Journal articles on the topic 'Abdomina Aortic Aneurysm'
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1
Genyk, Stepan. "Aneurysmal Disease of the Main Arteries." Archive of Clinical Medicine 22, no. 2 (December 8, 2016): 201627. http://dx.doi.org/10.21802/acm.2016.2.7.
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The high incidence of aneurysms of different arterial systems in case of abdominal aortic aneurysm causes the need for the examination of all patients with aortic aneurysm in order to detect aneurysmal process in all main arteries. The use of the mentioned predictors of aneurism wall failure in daily clinical practice provides an opportunity to improve the results of surgical treatment. Active surgical approach in relation to aortic aneurysm and main arteries is indicated in the presence of aneurismal disease. The choice of treatment depends on the severity of the patient’s condition, clinical manifestations, localization of the aneurysm and its morphology, with the preference for endovascular approach.
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Sebayang, Abed Nego Okthara, and Niko Azhari Hidayat. "Endovascular Aortic Repair (EVAR) Method in The Management of Abdominal Aortic Aneurysm." SCRIPTA SCORE Scientific Medical Journal 2, no. 1 (August 28, 2020): 53–7. http://dx.doi.org/10.32734/scripta.v2i1.3530.
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Aortic disease is a collection of diseases of the aorta, which includes aortic aneurysms; acute aortic infections consisting of aortic dissection, intramular hematoma, penetration of atherosclerotic ulcers (PAU) and traumatic injury to the aorta; pseudoaneurysm; aortic rupture; Marfan syndrome; and congenital abnormalities such as coarctation of the aorta. One of the aortic diseases that cause the death rate to increase according to the 2010 Global Burden Disease is aortic aneurysm. Abdominal aortic aneurysm (AAA) is a focal dilatation of the aortic segment. The diagnosis of AAA is done by history taking, physical examination and supporting examination. Management at AAA aims to prevent aortic wall rupture. An alternative procedure without open surgery is endovascular aortic repair (EVAR) using prostheses. It is expected that through the EVAR method, mortality and morbidity due to AAA can be reduced. Keywords: abdominal aortic aneursym, EVAR, prostheses Penyakit aorta merupakan kumpulan penyakit pada aorta yang meliputi aneurisma aorta; sindrom aorta akut berupa diseksi aorta, hematoma intramular, penetrating atherosclerosis ulcer (PAU) dan cedera akibat trauma pada aorta; pseudoaneurysm; ruptur aorta; sindrom Marfan; serta penyakit kongenital seperti koarktasio aorta. Salah satu penyakit aorta yang menyebabkan angka kematian meningkat menurut Global Burden Disease 2010 adalah aneurisma aorta. Aneurisma aorta abdominalis (AAA) merupakan dilatasi fokal pada segmen aorta. Penegakan diagnosis AAA dilakukan dengan anamnesis, pemeriksaan fisik dan pemeriksaan penunjang. Penatalaksanaan pada AAA bertujuan untuk mencegah pecahnya dinding aorta. Prosedur alternatif tanpa pembedahan terbuka yang dijadikan pilihan adalah endovascular aortic repair (EVAR) menggunakan protesa. Diharapkan melalui metode EVAR angka mortalitas dan morbiditas akibat AAA dapat diturunkan. Kata kunci: aneurisma aorta abdominalis, EVAR, protesa
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Batinic, Nikola, Tijana Kokovic, Dragan Nikolic, Vladimir Manojlovic, Viktor Till, and Slavko Budinski. "The impact of abdominal aortic aneurysm diameter on the outcome of endovascular aortic repair." Medical review 74, no. 11-12 (2021): 347–53. http://dx.doi.org/10.2298/mpns2112347b.
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Introduction. Abdominal aortic aneurysm diameter is one of the most important parameters in the diagnostic and therapeutic algorithm for aneurysm follow-up. Currently, two therapeutic modalities are used: open surgery and endovascular aortic repair. The aim of this study is to analyze the impact of the maximum transverse diameter of the abdominal aortic aneurysm on the incidence of general and specific complications. Material and Methods. The retrospective study included 75 patients with infrarenal abdominal aortic aneurysm who underwent endovascular aortic repair in the period from July 2008 to January 2020. The patients were divided into two groups: group A with an abdominal aortic aneurysm size ? 5.9 cm, and group B with an abdominal aortic aneurysm size ? 6.0 cm. Results. A total of 41.3% of patients presented with a maximum transverse aneurysm diameter of ? 5.9 cm, and 58.7% of patients had ? 6.0 cm. Of comorbid diseases, chronic obstructive pulmonary disease was more prevalent in patients with a large abdominal aortic aneurysm (group A 25.8%; group B 59.1%). None of the other comorbidities showed a statistically significant difference between the two groups of patients. Early complications were present in a total of 14.7% of patients, of which 12.9% of patients with a small and 15.9% with a large abdominal aortic aneurysm. Late complications occurred in a total of 18.7% of patients, in 9.7% of patients with a small and 25% of patients with a large abdominal aortic aneurysm. Conclusion. Patients with abdominal aortic aneurysms with a maximum transverse diameter of 6 cm and larger, present with a higher rate of late postoperative complications, increase in aneurysmal sac on control multislice computed tomography angiography, and have a worse prognosis compared to patients with smaller abdominal aortic aneurysms.
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Pereira, Thiago Scremin Boscolo, Vanessa Belentani Marques, Elizandra Moura dos Santos, Ana Letícia Daher Aprígio da Silva, Eduardo Martini Romano, and Carla Patricia Carlos. "Association Between Abdominal Aortic and Common Iliac Artery Aneurysms: Case Report." Journal of Biology and Life Science 10, no. 2 (June 30, 2019): 71. http://dx.doi.org/10.5296/jbls.v10i2.14714.
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The infrarenal abdominal aortic aneurysm is the most common among arterial aneurysms; it happens when there is an abnormal and irreversible enlargement of the blood vessel. This disease usually compromises other arterial segments and is linked to high mortality rates, mainly due to its rupture. Given its importance, we present a case study of an abdominal aortic aneurysm associated with a common iliac artery aneurysm. During a dissection practice in the Morphofunctional Laboratory at FACERES Medical School, we observed the presence of a mild stenosis in the abdominal aorta below the renal arteries, as well as the formation of an infrarenal abdominal aortic aneurysm. In addition, we noticed that the infrarenal abdominal aortic aneurysm was associated with a bilateral common iliac artery aneurysm. Morphological analyses carried out in the blood vessels showed a large quantity of atheromatous plaques, which are the probable cause of the pathology. The information herein may broaden the knowledge on the infrarenal abdominal aortic aneurysmal disease, thus reducing its complications and mortality rates.
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Joshi, Nikhil V., Maysoon Elkhawad, Rachael O. Forsythe, Olivia M. B. McBride, Nikil K. Rajani, Jason M. Tarkin, Mohammed M. Chowdhury, et al. "Greater aortic inflammation and calcification in abdominal aortic aneurysmal disease than atherosclerosis: a prospective matched cohort study." Open Heart 7, no. 1 (March 2020): e001141. http://dx.doi.org/10.1136/openhrt-2019-001141.
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ObjectiveUsing combined positron emission tomography and CT (PET-CT), we measured aortic inflammation and calcification in patients with abdominal aortic aneurysms (AAA), and compared them with matched controls with atherosclerosis.MethodsWe prospectively recruited 63 patients (mean age 76.1±6.8 years) with asymptomatic aneurysm disease (mean size 4.33±0.73 cm) and 19 age-and-sex-matched patients with confirmed atherosclerosis but no aneurysm. Inflammation and calcification were assessed using combined 18F-FDG PET-CT and quantified using tissue-to-background ratios (TBRs) and Agatston scores.ResultsIn patients with AAA, 18F-FDG uptake was higher within the aneurysm than in other regions of the aorta (mean TBRmax2.23±0.46 vs 2.12±0.46, p=0.02). Compared with atherosclerotic control subjects, both aneurysmal and non-aneurysmal aortae showed higher 18F-FDG accumulation (total aorta mean TBRmax2.16±0.51 vs 1.70±0.22, p=0.001; AAA mean TBRmax2.23±0.45 vs 1.68±0.21, p<0.0001). Aneurysms containing intraluminal thrombus demonstrated lower 18F-FDG uptake within their walls than those without (mean TBRmax2.14±0.43 vs 2.43±0.45, p=0.018), with thrombus itself showing low tracer uptake (mean TBRmax thrombus 1.30±0.48 vs aneurysm wall 2.23±0.46, p<0.0001). Calcification in the aneurysmal segment was higher than both non-aneurysmal segments in patients with aneurysm (Agatston 4918 (2901–8008) vs 1017 (139–2226), p<0.0001) and equivalent regions in control patients (442 (304-920) vs 166 (80-374) Agatston units per cm, p=0.0042).ConclusionsThe entire aorta is more inflamed in patients with aneurysm than in those with atherosclerosis, perhaps suggesting a generalised inflammatory aortopathy in patients with aneurysm. Calcification was prominent within the aneurysmal sac, with the remainder of the aorta being relatively spared. The presence of intraluminal thrombus, itself metabolically relatively inert, was associated with lower levels of inflammation in the adjacent aneurysmal wall.
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Samura, Makoto, Nobuya Zempo, Yoshitaka Ikeda, Masaaki Hidaka, Yoshikazu Kaneda, Kazuhiro Suzuki, Hidetoshi Tsuboi, and Kimikazu Hamano. "Single-stage thoracic and abdominal endovascular aneurysm repair for multilevel aortic disease." Vascular 22, no. 1 (May 13, 2013): 55–60. http://dx.doi.org/10.1177/1708538112473965.
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This investigation evaluated the results of single-stage thoracic endovascular aneurysm repair (TEVAR) and endovascular aneurysm repair (EVAR) for multilevel aortic disease in a series of nine patients. The lesions repaired included thoracic and abdominal aortic aneurysms ( n = 7) and subacute type B dissections with abdominal aortic aneurysms ( n = 2). All procedures were successfully performed, and none of the patients experienced postoperative stroke or spinal cord ischemia. The median follow-up period for these patients was 18.9 months (range 1.7–31.4 months) and none of the patients exhibited any signs of type I endoleaks or aneurysmal diameter enlargements more than 5 mm. In conclusion, single-stage TEVAR and EVAR procedures for multilevel aortic disease were found to be safe and feasible modalities for high-risk patients.
