All "difficult" abdominal aortic aneurysms-whether pararenal or inflammatory or associated with abnormal renal parenchymal anatomy-often best are approached with some combination of retroperitoneal exposure and supraceliac clamping. Preoperative recognition that an unusual case may exist, complete and appropriate imaging and formulation of a sensible plan before operation are absolutely critical ...

We report herein a unique cause of duodenal obstruction secondary to expansion of an abdominal aortic aneurysm in a 75-year-old man with congenital malrotation of the intestines. The duodenum was found to be compressed between the abdominal aortic aneurysm inferiorly and the peritoneal band superiorly. The patient underwent uncomplicated lysis ...

Inflammatory abdominal aortic aneurysms are associated with atherosclerosis, which are characterized by specific clinical manifestation. We treated two patients with unilateral solitary iliac artery aneurysms with perianeurysmal fibrosis which compressed the ureter resulting in ipsilateral hydronephrosis. After the iliac artery aneurysm was repaired with a prosthetic graft, the hydronephrosis resolved. ...

The patient was a 72-year-old male with three-vessel coronary artery disease, chronic dissecting aneurysm of the ascending aorta with moderate aortic regurgitation, and abdominal aortic aneurysm 7 cm in diameter. Because staged procedure seemed to exacerbate the risk due to the remaining lesion, simultaneous procedures (double coronary artery bypass, aortic ...

STUDY OBJECTIVE: To evaluate and compare the safety and efficacy of a new method to enter the abdominal cavity at laparoscopy. DESIGN: (Canadian Task Force classification II-2). SETTING: Referral center for reproductive surgery in a teaching hospital affiliated with a university-based residency program. PATIENTS: Twenty representative women of variable body ...

The management of concomitant abdominal aortic aneurysm and intra-abdominal malignancies is still disputed; whether to treat the lesions simultaneously or as staged procedures being the main controversy. Abdominal aortic aneurysm associated with renal carcinoma is rare and combined aneurysm repair and nephrectomy appears to be the treatment of choice in ...

Early detection of abdominal aortic aneurysms potentially can save many lives by preventing aneurysm rupture. Screening programs, however, have yet to be proven as an efficient means of accomplishing this goal and improving overall life expectancy. Until more information is available, selective high-risk screening may be the only viable option. ...

Isolated iliac artery aneurysms occur infrequently. They comprise about 2 per cent of all abdominal aneurysms. Most patients are symptomatic at the time of presentation. The average diameter is 5.7 cm at diagnosis. We report the acutely symptomatic presentation of a 76-year-old African-American man with 7- and 9-cm bilateral common ...

We report a case of a patient who presented to the Emergency Department with pulseless electrical activity. A rapid diagnosis of ruptured abdominal aortic aneurysm was made by Emergency Medicine bedside ultrasonography. On arrival, the patient was without palpable pulses and bradycardic. Therapy with epinephrine, fluids, and atropine was initiated. ...

A murine abdominal aortic aneurysm model was developed by applying calcium chloride periarterially. A 13.6 mEq/10 ml calcium chloride solution was applied to the abdominal aorta of nine mice. Three mice were randomly selected at the end of the first, second, and third weeks postoperatively, and their vessel diameters were ...

The proximal suture line is a vulnerable area after abdominal aortic aneurysm repairs. This area has been implicated in various postoperative complications, such as pseudoaneurysm formation, graft-enteric fistula, and suture line disruption. We present a technique that provides safe and adequate coverage of this suture line by using the aneurysm ...

BACKGROUND: Patients with abdominal aortic aneurysms (AAAs) exhibit arterial dilation and altered matrix composition throughout the vasculature. Matrix metalloproteinase-2 (MMP-2) is the dominant elastase in small AAAs, and overexpression of MMP-2 in vascular smooth muscle cells (SMCs) may be a primary etiological event in aneurysm genesis. The aim of this ...

