinical and radiological features of three such aneurysms. Ultrasound was the first imaging modality to be performed. Ipsilateral hydronephrosis was demonstrated in each case, this lead to imaging the pelvis and the correct diagnosis. We review the clinical and radiological literature and conclude that the pelvis should be imaged in all cases of unexplained hydronephrosis.

  2. MR angiography after coiling of intracranial aneurysms

    OpenAIRE

    Schaafsma, J.D.

    2012-01-01

    Introduction Endovascular occlusion with detachable coils has become an alternative treatment to neurosurgical clipping of intracranial aneurysms over the last two decades. Its minimal invasiveness is the most important advantage of this treatment compared to clipping. The disadvantage of occlusion with coils is an approximately 20% risk of reopening of the aneurysm as a result of coil impaction, dissolution of thrombus, or growth of the aneurysm and 10% of coiled patients need additional tre...

  3. Gender differences in cerebral aneurysm location

    OpenAIRE

    Ali Jourabchi Ghods; Demetrius eLopes; Michael eChen

    2012-01-01

    Background and Purpose: A limited number of studies consisting predominantly of ruptured aneurysms have looked at differences in anatomical distribution of aneurysms between male and females. Unlike all other causes of stroke, subarachnoid-hemorrhages (SAH) occur more often in women and are thought to be a result of both hormonal influences and variation in wall shear stress (WSS). This paper retrospectively looks at a cohort of largely unruptured intracranial aneurysms to determine if there ...

  4. Portal Vein Aneurysm Presenting with Obstructive Jaundice

    OpenAIRE

    Chandana Lall; Sadhna Verma; Rajesh Gulati; Puneet Bhargava

    2012-01-01

    To the best of our knowledge, a portal vein aneurysm presenting with obstructive jaundice has not been reported in the literature. The preferred treatment for these aneurysms is surgical and a shunting procedure should be considered in cases with portal hypertension to preserve portal vein flow when portal hypertension is present or is secondary to the aneurysm itself. In our case, due to patient′s advanced age and co-morbidities, an endoscopic biliary stent was placed which led to successful...

  5. Applying Craniofacial Principles to Neurosurgical Exposures in Cerebrovascular Aneurysm Repair.

    Science.gov (United States)

    Alperovich, Michael; Frey, Jordan D; Potts, Matthew B; Riina, Howard A; Staffenberg, David A

    2016-06-01

    The subspecialty of craniofacial surgery emphasizes skeletal exposure, preservation of critical structures, and provision of a superior cosmetic result. In recent decades, an emphasis on minimally invasive neurosurgical exposure has paved the way for increased collaboration between neurosurgeons and craniofacial surgeons.The 1990s saw the growing popularity of an eyebrow incision for orbital roof craniotomies in neurosurgery to address lesions in the anterior skull base. Disadvantages of this approach included conspicuous scarring above the brow skin, risk of injury to the frontal branch of the facial nerve, and numbness from supraorbital or supratrochlear nerve transection.A transpalpebral approach was first described in 2008 in the neurosurgical literature. An approach familiar to the craniofacial surgeon, transpalpebral exposure is used for zygomaticomaxillary complex fractures as well as aesthetic brow and periorbital surgery.In conjunction with neurosurgery, the authors have applied craniofacial principles to address the major pitfalls of the transpalpebral craniotomy. The authors present their patient series experience. Hopefully, in the future, other institutions will have increased collaboration between craniofacial surgeons and neurosurgeons. PMID:27192638

  6. 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.

  7. Endovascular treatment for pediatric intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Lv, Xianli; Jiang, Chuhan; Li, Youxiang; Yang, Xinjian; Wu, Zhongxue [Capital Medical University, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, Hebei (China)