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Faries, Peter L., Luis A. Sanchez, Michael L. Marin, Richard E. Parsons, Ross T. Lyon, Steve Oliveri, and Frank J. Veith. "An Experimental Model for the Acute and Chronic Evaluation of Intra-Aneurysmal Pressure." Journal of Endovascular Therapy 4, no. 3 (August 1997): 290–97. http://dx.doi.org/10.1177/152660289700400310.
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Purpose: To develop an animal model for the acute and chronic monitoring of pressure within abdominal aortic aneurysms (AAAs) to be treated with endovascular grafts. Methods: A strain-gauge pressure transducer was placed within an AAA created from a prosthetic vascular graft. Prosthetic aneurysms were implanted into 17 canine infrarenal aortas. The intra-aneurysmal pressure was monitored and correlated with noninvasive forelimb sphygmomanometry for 2 weeks. After this time, an intravascular manometer catheter was passed into the aneurysm. Simultaneous pressure measurements were obtained using the implanted strain-gauge pressure transducer, the manometer catheter, and the forelimb sphygmomanometer. Angiography was performed to assess intraluminal morphology, aneurysm anastomoses, and adjoining aortic vessels. In addition, two control animals underwent intra-aneurysmal pressure monitoring after standard surgical aneurysm repair. Results: There was excellent correlation (r = 0.97) between the pressure measurements obtained with the implanted strain-gauge pressure transducer and the intravascular manometer. Close correlation was also observed between the implanted strain-gauge transducer and the forelimb sphygmomanometer (r = 0.88) during postprocedural monitoring. Intra-aneurysmal pressure was lowered dramatically by surgical exclusion (aneurysm: 15/5 ± 7/4 mmHg; systemic: 124/66 ± 34/17 mmHg; p < 0.001). The prosthetic aneurysms were successfully imaged with angiography. Conclusions: This animal model provides an accurate and reproducible means for measuring intra-aneurysmal pressure on an acute and chronic basis. It may be possible to use this model in the assessment of endovascular devices to determine their efficacy in reducing intra-aneurysmal pressure. Evaluation of complications associated with their use, such as patent aneurysm side branches, perigraft channels, and perianastomotic reflux, may also be possible.
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Weiss, Norbert, Roman N. Rodionov, and Adrian Mahlmann. "Medical management of abdominal aortic aneurysms." Vasa 43, no. 6 (November 1, 2014): 415–21. http://dx.doi.org/10.1024/0301-1526/a000388.
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Abdominal aortic aneurysms (AAA) are the most common arterial aneurysms. Endovascular or open surgical aneurysm repair is indicated in patients with large AAA ≥ 5.5 cm in diameter as this prevents aneurysm rupture. The presence even of small AAAs not in need of immediate repair is associated with a very high cardiovascular risk including myocardial infarction, stroke or cardiovascular death. This risk by far exceeds the risk of aneurysm rupture. These patients therefore should be considered as high-risk patients and receive optimal medical treatment and life-style modificiation of their cardiovascular risk factors to improve their prognosis. In addition, these patients should be followed-up for aneurysm growth and receive medical treatment to decrease aneurym progression and rupture rate. Treatment with statins has been shown to reduce cardiovascular mortality in these patients, and also slows the rate of AAA growth. Use of beta-blockers, ACE inhibitors and AT1-receptor antagonists does not affect AAA growth but may be indicated for comorbidities. Antibiotic therapy with roxithromycin has a small effect on AAA growth, but this effect must be critically weighed against the potential risk of wide-spread use of antibiotics.
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Kontopodis, Nikolaos, Eleni Metaxa, Yannis Papaharilaou, Emmanouil Tavlas, Dimitrios Tsetis, and Christos Ioannou. "Advancements in identifying biomechanical determinants for abdominal aortic aneurysm rupture." Vascular 23, no. 1 (April 22, 2014): 65–77. http://dx.doi.org/10.1177/1708538114532084.
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Abdominal aortic aneurysms are a common health problem and currently the need for surgical intervention is determined based on maximum diameter and growth rate criteria. Since these universal variables often fail to predict accurately every abdominal aortic aneurysms evolution, there is a considerable effort in the literature for other markers to be identified towards individualized rupture risk estimations and growth rate predictions. To this effort, biomechanical tools have been extensively used since abdominal aortic aneurysm rupture is in fact a material failure of the diseased arterial wall to compensate the stress acting on it. The peak wall stress, the role of the unique geometry of every individual abdominal aortic aneurysm as well as the mechanical properties and the local strength of the degenerated aneurysmal wall, all confer to rupture risk. In this review article, the assessment of these variables through mechanical testing, advanced imaging and computational modeling is reviewed and the clinical perspective is discussed.
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Dolmaci, Onur B., Sulayman El Mathari, Antoine H. G. Driessen, Robert J. M. Klautz, Robert E. Poelmann, Jan H. N. Lindeman, and Nimrat Grewal. "Are Thoracic Aortic Aneurysm Patients at Increased Risk for Cardiovascular Diseases?" Journal of Clinical Medicine 12, no. 1 (December 29, 2022): 272. http://dx.doi.org/10.3390/jcm12010272.
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Objectives: Abdominal aortic aneurysms are associated with a sharply increased cardiovascular risk. Cardiovascular risk management is therefore recommended in prevailing guidelines for abdominal aneurysm patients. It has been hypothesized that associated risk relates to loss of aortic compliance. If this hypothesis is correct, observations for abdominal aneurysms would also apply to thoracic aortic aneurysms. The objective of this study is to test whether thoracic aneurysms are also associated with an increased cardiovascular risk burden. Methods: Patients who underwent aortic valve or root surgery were included in the study (n = 239). Cardiovascular risk factors were studied and atherosclerosis was scored based on the preoperative coronary angiographies. Multivariate analyses were performed, controlling for cardiovascular risk factors and aortic valve morphology. Comparisons were made with the age- and gender-matched general population and non-aneurysm patients as control groups. A thoracic aortic aneurysm was defined as an aortic aneurysm of ≥45 mm. Results: Thoracic aortic aneurysm was not associated with an increased coronary atherosclerotic burden (p = 0.548). Comparison with the general population revealed a significantly higher prevalence of hypertension (61.4% vs. 32.2%, p < 0.001) and a lower prevalence of diabetes (1.4% vs. 13.1%, p = 0.001) in the thoracic aneurysm group. Conclusions: The extreme cardiovascular risk associated with abdominal aortic aneurysms is location-specific and not explained by loss of aortic compliance. Thoracic aortic aneurysm, in contrast to abdominal, is not part of the atherosclerotic disease spectrum and, therefore, cardiovascular risk management does not need to be implemented in treatment guidelines of isolated thoracic aneurysms. Hypertension should be treated.
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Wilmink, A. B. M., M. Forshaw, C. R. G. Quick, C. S. Hubbard, and N. E. Day. "Accuracy of serial screening for abdominal aortic aneurysms by ultrasound." Journal of Medical Screening 9, no. 3 (September 1, 2002): 125–27. http://dx.doi.org/10.1136/jms.9.3.125.
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OBJECTIVES: To assess the accuracy of screening for abdominal aortic aneurysms (AAAs) by ultrasound (US). SETTING: An aneurysm screening programme in Huntingdon. METHODS: False negative tests were identified by tracing all patients with a ruptured aneurysm who were screened and then finding the number classified as normal on US. False positive tests were identified by calculating the number of aneurysmal aortas on US that were classified as normal on CT. Measurement variability of the infrarenal aortic diameter between US and CT was estimated. RESULTS: 14 out of 93 patients with a ruptured AAA since 1991 had been screened. No ruptured aneurysm had been classified as normal on US. All 64 patients with an AAA larger than 4.5 cm on US had their aneurysm confirmed on CT. The mean difference between CT and US measurements was 4 mm. The limit of variability between CT and US was 12 mm. CONCLUSION: No false negative scans were found using a cut off point of 3 cm as abnormal. No false positives were found if subjects with an AAA exceeding 4.5 cm were referred for further procedures. A serial US screening policy has excellent screening performance, justifying its use as a screening tool.
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Colovic, R., L. Davidovic, D. Bilanovic, Z. Krivokapic, N. Grubor, S. Cvetkovic, V. Radak, and M. Markovic. "Splenic artery aneurysms." Acta chirurgica Iugoslavica 53, no. 1 (2006): 41–44. http://dx.doi.org/10.2298/aci0601041c.
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Although the third most frequent aneurysm in the abdomen, after aneurysms of the aorta and iliac arteries, and most frequent aneurisms of visceral arteries, splenic artery aneurysms are rare, but not very rare. Thanks to the new imaging techniques, first of all ultrasonography, they have been discovered with increasing frequency. We present a series of 9 splenic artery aneurysms. Seven patients were female and two male of average age 49 years (ranging from 28 to 75 years). The majority of affected women were multiparae, with average 3 children (ranging from 1 to 6). One patient had a subacute rupture, and 2 had ruptures into the splenic vein causing portal hypertension. The spleen was enlarged in 7 out of 9 patients. The average size of aneurysms was 3,2 cm (ranging from 2 to 8 cm). The preoperative diagnosis of splenic artery aneurysm was established in 6 patients while in 3 patients aneurism was accidentally found during other operations, during splenectomy in 2, and during the excision of a retroperitoneal tumor in 1 patient. Aneurysmectomy was carried out in 7 patients, while a ligation of the incoming and out coming wessels was performed in 2 patients with arteriovenous fistula. Splenectomy was performed in 6 patients, while pancreatic tail resection, cholecystectomy and excision of the retroperitoneal tumor were performed in 3 patients. Additional resection of the abdominal aortic aneurysm with reconstruction of aortoiliac segment was performed in 2 patients. There were no mortality and the postoperative recovery was uneventful in all patients.
