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Endotension: rupture of abdominal aortic aneurysm
Amato, Alexandre Campos Moraes;Abraham, Flávio Amim;Kraide, Henrique Dini;Rocha, Leandro Teixeira;Santos, Ricardo Virginio dos;
Jornal Vascular Brasileiro , 2012, DOI: 10.1590/S1677-54492012000200016
Abstract: aortic endovascular exclusion technique called 'chimney' consists of placing stents through abdominal aortic visceral branches and a prosthesis that excludes the thoraco-abdominal aneurysm. stents and an aortic endoprosthesis are placed in the renal arteries. this method is primarily used when open surgery is too risky. the mechanism that provides aneurysm sac increase without the visible presence of endoleaks has not been fully elucidated. the expansion of the aneurysm sac, due to endotension, is difficult to diagnose, even with the use of advanced imaging tests. its diagnosis is made by exclusion. we present a case of a late complication in a high-risk patient after a 'chimney' endovascular procedure. following the surgery, the patient presented a ruptured aneurysm sac without a visible endoleak. a second intervention was not feasible due to the high risk of occluding all of the branches, and complicated by previous 'chimney'. endotension is a possible cause of aneurysm rupture and death.
Biomechanical prediction of abdominal aortic aneurysm rupture risk: Sensitivity analysis  [PDF]
Shijia Zhao, Wenlong Li, Linxia Gu
Journal of Biomedical Science and Engineering (JBiSE) , 2012, DOI: 10.4236/jbise.2012.511083
Abstract: Objectives: The purpose of this research is to determine the quantitative relationship between the peak wall stress of abdominal aortic aneurysm (AAA) and its clinical risk factors including its maximum diameter, asymmetry index, wall thickness and abnormal high blood pressure. Methods: The response surface experimental design with one response and four variables was used to design the experimental tests. Thirty experiments were performed through finite element analysis in order to obtain the designed response values. Results: A nonlinear multivariable regression function was developed based on the experimental data. Results demonstrated the inefficiency of traditional 5-cm criterion for estimating the rupture of AAA. The profound effect of wall thickness on the peak wall stress has been observed and validated by the existing publications. Conclusion: The conventional 5-cm criterion for estimating AAA rupture might induce biased prediction, and multiple clinical risk factors need to be considered in realistic clinical settings.
SURGICAL MANAGEMENT OF A RARE CASE OF MARFAN SYNDROME - THE RUPTURE OF AN ABDOMINAL AORTIC ANEURYSM  [PDF]
L. Stoica,E. Bitere,A. Ciucu,A. Dabija
Jurnalul de Chirurgie , 2005,
Abstract: We present a rare manifestation of the Marfan syndrome. A 33 years old woman with a 10 cm diameter juxta-renal aortic aneurysm ruptured in the retro peritoneum arrived in hemorrhagic shock. Surgery was performed in emergency by thoraco-phreno-laparatomy, the aneurysm was resected and a 20 mm Dacron tube was sutured between the origin of the renal arteries and the aortic bifurcation. Rapid thoracic aortic cross-clamping to stop the hemorrhage and good aneurismal exposure by the division of the left renal vein was the key of this successful management. The patient recovered without any complication. Rupture of the abdominal aortic aneurysm is a life threatening complication which requires a rapid diagnosis and an emergency treatment by open surgery or by endovascular stent grafting. We present the surgical strategy in our case
The Murine Angiotensin II-Induced Abdominal Aortic Aneurysm Model: Rupture Risk and Inflammatory Progression Patterns  [PDF]
Richard Y. Cao,Tim St. Amand,Matthew D. Ford,Ugo Piomelli,Colin D. Funk
Frontiers in Pharmacology , 2010, DOI: 10.3389/fphar.2010.00009
Abstract: An abdominal aortic aneurysm (AAA) is an enlargement of the greatest artery in the body defined as an increase in diameter of 1.5-fold. AAAs are common in the elderly population and thousands die each year from their complications. The most commonly used mouse model to study the pathogenesis of AAA is the angiotensin II (Ang II) infusion method delivered via osmotic mini-pump for 28 days. Here, we studied the site-specificity and onset of aortic rupture, characterized three-dimensional (3D) images and flow patterns in developing AAAs by ultrasound imaging, and examined macrophage infiltration in the Ang II model using 65 apolipoprotein E-deficient mice. Aortic rupture occurred in 16 mice (25%) and was nearly as prevalent at the aortic arch (44%) as it was in the suprarenal region (56%) and was most common within the first 7 days after Ang II infusion (12 of 16; 75%). Longitudinal ultrasound screening was found to correlate nicely with histological analysis and AAA volume renderings showed a significant relationship with AAA severity index. Aortic dissection preceded altered flow patterns and macrophage infiltration was a prominent characteristic of developing AAAs. Targeting the inflammatory component of AAA disease with novel therapeutics will hopefully lead to new strategies to attenuate aneurysm growth and aortic rupture.
