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Abdominal Aortic Aneurysm

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6741. Imaging techniques for detection and management of endoleaks after endovascular aortic aneurysm repair. (Abstract)

Imaging techniques for detection and management of endoleaks after endovascular aortic aneurysm repair. Endovascular aortic aneurysm repair (EVAR) is evolving into a viable alternative to open surgical repair for many patients with abdominal and thoracic aortic aneurysms. Endoleak development is a complication of EVAR and represents one of the limitations of this procedure. Endoleaks represent blood flow outside the stent-graft lumen but within the aneurysm sac. Lifelong imaging surveillance

2007 Radiology

6742. Contrast-enhanced MR imaging for evaluation of coronary artery disease before elective repair of aortic aneurysm. (Abstract)

patients. MR imaging was performed in 49 patients (42 men and seven women; mean age, 72.2 years; age range, 58-85 years) before the elective repair of atherosclerotic aortic aneurysms. Thirty-two patients had an abdominal aneurysm, 12 had a thoracic aneurysm, and five had a thoracoabdominal aneurysm. First-pass contrast-enhanced MR images were obtained with short-axis sections encompassing the entire left ventricular myocardium in the resting state and during pharmacologic stress. Inversion-recovery (...) Contrast-enhanced MR imaging for evaluation of coronary artery disease before elective repair of aortic aneurysm. To prospectively evaluate the accuracy of first-pass contrast material-enhanced magnetic resonance (MR) imaging during stress and delayed contrast-enhanced MR imaging in the detection of significant coronary artery disease in patients before elective repair of aortic aneurysm.The study was approved by the institutional ethics committee, and informed consent was obtained from all

2005 Radiology

6743. Air transport of patients with unstable aortic aneurysms directly into operating rooms. (Abstract)

Air transport of patients with unstable aortic aneurysms directly into operating rooms. The purpose of this study was to describe an air transport service's protocol for direct transport of patients with abdominal aortic aneurysm leak (AAAL) into receiving hospital operating rooms (ORs).This retrospective consecutive-case analysis examined AAAL patients undergoing nurse-paramedic Boston MedFlight (BMF) transport during 1999-2004, who were taken directly into ORs at four academic centers. BMF

2007 Prehospital emergency care

6744. Midterm results of the multicenter trial of the powerlink bifurcated system for endovascular aortic aneurysm repair. (Full text)

Midterm results of the multicenter trial of the powerlink bifurcated system for endovascular aortic aneurysm repair. We assessed the results of abdominal aortic aneurysm (AAA) repair with the Powerlink bifurcated endovascular graft compared with open AAA repair.A prospective controlled multicenter trial of the Powerlink system for endovascular aneurysm repair was conducted at 15 sites as part of a pivotal US Food and Drug Administration trial. Between July 2000 and March 2003, 258 patients (192 (...) test patients, 66 control patients) were enrolled. Stent grafts were oversized by 10% to 20% relative to computed tomography scan (CT)-based diameter measurements. All repairs were performed in the operating room through 1 surgically exposed femoral artery and a contralateral 9F sheath percutaneously placed. Results were assessed with contrast material-enhanced CT scans and plain abdominal x-ray studies at 1, 6, and 12 months, and annually postoperatively.Patients were followed up for a mean of 22

2004 Journal of vascular surgery Controlled trial quality: uncertain PubMed abstract

6745. Is three-dimensional computed tomography reconstruction justified before endovascular aortic aneurysm repair? (Full text)

Is three-dimensional computed tomography reconstruction justified before endovascular aortic aneurysm repair? The endovascular management of abdominal aortic aneurysm (AAA) relies on accurate preoperative imaging for proper patient selection and operative planning. Three-dimensional (3-D) computed tomography (CT) with reformatted images perpendicular to blood flow has gained popularity as a method of AAA assessment and image-based planning before endovascular aneurysm repair (EVAR). The current (...) of the proximal neck, maximal AAA, aortic bifurcation, common iliac diameter, and aortic angulation. The proximal neck and common iliac arteries were also assessed for thrombus, calcification, and tortuosity. Agreement of the measurements on axial CT scans was compared with those on MMS CT scans by calculating the kappa statistic. Complete agreement was defined as kappa = 1.0. The limits of agreement between observers were also calculated.The cumulative interobserver agreement of MMS CT scans (kappa =.81