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Baykova, A. V., A. Ya Bedrov, A. A. Moiseev, and V. V. Baykov. "Gender based differences in histopathology of abdominal aorta in patients with abdominal aortic aneurysm and aortoiliac occlusive disease." Scientific Notes of the Pavlov University 29, no. 3 (July 4, 2022): 106–17. http://dx.doi.org/10.24884/1607-4181-2022-29-3-106-117.
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Relevance. Evidence exists that infrarenal aortic aneurisms and aortoiliac occlusive disease in women are different than in men in terms of anatomical features and more severe clinical course. Gender differences in histopathology of abdominal aorta are not fully studied.The objective was to study gender based differences in histopathology of abdominal aorta in patients with aortic aneurisms and aortoiliac occlusive disease.Methods and materials. The study included 96 biopsy specimens from 71 patients with aorto-iliac lesions (23 women and 48 men). A number of morphological characteristics and expression of matrix metalloproteinase 9 (MMP-9) were analyzed. The data obtained were processed statistically.Results. Adventitial infiltrate and medial sclerosis are more intense in the aneurysm than in occlusive-stenotic lesions, differences in the grade of fibrosis were proven only in men. Regardless of the patients’ gender, adventitial infiltration is denser in the aneurysmal body than in the neck; other changes in the anatomic parts of the aneurysm are similar. MMP-9 expression in the adventitia in the aneurysmal neck is higher in women, than in men. MMP-9 expression in the media and adventitia is higher in men with aneurysm, then with occlusive or stenotic lesion. Almost all indices of the aortic wall remodeling and MMP-9 expression correlate with each other in men with the aneurysm, in contrast to women.Conclusion. Gender based features in histopathology of abdominal aorta and the degree of their correlation may determine differences in the anatomy and course of abdominal aortic aneurysm and aortoiliac occlusive disease in women and men.
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Karaarslan Cengiz, O., and G. Nergizoglu. "Prevalenceof abdominal aortic aneurysm among stage 3-4 chronic kidney disease patients aged 55 years and older." Ukrainian Journal of Nephrology and Dialysis, no. 2(66) (March 24, 2020): 9–16. http://dx.doi.org/10.31450/ukrjnd.2(66).2020.02.
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The risk of cardiovascular disease begins to increase from the early stages of chronic kidney disease (CKD). Abdominal aortic aneurysms are the most common arterial aneurysms of peripheral arterial diseases. The frequency of abdominal aortic aneurysm varies according to the population studied. This study aimed to determine the prevalence of abdominal aortic aneurysm in patients with stage 3-4 CKD and investigate CKD is a risk factor for abdominal aortic aneurysm formation.
Methods. Patients aged 55 years and older who were followed up in the internal medicine outpatient clinics were enrolled. Two hundred CKD patients with glomerular filtration rates between 15-59 mL/min per 1.73 m2 were included in the study group, and 110 patients with glomerular filtration rates of 60 mL/min per 1.73 m2 or above were assigned to the control group. An ultrasonography device with a 3.5 MHz probe was used for screening. Abdominal aortic diameters of 3 cm and above were accepted as abdominal aortic aneurysms.
Results. Eighteen patients in the study group (9%) and four in the control group (3.6%) had an abdominal aortic aneurysm. The prevalence of abdominal aortic aneurysms was higher in the CKD group. However, the difference was not statistically significant (p=0.078). Moreover, the median aortic diameter was 21.8 mm (14-44 mm) in the study group, compared to 21.0 mm (14-46 mm) in the control group. The prevalence of the abdominal aortic aneurysm was 14.9% in stage 4 CKD patients and 6% in stage 3 CKD patients (p=0.038).
Conclusion. An abdominal aortic aneurysm is more common in patients with CKD although it does not reach statistical significance. The median aortic diameter was significantly wider in CKD patients compared to the control group . The prevalence of abdominal aortic aneurysm increased with an increase in the CKD stage .
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Ascoli Marchetti, Andrea, Fabio Massimo Oddi, Nicolò Diotallevi, Martina Battistini, and Arnaldo Ippoliti. "An unusual complication after endovascular aneurysm repair for giant abdominal aortic aneurysm with aortocaval fistula: High bilirubin levels." SAGE Open Medical Case Reports 8 (January 2020): 2050313X2098432. http://dx.doi.org/10.1177/2050313x20984322.
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Abdominal aortic aneurysm has among its rare complications the aortocaval fistula. It is observed in less than 1% of all abdominal aortic aneurysms and represents 3%–7% of clinical presentation in case of rupture. A male patient was presented to the emergency department with pulsating mass with continuous vascular systo-diastolic bruit, located in the lower part of abdomen with the back pain radiating anteriorly in lower abdomen. After diagnosis of abdominal aortic aneurysm with aortocaval fistula, a trimodular Endurant endograft was placed. Migration of the endoprosthesis was treated with Endoanchor and endovascular aneurysm sealing device. In the postoperative course, the patient had jaundice due to high bilirubin levels, cholestasis and increased hepatocyte cytolysis: aspartate aminotransferase and alanine aminotransferase. The treatment with appropriate continuous filtration rapidly reduced bilirubin values and the patient gradually improved.
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Khashram, Manar, Julie S. Jenkins, Jason Jenkins, Allan J. Kruger, Nicholas S. Boyne, Wallace J. Foster, and Philip J. Walker. "Long-term outcomes and factors influencing late survival following elective abdominal aortic aneurysm repair: A 24-year experience." Vascular 24, no. 2 (May 12, 2015): 115–25. http://dx.doi.org/10.1177/1708538115586682.
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Background Abdominal aortic aneurysms can be either treated by an open abdominal aortic aneurysm repair or an endovascular repair. Comparing clinical predictors of outcomes and those which influence survival rates in the long term is important in determining the choice of treatment offered and the decision-making process with patients. Aims To determine the influence of pre-existing clinical predictors and perioperative determinants on late survival of elective open abdominal aortic aneurysm repair and endovascular repair at a tertiary hospital. Methods Consecutive patients undergoing elective abdominal aortic aneurysm repair from 1990 to 2013 were included. Data were collected from a prospectively acquired database and death data were gathered from the Queensland state death registry. Pre-existing risks and perioperative factors were assessed independently. Kaplan–Meier and Cox regression modeling were performed. Results During the study period, 1340 abdominal aortic aneurysms were repaired electively, of which 982 were open abdominal aortic aneurysm repair. The average age was 72.4 years old and 81.7% were males. The cumulative percentage survival rates for open abdominal aortic aneurysms repair at 5, 10, 15 and 20 years were 79, 49, 31 and 22, respectively. The corresponding 5-, 10- and 15-year survival rates for endovascular repair were not significantly different at 75, 49 and 33%, respectively (P = 0.75). Predictors of reduced survival were advanced age, American Society of Anaesthesiology scores, chronic obstructive pulmonary disease, renal impairment, bifurcated grafts, peripheral vascular disease and congestive heart failure. Conclusions Open repair offers a good long-term treatment option for patients with an abdominal aortic aneurysm and in our experience there is no significant difference in late survival between open abdominal aortic aneurysms repair and endovascular repair. Consideration of the factors identified in this study that predict reduced long-term survival for open abdominal aortic aneurysms repair and endovascular repair should be considered when deciding repair of abdominal aortic aneurysm.
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Zotikov, A. E., M. R. Khokonov, K. Kh Eminov, A. M. Solovieva, A. V. Kozhanova, V. S. Ostapenko, A. Yu Shchedrina, et al. "A case of successful surgical treatment of a ruptured giant aneurysm of the infrarenal aorta in an elderly patient." Aterotromboz = Atherothrombosis, no. 1 (July 13, 2021): 157–63. http://dx.doi.org/10.21518/2307-1109-2021-11-1-157-163.
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Today, abdominal aortic aneurysm surgery is a fairly well-studied area of medicine. Nevertheless, some questions remain rather debatable. No clear criteria for giant aneurysms have been developed so far. The available foreign and domestic literature reports about 40 cases of surgical treatment of giant abdominal aortic aneurysms, 16 of which are cases of aneurysm rupture. Open surgery remains the method of choice in the treatment of giant aneurysms due to the pronounced technical difficulties of endovascular intervention. The authors present a case of successful surgical treatment of a giant aneurysm rupture in an elderly patient. The peculiarity of this patient's condition is the occurrence of aneurysm rupture after hospital admission. The patient refused surgical treatment for two years after aneurysm detection. On examination after admission, multispiral computed tomography revealed an aneurysm size of 101 mm. On the eve of surgery, pain syndrome in the left abdomen and tachycardia appeared. Aneurysm rupture was suspected and the patient was urgently admitted to the operating room. The surgery was performed under the conditions of machine reinfusion of autoblood. The patient underwent abdominal aortic aneurysm resection with linear prosthesis and retroperitoneal hematoma removal. The postoperative period had no peculiarities. On the 10th day after the operation the patient was discharged in satisfactory condition to the outpatient treatment. This clinical case demonstrates the possibility of successful surgical treatment of giant aneurysm rupture in elderly patients.
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Babic, Srdjan, Petar Popov, Miroslav Milicic, Nenad Ilijevski, Dragoslav Nenezic, Slobodan Tanaskovic, Predrag Gajin, et al. "Surgery of infrarenal inflammatory aneurysm of abdominal aorta infected with methicillin resistant Staphylococcus aureus in a patient undergoing haemodialysis." Srpski arhiv za celokupno lekarstvo 136, no. 9-10 (2008): 529–32. http://dx.doi.org/10.2298/sarh0810529b.
