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Abdominal Aortic Aneurysm

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6721. Acute renal failure after endovascular vs open repair of abdominal aortic aneurysm. Full Text available with Trip Pro

Acute renal failure after endovascular vs open repair of abdominal aortic aneurysm. Endovascular aneurysm repair (EVAR) is an increasingly used alternative to open surgical repair of unruptured abdominal aortic aneurysms (AAAs). The effect of EVAR on postprocedure acute renal failure has not been determined. We hypothesized that EVAR would be associated with a lower risk of acute renal failure and acute renal failure requiring hemodialysis.A retrospective cohort study was conducted of the 2002

2006 Journal of Vascular Surgery

6722. Informed prognosis [corrected] after abdominal aortic aneurysm repair using predictive modeling techniques [corrected] Full Text available with Trip Pro

Informed prognosis [corrected] after abdominal aortic aneurysm repair using predictive modeling techniques [corrected] To identify the best method for the prediction of postoperative mortality in individual abdominal aortic aneurysm surgery (AAA) patients by comparing statistical modelling with artificial neural networks' (ANN) and clinicians' estimates.An observational multicenter study was conducted of prospectively collected postoperative Acute Physiology and Chronic Health Evaluation II

2006 Journal of Vascular Surgery

6723. Reduced lung function in patients with abdominal aortic aneurysm is associated with activation of inflammation and hemostasis, not smoking or cardiovascular disease. Full Text available with Trip Pro

Reduced lung function in patients with abdominal aortic aneurysm is associated with activation of inflammation and hemostasis, not smoking or cardiovascular disease. Abdominal aortic aneurysms often coexist with reduced lung function and chronic obstructive pulmonary disease (COPD). These conditions are each associated with cigarette smoking, cardiovascular disease, and evidence of increased inflammatory and hemostatic activity. The aim of this study was to determine if these factors accounted (...) for the link between aneurysms and pulmonary disease.The design was a case-control study comparing patients with an asymptomatic abdominal aortic aneurysm with population-based controls without an aneurysm. Aneurysms were diagnosed by ultrasound scan, and pulmonary function was measured by respiratory questionnaire and spirometry. Activation of inflammation and hemostasis was measured by assay of plasma interleukin-6 (IL-6), fibrinogen, von Willebrand factor (vWF), tissue plasminogen activator (tPA

2006 Journal of Vascular Surgery

6724. Daily diurnal variation in admissions for ruptured abdominal aortic aneurysms. (Abstract)

Daily diurnal variation in admissions for ruptured abdominal aortic aneurysms. Many vascular events, such as myocardial infarction and cerebrovascular accident, demonstrate a circadian pattern of presentation. Blood pressure is intimately related to these pathologies and is the one physiological variable consistently associated with abdominal aortic aneurysm rupture. It also demonstrates a diurnal variation. The purpose of this study was to determine if rupture of an abdominal aortic aneurysm (...) suggest a distinct circadian pattern of presentation for RAAA. Systolic blood pressure has a circadian rhythm that mirrors this pattern of presentation. Our results further support the association between RAAA and hypertension, and they may also indicate that chronotropic blood pressure control combating the early-morning peak in systolic blood pressure may assist in the management of abdominal aortic aneurysms.

2007 World Journal of Surgery

6725. Infrarenal abdominal aortic aneurysm repair: time-trends during a 20-year period. (Abstract)

Infrarenal abdominal aortic aneurysm repair: time-trends during a 20-year period. The goal of the present study was to investigate the number of operations for abdominal aortic aneurysm (AAA) including time-trends in treatment during a 20-year period. Operating time and anesthesia time were also studied.During the period 1983-2002, a total of 1,041 patients with AAA were treated with open surgery (905) or EVAR (136). Number of operations, type of graft, anesthesia time, and operating time were (...) the variables investigated. Data were collected retrospectively from the patients' medical records.There was an increase in the number of operations both for ruptured and non-ruptured AAA in men during the study period. Among women, an increase was observed only for ruptured aneurysm. Operating time and anesthesia time increased significantly during the 20-year period. The number of patients treated by EVAR increased significantly, beginning in 1995.In conclusion, there has been an increase in the number