2004 Journal of vascular surgery PubMed abstract

6746. Ruptured aortic aneurysm masquerading as phlegmasia cerulea. (Abstract)

presented with asthenia, macrohematuria, and mild back pain, as well as edema and blue mottling of the lower limbs and abdomen for 24 hours. The abdomen was nontender without a pulsatile mass or murmur. Computed tomography showed an 85-mm abdominal aortic aneurysm ruptured into the inferior vena cava. Phlegmasia cerulea dolens-like symptoms were explained by compromised venous outflow from the lower limbs because of an aortocaval fistula. The patient died of uncontrollable hemorrhage during emergent (...) surgical repair. Three percent to 6% of patients with abdominal aortic aneurysm rupture present an aortocaval fistula, which can be suspected by the triad of abdominal or lower back pain, pulsatile abdominal mass, and machinery-type abdominal murmur. Left untreated, this condition rapidly leads to death from congestive heart failure. Only one third of patients are diagnosed before surgery because a fistula is often not suspected until unexplained massive hemorrhage occurs during the operation

2008 American Journal of Emergency Medicine

6747. Development of aortic aneurysm/dilatation during the followup of patients with giant cell arteritis: A cross-sectional screening of fifty-four prospectively followed patients. (Abstract)

and assessed whether persisting low-grade disease activity is associated with higher risk of developing aortic aneurysm.Fifty-four patients with GCA (14 men and 40 women) were cross-sectionally evaluated after a median followup of 5.4 years (range 4.0-10.5 years). The screening protocol included a chest radiograph, abdominal ultrasonography scan, and computed tomography scan when aortic aneurysm was suspected or changes with respect to the baseline chest radiograph were observed. Clinical and laboratory (...) Development of aortic aneurysm/dilatation during the followup of patients with giant cell arteritis: A cross-sectional screening of fifty-four prospectively followed patients. Giant cell arteritis (GCA) may involve the aorta. Retrospective studies have demonstrated a higher prevalence of aortic aneurysm among patients with GCA compared with the general population. We investigated the prevalence of aortic aneurysm in a cohort of patients with biopsy-proven GCA using a defined protocol

2008 Arthritis and Rheumatism

6748. Dilation-Dependent Activation of Platelets and Prothrombin in Human Thoracic Ascending Aortic Aneurysm. (Full text)

Dilation-Dependent Activation of Platelets and Prothrombin in Human Thoracic Ascending Aortic Aneurysm. The purpose of this study was to investigate whether thoracic ascending aortic aneurysm (TAAA) induces platelet activation as mural thrombus participates in aortic dilatation in abdominal aortic aneurysm and TAAA are associated with rheological factors favoring coagulation activation.We studied the relation between coagulation activation and aortic diameter in Marfan patients (MFS (...) ) with various aortic diameters (n=52). We then studied patients presenting large aneurysms associated with bicuspid aortic valve (BAV) and degenerative form. Lastly, we used immunochemistry and biochemistry to investigate prothrombin/thrombin retention within the aortic wall. Microparticles, sGPV, tissue factor, and TAT complexes were increased in plasma from MFS with large aneurysms (>or=45 mm) compared to MFS with limited aortic dilatation (<45 mm). Similar elevations were observed in all patients