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INTRODUCTION Inflammatory abdominal aortic aneurysm accounts for 5% to 10% of all cases of abdominal aortic aneurysm and differs from typical atherosclerotic abdominal aortic aneurysm in many important ways. Although both inflammatory and atherosclerotic abdominal aortic aneurysms most commonly affect the infrarenal portion of the abdominal aorta, patients with the inflammatory variant are younger and usually symptomatic, chiefly from back or abdominal pain. Unlike patients with atherosclerotic abdominal aortic aneurysm, most with the inflammatory variant have an elevated erythrocyte sedimentation rate or abnormalities of other serum inflammatory markers. Computed tomography and magnetic resonance imaging are both sensitive for demonstrating the cuff of soft tissue inflammation surrounding the aneurysm that is characteristic of inflammatory abdominal aortic aneurysm. Inflammatory abdominal aortic aneurysm can be primarily infected by degenaration of an infected artery (in less than 1% of cases), or can become secondary infected in the already existing aneurysm. Secondary infection of the pre-existing aneurysm has big influence on treatment choice, but is also rare. Clinically non-symptomatic infection, also known as bacterial collonisation, can be very frequent, regarding a greatly increased number of positive intraoperative findings (10-15%). Prolonged intravascular catheterization, vascular grafting, repeated punctures with large bore needles, and decreased immune defense mechanism make uraemic patients undergoing hemodialysis more likely to develop Staphylococcus aureus bacteraemia and its complications. CASE OUTLINE The case shows a gigantic inflammatory aneurysm of the abdominal aorta, localized infrarenally, which was solved successfully by resection of the aneurysm of the abdominal aorta, and interposition of Dacron tubular graft 22 mm. Bacterial examination of the aneurysmal sac was positive: methicillin-resistent Staphylococcus aureus was detected. CONCLUSION There were no postoperative complications, and the final outcome was fully satisfactory. Control CT scans after 3, 6 and 12 months were regular, with signs of regression fibrosis of the retroperitoneum.
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Torra, R., C. Nicolau, C. Badenas, C. Brú, L. Pérez, X. Estivill, and A. Darnell. "Abdominal aortic aneurysms and autosomal dominant polycystic kidney disease." Journal of the American Society of Nephrology 7, no. 11 (November 1996): 2483–86. http://dx.doi.org/10.1681/asn.v7112483.
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Although cases of autosomal dominant polycystic kidney disease (ADPKD) associated with abdominal aortic aneurysm have been repeatedly reported in the literature, no systematic studies of the aortas of these patients have been performed. In the study presented here, a sonographic study of the abdominal aorta in 139 ADPKD patients and in 149 healthy family members was carried out. For both groups, an increase in aortic diameter related to age and sex, (being wider in men than women) was found. In ADPKD patients, neither a wider aortic diameter nor a higher prevalence of abdominal aortic aneurysms could be found in any age group. It was concluded that, although these patients are prone to develop aortic aneurysms because of hypertension and associated connective tissue disorders, the presence of abdominal aortic aneurysms should be questioned as a frequent feature of ADPKD.
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Kim, Ha Won, and Brian K. Stansfield. "Genetic and Epigenetic Regulation of Aortic Aneurysms." BioMed Research International 2017 (2017): 1–12. http://dx.doi.org/10.1155/2017/7268521.
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Aneurysms are characterized by structural deterioration of the vascular wall leading to progressive dilatation and, potentially, rupture of the aorta. While aortic aneurysms often remain clinically silent, the morbidity and mortality associated with aneurysm expansion and rupture are considerable. Over 13,000 deaths annually in the United States are attributable to aortic aneurysm rupture with less than 1 in 3 persons with aortic aneurysm rupture surviving to surgical intervention. Environmental and epidemiologic risk factors including smoking, male gender, hypertension, older age, dyslipidemia, atherosclerosis, and family history are highly associated with abdominal aortic aneurysms, while heritable genetic mutations are commonly associated with aneurysms of the thoracic aorta. Similar to other forms of cardiovascular disease, family history, genetic variation, and heritable mutations modify the risk of aortic aneurysm formation and provide mechanistic insight into the pathogenesis of human aortic aneurysms. This review will examine the relationship between heritable genetic and epigenetic influences on thoracic and abdominal aortic aneurysm formation and rupture.
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Kostic, Dusan, Lazar Davidovic, Drago Milutinovic, Radomir Sindjelic, Marko Dragas, and Momcilo Colic. "Ex vivo repair of renal artery aneurysm associated with surgical treatment of abdominal aortic aneurysm." Srpski arhiv za celokupno lekarstvo 132, no. 7-8 (2004): 250–53. http://dx.doi.org/10.2298/sarh0408250k.
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INTRODUCTION Renal artery aneurysms is relatively uncommon with reported incidence ranges from 0.3% to 1%. However, considering all visceral artery aneurysms the percentage of renal artery aneurysms is relatively high between 15-25%. The distal forms of renal artery aneurysms sometimes require "ex vivo" reconstruction and kidney autotransplantation. CASE REPORT A 75-year-old male presented with the right abdominal and back pain. He suffered from a long history of arterial hypertension and chronic renal failure over the last few months (urea blood = 19.8 mmol/l; creatinine = 198 mmol/l). Duplex ultrasonography showed abdominal aortic aneurysm. Subsequent translumbarangiography revealed juxtarenal abdominal aortic aneurysm associated with distal right renal artery aneurysm. The operation was performed under combined thoracic epidural analgesia and general anesthesia using transperitoneal approach. After the laparotomy, the ascending colon was mobilized and reflected medially followed by Kocher maneuver. The result was visualization of the anterior aspect of the right kidney, the collecting system, ureter as well as the right renal vein and artery with large saccular aneurysm located distally. After mobilization of the renal vessels and careful dissection of the ureter, the kidney was explanted. The operation was continued by two surgical teams. The first team performed abdominal aortic aneurysm resection and reconstruction with bifurcated Dacron graft. The second team performed ex vivo reparation of renal artery aneurysm. All time during the explantation, the kidney was perfused by Collins' solution. The saccular right renal artery aneurysm 4 cm in diameter was located at the kidney hilus at the first bifurcation. Three branches originated from the aneurysm. The aneurysm was resected completely. The longest and widest of three branches arising from the aneurysmal sac was end-to-end anastomized with 6 mm PTFE graft. After this intervention, one of shorter arteries was implanted into the long artery, and another one into PTFE graft. After 30 minutes of explanation, autotransplantation of the kidney into the right iliac fossa was performed. The right renal vein was implanted into the inferior vein cava, and PTFE graft into the right limb of Dacron graft. Immediately following the completion of both anastomoses, large volume of urine was evident. Finally, ureteneocystostomy was performed with previous insertion of double "J" catheter. In the immediate postoperative period, renal function was restored to normal, while postoperative angiography revealed all patent grafts. DISCUSSION The most common causes of renal artery aneurysms are arteriosclerosis, as in our case, and fibro-muscular dysplasia. Very often, renal artery aneurysms are asymptomatic and discovered only during angiography in patients with aneurysmal and occlusive aortic disease. Other cases include: arterial hypertension, groin pain and acute or chronic renal failure. Due to relatively small number of evaluated cases, the risk of aneurysmal rupture is not known. According to some authors, the overall rupture rate of renal artery aneurysm is 5%, however, the rupture risk becomes higher in young pregnant woman. Several standard surgical procedures are available for the repair of renal artery aneurysms. These include saphenous vein angioplasty, bypass grafting, as well as ex vivo reconstruction with reimplantation or autotransplantation. Furthermore, interventional embolization therapy, as well as endovascular treatment with ePTFE covered stent, or autologous vein-coverage stent graft, have been also reported to be successful. CONCLUSION The major indications for surgical treatment of renal artery aneurysms are to eliminate the source of thromboembolism which leads to fixed renal hypertension and kidney failure, as well as prevention of aneurysmal rupture.
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Rajab, T., Miriam Beyene, Farhang Yazdchi, and Matthew Menard. "Aortic Aneurysm Eroding into the Spine." AORTA 06, no. 02 (April 2018): 068–69. http://dx.doi.org/10.1055/s-0038-1669416.
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AbstractAortic aneurysms are usually asymptomatic until catastrophic rupture occurs. Ruptured abdominal aortic aneurysms classically present with acute back pain, shock, and a pulsatile abdominal mass. The natural history of some aortic aneurysms also includes a stage of contained rupture. This occurs when extravasation of blood from the ruptured aneurysm is contained by surrounding tissues. Here, the authors report the case of a chronic contained abdominal aortic aneurysm rupture that resulted in erosion of the spine.
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Vänni, V., T. Hakala, J. Mustonen, J. Turtiainen, T. T. Rissanen, O. Kajander, E. Ilveskoski, J. Koivumäki, M. Eskola, and J. Hernesniemi. "Ultrasound Screening of Men with Coronary Artery Disease for Abdominal Aortic Aneurysms: A Prospective Dual Center Study." Scandinavian Journal of Surgery 105, no. 4 (June 22, 2016): 235–40. http://dx.doi.org/10.1177/1457496915626839.
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Background and Aims: According to the heterogeneous results of previous studies, the prevalence of abdominal aortic aneurysm seems high among men with coronary artery disease. The associating risk factors for abdominal aortic aneurysm in this population require clarification. Our objective was to assess the prevalence of non-diagnosed abdominal aortic aneurysms in men with angiographically verified coronary artery disease and to document the associated co-morbidities and risk factors. Material and Methods: Altogether, 407 men with coronary artery disease were screened after invasive coronary angiography in two series at independent centers. Risk factor data were recorded and analyzed. Results and Conclusion: The mean age of the study cohort was 70.0 years (standard deviation: 11.0). The prevalence of previously undiagnosed abdominal aortic aneurysms in the whole screened population of 407 men was 6.1% (n = 25/407). In a multivariate analysis of the whole study population, the only significant risk factors for abdominal aortic aneurysm were age (odds ratio: 1.04, 95% confidence interval: 1.00–1.09) and history of smoking (odds ratio: 3.13, 95% confidence interval: 1.26–7.80). Non-smokers with abdominal aortic aneurysm were significantly older than smokers (mean age: 80.7 (standard deviation: 8.0) vs 68.0 (standard deviation: 11.1), p = 0.003), and age was a significant risk factor only among non-smokers (p = 0.011; p = 0.018 for interaction). Among smokers, the prevalence of abdominal aortic aneurysm was 8.8%, and 72% (n = 18/25) of all diagnosed abdominal aortic aneurysm patients were smokers. Prevalence of undiagnosed abdominal aortic aneurysms among patients with coronary artery disease is high, and history of smoking is the most significant risk factor for abdominal aortic aneurysm. Effectiveness of selective screening of abdominal aortic aneurysm in male patients with coronary artery disease warrants further studies.