    2009-11-15

    The purpose of this study is to report the characteristics and outcomes of pediatric patients with intracranial aneurysms. From 1998 to 2005, 25 pediatric patients (aged {<=}17 years) with intracranial aneurysm were treated at our institute. Eleven of 25 patients had subarachnoid hemorrhage. In ten patients, the aneurysm was an incidental finding. One patient presented with cranial nerves dysfunction and three with neurological deficits. The locations of the aneurysms were as follows: vertebral artery (VA; n = 9), middle cerebral artery (MCA; n = 5), posterior cerebral artery (PCA; n = 4), basilar artery (BA; n = 2), anterior communicating artery (n = 2), anterior cerebral artery (n = 2), and internal carotid artery (n = 1). Five patients were treated with selective embolization with coils. Sixteen patients were treated with parent vessel occlusion (PVO). Eight PVOs were performed with balloons and eight were performed with coils. One patient with a VA aneurysm was spontaneously thrombosed 4 days after the initial diagnostic angiogram. In three patients treated with stent alone or stent-assisted coiling, one with BA trunk aneurysm died. One aneurismal recurrence occurred and was retreated. At a mean follow-up duration of 23.5 months, 96% of patients had a Glasgow Outcome Scale score of 4 or 5. Pediatric intracranial aneurysms occur more commonly in male patients and have a predilection for the VA, PCA, and MCA. PVO is an effective and safe treatment for fusiform aneurysms. Basilar trunk fusiform aneurysms were difficult to treat and were associated with a high mortality rate. (orig.)

  8. Natural history of giant intracranial aneurysms

    International Nuclear Information System (INIS)

    The outcome of a consecutive series of 28 patients with giant aneurysm who had been followed without surgery from one month to 12 years after the diagnosis was made, are presented with reviewing their radiological and clinical features. Symptoms and signs were directly or indirectly attributable to the intracranial mass effect and nine patients (32 %) presented subarachnoid hemorrhage. Subarachnoid hemorrhage was frequently associated with intraventricular or intracerebral hemorrhage, a poor clinical grading at admission and a high mortality. Subarachnoid hemorrhage was most often recorded from the giant aneurysm at the supraclinoid portion of the internal carotid artery and the vertebro-basilar artery, but the rupture from the intracavernous giant aneurysm, completely thrombosed giant aneurysm and the fusiform type of giant aneurysm was rare. The mortality rate in 28 cases for the above follow up period was 46 % (13 in 28 cases) and major morbidity occured in 11 % (3 in 28 cases). The above outcome of non operated giant aneurysm cases may justify the surgical management of the giant aneurysm, but as the intracavernous giant aneurysm and thrombosed giant aneurysm are relatively harmless, surgical indication should be carefully decided, especially in the older patients. (author)

  9. Angiographic Findings In Patients With Cerebral Aneurysm

    Directory of Open Access Journals (Sweden)

    Miri S M

    2004-09-01

    Full Text Available Background: This investigation was conducted in order to study angiographic findings in patients with cerebral aneurysm. Materials and Methods: The study conducted on 136 cases of ruptured cerebral aneurysms between 1995-2000 confirmed by means of 4-vessel cerebral angiography to get an insight to racial, geographic and environmental factors predisposing to the occurrence of subarachnoid hemorrhage and aneurysm formation. Results: The data analysis revealed the following results: 58% of the population comprised of male and 42% female with a mean age of 46 years. 89% of the aneurysms were found in the anterior circulation and 11% occurred in the posterior cerebral circulation. The most common site in both the sexes was the anterior communicating artery. 9.6% of the patients displayed two separate aneurysms. 5.2% of the aneurysms were found to be giant aneurysms and 3% of the patients had fusiform aneurysms. Conclusion: The low average age, a predilection in male population and the prevalence of aneurysms at carotid and middle cerebral artery bifurcation and the distal branches of anterior cerebral artery and a higher incidence of anterior communicating artery in women were the findings observed in this study.

  10. Microsurgical clipping of an unruptured lenticulostriate aneurysm.

    Science.gov (United States)

    Kalani, M Yashar S; Martirosyan, Nikolay L; Nakaji, Peter; Spetzler, Robert F

    2012-11-01

    Aneurysms of the lenticulostriate artery have been associated with hypertension, vasculopathy, tumors, and arteriovenous malformations. Although several cases of microsurgical treatment of ruptured lenticulostriate artery aneurysms have been reported, to our knowledge there is no published case of microsurgical treatment of an unruptured lenticulostriate artery aneurysm. We report a 66-year-old woman with a history of moyamoya disease, previously treated with a right-sided middle cerebral artery-to-superficial temporal artery bypass who presented with an unruptured aneurysm of a lenticulostriate artery. We report successful microsurgical treatment of this rare lesion and discuss the rationale for our treatment strategy. PMID:22925414

  11. Endovascular treatment for pediatric intracranial aneurysms

    International Nuclear Information System (INIS)