The left thoracoabdominal incision with retroperitoneal dissection offers excellent exposure of the abdominal and thoracic aorta. Disadvantages to this approach include inadequate access to the right ileofemoral arterial segments and the right renal artery. Additional difficulties with this approach include flank bulges, hernias, and neuropathy. We present a case of ...

Abdominal aortic aneurysm is a chronic dilation of the aorta with a natural history toward enlargement and rupture. Its pathogenesis is believed to be multifactorial and complex. Clinical presentation may be asymptomatic, symptomatic, or as rupture. Elective surgery by open transperitoneal or retroperitoneal approach is the most common repair intervention. ...

Endovascular stent grafting of abdominal aortic aneurysms is a new technique that may replace open surgery in selected cases. Pre-and postoperative angiography can be replaced by helical CT. This pictorial essay describes and illustrates the use of multislice helical CT where maximum intensity projection and multiplanar reformats play a central ...

Placement of an aortic wallstent for treatment of an abdominal aortic aneurysm (AAA) is a frequent therapeutic measure. Whereas AAA is known to mimic renal colic, aortic wallstent dislocation is a novel diagnostic problem. Herein, we report the first case of a patient with a dislocated aortic wallstent and subsequent ...

A 77-year-old man developed chronic disseminated intravascular coagulation (DIC) after surgical repair of a large infrarenal aortic aneurysm. Self-administered subcutaneous dalteparin therapy (5000 units o.d.) led to rapid relief of symptoms and sustained improvements in his platelet count and fibrinogen level; activation of coagulation and fibrinolysis appeared to be relatively ...

Abdominal aortic aneurysms and their management remain a significant health problem that is likely to assume greater importance with the expansion of the elderly population. Elastin fibres degradation and extracellular matrix remodelling seems to be the basic process in aneurysm formation. Recent investigations revealed the principal role of elastin-laminin receptor ...

We describe a case of a successfully treated ruptured abdominal aortic aneurysm during pregnancy. The importance of close clinical follow-up after any aortic reconstructions is highlighted.

Proximal pseudoaneurysm of ascending-abdominal aortic bypass is an uncommon surgical disease. We report a repair of complete detachment of proximal anastomosis of the ascending-abdominal aortic bypass in a 68-year-old man that underwent surgery in 1988 for chronic descending thoracic aortic aneurysm treated with thromboesclusion technique. The clinical, diagnostic, and operative ...

There are many causes of acute abdominal pain, or abdominal "crises," in patients with systemic lupus erythematosus (SLE), most frequently the causes are serositis or vasculitis. Vasculitis generally causes small vessel abnormalities and may present with symptoms owing to mucosal damage, such as pain, diarrhea, or bleeding. We present a ...

The authors report a case of a 70-year-old man, with repeating episodes of systemic subdermal hematoma due to consumption coagulopathy associated with abdominal aortic aneurysm and the bilateral femoral arterial aneurysms. Prior to the first operation for abdominal aortic repair, anticoagulation therapy was applied to treat thrombocytopenia and hypofibrinogenemia. Five ...

Congenital abdominal aortic aneurysms are a distinct entity from acquired aortic aneurysms. The authors present the case of a 6-week-old boy with a 6-cm aneurysm involving the abdominal aorta and common iliac arteries. Three other cases of congenital aortic aneurysms are reviewed, and an approach to these rare patients is ...

Simultaneous repair of abdominal aortic aneurysm and treatment of cholelithiasis by the transperitoneal approach is controversial because of the risk of prosthesis infection. We report two patients who underwent a successful combined procedure using a retroperitoneal approach for the aortic aneurysm repair and a laparoscopic approach to the cholecystectomy. This ...

Kawasaki disease (KD) often presents with a challenging variety of clinical symptoms. Severe gastrointestinal complications are rare and mainly appear as pseudo-obstruction. However, the authors report the unique case of a 4-month-old girl with KD suffering from a mechanical ileus. The optimal timing of surgery presented a dilemma, because she ...