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Sukovatykh, B. S., L. N. Belikov, M. B. Sukovatykh, and A. I. Itinson. "Sclerosurgical treatment of the ruptured abdominal aortic aneurisms." VESTNIK KHIRURGII IMENI I.I.GREKOVA 177, no. 6 (December 30, 2018): 11–15. http://dx.doi.org/10.24884/0042-4625-2018-177-6-11-15.
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The objectiveof the study is to assess the efficacy of the invented in the clinic technique of sclerosurgical treatment of the ruptured abdominal aortic aneurisms.Material and methods.The analysis of the treatment of 40 patients with ruptured abdominal aortic aneurism was done. All patients were divided into two groups consisted of 20 patients. The first group of patients were treated using conventional technique. Patients from the second group were treated using sclerosurgical treatment. The aneurysm was neither opened nor resected. The aneurism was punctured and injected 4 ml of 70 % ethanol under ultrasound guidance.Results.The second group of patients had decreased both the postoperative complications and mortality rate by 10 % and 30 % respectively.Conclusion.The original technique of sclerosurgical treatment of the ruptured abdominal aortic aneurisms is effective and pathogenically supported.
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da Silva, Erasmo S., Vitor C. Gornati, Ivan B. Casella, Ricardo Aun, Andre EV Estenssoro, Pedro Puech-Leão, and Nelson De Luccia. "The similarities and differences among patients with abdominal aortic aneurysms referred to a tertiary hospital and found at necropsy." Vascular 23, no. 4 (September 23, 2014): 411–18. http://dx.doi.org/10.1177/1708538114552095.
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Objective To analyze the characteristics of patients with abdominal aortic aneurysms referred to a tertiary center and to compare with individuals with abdominal aortic aneurysm found at necropsy. Methods We have retrospectively analyzed the medical records of 556 patients with abdominal aortic aneurysm and 102 cases abdominal aortic aneurysm found at necropsy. Results At univariated analysis, hypertension, tobacco use and maximum diameter were significant risk factors for symptomatic aneurysm, while diabetes tended to be a protective factor for rupture. By logistic regression analysis, the largest transverse diameter was the only one significantly associated with abdominal aortic aneurysm rupture ( p < .0001, odds ratio 1.7, 95% confidence interval 1.481–1.951). Intact abdominal aortic aneurysm found at necropsy showed similarities with outpatients in relation to abdominal aortic aneurysm diameter and risk factors. Conclusion Intact abdominal aortic aneurysm at necropsy and at outpatients setting showed similarities that confirmed that abdominal aortic aneurysm repair is less offered to women, and they died more frequently with intact abdominal aortic aneurysm from other causes.
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Cury, Marcelo, Fernanda Zeidan, and Armando C. Lobato. "Aortic Disease in the Young: Genetic Aneurysm Syndromes, Connective Tissue Disorders, and Familial Aortic Aneurysms and Dissections." International Journal of Vascular Medicine 2013 (2013): 1–7. http://dx.doi.org/10.1155/2013/267215.
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There are many genetic syndromes associated with the aortic aneurysmal disease which include Marfan syndrome (MFS), Ehlers-Danlos syndrome (EDS), Loeys-Dietz syndrome (LDS), familial thoracic aortic aneurysms and dissections (TAAD), bicuspid aortic valve disease (BAV), and autosomal dominant polycystic kidney disease (ADPKD). In the absence of familial history and other clinical findings, the proportion of thoracic and abdominal aortic aneurysms and dissections resulting from a genetic predisposition is still unknown. In this study, we propose the review of the current genetic knowledge in the aortic disease, observing, in the results that the causative genes and molecular pathways involved in the pathophysiology of aortic aneurysm disease remain undiscovered and continue to be an area of intensive research.
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Nakayama, Ken, Tadashi Furuyama, Yutaka Matsubara, Koichi Morisaki, Toshihiro Onohara, Tetsuo Ikeda, and Tomoharu Yoshizumi. "Gut dysbiosis and bacterial translocation in the aneurysmal wall and blood in patients with abdominal aortic aneurysm." PLOS ONE 17, no. 12 (December 14, 2022): e0278995. http://dx.doi.org/10.1371/journal.pone.0278995.
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Inflammation plays a part in the development of abdominal aortic aneurysm (AAA), and the gut microbiota affects host inflammation by bacterial translocation. The relationship between abdominal aortic aneurysm and the gut microbiota remains unknown. This study aimed to detect bacterial translocation in the aneurysmal wall and blood of patients with abdominal aortic aneurysm, and to investigate the effect of the gut microbiota on abdominal aortic aneurysm. We investigated 30 patients with abdominal aortic aneurysm from 2017 to 2019. We analysed the aneurysmal wall and blood using highly sensitive reverse transcription-quantitative polymerase chain reaction, and the gut microbiota was investigated using next-generation sequencing. In the 30 patients, bacteria were detected by reverse transcription- quantitative polymerase chain reaction in 19 blood samples (detection rate, 63%) and in 11 aneurysmal wall samples (detection rate, 37%). In the gut microbiota analysis, the Firmicutes/Bacteroidetes ratio was increased. The neutrophil-lymphocyte ratio was higher (2.94 ± 1.77 vs 1.96 ± 0.61, P < 0.05) and the lymphocyte-monocyte ratio was lower (4.02 ± 1.25 vs 5.86 ± 1.38, P < 0.01) in the bacterial carrier group than in the bacterial non-carrier group in blood samples. The volume of intraluminal thrombus was significantly higher in the bacterial carrier group than in the bacterial non-carrier group in aneurysmal wall samples (64.0% vs 34.7%, P < 0.05). We confirmed gut dysbiosis and bacterial translocation to the blood and aneurysmal wall in patients with abdominal aortic aneurysm. There appears to be a relationship between the gut microbiota and abdominal aortic aneurysm.
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OLIVEIRA, JAHIR RICHARD DE, MAURÍCIO DE AMORIM AQUINO, SVETLANA BARROS, GUILHERME BENJAMIN BRANDÃO PITTA, and ADAMASTOR HUMBERTO PEREIRA. "Alterations of blood flow pattern after triple stent endovascular treatment of saccular abdominal aortic aneurysm: a porcine model." Revista do Colégio Brasileiro de Cirurgiões 43, no. 3 (June 2016): 154–59. http://dx.doi.org/10.1590/0100-69912016003004.
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ABSTRACT Objective: to determine the blood flow pattern changes after endovascular treatment of saccular abdominal aortic aneurysm with triple stent. Methods: we conducted a hemodynamic study of seven Landrace and Large White pigs with saccular aneurysms of the infrarenal abdominal aorta artificially produced according to the technique described. The animals were subjected to triple stenting for endovascular aneurysm. We evaluated the pattern of blood flow by duplex scan before and after stent implantation. We used the non-paired Mann-Whitney test for statistical analysis. Results: there was a significant decrease in the average systolic velocity, from 127.4cm/s in the pre-stent period to 69.81cm/s in the post-stent phase. There was also change in the flow pattern from turbulent in the aneurysmal sac to laminate intra-stent. Conclusion: there were changes in the blood flow pattern of saccular abdominal aortic aneurysm after endovascular treatment with triple stent.
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Gopalakrishnan, Shyam Sunder, Benoît Pier, and Arie Biesheuvel. "Dynamics of pulsatile flow through model abdominal aortic aneurysms." Journal of Fluid Mechanics 758 (October 7, 2014): 150–79. http://dx.doi.org/10.1017/jfm.2014.535.
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AbstractTo contribute to the understanding of flow phenomena in abdominal aortic aneurysms, numerical computations of pulsatile flows through aneurysm models and a stability analysis of these flows were carried out. The volume flow rate waveforms into the aneurysms were based on measurements of these waveforms, under rest and exercise conditions, of patients suffering abdominal aortic aneurysms. The Reynolds number and Womersley number, the dimensionless quantities that characterize the flow, were varied within the physiologically relevant range, and the two geometric quantities that characterize the model aneurysm were varied to assess the influence of the length and maximal diameter of an aneurysm on the details of the flow. The computed flow phenomena and the induced wall shear stress distributions agree well with what was found in PIV measurements by Salsac et al. (J. Fluid Mech., vol. 560, 2006, pp. 19–51). The results suggest that long aneurysms are less pathological than short ones, and that patients with an abdominal aortic aneurysm are better to avoid physical exercise. The pulsatile flows were found to be unstable to three-dimensional disturbances if the aneurysm was sufficiently localized or had a sufficiently large maximal diameter, even for flow conditions during rest. The abdominal aortic aneurysm can be viewed as acting like a ‘wavemaker’ that induces disturbed flow conditions in healthy segments of the arterial system far downstream of the aneurysm; this may be related to the fact that one-fifth of the larger abdominal aortic aneurysms are found to extend into the common iliac arteries. Finally, we report a remarkable sensitivity of the wall shear stress distribution and the growth rate of three-dimensional disturbances to small details of the aneurysm geometry near the proximal end. These findings suggest that a sensitivity analysis is appropriate when a patient-specific computational study is carried out to obtain a quantitative description of the wall shear stress distribution.
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Lu, Hong, Debra L. Rateri, Dennis Bruemmer, Lisa A. Cassis, and Alan Daugherty. "Involvement of the renin–angiotensin system in abdominal and thoracic aortic aneurysms." Clinical Science 123, no. 9 (July 13, 2012): 531–43. http://dx.doi.org/10.1042/cs20120097.
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Aortic aneurysms are relatively common maladies that may lead to the devastating consequence of aortic rupture. AAAs (abdominal aortic aneurysms) and TAAs (thoracic aortic aneurysms) are two common forms of aneurysmal diseases in humans that appear to have distinct pathologies and mechanisms. Despite this divergence, there are numerous and consistent demonstrations that overactivation of the RAS (renin–angiotensin system) promotes both AAAs and TAAs in animal models. For example, in mice, both AAAs and TAAs are formed during infusion of AngII (angiotensin II), the major bioactive peptide in the RAS. There are many proposed mechanisms by which the RAS initiates and perpetuates aortic aneurysms, including effects of AngII on a diverse array of cell types and mediators. These experimental findings are complemented in humans by genetic association studies and retrospective analyses of clinical data that generally support a role of the RAS in both AAAs and TAAs. Given the lack of a validated pharmacological therapy for any form of aortic aneurysm, there is a pressing need to determine whether the consistent findings on the role of the RAS in animal models are translatable to humans afflicted with these diseases. The present review compiles the recent literature that has shown the RAS as a critical component in the pathogenesis of aortic aneurysms.
