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Abdominal Aortic Aneurysm

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6621. Rupture of abdominal aortic aneurysm: concurrent comparison of outcome of those occurring after endovascular repair versus those occurring without previous treatment in an 11-year single-center experience. Full Text available with Trip Pro

Rupture of abdominal aortic aneurysm: concurrent comparison of outcome of those occurring after endovascular repair versus those occurring without previous treatment in an 11-year single-center experience. The purpose of this single-center study was to compare findings at presentation and surgical outcome in patients in whom abdominal aortic aneurysms (AAAs) ruptured after endovascular repair and patients in whom AAAs ruptured before any treatment, over a defined period.From May 1992 (...) to September 2003, 1043 patients underwent elective repair of intact infrarenal AAAs. Endovascular repair was performed in 609 patients, and open repair in 434 patients. Eighteen of 609 patients (3%) who underwent endovascular AAA repair required treatment because of rupture of the aneurysm after a mean of 29 months (group 1). During the same 11-year period, another 91 patients without previous treatment required urgent repair of a ruptured AAA (group 2). Rupture was diagnosed at contrast material-enhanced

2004 Journal of Vascular Surgery

6622. Midterm outcome of endovascular abdominal aortic aneurysm repair in octogenarians: a single institution's experience. Full Text available with Trip Pro

Midterm outcome of endovascular abdominal aortic aneurysm repair in octogenarians: a single institution's experience. We analyzed midterm durability of endovascular abdominal aortic aneurysm repair (EVAR) in octogenarians compared with younger patients.Data for 182 consecutive patients who underwent elective EVAR between 1999 and 2003 were retrospectively reviewed. Forty-nine patients (27%) were 80 years or older (study group [SG]; mean age, 84 years; range, 80-89 years), and 133 patients (73 (...) is not associated with diminished procedural outcome, clinical success, or postoperative survival, compared with younger age. Because of low perioperative mortality and high procedural success, EVAR may be the preferred approach to abdominal aortic aneurysm treatment in selected elderly patients.

2004 Journal of Vascular Surgery

6623. Bilateral gluteal compartment syndrome after elective unilateral hypogastric artery ligation and revascularization of the contralateral hypogastric artery during open abdominal aortic aneurysm repair. Full Text available with Trip Pro

Bilateral gluteal compartment syndrome after elective unilateral hypogastric artery ligation and revascularization of the contralateral hypogastric artery during open abdominal aortic aneurysm repair. Gluteal compartment syndrome is an uncommon entity that has been described in the literature after drug overdose and orthopedic procedures. We describe the first case of bilateral gluteal compartment syndrome that followed pelvic revascularization after the repair of an abdominal aortic aneurysm (...) with bilateral common and internal iliac aneurysms. The patient was treated with aggressive fluid hydration and bilateral gluteal fasciotomies with resolution. The bilateral gluteal compartment syndrome was likely caused by increased pressure on the gluteal muscles, secondary to increased patient weight combined with a period of local ischemia to the watershed areas during iliac cross-clamp.

2005 Journal of Vascular Surgery

6624. Failure properties of intraluminal thrombus in abdominal aortic aneurysm under static and pulsating mechanical loads. Full Text available with Trip Pro

Failure properties of intraluminal thrombus in abdominal aortic aneurysm under static and pulsating mechanical loads. It has been suggested that mechanical failure of intraluminal thrombus (ILT) could play a key role in the rupture of abdominal aortic aneurysms (AAAs), and in the present study, this hypothesis has been investigated. An in vitro experimental approach has been proposed, which provides layer-specific failure data of ILT tissue under static and pulsatile mechanical loads.In total

2008 Journal of Vascular Surgery

6625. Zenith abdominal aortic aneurysm endovascular graft. Full Text available with Trip Pro

Zenith abdominal aortic aneurysm endovascular graft. The safety and efficacy of the Zenith (Cook Inc, Bloomington, Ind) endovascular graft was assessed based on the United States multicenter trial through 5 years of follow-up.Between 2000 and 2003, the pivotal study enrolled patients to open surgery (control) or the Zenith endovascular graft (endovascular). A separate continued access study arm enrolled endovascular patients using the same inclusion/exclusion criteria. Both studies were (...) ) was established as an end point to assess late adverse outcomes. Statistical analyses included Kaplan-Meier estimations and Cox regression to assess factors contributing to sac enlargement and SER.The study enrolled 739 endovascular patients (352 pivotal, 387 continued access); 158 patients in the pivotal study reconsented to be followed up for 5 years. For the patients at standard and high risk at 5 years, the respective survival estimate was 83% and 61%, aneurysm-related death was 2% and 4%, and freedom