2007 World Journal of Surgery

6726. Systemic inflammation and repair of abdominal aortic aneurysm. (Abstract)

Systemic inflammation and repair of abdominal aortic aneurysm. Inflammation is integral to the pathogenesis of abdominal aortic aneurysm (AAA). This study examines preoperative biomarkers of systemic inflammation in patients undergoing open repair of intact and ruptured AAA.One-hundred twelve patients were entered into a prospective observational study. Preoperative POSSUM physiology score, C-reactive protein (CRP), white blood count (WBC), platelet count, fibrinogen, and albumin were recorded (...) and related to clinical variables using univariate analysis.Sixty-one patients with a ruptured AAA, 39 with an asymptomatic intact AAA, and 12 with an acutely symptomatic intact AAA underwent attempted repair. There were two inflammatory asymptomatic aneurysms and one inflammatory ruptured aneurysm. No patient had clinical evidence of coexistent inflammatory disease. Patients with a symptomatic intact AAA had a significantly greater level of CRP and fibrinogen, higher WBC, and lower serum albumin, than

2007 World Journal of Surgery

6727. Tissue inhibitor of metalloproteinase-1 (TIMP-1) polymorphisms in a Caucasian population with abdominal aortic aneurysm. (Abstract)

Tissue inhibitor of metalloproteinase-1 (TIMP-1) polymorphisms in a Caucasian population with abdominal aortic aneurysm. The formation of a sporadic abdominal aortic aneurysm (AAA) is explained by the remodeling of the extracellular matrix (ECM) and breakdown of structural components of the vascular wall. Matrix metalloproteinases are the principal matrix-degrading proteases and are known to play a major role in the remodeling of the extracellular matrix in arterial vessels. Their activity

2007 World Journal of Surgery

6728. Can local secretion of prostaglandin E2, thromboxane B2, and interleukin-6 play a role in ruptured abdominal aortic aneurysm? (Abstract)

Can local secretion of prostaglandin E2, thromboxane B2, and interleukin-6 play a role in ruptured abdominal aortic aneurysm? Our laboratory has previously shown that the levels of secreted prostaglandin E(2) (PGE(2)), Thromboxane B(2) (TxB(2)), and interleukin-6 (IL-6) by aortic explant cultures were high in patients with ruptured abdominal aortic aneurysm (AAA). In the present study, we sought to examine the secretory levels of these inflammatory mediators in aortic explant cultured from (...) a group of AAAs rupturing at a certain size and a group that did not rupture at that size. It was thought that such a comparison might reveal the contribution of those inflammatory mediators to the risk of AAA rupture.All subjects had abdominal computed tomography (CT) scans to determine the size of the aneurysm, and surgical aortic tissue was collected from both nonruptured AAAs (18 with a mean size of 6 + 0.5 cm [range: 5-7 cm] and 12 with a mean size of 8 + 0.1 cm [range: 7.01-10 cm]) and ruptured

2008 World Journal of Surgery

6729. Early and mid-term results of ruptured abdominal aortic aneurysms in the endovascular era in a community hospital. Full Text available with Trip Pro

Early and mid-term results of ruptured abdominal aortic aneurysms in the endovascular era in a community hospital. Endovascular repair (EVAR) has been increasingly used for ruptured abdominal aortic aneurysms (rAAAs), especially in major academic centers. The goal of this article is to report our results with an EVAR-first approach for rAAA which we adopted in 2001 in our community hospital.All consecutive patients who underwent attempted repair for rAAA between February 2001 and July 2006 were

2007 Journal of Vascular Surgery

6730. Peak wall stress measurement in elective and acute abdominal aortic aneurysms. Full Text available with Trip Pro

Peak wall stress measurement in elective and acute abdominal aortic aneurysms. Abdominal aortic aneurysm (AAA) rupture occurs when wall stress exceeds wall strength. Engineering principles suggest that aneurysm diameter is only one aspect of its geometry that influences wall stress. Finite element analysis considers the complete geometry and determines wall stresses throughout the structure. This article investigates the interoperator and intraoperator reliability of finite element analysis (...) in the calculation of peak wall stress (PWS) in AAA and examines the variation in PWS in elective and acute AAAs.Full ethics and institutional approval was obtained. The study recruited 70 patients (30 acute, 40 elective) with an infrarenal AAA. Computed tomography (CT) images were obtained of the AAA from the renal vessels to the aortic bifurcation. Manual edge extraction, three-dimensional reconstruction, and blinded finite element analysis were performed to ascertain location and value of PWS. Ten CT data

2008 Journal of Vascular Surgery

6731. Open abdominal aortic aneurysm repair in octogenarians before and after the adoption of endovascular grafting procedures. Full Text available with Trip Pro