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Müller, Verena, Milena Miszczuk, Christian E. Althoff, Andrea Stroux, Andreas Greiner, Helena Kuivaniemi, and Irene Hinterseher. "Comorbidities Associated with Large Abdominal Aortic Aneurysms." AORTA 07, no. 04 (June 2019): 108–14. http://dx.doi.org/10.1055/s-0039-1692456.
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Background Abdominal aortic aneurysm has become increasingly important owing to demographic changes. Some other diseases, for example, cholecystolithiasis, chronic obstructive pulmonary disease, and hernias, seem to co-occur with abdominal aortic aneurysm. The aim of this retrospective analysis was to identify new comorbidities associated with abdominal aortic aneurysm. Methods We compared 100 patients with abdominal aortic aneurysms and 100 control patients. Their preoperative computed tomographic scans were examined by two investigators independently, for the presence of hernias, diverticulosis, and cholecystolithiasis. Medical records were also reviewed. Statistical analysis was performed using univariate analysis and multiple logistic regression analysis. Results The aneurysm group had a higher frequency of diverticulosis (p = 0.008). There was no significant difference in the occurrence of hernia (p = 0.073) or cholecystolithiasis (p = 1.00). Aneurysm patients had a significantly higher American Society of Anesthesiology score (2.84 vs. 2.63; p = 0.015) and were more likely to have coronary artery disease (p < 0.001), congestive heart failure (p < 0.001), or chronic obstructive pulmonary disease (p < 0.001). Aneurysm patients were more likely to be former (p = 0.034) or current (p = 0.006) smokers and had a significantly higher number of pack years (p < 0.001). Aneurysm patients also had a significantly poorer lung function. In multivariate analysis, the following factors were associated with aneurysms: chronic obstructive pulmonary disease (odds ratio, OR = 12.24; p = 0.002), current smoking (OR = 4.14; p = 0.002), and coronary artery disease (OR = 2.60; p = 0.020). Conclusions Our comprehensive analysis identified several comorbidities associated with abdominal aortic aneurysms. These results could help to recognize aneurysms earlier by targeting individuals with these comorbidities for screening.
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Gilemkhanov, A. R., V. V. Plechev, V. Sh Ishmetov, I. M. Gilemkhanova, R. V. Khalitova, and N. A. Garifullina. "Step surgical treatment of a patient with abdominal aortic and internal carotid artery aneurysms." Russian Medical Inquiry 4, no. 7 (2020): 463–66. http://dx.doi.org/10.32364/2587-6821-2020-4-7-463-466.
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The presence of associated cerebral aneurysm and abdominal aortic aneurysm is an extremely rare degenerative vascular pathology. The article describes a two-stage treatment of a patient with aneurysms that occur in different types of blood vessels characterized by different hemodynamic conditions. A 56-year-old man suffering from hypertension complained of abdominal pain, headache, and dizziness. The exam-ination revealed multiple aneurysms: in the abdominal and iliac arteries, as well as an ophthalmic artery aneurysm of the internal carotid ar-tery. Surgical interventions were carried out in stages: osteoplastic pterional craniotomy with aneurysm clipping of the right internal carotid artery with vascular ultrasound and endoprosthesis of abdominal aorta and iliac arteries with a stent graft. The patient was discharged in a satisfactory condition. Regression of clinical disease manifestations was found. It was shown that the key point was to create a multidisci-plinary team and determine the stages of surgical treatment when managing such patients.KEYWORDS: abdominal aortic aneurysm, iliac artery aneurysm, cerebral aneurysm, hypertension, degenerative pathology, treatment stages.FOR CITATION: Gilemkhanov A.R., Plechev V.V., Ishmetov V.Sh. et al. Step surgical treatment of a patient with abdominal aortic and internal carotid artery aneurysms. Russian Medical Inquiry. 2020;4(7):463–466. DOI: 10.32364/2587-6821-2020-4-7-463-466.
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Aslanov, A. D., O. E. Logvina, A. G. Kugotov, A. S. Maremov, A. Kh Kugotov, А. T. Edigov, L. I. Taukenova, L. Yu Cardanova, A. A. Teuvov, and A. R. Tambiev. "Double strengthening of the neck of the aortic aneurysmal sac." Grekov's Bulletin of Surgery 180, no. 6 (May 25, 2022): 62–67. http://dx.doi.org/10.24884/0042-4625-2021-180-6-62-67.
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INTRODUCTION. The article presents the experience of treatment of abdominal aortic aneurysms from 2011 to 2016 using the author’s technology, which contains the method of double strengthening of the neck of the aortic aneurysm, on the basis of the Department of Hospital Surgery in the Department of Vascular Surgery of the RCH of Nalchik.METHODS AND MATERIALS. According to this method, 202 patients with abdominal aortic aneurysm (group I) were operated on, 116 were admitted as planned, 86 were admitted as emergency and urgent, while 183 were men and 19 were women. Without using the technique of double strengthening of the aneurysm neck, 205 patients were selected for the period from 2006 to 2011. They were included in group II. Among them, 118 were received as planned, 87 were received in special and urgent cases. The patients were examined thoroughly. CT angiography in 3-dimensional reconstruction was performed using special research methods.RESULTS. All patients were transferred to the intensive care unit after the operation. In the operative and immediate postoperative periods, among the operated patients admitted in an emergency and urgent, 19 patients with a ruptured aortic aneurysm died in group I, 23 patients – in group II. Among the planned patients, 2 in group II died from a combined severe concomitant pathology. All other patients were activated on the 2nd-3rd day, and subsequently discharged in a satisfactory condition.CONCLUSION. The advantages of the proposed method of surgical treatment of abdominal aortic aneurysm are: technical simplicity of execution, double strengthening of the neck of the aneurysmal sac, tightness of the anastomosis, therefore, the reduction of intraoperative blood loss, the possibility of performing aortic prosthetics with suprarenal and renal aneurysms and weakness of the wall in the neck area in the absence of an artificial circulation apparatus.
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Gonzalez-Urquijo, Mauricio, Raul Garza de Zamacona, Ana Karen Martinez Mendoza, Miranda Zamora Iribarren, Erika Garza Ibarra, Marcos David Moya Bencomo, and Mario Alejandro Fabiani. "3D Modeling of Blood Flow in Simulated Abdominal Aortic Aneurysm." Vascular and Endovascular Surgery 55, no. 7 (April 27, 2021): 677–83. http://dx.doi.org/10.1177/15385744211012926.
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Background: Besides biological factors, abdominal aortic aneurysm rupture is also caused by mechanical parameters, which are constantly affecting the wall’s tissue due to their abnormal values. The ability to evaluate these parameters could vastly improve the clinical treatment of patients with abdominal aortic aneurysms. The objective of this study was to develop and demonstrate a methodology to analyze the fluid dynamics that cause the wall stress distribution in abdominal aortic aneurysms, using accurate 3D geometry and a realistic, nonlinear, elastic biomechanical model using a computer-aided software. Methods: The geometry of the abdominal aortic aneurysm; was constructed on a 3D scale using computer-aided software SolidWorks (Dassault Systems SolidWorksCorp., Waltham MA). Due to the complex nature of the abdominal aortic aneurysm geometry, the physiological forces and constraints acting on the abdominal aortic aneurysm wall were measured by using a simulation setup using boundary conditions and initial conditions for different studies such as finite element analysis or computational fluid dynamics. Results: The flow pattern showed an increase velocity at the angular neck, followed by a stagnated flow inside the aneurysm sack. Furthermore, the wall shear stress analysis showed to focalized points of higher stress, the top and bottom of the aneurysm sack, where the flow collides against the wall. An increase of the viscosity showed no significant velocity changed but results in a slight increase in overall pressure and wall shear stress. Conclusions: Conducting computational fluid dynamics modeling of the abdominal aortic aneurysm using computer-aided software SolidWorks (Dassault Systems SolidWorksCorp., Waltham MA) proves to be an insightful approach for the clinical setting. The careful consideration of the biomechanics of the abdominal aortic aneurysm may lead to an improved, case-specific prediction of the abdominal aortic aneurysm rupture potential, which could significantly improve the clinical management of these patients.
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Khashram, Manar, Phil N. Hider, Jonathan A. Williman, Gregory T. Jones, and Justin A. Roake. "Does the diameter of abdominal aortic aneurysm influence late survival following abdominal aortic aneurysm repair? A systematic review and meta-analysis." Vascular 24, no. 6 (July 9, 2016): 658–67. http://dx.doi.org/10.1177/1708538116650580.
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Background Studies reporting the influence of preoperative abdominal aortic aneurysm diameter on late survival following abdominal aortic aneurysm repair have not been consistent. Aim: To report the influence of abdominal aortic aneurysm diameter on overall long-term survival following abdominal aortic aneurysm repair. Methods Embase, Medline and the Cochrane electronic databases were searched to identify articles reporting the influence of abdominal aortic aneurysm diameter on late survival following open aneurysm repair and endovascular aneurysm repair published up to April 2015. Data were extracted from multivariate analysis; estimated risks were expressed as hazard ratio. Results A total of 2167 titles/abstracts were retrieved, of which 76 studies were fully assessed; 19 studies reporting on 22,104 patients were included. Preoperative larger abdominal aortic aneurysm size was associated with a worse survival compared to smaller aneurysms with a pooled hazard ratio of 1.14 (95% CI: 1.09–1.18), per 1 cm increase in abdominal aortic aneurysm diameter. Subgroup analysis of the different types of repair was performed and the hazard ratio (95% CI), for open aneurysm repair and endovascular aneurysm repair were 1.08 (1.03–1.12) and 1.20 (1.15–1.25), respectively, per 1 cm increase. There was a significant difference between the groups p < 0.02. Conclusions This meta-analysis suggests that preoperative large abdominal aortic aneurysm independently influences overall late survival following abdominal aortic aneurysm repair, and this association was greater in abdominal aortic aneurysm repaired with endovascular aneurysm repair.