2008 Journal of Vascular Surgery

6626. Total laparoscopic juxtarenal abdominal aortic aneurysm repair. Full Text available with Trip Pro

Total laparoscopic juxtarenal abdominal aortic aneurysm repair. This study describes our experience of total laparoscopic juxtarenal abdominal aortic aneurysm (JAAA) repair.Between February 2002 and October 2007, we performed 148 total laparoscopic AAA repairs, including a subset of 13 patients who underwent a laparoscopic JAAA repair. Median age was 70 years (range, 50-81years). Median aneurysm size was 55 mm (range, 50-80 mm). Eight patients were in American Society of Anesthesiologist class (...) II, and five were in class III. We used laparoscopic transperitoneal left retrorenal approaches and suprarenal clamping in all patients.We implanted tube grafts in nine patients and bifurcated grafts in four. No conversions to open repair were required. Median operative time was 260 minutes (range, 180-355 minutes). Total median aortic clamping time was 77 minutes (range, 36-105 minutes). Median suprarenal clamping time was 24 minutes (range, 9-37 minutes). Median blood loss was 855 mL (range

2008 Journal of Vascular Surgery

6627. Reduction of in-hospital mortality among California hospitals meeting Leapfrog evidence-based standards for abdominal aortic aneurysm repair. Full Text available with Trip Pro

Reduction of in-hospital mortality among California hospitals meeting Leapfrog evidence-based standards for abdominal aortic aneurysm repair. The Leapfrog Group established evidence-based standards for abdominal aortic aneurysm (AAA) repair, including targets for case volume and perioperative beta-blocker usage. The purpose of this study was to determine whether meeting these benchmarks correlated with improved patient outcomes over time.We studied California hospitals that responded

2008 Journal of Vascular Surgery

6628. Endovascular abdominal aortic aneurysm repair complicated by spondylodiscitis and iliaco-enteral fistula. Full Text available with Trip Pro

Endovascular abdominal aortic aneurysm repair complicated by spondylodiscitis and iliaco-enteral fistula. Infections of abdominal aortic endografts are rare. There are no reports on the association with spondylodiscitis. We report a case of a 74-year-old man who underwent endovascular aneurysm repair (EVAR) and subsequently femorofemoral bypass placement due to occlusion of the right limb of the endograft. Six months later, he presented with rectal bleeding, weight loss, back pain, and low (...) abdominal pain. Computed tomography revealed extensive abscess formation with air in and around the endograft and psoas muscles, in continuity with destructive spondylodiscitis L3-4. There was a small bowel loop in close proximity to the occluded right leg of the endograft, which was filled with air bubbles. An axillofemoral bypass was created followed by a laparotomy. Intra-operatively, an iliaco-enteral fistula was found. The small bowel defect was sutured, the endograft completely removed

2008 Journal of Vascular Surgery

6629. Informed consent for abdominal aortic aneurysm repair: The patient's perspective. Full Text available with Trip Pro

Informed consent for abdominal aortic aneurysm repair: The patient's perspective. Whether or not to undergo surgery for abdominal aortic aneurysm (AAA), and whether to have open or endovascular repair (EVAR), is a complex decision that relies heavily on patient preferences, and yet little is known about the patient perspective on informed consent in this context. This study explores patients' views on their decision-making processes and the quality of surgeon-patient communication during

2008 Journal of Vascular Surgery

6630. Association of abdominal aortic aneurysm, horseshoe kidneys, and left-sided inferior vena cava: report of two cases. Full Text available with Trip Pro

Association of abdominal aortic aneurysm, horseshoe kidneys, and left-sided inferior vena cava: report of two cases. Surgery for abdominal aortic aneurysm may be challenging when rare renal or venous anomalies are present. This article reports two similar cases of aortic abdominal aneurysm associated with horseshoe kidney and left-sided inferior vena cava treated with a transperitoneal approach. Preoperative knowledge of the anatomic situation enabled appropriate aneurysm repair. Operative (...) strategy is discussed. This report describes an uncommon venous vascular malformation complex and stresses the importance of computed tomography imaging not only in assessing the characteristics of the aneurysmal disease but also in detecting variations in pertinent vascular or parenchymal anatomy.