    The purpose of this study is to report the characteristics and outcomes of pediatric patients with intracranial aneurysms. From 1998 to 2005, 25 pediatric patients (aged ≤17 years) with intracranial aneurysm were treated at our institute. Eleven of 25 patients had subarachnoid hemorrhage. In ten patients, the aneurysm was an incidental finding. One patient presented with cranial nerves dysfunction and three with neurological deficits. The locations of the aneurysms were as follows: vertebral artery (VA; n = 9), middle cerebral artery (MCA; n = 5), posterior cerebral artery (PCA; n = 4), basilar artery (BA; n = 2), anterior communicating artery (n = 2), anterior cerebral artery (n = 2), and internal carotid artery (n = 1). Five patients were treated with selective embolization with coils. Sixteen patients were treated with parent vessel occlusion (PVO). Eight PVOs were performed with balloons and eight were performed with coils. One patient with a VA aneurysm was spontaneously thrombosed 4 days after the initial diagnostic angiogram. In three patients treated with stent alone or stent-assisted coiling, one with BA trunk aneurysm died. One aneurismal recurrence occurred and was retreated. At a mean follow-up duration of 23.5 months, 96% of patients had a Glasgow Outcome Scale score of 4 or 5. Pediatric intracranial aneurysms occur more commonly in male patients and have a predilection for the VA, PCA, and MCA. PVO is an effective and safe treatment for fusiform aneurysms. Basilar trunk fusiform aneurysms were difficult to treat and were associated with a high mortality rate. (orig.)

  12. 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.

  13. Endovascular aortic repair: first twenty years.

    Science.gov (United States)

    Koncar, Igor; Tolić, Momcilo; Ilić, Nikola; Cvetković, Slobodan; Dragas, Marko; Cinara, Ilijas; Kostić, Dusan; Davidović, Lazar

    2012-01-01

    Endovascular aortic/aneurysm repair (EVAR) was introduced into clinical practice at the beginning of the nineties. Its fast development had a great influence on clinicians, vascular surgeons and interventional radiologists, educational curriculums, patients, industry and medical insurance. The aim of this paper is to present the contribution of clinicians and industry to the development and advancement of endovascular aortic repair over the last 20 years. This review article presents the development of EVAR by focusing on the contribution of physicians, surgeons and interventional radiologists in the creation of the new field of vascular surgery termed hybrid vascular surgery, and also the contribution of technological advancement by a significant help of industrial representatives--engineers and their counselors. This article also analyzes studies conducted in order to compare the successfulness of EVAR with up-to-now applied open surgical repair of aortic aneurysms, and some treatment techniques of other aortic diseases. During the first two decades of its development the EVAR method was rapidly progressing and was adopted concurrently with the expansion of technology. Owing to large randomized studies, early and long-term results indicate specific complications of this method, thus influencing further technological improvement and defining risk patients groups in whom the use of the technique should be avoided. Good results are insured only in centers, specialized in vascular surgery, which have on their disposal adequate conditions for solving all complications associated with this method. PMID:23350259

  14. Time evolution and hemodynamics of cerebral aneurysms

    Science.gov (United States)

    Sforza, Daniel M.; Putman, Christopher; Tateshima, Satoshi; Viñuela, Fernando; Cebral, Juan

    2011-03-01

    Cerebral aneurysm rupture is a leading cause of hemorrhagic strokes. Because they are being more frequently diagnosed before rupture and the prognosis of subarachnoid hemorrhage is poor, clinicians are often required to judge which aneurysms are prone to progression and rupture. Unfortunately, the processes of aneurysm initiation, growth and rupture are not well understood. Multiple factors associated to these processes have been identified. Our goal is to investigate two of them, arterial hemodynamics (using computational fluid dynamics) and the peri-aneurysmal environment, by studying a group of growing cerebral aneurysms that are followed longitudinally in time. Six patients with unruptured untreated brain aneurysms which exhibited growth during the observation period were selected for the study. Vascular models of each aneurysm at each observation time were constructed from the corresponding computed tomography angiography (CTA) images. Subsequently, models were aligned, and geometrical differences quantified. Blood flow was modeled with the 3D unsteady incompressible Navier-Stokes equation for a Newtonian fluid, and wall shear stress distribution and flow patterns were calculated and visualized. Analysis of the simulations and changes in geometry revealed asymmetric growth patterns and suggests that areas subject to vigorous flows, i.e. relative high wall shear stress and concentrated streamlines patterns; correspond to regions of aneurysm growth. Furthermore, in some cases the geometrical evolution of aneurysms is clearly affected by contacts with bone structures and calcifications in the wall, and as a consequence the hemodynamics is greatly modified. Thus, in these cases the peri-aneurysmal environment must be considered when analyzing aneurysm evolution.