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Chen, Xiao-feng, Jian-an Wang, Jun Hou, Chun Gui, Li-jiang Tang, Xiao-quan Chen, Xiao-jie Xie, et al. "Extracellular matrix metalloproteinase inducer (EMMPRIN) is present in smooth muscle cells of human aneurysmal aorta and is induced by angiotensin II in vitro." Clinical Science 116, no. 11 (May 1, 2009): 819–26. http://dx.doi.org/10.1042/cs20080235.
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The aim of the present study was to determine whether EMMPRIN (extracellular matrix metalloproteinase inducer) is present and is up-regulated in human aneurysmal aortas, and to assess a possible association with AngII (angiotensin II)-induced aneurysm formation. The presence of EMMPRIN was assessed in 41 surgical specimens from patients with a TAA (thoracic aortic aneurysm) (Type A aortic dissection, n=12; Type B aortic dissection, n=7; and TAA without dissection, n=7) or an AAA (abdominal aortic aneurysm, n=15) by immunohistochemistry. EMMPRIN expression in aortic aneurysm tissues was compared with 12 aortas obtained during autopsy (free of any vascular diseases), and scored for both staining intensity and the percentage of vascular cells stained. EMMPRIN protein levels in cultured human aortic SMCs (smooth muscle cells) following stimulation of AngII were analysed by Western blotting. Significant EMMPRIN immunoreactivity was detected in aortic aneurysm lesions from patients with TAAs and AAAs. In the aneurysmal wall, α-actin-positive SMCs were the main source of EMMPRIN. The frequency of EMMPRIN overexpression was significantly higher (P=0.026) in TAAs with dissection (68.4%) than TAAs without dissection (14.3%). AngII stimulation up-regulated the expression of EMMPIRN in cultured human aortic SMCs, which was suppressed by the addition of the AT1R (AngII type 1 receptor) antagonist losartan. In conclusion, the present study is the first to report the expression of EMMPRIN in aortic aneurysmal diseases, and we speculate that EMMPRIN may be important in the pathogenesis of these diseases. Whether these abnormalities are potential therapeutic targets deserve further investigation.
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Puech-Leão, Pedro, Lazlo Josef Molnar, Ilka Regina de Oliveira, and Giovanni Guido Cerri. "Prevalence of abdominal aortic aneurysms: a screening program in São Paulo, Brazil." Sao Paulo Medical Journal 122, no. 4 (2004): 158–60. http://dx.doi.org/10.1590/s1516-31802004000400005.
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CONTEXT: Abdominal aortic aneurysm is an asymptomatic but potentially fatal condition. Elective surgery can prevent death from rupture, and is indicated for aneurysms larger than 45 mm. Because aneurysms tend to grow with time, detection of small ones (> 29 mm) may lead to a closer follow-up of patients at risk. OBJECTIVE: To determine the prevalence of abdominal aortic aneurysms in São Paulo, Brazil. DESIGN: Prospective, descriptive. SETTING: University Hospital. PARTICIPANTS: Persons aged 50 years or more were offered, through the press, the opportunity to be screened for abdominal aortic aneurysm. The total number screened was 2,756. PROCEDURE: All were submitted to abdominal palpation and ultrasound examination. PARAMETER STUDIED: A maximum diameter of 30 mm or more was considered to be an aneurysm. RESULTS: Sixty-four aneurysms were detected, nine of which measuring more than 49 mm. Palpation detected 60 aneurysms, but only 20 of these were confirmed by the ultrasound. Conversely, 41 of the ultrasound-detected aneurysms were not palpable. The percentages of abdominal aortic aneurysms found in the subgroups via ultrasound examination (with 95% confidence interval) were as follows: total group, 2.3 (1.8-3); men, 4.6 (3.5-5.9); women, 0.6 (0.3-1.1); men aged 60 or more, 6 (4.3-8); women aged 60 or more, 0.9 (0.4-1.8). CONCLUSION: In São Paulo, Brazil, 1.8 to 3 % of persons aged 50 years or more are expected to have abdominal aortic aneurysms. In the subgroup of men aged 60 or more, the expected prevalence is between 4.3 and 8%.
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Bararu Bojan (Bararu), Iris, Carmen Elena Pleșoianu, Oana Viola Badulescu, Maria Cristina Vladeanu, Minerva Codruta Badescu, Dan Iliescu, Andrei Bojan, and Manuela Ciocoiu. "Molecular and Cellular Mechanisms Involved in Aortic Wall Aneurysm Development." Diagnostics 13, no. 2 (January 10, 2023): 253. http://dx.doi.org/10.3390/diagnostics13020253.
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Aortic aneurysms represent a very common pathology that can affect any segment of the aorta. These types of aneurysms can be localized on the thoracic segment or on the abdominal portion, with the latter being more frequent. Though there are similarities between thoracic and abdominal aortic aneurysms, these pathologies are distinct entities. In this article, we undertook a review regarding the different mechanisms that can lead to the development of aortic aneurysm, and we tried to identify the different manners of treatment. For a long time, aortic wall aneurysms may evolve in an asymptomatic manner, but this progressive dilatation of the aneurysm can lead to a potentially fatal complication consisting in aortic rupture. Because there are limited therapies that may delay or prevent the development of acute aortic syndromes, surgical management remains the most common manner of treatment. Even though, surgical management has improved much in the last years, thus becoming less invasive and sophisticated, the morbi-mortality linked to these therapies remains increased. The identification of the cellular and molecular networks triggering the formation of aneurysm would permit the discovery of modern therapeutic targets. Molecular and cellular mechanisms are gaining a bigger importance in the complex pathogenesis of aortic aneurysms. Future studies must be developed to compare the findings seen in human tissue and animal models of aortic aneurysm, so that clinically relevant conclusions about the aortic aneurysm formation and the pharmacological possibility of pathogenic pathways blockage can be drawn.
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Hossack, Martin, Robert Fisher, Francesco Torella, Jillian Madine, Mark Field, and Riaz Akhtar. "Micromechanical and Ultrastructural Properties of Abdominal Aortic Aneurysms." Artery Research 28, no. 1 (March 2022): 15–30. http://dx.doi.org/10.1007/s44200-022-00011-3.
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AbstractAbdominal aortic aneurysms are a common condition of uncertain pathogenesis that can rupture if left untreated. Current recommended thresholds for planned repair are empirical and based entirely on diameter. It has been observed that some aneurysms rupture before reaching the threshold for repair whilst other larger aneurysms do not rupture. It is likely that geometry is not the only factor influencing rupture risk. Biomechanical indices aiming to improve and personalise rupture risk prediction require, amongst other things, knowledge of the material properties of the tissue and realistic constitutive models. These depend on the composition and organisation of the vessel wall which has been shown to undergo drastic changes with aneurysmal degeneration, with loss of elastin, smooth muscle cells, and an accumulation of isotropically arranged collagen. Most aneurysms are lined with intraluminal thrombus, which has an uncertain effect on the underlying vessel wall, with some authors demonstrating a reduction in wall stress and others a reduction in wall strength. The majority of studies investigating biomechanical properties of ex vivo abdominal aortic aneurysm tissues have used low-resolution techniques, such as tensile testing, able to measure the global material properties at the macroscale. High-resolution engineering techniques such as nanoindentation and atomic force microscopy have been modified for use in soft biological tissues and applied to vascular tissues with promising results. These techniques have the potential to advance the understanding and improve the management of abdominal aortic aneurysmal disease.
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White, Rodney A., Carlos Donayre, Irwin Walot, James Lee, and George E. Kopchok. "Regression of a Descending Thoracoabdominal Aortic Dissection following Staged Deployment of Thoracic and Abdominal Aortic Endografts." Journal of Endovascular Therapy 9, no. 2_suppl (June 2002): II—92—II—97. http://dx.doi.org/10.1177/15266028020090s215.
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Purpose: To describe the successful endovascular repair and regression of an extensive descending thoracoabdominal aortic dissection associated with thoracic and abdominal aortic aneurysms. Case Report: An 83-year-old man presented with acute chest pain and shortness of breath. A descending thoracoabdominal aortic dissection that extended from near the left subclavian artery (LSA) to the right common iliac artery was found on computed tomography. Separate aneurysms in the thoracic and abdominal aorta were also identified. Staged endovascular procedures were undertaken to (1) close the single entry site and exclude the aneurysm in the thoracic aorta with an AneuRx thoracic stent-graft, (2) exclude the abdominal aneurysm and distal re-entry site with a bifurcated AneuRx endograft, and (3) treat a newly dilated thoracic segment between the LSA and first thoracic stent-graft. At 1 year, the false lumen had completely disappeared, the thoracic aneurysm had collapsed onto the endograft, and the abdominal aneurysm had shrunk by 30%. Conclusions: The potential to treat extensive aortic dissections with the hope that they might regress is promising, but repair of highly complex lesions involving one or more aneurysms in addition to the dissection requires meticulous imaging studies both preoperatively and intraprocedurally.
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Mirza, Rida Tariq, Shahan Haseeb, Fahad Mushtaq, Yashfeen Malik, and Omer Ehsan. "Mycotic tubercular abdominal aortic aneurysm: A case report." Journal of Shifa Tameer-e-Millat University 5, no. 1 (September 3, 2022): 64–66. http://dx.doi.org/10.32593/jstmu/vol5.iss1.139.
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The mycotic tuberculous aneurysm of the Abdominal Aorta is an extremely rare disease. An aortic mycotic aneurysm is a life-threatening condition caused by tuberculous infection. Tuberculous aneurysms of the aorta usually present as rapidly growing or ruptured pseudoaneurysms. Most of these aneurysms are of the pseudoaneurysm type. We presented a case of a 61-year-old man who was diagnosed with a tubercular abdominal aortic mycotic aneurysm associated with the posterior invasion of the vertebral body leading to discitis. The patient underwent a mycotic aneurysm repair with grafting. Even with a combination of surgical and medical treatment, a favorable outcome could not be achieved.