2008 Journal of Vascular Surgery

6631. Elective endovascular and open repair of abdominal aortic aneurysms in octogenarians. Full Text available with Trip Pro

Elective endovascular and open repair of abdominal aortic aneurysms in octogenarians. Endovascular aortic aneurysm repair (EVAR) is an increasingly popular treatment option for patients with abdominal aortic aneurysms (AAA), although open repair is considered the standard by virtue of its durability. Octogenarians, as a subgroup, may stand to benefit the most by EVAR. The purpose of this study is to review operative results and durability of open AAA repair and EVAR in octogenarians.From May (...) 1996 to August 2006, 150 patients aged >or=80 years underwent elective repair of their infrarenal AAA. Eighty-one underwent EVAR and 69 had open repair. Demographic data, aneurysm specifics, comorbidities, operative morbidity and mortality, intensive care unit and hospital length of stay, and late outcomes were analyzed.In the EVAR group, 27 of 81 (33%) patients died during a mean follow-up of 25 months. In the open repair group, 34 of 69 (49%) patients died during a mean follow-up of 43 months

2008 Journal of Vascular Surgery

6632. Impact of calcification and intraluminal thrombus on the computed wall stresses of abdominal aortic aneurysm. Full Text available with Trip Pro

Impact of calcification and intraluminal thrombus on the computed wall stresses of abdominal aortic aneurysm. Increased biomechanical stresses within the abdominal aortic aneurysm (AAA) wall contribute to its rupture. Calcification and intraluminal thrombus can be commonly found in AAAs, but the relationship between calcification/intraluminal thrombus and AAA wall stress is not completely described.Patient-specific three-dimensional AAA geometries were reconstructed from computed tomographic (...) images of 20 patients. Structural analysis was performed to calculate the wall stresses of the 20 AAA models and their altered models when calcification or intraluminal thrombus was not considered. A nonlinear large-strain finite element method was used to compute the wall stress distribution. The relationships between wall stresses and volumes of calcification and intraluminal thrombus were sought.Maximum stress was not correlated with the percentage of calcification, and was negatively correlated

2008 Journal of Vascular Surgery

6633. Bleeding into the intraluminal thrombus in abdominal aortic aneurysms is associated with rupture. Full Text available with Trip Pro

Bleeding into the intraluminal thrombus in abdominal aortic aneurysms is associated with rupture. The aim of this study was to determine signs of bleeding in the intraluminal thrombus and the site of rupture using multislice computed tomography (CT) imaging in patients with abdominal aortic aneurysms (AAA).We analyzed CT images of 42 patients with ruptured infrarenal AAA in two hospitals in Stockholm, Sweden during a 3-year period. A "crescent sign" or localized areas with higher attenuation (...) in the thrombus were interpreted as signs of bleeding in the thrombus. A localized area of hyperattenuation did not have the typical crescent shape and was distinguished from calcifications in the thrombus. We measured the attenuation in Hounsfield units in the intraluminal thrombus using CT software to quantify the presence of blood in the thrombus. As controls, we analyzed 36 patients with intact AAA and a comparable aneurysm diameter and age.The crescent sign was more frequent in the ruptured group (38% vs

2008 Journal of Vascular Surgery

6634. National trends in the repair of ruptured abdominal aortic aneurysms. Full Text available with Trip Pro

National trends in the repair of ruptured abdominal aortic aneurysms. This study evaluated trends in hospitalizations, treatment, and mortality of ruptured abdominal aortic aneurysms (rAAAs) in the United States Medicare population.The Medicare inpatient database (1995 through 2006) was reviewed for patients with rAAA and AAA by using International Classification of Disease (9th Clinical Modification) codes for rAAA and AAA. Proportions and trends were analyzed by chi(2) analysis, continuous

2008 Journal of Vascular Surgery

6635. Biomechanical properties of abdominal aortic aneurysms assessed by simultaneously measured pressure and volume changes in humans. Full Text available with Trip Pro

Biomechanical properties of abdominal aortic aneurysms assessed by simultaneously measured pressure and volume changes in humans. Abdominal aortic aneurysms (AAA) are at risk of rupture when the internal load (blood pressure) exceeds the aneurysm wall strength. Generally, the maximal diameter of the aneurysm is used as a predictor of rupture; however, biomechanical properties may be a better predictor than the maximal diameter. Compliance and distensibility are two biomechanical properties (...) that can be determined from the pressure-volume relationship of the aneurysm. This study determined the compliance and distensibility of the AAA by simultaneous instantaneous pressure and volume measurements; as a secondary goal, the influence of direct and indirect pressure measurements was compared.Ten men (aged 73.6 +/- 6.4 years) with an infrarenal AAA were studied. Three-dimensional balanced turbo field echo (3D B-TFE) images were acquired with noncontrast-enhanced magnetic resonance imaging (MRI