2008 Thrombosis and Vascular Biology PubMed abstract

6749. Surgery for infected aneurysm of the aortic arch. (Full text)

prosthetic graft infection occurred in 1 patient, who died of massive gastrointestinal bleeding 4 months after the operation. Of the 9 patients with distal arch aneurysms, 3 were operated on through a sternotomy with a hospital mortality rate of 33% and an aneurysm-related mortality rate of 67%. The operation was performed through a thoracotomy in 6 patients, with no hospital mortality and an aneurysm-related mortality rate of 17%.Infected aortic arch aneurysm was uncommon and nontyphoid Salmonella (...) Surgery for infected aneurysm of the aortic arch. Infected aneurysm of the aortic arch is rare and can be fatal without surgery. We report our surgical experience with infected aneurysms of the aortic arch.We conducted a retrospective chart review.Between 1995 and 2006, 10 patients with infected aneurysms of the aortic arch were treated at our hospital. There were 8 men with a median age of 67.5 years (range, 50-79 years). The most common pathogen was nontyphoid Salmonella in 5 (50%) patients

2007 Journal of Thoracic and Cardiovascular Surgery PubMed abstract

6750. Long-term predictors of descending aorta aneurysmal change in patients with aortic dissection. (Full text)

Long-term predictors of descending aorta aneurysmal change in patients with aortic dissection. We sought to demonstrate the long-term natural course of descending aorta dilation after acute aortic dissection (AD) and identify early predictors for late aneurysmal change.Aneurysmal dilation of the aorta is a critical late complication in AD patients.Contrast-enhanced computed tomography (CT) was performed during the acute phase in 100 AD patients, comprising 51 type 1 who underwent ascending (...) = 42) showed higher event rate (aneurysm or death) than others (n = 58) (p < 0.001).The UT is the major site of late aneurysmal dilation. A large UT false lumen diameter on the initial CT portends late aneurysm and adverse outcome warranting early intervention.

2007 Journal of the American College of Cardiology PubMed abstract

6751. Hybrid approaches to thoracic aortic aneurysms: the role of endovascular elephant trunk completion. (Full text)

%, and 15.8%, respectively. Caudal migration of the endograft occurred in 1 patient, and all but 2 aneurysms decreased or remained stable in size. The 2 patients with growth included a type III endoleak (which resolved after treatment) and pressurization through an expanded PTFE stentgraft. Three cases of transient paraparesis occurred (all in patients requiring mesenteric bypass or abdominal aortic aneurysm repair), and there were no paraplegias or strokes.Endovascular completion of elephant trunks (...) Hybrid approaches to thoracic aortic aneurysms: the role of endovascular elephant trunk completion. Thoracic aortic aneurysm affecting the arch and proximal descending thoracic aorta requires 2-stage repairs that include proximal elephant trunk graft placement and completion of thoracic or thoracoabdominal repair. The application of endovascular grafting to complete the proximal procedure avoids a thoracotomy and may improve the morbidity and mortality of the patient population at risk.A

2005 Circulation PubMed abstract

6752. Overexpression of transforming growth factor-beta1 stabilizes already-formed aortic aneurysms: a first approach to induction of functional healing by endovascular gene therapy. (Full text)

Overexpression of transforming growth factor-beta1 stabilizes already-formed aortic aneurysms: a first approach to induction of functional healing by endovascular gene therapy. The cell response to transforming growth factor-beta1 (TGF-beta1), a multipotent cytokine with healing potential, varies according to tissue context. We have evaluated the ability of TGF-beta1 overexpression by endovascular gene therapy to stabilize abdominal aortic aneurysms (AAAs) already injured by inflammation (...) -induction after transient exogenous overexpression reprograms dilated aortas altered by inflammation and proteolysis and restores their ability to withstand arterial pressure without further dilation. This first demonstration of stabilization of expanding AAAs by delivery of a single multipotent self-promoting gene supports the view that endovascular gene therapy should be considered for treatment of aneurysms.