BACKGROUND: Screening for abdominal aortic aneurysm (AAA) has not yet been established in Japan. We therefore report the characteristics of a screened population and discuss the implications of screening using ultrasound in Japan. METHODS: The subjects in our screening group were composed of 4428 participants who were 60 years of ...

Beside atherosclerosis, aortic aneurysms can be part of the clinical spectrum of many systemic diseases, including infectious, inflammatory, genetic and, less often, congenital disorders. A 48-year-old white man presented with multiple large aneurysms of the aorta and its main branches. Medical history was unremarkable except for the presence of a ...

BACKGROUND: Persons with abdominal aortic aneurysm are more likely to have a higher prevalence of risk factors for and clinical manifestations of cardiovascular disease. It is unknown whether these factors explain the high mortality rate associated with abdominal aortic aneurysm. OBJECTIVE: To describe the risk for mortality, cardiovascular mortality, and ...

We assessed the association between pseudoexfoliation syndrome, a common age-related fibrillopathy of unknown cause, and vascular diseases, especially aneurysms of the abdominal aorta. In a prospective single-blind study we ophthalmoscopically examined 55 patients with aneurysms of the abdominal aorta and 41 controls with carotic-artery occlusion. 24 of 55 patients with ...

Many devices are being investigated for treatment of infrarenal abdominal aortic aneurysms. This report describes the particular characteristics of a next generation modular endograft and the Phase I results in 29 patients. Larger comparative studies are in progress to assess the safety and efficacy of this new design.

A minimally invasive surgical technique for repair of aortic aneurysms and aortoiliac occlusive disease was studied. A small periumbilical incision, nondisplacement of the small bowel outside the abdominal cavity, and hand-sewn anastomoses are performed without laparoscopic assistance. This technique may reduce the duration of hospital stay.

Aortic aneurysms in infants and children are quite rare. The use of umbilical artery catheters in the management of critically ill neonates has been associated with infection and subsequent aneurysm formation. There have been 46 cases reported (including our own); most of the aneurysms have been located in the abdominal ...

The natural history of abdominal aortic aneurysms is to enlarge gradually. Associated complications are rupture, peripheral embolization and infection.1-5 Complete occlusion of an abdominal aortic aneurysm by thrombus is extremely rare and constitutes a surgical emergency, with an estimated mortality of 50%.1-5 We report a case of a patient with ...

To elucidate compositional changes of arteries with aging, the authors previously investigated age-related changes of mineral contents in the various arteries of Japanese and Japanese monkey. To examine whether there were differences between races in regard to age-related changes of mineral contents and the relationships among element contents in the ...

Emergency surgery for ruptured abdominal aortic aneurysms is accompanied with massive blood loss and is correlated with high incidences of coagulopathy. Following established results with abdominal packing to control hepatic hemorrhage, we present this technique for uncontrollable hemorrhage in patients with ruptured abdominal aortic aneurysm. The experience with this technique ...

We present herein two cases of a ruptured aneurysm of the visceral artery. The first case involved a 74-year-old man with abdominal pain who was admitted to our hospital with a tentative diagnosis of intra-abdominal bleeding of unknown origin. Computed tomography revealed a hematoma in the greater curvature of the ...

We report herein the case of a 47-year-old woman of the Jehovah's Witness faith in whom Y-grafting for a ruptured abdominal aortic aneurysm was successfully performed without a homologous blood transfusion. We used a Cell Saver (Haemonetics, Braintree, MA. USA) red cell salvaging device and an aortic occlusion balloon catheter, ...

Two cases of a concealed aortocaval fistula (ACF) associated with an abdominal aortic aneurysm (AAA) are presented herein. ACF is a rare complication of AAA and only a few cases have so far shown the triad of symptoms, including congestive heart failure, a continuous abdominal bruit, and a pulsating abdominal ...