  15. Aneurysmal subarachnoid hemorrhage: outcome of aneurysm clipping versus coiling in anterior circulation aneurysm

    International Nuclear Information System (INIS)

    To compare the neurological outcome of microsurgical clipping versus coiling in patients with anterior circulation aneurysm. Study Design: Comparative study. Place and Duration of Study: Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2010 to December 2013. Methodology: Patients aged 14 - 60 years, with ruptured cerebral aneurysm of anterior circulation and World Federation of Neurosurgical Society (WFNS) grades 1, 2 and 3 were included. Patients more than 60 years, medically unfit patient and posterior circulation aneurysms and WFNS grades 4 and 5 were excluded. Aneurysm sac obliteration was done in randomized manner with microsurgical clipping or coiling. Postoperatively, the patients were assessed and followed-up upto one year for outcome parameters on the bases of WFNS grade and Modified Ranking Scale (mRS) as favourable (mRS =2 ) and unfavourable (mRS > 2). Results: Among 140 subjects selected for study, 70 were included in group A, i.e. coiling and other 70 were in group B, i.e. clipping. The median age of patients in group A was 52.5 ± 10 years and in group B was 51.00 ± years. Overall, 56 (40%) males, 28 (60%) males in each group; and 84 (60%) females, 42 (60%) in each group were included. The male to female ratio in this study was 1:1.5. In group A, i.e. coiling, 27 (38.6%) patients had no disability (grades 1 and 2), 25 (35.7%) were slightly disabled (grade 3) and 18 (25.7%) had moderate disability (grade 4); whereas in group B, i.e. clipping group 23 (32.9%) patients had no disability (grades 1 and 2), 23 (32.9%) were slightly disabled (grade 3) and 24 (34.3%) had moderate disability (grade 4). At one year follow-up, in group A, favourable outcome was achieved in 56 (80%) of patients compared to 48 (68.6%) in group B; whilst, 14 (20%) patients in group A and 22 (33.1%) in group B showed unfavourable outcome. Although mortality rate was higher in clipping (n=3, 4.3%) as compared to coiling (n=1, 1.4%), but was not statistically

  16. Coronary artery aneurysm: case report

    OpenAIRE

    Burkhart Harold M; Everett Jeffrey E

    2008-01-01

    Abstract Introduction Aneurysms of the left main coronary artery are rare with an incidence of 0.1% in large angiographic series. The majority are atherosclerotic in origin. Other causes include connective tissue disorders, trauma, vasculitis, congenital, mycotic and idiopathic. The primary complication is myocardial ischemia or infarction, with rupture being rare. Treatment options include anticoagulation, custom made covered stents, reconstruction, resection, and exclusion with bypass. Case...

  17. Traumatic intracranial aneurysms in children

    International Nuclear Information System (INIS)

    To describe the imaging findings of traumatic intracranial aneurysms (TICA) in children. Five boys aged 3-15 (mean, 7) years with surgically confirmed TICA were included in this study. All had a history of nonpenetrating head trauma, and they underwent precontrast CT imaging immediately after the injury and follow-up CR or MRI. In all cases, angiography revealed the presence of aneurysms, which at surgery were shown to be pseudoaneurysms with sever adhesions. Angiography demonstrated that all aneurysms were located in the anterior cerebral artery (ACA) or its branches. The precise locations were the A2 segment of the ACA, the site of origin of the callosomarginal artery or its first branch, or of the anterior internal frontal artery, or between the first and second branch of the pericallosal artery. In all patients, precontrast CT performed immediately after trauma depicted subarachnoid hemorrhage (SAH) in the anterior interhemispheric fissure (AIHF). Follow-up precontrast CT showed nodular high density around the anterior falx in three, recurrent SAH in the AIHF in two, and intracerebral hemorrhage (ICH) with intraventricular hemorrhage in two. In two patients with a nodular high-density lesion, nodular enhancement was demonstrated at postcontrast CT, and in one, follow-up MRI revealed a nodular signal void around the anterior falx; nodular enhancement was seen at postcontrast imaging, and MR angiogram depicted a saccular aneurysm. In one patient, MRI demonstrated infarction in the caudate nucleus and ACA territory. If, after head injury, an area of nodular high density is revealed by CT, or a signal void by MRI, or is SAH or ICH is present around the anterior falx, the possibility of TICA should be considered