2005 Circulation PubMed abstract

6753. Hyperplastic cellular remodeling of the media in ascending thoracic aortic aneurysms. (Full text)

Hyperplastic cellular remodeling of the media in ascending thoracic aortic aneurysms. Progressive medial degeneration and atrophy is thought to be a cause of ascending thoracic aortic aneurysms in the elderly. Extensive apoptosis of vascular smooth muscle cells (VSMCs) has been demonstrated in the media of abdominal aortic aneurysms. We investigated whether medial atrophy from loss of VSMCs occurs in primary ascending thoracic aortic aneurysms.Morphometric analysis of 28 nonaneurysmal ascending (...) as a result of the increased medial mass. There was decreased expression of matrix proteins, despite sustained synthesis of these molecules, which was associated with evidence of increased matrix degradation. The remodeling and expansion of the media was most evident in comparisons between nonaneurysmal aortas versus smaller aneurysms and did not evolve further in larger aneurysms.The mechanisms for luminal enlargement in thoracic and abdominal aortic aneurysms differ significantly with regard

2005 Circulation PubMed abstract

6754. Response of plasma matrix metalloproteinases and tissue inhibitor of metalloproteinases to stent-graft surgery for descending thoracic aortic aneurysms. (Full text)

Response of plasma matrix metalloproteinases and tissue inhibitor of metalloproteinases to stent-graft surgery for descending thoracic aortic aneurysms. The role of matrix metalloproteinases and their tissue endogenous inhibitors has been documented in abdominal aortic aneurysms, but few articles have investigated their role after thoracic aortic aneurysm treatment. Our report investigates matrix metalloproteinases and tissue endogenous inhibitor-1 plasmatic changes in patients who have (...) undergone endovascular aneurysm repair for descending thoracic aortic aneurysms and assesses their clinical significance.Thirty-two patients with thoracic aortic aneurysms who underwent endovascular aneurysm repair were compared with 25 healthy volunteers. Plasma matrix metalloproteinase-3/matrix metalloproteinase-9 and tissue endogenous inhibitor-1 values were determined by an enzyme-linked immunosorbent assay method at a predetermined time interval.The preoperative levels of matrix metalloproteinases

2007 Journal of Thoracic and Cardiovascular Surgery PubMed abstract

6755. Rupture of thoracoabdominal aortic aneurysm associated with Behcet's disease. (Abstract)

Rupture of thoracoabdominal aortic aneurysm associated with Behcet's disease. Surgical treatment of arterial Behcet's disease (BD) has a higher incidence of graft-related complications such as anastomotic pseudoaneurysm or graft occlusion. A 64-year-old man presented with a rupture of the thoracoabdominal aortic aneurysms associated with BD. Evaluation shows a large hematoma in the retroperitoneum and multiple aneurysms of the thoracoabdominal aorta. Physical examination and past history (...) fulfills the diagnostic criteria of BD. The abdominal aorta was replaced with an allograft and the major branches were reconstructed with its branches. The postoperative course was uneventful. A 10-month follow-up computed tomographic scan did not show any graft-related complications. This case suggests the usefulness of an allograft for arterial involvement of BD.

2007 Annals of Thoracic Surgery

6756. Fenestrated endovascular repair for juxtarenal aortic aneurysm. (Abstract)

Fenestrated endovascular repair for juxtarenal aortic aneurysm. The outcome of fenestrated endovascular aneurysm repair (F-EVAR) was evaluated.Between February 2003 and December 2006, 45 patients (median age 73 (range 53-85) years) underwent primary (41) or secondary (four) F-EVAR for an abdominal aortic aneurysm with infrarenal neck anatomy unsuitable for a standard stent-graft. Median aneurysm diameter was 68 (range 55-100) mm and median infrarenal aortic neck length was 6 (range 0-13) mm (...) to atheroembolism. At median follow-up of 24 (range 1-48) months, all aneurysms were stable or shrinking, with no late ruptures or graft-related endoleaks. Six patients required a secondary intervention. The primary vessel patency rate was 96.6 per cent. There were four late deaths, unrelated to the aneurysm.F-EVAR enabled successful treatment of juxtarenal aortic aneurysm with a low complication rate.2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