A 37-year-old patient with back pain and somatomegaly was found to have a penetrating aneurysm of sections IV and V of the abdominal aorta. Results of a family history and clinical examination confirmed suspicions of Marfan's syndrome. Further angiologic studies depicted an aneurysmatic dilatation of the left popliteal artery. Aneurysmatic ...

The aim of this study was to analyze the scientific protocol of 21 patients operated due to abdominal aortic aneurysm. Arterial hypertension was the common feature for the whole group. Typical microscopic changes for true aortic aneurysm in all histopathological findings were approved. A different in size thrombus was always ...

A 78-year-old woman with an abdominal aortic aneurysm, 57 mm in diameter, was admitted to our hospital for endovascular grafting. Preoperative computed tomography and angiography showed friable mural thrombus in the suprarenal and infrarenal aorta, and a diagnosis of shaggy aorta was made. Postoperatively, the patient suffered cerebral infarction, and ...

Chronic rupture of an abdominal aortic aneurysm (AAA) is a rare occurrence, the presentation of which is unusual, often mimicking other conditions such as femoral neuropathy or radicular compression syndrome. We report herein the case of an 87-year-old woman found to have a contained rupture of an AAA after presenting ...

Streptococcus pneumoniae was the unsuspected cause of a ruptured aortic aneurysm in 3 patients, as confirmed by culture of specimens obtained during surgery. A 60-y-old woman had a recently diagnosed saccular aortic aneurysm and presented with symptoms indicating a vascular catastrophe. A 66-y-old man and a 69-y-old woman were both ...

A 62-year-old patient presented with flatulence, abdominal distension and other symptoms of ileus. Roentgenographic finding found compression on duodenum. Blood pool scintigraphy ((99m)Tc erythrocytes) showed aortal aneurysm, while simultaneous gastric emptying study with liquid meal ((99m)Tc-S-colloid) showed dislocation of duodenum and compression from abdominal aortal aneurysm.

Suprarenal or supraceliac aortic clamping during repair of infrarenal abdominal aortic aneurysms can be complicated by renal, hepatic, and intestinal ischemia. To determine whether suprarenal or supraceliac clamping increases morbidity and mortality we retrospectively reviewed our recent nonrandomized experience. Between January 1993 and December 1998, 716 patients underwent elective (n=682) ...

When one is faced with impending rupture, repair of an aortic aneurysm cannot be delayed. In the presence of coexisting intra-abdominal sepsis, traditional therapy would call for aneurysm exclusion and axillofemoral bypass grafting. Consequences of this choice of treatment include limited long-term graft patency and recurrent prosthetic infection. Autogenous deep ...

OBJECTIVES: to investigate the activity of matrix metalloproteinase (MMP)-2 and -9 in asymptomatic abdominal aortic aneurysms (aAAAs) and ruptured abdominal aortic aneurysms (rAAAs). DESIGN: cross-sectional study. MATERIALS AND METHODS: MMP-2 and MMP-9 activity was estimated in biopsies from the anterior wall of 60 AAAs using gelatin zymography. There were 20 ...

Intermittent claudication (IC) due to arterial occlusive disease was first diagnosed by the French veterinary surgeon Jean-François Bouley jeune in a horse drawing a cabriolet in the streets of Paris as early as 1831. The animal was repeatedly exercised and always started to limp with the hind legs at similar ...

Combined surgical repair for large abdominal aortic aneurysm and severe symptomatic coronary artery disease is a safe and effective procedure. Simultaneous operation for minimally invasive direct coronary artery bypass and abdominal aortic aneurysm repair were performed on a 75-yr-old man. First, we harvested the right gastroepiploic artery and passed it ...

Tuberculous aneurysm of the aorta is exceedingly rare. To date, the standard therapy for mycotic aneurysm of the abdominal aorta has been surgery involving in-situ graft placement or extra-anatomic bypass surgery followed by effective anti-tuberculous medication. Only recently has the use of a stent graft in the treatment of tuberculous ...