  18. Idiopathic giant right atrial aneurysm

    International Nuclear Information System (INIS)

    A 2-year-old boy with an incidental finding of massive cardiomegaly on a chest X-ray was diagnosed with a giant right atrial aneurysm upon further investigation with echocardiography. The patient underwent successful surgical reduction of the right atrium and closure of the patent foramen ovale to prevent thromboembolic complications and to lower the risk of atrial arrhythmias. The resected atrium had paper-thin walls and pathological features of interstitial fibrosis with endocardial thickening

  19. Comparison of contrast-enhanced MR angiography of the aortoiliac vessels using a 1.0 molar contrast agent at 1.0T with intra-arterial digital subtraction angiography; Ergebnisse der kontrastverstaerkten MR-Angiographie der aortoiliakalen Gefaesse mit einem 1-molaren Kontrastmittel bei 1,0 T; Vergleich zur i.a. DSA

    Energy Technology Data Exchange (ETDEWEB)

    Mohrs, O.K. [Klinik und Poliklinik fuer Radiologie, Johannes Gutenberg-Univ. Mainz (Germany); Cardioangiologisches Centrum Bethanien, Frankfurt/Main (Germany); Oberholzer, K.; Bernhard, S.; Kalden, P.; Thelen, M.; Kreitner, K.F. [Klinik und Poliklinik fuer Radiologie, Johannes Gutenberg-Univ. Mainz (Germany); Krummenauer, F. [Inst. fuer Med. Biometrie, Epidemiologie und Informatik, Johannes Gutenberg-Univ. Mainz (Germany); Neufang, A. [Klinik fuer Herz- und Thoraxchirurgie, Johannes Gutenberg-Univ. Mainz (Germany)

    2004-07-01

    Purpose: To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE-MRA) using a 1.0 molar contrast agent at 1.0 T for the diagnosis of abdominal aortic aneurysms and stenoses of renal or iliac arteries in comparison to intraarterial digital subtraction angiography (DSA). Materials and Methods: A total of 19 patients with the suspicion of abdominal aortic aneurysm or stenosis of renal or iliac arteries were examined with CE-MRA at 1.0 T. Intra-arterial DAS served as reference in all cases. After test bolus tracking, 10 or 8 ml of the 1.0 molar contrast agent Gadobutrol corresponding to a dose of 0.1-0.15 mmol/kg bw were injected and imaging performed using a FLASH-3D sequence. To evaluate the interobserver-variability, the blinded images were analyzed by two radiologists. Besides the rating of overall image quality on a 4-point-scale, the images were evaluated for aneurysms and arteriosclerotic lesions with a stenosis of < 50% or > 50% or occlusion. Results: A total of 144 segments were analyzed. The mean value of the CE-MRA image quality was 3.4 on a 4-point scale. The sensitivity of CE-MRA in depicting relevant pathological findings was 96% and the specifity 99%. The positive predictive value was 96% and the negative predictive value 99%. Inter-observer variability was low with a kappa value of 0.82. Conclusion: CE-MRA using a 1.0 molar contrast agent at 1.0 Tenables an excellent diagnosis or exclusion of pathologies of the aortoiliac vessels. (orig.) [German] Ziel: Vergleich der MR-Angiographie (ce-MRA) der aortoiliakalen Gefaesse unter Verwendung eines 1-molaren, paramagnetischen Kontrastmittels bei 1,0 T zur intraarteriellen digitalen Subtraktionsangiographie (i.a. DSA). Material und Methoden: Es wurden 19 Patienten mit Verdacht auf ein infrarenales Aortenaneurysma bzw. eine Stenose der Nieren- oder Iliakalarterien untersucht. Die Messungen erfolgten bei 1,0 T unter Verwendung des 1-molaren, paramagnetischen Kontrastmittels Gadobutrol

  20. Intracranial dissecting and saccular aneurysms in polycystic kidney disease.

    Science.gov (United States)

    Kulla, L; Deymeer, F; Smith, T W; Weiner, M; Mullins, T F

    1982-12-01

    A young man with polycystic kidney disease was seen initially with an brain-stem infarction. Postmortem examination disclosed a dissecting aneurysm of the basilar artery and a saccular aneurysm of the right vertebral artery. Dissecting intracranial aneurysms rarely are associated with saccular aneurysms and, to our knowledge, have not been reported in association with polycystic kidney disease. PMID:7138321