2007 British Journal of Surgery

6757. Endovascular aortic aneurysm repair in patients with the highest risk and in-hospital mortality in the United States. (Full text)

in the United States is lower than that reported in EVAR trial 2.Population-based, cross-sectional study.The 2001-2004 Nationwide Inpatient Sample.The Nationwide Inpatient Sample identified EVAR procedures for nonruptured abdominal aortic aneurysms. Risk stratification was based on comorbidities and the Charlson comorbidity index, a validated predictor of in-hospital mortality after abdominal aortic aneurysms repairs. Weighted univariate and logistic regression analyses were used to determine (...) increased risk of adjusted in-hospital mortality (odds ratio, 1.6; 95% confidence interval, 1.2-2.2) compared with patients with low risk.The EVAR procedure is currently being performed in the United States with low in-hospital mortality, even in patients with the highest risk. Therefore, EVAR should not be denied to high-risk patients with abdominal aortic aneurysms in the United States on the basis of the level I evidence from the United Kingdom study.

2007 Archives of Surgery PubMed abstract

6758. Endovascular aortic aneurysm repair in the octogenarian: is it worthwhile? (Full text)

Endovascular aortic aneurysm repair in the octogenarian: is it worthwhile? During the past decade, endovascular stent graft repair (EVSG) of abdominal aortic aneurysms has emerged as a less invasive and less morbid alternative to open surgical repair. We hypothesize that EVSG may become the treatment method of choice among patients older than 80 years.Retrospective case series.Major academic medical center with extensive experience in endovascular and open aortic aneurysm surgery.During a 5 (...) (24.10%), and 1 type III (0.69%). The majority either resolved spontaneously (type IIs) or with minimally invasive secondary intervention, which was performed in 13 patients. Perioperative local/vascular and systemic complications occurred in 16 (10.7%) and 8 (5.3%) patients, respectively. There were 5 perioperative deaths (3.3%)(<30 days postoperatively). Forty late deaths (26.7%)(>30 days postoperatively) occurred, which were unrelated to the EVSG procedure.Endovascular repair of abdominal aortic

2004 Archives of Surgery PubMed abstract

6759. Genome Screen to Detect Linkage to Common Susceptibility Genes for Intracranial and Aortic Aneurysms. (Full text)

Aneurysm study.Available medical records of subjects who reported IA or abdominal/thoracic AA were reviewed with adjudication as definite/probable, possible, or not a case. To identify genes contributing to the susceptibility for IA and AA, genomewide linkage analysis was performed in the 26 multiplex IA families who had members who also had thoracic or abdominal AA. Individuals (n=91) were defined as affected if they had an IA (definite/probable) or an aortic or thoracic AA (definite/probable).Maximum (...) Genome Screen to Detect Linkage to Common Susceptibility Genes for Intracranial and Aortic Aneurysms. Risk for both intracranial aneurysms (IAs) and aortic aneurysms (AAs) is thought to be heritable with mounting evidence for genetic predisposition. The concept of shared risk for these conditions is challenged by differences in age of diagnosis and demographic characteristics. We performed a genomewide linkage analysis in multiplex families with both IA and AA from the Familial Intracranial

2008 Stroke PubMed abstract

6760. Genetic Analysis of 56 Polymorphisms in 17 Genes involved in Methionine Metabolism in patients with Abdonminal Aortic Aneurysm. (Abstract)

Genetic Analysis of 56 Polymorphisms in 17 Genes involved in Methionine Metabolism in patients with Abdonminal Aortic Aneurysm. Previous studies suggested an association between abdominal aortic aneurysm (AAA) and hyperhomocysteinaemia, a complex trait determined by genetic and environmental factors. Our hypothesis was that polymorphisms in genes directly or indirectly involved in methionine metabolism may contribute to AAA susceptibility.We studied 56 polymorphisms in MTHFR, MTR, MTRR, CBS

2008 Journal of Medical Genetics

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