2008 Journal of Vascular Surgery

6636. Elastic fibers reconstructed using adenovirus-mediated expression of tropoelastin and tested in the elastase model of abdominal aortic aneurysm in rats. Full Text available with Trip Pro

Elastic fibers reconstructed using adenovirus-mediated expression of tropoelastin and tested in the elastase model of abdominal aortic aneurysm in rats. An adenoviral vector carrying a recombinant tropoelastin (TE) gene with a Green Fluorescent Protein (GFP) tag adenoviral tropoelastin green fluorescent protein (AdTE-GFP) was transferred to aortic vascular smooth muscle cells (VSMCs) for studying the expression of recombinant elastin in vitro and the reconstruction of elastic fibers in vivo (...) in experimental abdominal aortic aneurysm (AAA).The AAAs were induced in rats by perfusing the arteries with porcine pancreatic elastase, and after AAA formation, adenoviral vectors were perfused directly into the aneurysmal lumen. VSMCs transfected with AdTE-GFP in vitro and in vivo were detected by fluorescence microscopy. The TE mRNA levels and the level of recombinant elastin expression of AdTE-GFP transfected VSMCs in vitro (at 1, 3, and 5 days) and in vivo (at 2 and 4 weeks) were compared by real-time

2008 Journal of Vascular Surgery

6637. Endovascular treatment of abdominal aortic aneurysms with the Powerlink Endograft System: influence of placement on the bifurcation and use of a proximal extension on early and late outcomes. Full Text available with Trip Pro

Endovascular treatment of abdominal aortic aneurysms with the Powerlink Endograft System: influence of placement on the bifurcation and use of a proximal extension on early and late outcomes. We evaluated the influence of placement of the bifurcated Powerlink endograft (Endologix Inc, Irvine, Calif) on the aortic bifurcation, with the addition of a proximal extension, in the endovascular treatment (EVAR) of selected patients with atherosclerotic abdominal aortic aneurysms (AAAs).From September (...) endoleak rate (3.8% vs 35.3% P < .001) and the need for a secondary intervention (6.3% vs 35.3% P < .001) Two aneurysm ruptures and five cases of late conversion occurred in the group treated with a bifurcated graft only (4%, P = .52, P = .159). Analysis of aneurysm sac behavior was not statistically significant: enlargement, 4.1% vs 1.3% (P = .158); reduction, 34.1% vs 40.5% (P = .542).The placement of the bifurcated Powerlink endograft on the aortic bifurcation with a proximal extension for complete

2008 Journal of Vascular Surgery

6638. Regionalization of abdominal aortic aneurysm repair: evidence of a shift to high-volume centers in the endovascular era. Full Text available with Trip Pro

Regionalization of abdominal aortic aneurysm repair: evidence of a shift to high-volume centers in the endovascular era. Since the early 1990s, many studies have shown lower mortality for abdominal aortic aneurysm (AAA) repair at high-volume centers compared with low-volume centers. The introduction of endovascular AAA repair (EVAR) also has changed the practice of AAA repair. The goal of this study was to determine if regionalization of AAA repair occurred in the United States. Etiologic

2008 Journal of Vascular Surgery

6639. The Powerlink system for endovascular abdominal aortic aneurysm repair: six-year results. Full Text available with Trip Pro

The Powerlink system for endovascular abdominal aortic aneurysm repair: six-year results. We compared the results of endovascular repair using the Powerlink endovascular graft with conventional open abdominal aortic aneurysm repair through a 6-year follow-up period.Two hundred fifty-eight patients with abdominal aortic aneurysms were prospectively enrolled in a multicenter trial and underwent endovascular repair (N = 192) or conventional open surgery (N = 66). All endovascular repairs were (...) reduced in the endovascular group compared with the open repair group. Six-year follow-up of patients treated with the Powerlink system demonstrates the continued safety and efficacy of its treatment of abdominal aortic aneurysm.

2008 Journal of Vascular Surgery

6640. More patients are treated for nonruptured abdominal aortic aneurysms, but the proportion of women remains unchanged. Full Text available with Trip Pro

More patients are treated for nonruptured abdominal aortic aneurysms, but the proportion of women remains unchanged. Large variations in the intervention rates for ruptured and nonruptured abdominal aortic aneurysm (AAA) over time have been reported, both decreasing and increasing numbers. Women have been reported to constitute an increasing proportion of patients treated for several manifestations of cardiovascular disease; whether a similar trend is true for AAA is not well understood

2008 Journal of Vascular Surgery

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