Open abdominal aortic aneurysm repair in octogenarians before and after the adoption of endovascular grafting procedures. This study evaluated (1) elective open abdominal aortic aneurysm repair (OAR) in patients aged > or =80 years before and after stent graft devices for endovascular aneurysm repair (EVAR) became commercially available and (2) the effect on perioperative (30-day) outcome of the anatomic constraints that led to EVAR being excluded for many of them.A review was conducted (...) on the records of 111 patients aged > or =80 years who underwent elective OAR during a 14-year period at the University of Padua School of Medicine. Patients were separated into two groups: group 1 (n = 65) had OAR before and group 2 (n = 46) after an EVAR program was adopted at the medical school in mid-2000. Perioperative death and morbidity, location of proximal aortic clamp, management of the left renal vein, associated iliac aneurysmal or occlusive diseases, the type of surgical reconstruction

2008 Journal of Vascular Surgery

6732. Cysteine protease activity in the wall of abdominal aortic aneurysms. Full Text available with Trip Pro

Cysteine protease activity in the wall of abdominal aortic aneurysms. Cysteine proteases are potent elastolytic enzymes and together with their inhibitor, cystatin C, have been linked with the growth of abdominal aortic aneurysms (AAAs). These enzymes and their inhibitors have previously been studied in AAAs, but comparisons have always been made with wall from normal aorta. Atherosclerosis is a feature of aneurysmal disease and may therefore confound comparisons with normal wall. This study (...) compared the expression and activity of cysteine proteases and their inhibitors in aneurysm wall with their expression in the aortic wall of patients with aortic occlusive disease (AOD).Aortic wall was obtained from 82 patients with AAA and 13 with AOD. Protein expression and activity of cathepsin B, H, K, L and S, and cystatins A, B, and C were measured by enzyme-linked immunosorbent assay and specific fluorogenic substrate assays. Matrix metalloproteinase 9 (MMP-9) activity was measured

2007 Journal of Vascular Surgery

6733. Infected abdominal aortic aneurysm caused by Brucella abortus: a case report. Full Text available with Trip Pro

Infected abdominal aortic aneurysm caused by Brucella abortus: a case report. This case report describes an infected aneurysm caused by Brucella abortus. To the best of our knowledge, this case represents the first reported occurrence of an infected abdominal aortic aneurysm caused by this pathogen. The clinical findings included mild fever, fatigue, cold sweats, and abdominal pain. The diagnosis was reached by computed tomography scanning. The patient was treated by urgent surgery, which (...) consisted of resection of the aneurysmal sac, prosthetic graft replacement, and omental wrapping. Antibiotics were administrated for 3 months. A bacteriologic specimen was isolated from the blood culture. At 1 year 10 months after surgery, the patient remains in good health.

2007 Journal of Vascular Surgery

6734. Anemia is associated with abdominal aortic aneurysm (AAA) size and decreased long-term survival after endovascular AAA repair. Full Text available with Trip Pro

Anemia is associated with abdominal aortic aneurysm (AAA) size and decreased long-term survival after endovascular AAA repair. Anemia is a common comorbid condition in various inflammatory states and an established predictor of mortality in patients with chronic heart failure, ischemic heart disease, and end-stage renal disease. The present study of patients with abdominal aortic aneurysm (AAA) undergoing endovascular repair (EVAR) assessed the relationships between baseline hemoglobin

2007 Journal of Vascular Surgery

6735. The role of tissue factor in patients undergoing open repair of ruptured and nonruptured abdominal aortic aneurysms. Full Text available with Trip Pro

The role of tissue factor in patients undergoing open repair of ruptured and nonruptured abdominal aortic aneurysms. Ruptured abdominal aortic aneurysm (AAA) is associated with the development of a procoagulant and hypofibrinolytic state. Tissue factor (TF) and its naturally occurring inhibitor, tissue factor pathway inhibitor (TFPI), play a central role in the initiation and progression of such a hypercoagulable state, but their role in patients undergoing open AAA repair has not previously (...) been examined.A prospective study was conducted of 17 patients undergoing elective AAA repair and 10 patients undergoing emergency AAA repair. Blood was taken before induction, and 5 minutes, 24 hours, and 48 hours after aortic cross-clamp release and assayed for plasma TF, TFPI, tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI), and thrombin-activatable fibrinolysis inhibitor (TAFI) activities.TF activity was significantly higher at all time points in patients

2007 Journal of Vascular Surgery

6736. Prosthetic stent graft infection after endovascular abdominal aortic aneurysm repair. Full Text available with Trip Pro