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Peate, Ian. "Abdominal aortic aneurysm screening programme." British Journal of Healthcare Assistants 13, no. 9 (September 2, 2019): 430–34. http://dx.doi.org/10.12968/bjha.2019.13.9.430.
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This is the second article in a series of articles regarding screening programmes. In this article, an overview of the abdominal aorta is provided. The article also considers the abdominal aortic aneurysm screening programme. Aortic abdominal aneurysm is described. The majority of abdominal aortic aneurysms are asymptomatic; however, if there are any symptoms, these are explained. All four UK countries offer men aged 65 years and over a screening opportunity using an ultrasound scan, the fundamental aspects of abdominal aortic aneurysm screening programmes is offered. It is emphasised that screening is not mandatory in the UK; the man has a right to decline the invitation to attend any screening programme.
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Sousa, Joel, Daniel Brandão, Paulo Barreto, Joana Ferreira, José Almeida Lopes, and Armando Mansilha. "Tratamento Endovascular do Aneurisma da Aorta Abdominal por Via Percutânea e Anestesia Local – One Day Surgery." Acta Médica Portuguesa 29, no. 6 (June 30, 2016): 381. http://dx.doi.org/10.20344/amp.7715.
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<p><strong>Introduction:</strong> To evaluate the results of the abdominal aortic aneurism endovascular treatment (EVAR), percutaneously and with local anesthesia, according to the concept of one day surgery.<br /><strong>Material and Methods:</strong> Unicentric, retrospective analysis of patients with aorto-iliac aneurysmal disease, consecutively treated by EVAR with percutaneous access trough the Preclose technique (pEVAR), according to the outpatient criteria, with one overnight stay in the hospital. The technical success, exclusion of the aneurysmal sac, endoleak, re-intervention and mortality were evaluated.<br /><strong>Results:</strong> Twenty consecutive patients (all male; mean age 74.65 years) were treated by EVAR with percutaneous access and local anesthesia, from which 95% (19) presented with abdominal aortic aneurysm and 5% (1) common iliac aneurysm. All implants were sucessfully performed, with an initial endoleak rate of 10% (2), determined by one type 1a endoleak successfully corrected intra-operatively and one type 2a endoleak diagnosed in the first imaging control, which sealed spontaneously on the second control. Initial technical success for percutaneous closure was 97.5%, with one case reported of femoral pseudo-aneurism, posteriorly treated by percutaneous thrombin injection. Median length of stay was one day [1-10], with a mean follow-up of 11.4 months [1-36]. Both the re-intervention and mortality rate are 0% for the selected period.<br /><strong>Conclusion:</strong> Our one day surgery model for the outpatient treatment of abdominal aortic aneurysm by the pEVAR technique is innovative, safe and effective, as long as the selection criteria are respected.</p>
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Synowiec, Checinski, Micker, Samolewski, Glyda, and Ast. "Unusual abdominal aneurysms in a patient after kidney transplantation treated by endovascular technique." Vasa 41, no. 1 (January 1, 2012): 63–66. http://dx.doi.org/10.1024/0301-1526/a000165.
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While abdominal aortic aneurysms are quite common, visceral aneurysms are a seldomly diagnosed vascular pathology. Aneurysms of renal arteries, abdominal aorta and iliac arteries seem to be very rare. We present a patient after renal transplantation with aneurysms of both stumps of the renal arteries, abdominal aortic aneurysm and aneurysms of common iliac arteries. Because of the symptomatic course, the patient required urgent treatment. A successful endovascular procedure was performed. Follow-up imaging did not reveal any complications.
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Frech, Andreas, Juergen Falkensammer, Gustav Fraedrich, and Michael Schirmer. "Abdominal Aortic Aneurysms." Journal of Primary Care & Community Health 3, no. 2 (November 22, 2011): 142–47. http://dx.doi.org/10.1177/2150131911421506.
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Abdominal aortic aneurysms represent both an individual risk of mortality and a socioeconomic burden for health care systems worldwide, but screening is not performed in all countries. Here, the authors summarize the pros and cons of screening to reduce abdominal aortic aneurysm–related mortality.
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Kisis, Kaspars, Dainis Krievins, Marcis Gedins, Janis Savlovskis, Natalija Ezite, and Patricija Ivanova. "Patient with Syphilitic Thoracic and Abdominal Aortic Aneurysms." Acta Chirurgica Latviensis 10, no. 2 (January 1, 2010): 131–33. http://dx.doi.org/10.2478/v10163-011-0028-7.
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Patient with Syphilitic Thoracic and Abdominal Aortic AneurysmsWe are presenting a rare case of patient with two syphilitic aneurysms localized in thoracic and abdominal aorta. Routine lung computer tomography (CT) for the patient with complains about irritating and unclear ethiology cough revealed 10 cm diameter aneurysm of descending thoracic aorta (TAA) and additionally 4.8 cm aneurysm of abdominal aorta (AAA) just below the aortic hiatus. As there was no evidence of previous trauma, Marfan syndrome or connective tissue disease patient was screened for syphilis. Diagnosis of tertiary syphilis was confirmed and specific treatment started. As complains of irritating cough intensified - patients TAA was successfully treated endovascularly with thoracic stent graft (Valiant®Captivia, Medtronic Ltd.) on emergency basis. On control CT angiography 3 month after treatment there was no evidence of graft migration, endoleaks and aneurysmal sac was thrombosed. AAA has not increased in size, and open repair is planned.
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Wilson, J. S., S. Baek, and J. D. Humphrey. "Importance of initial aortic properties on the evolving regional anisotropy, stiffness and wall thickness of human abdominal aortic aneurysms." Journal of The Royal Society Interface 9, no. 74 (April 4, 2012): 2047–58. http://dx.doi.org/10.1098/rsif.2012.0097.
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Complementary advances in medical imaging, vascular biology and biomechanics promise to enable computational modelling of abdominal aortic aneurysms to play increasingly important roles in clinical decision processes. Using a finite-element-based growth and remodelling model of evolving aneurysm geometry and material properties, we show that regional variations in material anisotropy, stiffness and wall thickness should be expected to arise naturally and thus should be included in analyses of aneurysmal enlargement or wall stress. In addition, by initiating the model from best-fit material parameters estimated for non-aneurysmal aortas from different subjects, we show that the initial state of the aorta may influence strongly the subsequent rate of enlargement, wall thickness, mechanical behaviour and thus stress in the lesion. We submit, therefore, that clinically reliable modelling of the enlargement and overall rupture-potential of aneurysms may require both a better understanding of the mechanobiological processes that govern the evolution of these lesions and new methods of determining the patient-specific state of the pre-aneurysmal aorta (or correlation to currently unaffected portions thereof) through knowledge of demographics, comorbidities, lifestyle, genetics and future non-invasive or minimally invasive tests.
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Dattani, Nikesh, Robert D. Sayers, and Matthew J. Bown. "Diabetes mellitus and abdominal aortic aneurysms: A review of the mechanisms underlying the negative relationship." Diabetes and Vascular Disease Research 15, no. 5 (June 6, 2018): 367–74. http://dx.doi.org/10.1177/1479164118780799.
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Introduction: Diabetes mellitus appears to be negatively associated with abdominal aortic aneurysm; however, the mechanisms underlying this relationship remain poorly understood. The aim of this article is to provide a comprehensive review of the currently understood biological pathways underlying this relationship. Methods: A review of the literature (‘diabetes’ OR ‘hyperglycaemia’ AND ‘aneurysm’) was performed and relevant studies grouped into biological pathways. Results: This review identified a number of biological pathways through which diabetes mellitus may limit the presence, growth and rupture of abdominal aortic aneurysms. These include those influencing extracellular matrix volume, extracellular matrix glycation, the formation of advanced glycation end-products, inflammation, oxidative stress and intraluminal thrombus biology. In addition, there is an increasing evidence to suggest that the medications used to treat diabetes can also limit the development and progression of abdominal aortic aneurysms. Conclusion: The negative association between diabetes and abdominal aortic aneurysm is robust. Future studies should attempt to target the pathways identified in this review to develop novel therapeutic agents aimed at slowing or even halting aneurysm progression.
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Modugno, Pietro, Fadia Salman, Veronica Picone, Maurizio Maiorano, Enrico Maria Centritto, and Massimo Massetti. "Chronic abdominal aortic rupture mimicking femoral neuropathy." SAGE Open Medical Case Reports 10 (January 2022): 2050313X2211099. http://dx.doi.org/10.1177/2050313x221109973.
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Chronic-contained rupture of an aortic aneurysm is a rare subset of ruptured aneurysms. The presentation is unusual, and the diagnosis is frequently delayed. Here, we describe a case of contained rupture of abdominal aortic aneurysm that presented with signs and symptoms of femoral neuropathy. Clinical and radiological findings were initially misinterpreted. The correct diagnosis was formulated belatedly, causing a progressively increased risk of fatal events. Surgical aortic repair was performed and the postoperative course was uneventful. In conclusion, in the presence of a retroperitoneal mass, a diagnosis of chronic-contained rupture of an abdominal aortic aneurysm should be considered.
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Bhandari, N., RM Karmacharya, M. Devbhandari, B. Shrestha, AK Singh, S. Ranjit, and KR Shrestha. "Open Surgical Management of Abdominal Aortic Aneurysm at a Community Based University Hospital in Nepal." Kathmandu University Medical Journal 18, no. 1 (January 6, 2020): 96–98. http://dx.doi.org/10.3126/kumj.v18i1.34662.
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Aortic aneurysms are abnormal dilatation of aorta. The risk factors include male sex, age > 65, smoking, coronary artery disease and hypertension. Here we report a case of infra-renal abdominal aortic aneurysm (AAA) of diameter 6 cm. The patient sucessfully underwent aorto-biiliac bypass surgery using Dacron Y graft. During abdominal aortic aneurysm surgery anesthetic challenge is also of paramount importance and should be considered.