Prosthetic stent graft infection after endovascular abdominal aortic aneurysm repair. The purpose of this report is to discuss the incidence, diagnosis, and management of stent graft infections after endovascular aneurysm repair (EVAR).Data were collected from the hospital database and medical case notes for all patients with infected endografts after elective or emergency EVAR for abdominal aortic aneurysm (AAA) during the last 8 years in two university teaching hospitals in Northern Ireland (...) presented with left psoas abscess and were treated successfully with extra-anatomic bypass and removal of the infected stent graft. Two more patients presented with infected graft without other evidence of intra-abdominal sepsis: one underwent successful removal of the infected prosthesis with extra-anatomical bypass, and the other was treated conservatively and died of progressively worsening sepsis. The fifth patient presented with unexplained fever and died suddenly, with a postmortem diagnosis

2007 Journal of Vascular Surgery

6737. Abdominal aortic aneurysm in women: prevalence, risk factors, and implications for screening. Full Text available with Trip Pro

Abdominal aortic aneurysm in women: prevalence, risk factors, and implications for screening. Accurate data regarding the prevalence and associated risk factors for aneurysmal disease is essential when determining the appropriateness of screening for abdominal aortic aneurysms (AAA). Although women are poorly represented in most large studies of AAA prevalence, the US Preventative Services Task Force recently recommended against primary screening for AAA in women. The purpose of this analysis (...) was to define the prevalence and risk factors associated with the development of AAA in women.A free duplex ultrasound screening was offered to men and women with cardiovascular risk factors or a family history of AAA. Patients were recruited through advertising at local screening centers and screenings were performed between 2004 and 2006. Demographic information and cardiovascular and aneurysmal disease risk factors were obtained for each patient through a questionnaire. A total of 17,540 subjects were

2007 Journal of Vascular Surgery

6738. Informed consent for abdominal aortic aneurysm repair: assessing variations in surgeon opinion through a national survey. Full Text available with Trip Pro

Informed consent for abdominal aortic aneurysm repair: assessing variations in surgeon opinion through a national survey. Informed consent discussions for elective abdominal aortic aneurysm (AAA) repair should reflect appropriate risks of the open or endovascular repair (EVAR), but few guidelines exist describing what surgeons should discuss. This study examines expert opinion regarding what constitutes informed consent.Design. We conducted an anonymous, web-based, national survey of vascular

2008 Journal of Vascular Surgery

6739. Minimally invasive retrieval of a dislodged Wallstent endoprosthesis after an endovascular abdominal aortic aneurysm repair. Full Text available with Trip Pro

Minimally invasive retrieval of a dislodged Wallstent endoprosthesis after an endovascular abdominal aortic aneurysm repair. Endovascular abdominal aortic aneurysm repair (EVAR) is being performed more frequently in patients with concomitant iliac artery occlusive disease. We report a case of a 70-year-old male status post angioplasty and stenting of bilateral iliac arteries for occlusive disease who subsequently underwent EVAR for a rapidly expanding abdominal aortic aneurysm (AAA). One month (...) after the placement of the endograft, it was discovered that the previously placed Wallstent had been dislodged during the endovascular abdominal aortic aneurysm repair. Minimally invasive retrieval using an Amplatz Goose Neck Snare was successful in recovering the stent. This case underscores the danger of performing EVAR in the setting of prior iliac artery stenting and the potential complications that may ensue.

2008 Journal of Vascular Surgery

6740. Endovascular versus open surgical repair of abdominal aortic aneurysm with concomitant malignancy. Full Text available with Trip Pro

Endovascular versus open surgical repair of abdominal aortic aneurysm with concomitant malignancy. The management of patients with abdominal aortic aneurysm (AAA) and concurrent malignancy is controversial. This study retrospectively assessed the outcome of endovascular repair (EVAR) and open repair (OR) for the treatment of AAA in patients undergoing curative treatment for concomitant malignancies.All patients who underwent surgery for a nonruptured infrarenal AAA of > or =5.5 cm (...) and concomitant malignancy between 1997 and 2005 were retrospectively reviewed.Identified were 25 patients (22 men; mean age, 70.3 years) with nonruptured infrarenal AAA of > or =5.5 cm (mean size, 6.4 cm) and concomitant malignancy amenable for curative treatment. EVAR was used to treat 11 patients, and 14 underwent OR. The EVAR patients had a smaller mean aneurysm size (5.9 cm vs 6.8 cm; P = .006) than the OR patients. The mean cumulative length of stay for all patients who received treatment for both AAA

2007 Journal of Vascular Surgery

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