Rupture of abdominal aortic aneurysm with pulmonary embolism and without an aortocaval fistula  [PDF]
Gordana Cavri?,Dubravka Bartolek,Klara Juri?,Mirjana Vukeli? Markovi?
Medicinski Glasnik , 2008,
Abstract: In this report, we presented a case of a patient with a rupturedabdominal aortic aneurysm (AAA) accompanied by pulmonaryembolism but without an aortocaval fistula, which has not beenreported so far.
Complete abdominal aortic aneurysm thrombosis and obstruction of both common iliac arteries with intrathrombotic pressures demonstrating a continuing risk of rupture: a case report and review of the literature  [cached]
Filis Konstantinos,Lagoudianakis Emmanuel,Markogiannakis Haridimos,Kotzadimitriou Aikaterini
Journal of Medical Case Reports , 2009,
Abstract: Introduction Although mural thrombus in an abdominal aortic aneurysm is frequent and its role has been studied extensively, complete thrombosis of an abdominal aneurysm is extremely rare and its natural history in relation to the risk of rupture is not known. The case of a patient with a completely thrombosed infrarenal aneurysm is presented along with a literature review. Case presentation We report the case of a 56-year-old Caucasian man with an infrarenal abdominal aortic aneurysm, presenting at our hospital due to critical ischemia of his right lower limb. Computed tomography and angiography demonstrated complete aneurysm thrombosis and obstruction of both common iliac arteries. Conclusion During the operation, systolic and mean intrathrombotic pressures, measured in different levels, constituted 74.5-90.2% and 77.5-92.5% of systolic and mean intraluminal pressure and 73-88.4% and 76.5-91.3% of systemic pressure, respectively. Our findings show that there may be a continuing risk of rupture in cases of a thrombosed abdominal aortic aneurysm.
What Should Be Done if There Is Coronary Artery Disorder in Ruptured Abdominal Aortic Aneurysm?  [PDF]
Erdal Simsek, Mehmet Bayraktaroglu, Huseyin Bayram, Sevket Atasoy, Salih Fehmi Katircioglu
World Journal of Cardiovascular Surgery (WJCS) , 2011, DOI: 10.4236/wjcs.2011.11001
Abstract: Abdominal aortic aneurysm (AAA) is the most common type of aneurismal diseases. Generally, it is asymptomatic and when it is ruptured, it develops with high morbidity and mortality. Case report: A 62-years-old male patient consulted our emergency with a pain at his dorsum and lumbar part. Cardiologist with a suspicion of coronary artery disorder or dissection, coronary angiography was executed. Consecutive lesions of LAD artery (left anterior descending) 40% - 50% and 90%, CX artery (circumflex) 40% and 80% - 90%, and a lesion of RCA (right coronary artery) 20% - 30% were detected. With a suspicion of rupture, abdominal aneurysm tomography (CT) was demanded. In the tomography, a 7-cm-diameter ruptured abdominal aortic aneurysm was diagnosed. Levosimendan support was started. Under the support of levosimendan a Y graft operation was performed. The operation was ended up with levosimendan support considering that coronary bypass would increase mortality and morbidity. Discussion: Approximately 50% of the ruptured aneurysms are died before they reach hospital while the 30% - 70% operated ones are died within 30 days after operation. Early diagnosis and follow-up is extremely important to decrease morbidity and mortality. The patients consulting with rupture must be taken to the operation without delay. What should be done if coronary artery disorder is detected in the patient whose AAA is ruptured and if the bypass is necessary? In our opinion, a decision must be made according to the patient’s clinical condition. As a result of our case, we thought repairing the abdominal aortic aneurysm necessitates the other comorbidites must be treated medically. We aimed to decrease the cardiac oxygen requirement by starting levosimendan and decline afterload. If the patient, whose coronary artery disorder is detected, is under risk and his overall condition is bad, we think that coronary bypass operation can be delayed.
Complete abdominal aortic aneurysm thrombosis and obstruction of both common iliac arteries with intrathrombotic pressures demonstrating a continuing risk of rupture: a case report and review of the literature
Konstantinos A Filis, Emmanuel E Lagoudianakis, Haridimos Markogiannakis, Aikaterini Kotzadimitriou, Nikolaos Koronakis, Konstantinos Bramis, Konstantinos Xiromeritis, Dimitrios Theodorou, Andreas Manouras
Journal of Medical Case Reports , 2009, DOI: 10.1186/1752-1947-3-9292
Abstract: We report the case of a 56-year-old Caucasian man with an infrarenal abdominal aortic aneurysm, presenting at our hospital due to critical ischemia of his right lower limb. Computed tomography and angiography demonstrated complete aneurysm thrombosis and obstruction of both common iliac arteries.During the operation, systolic and mean intrathrombotic pressures, measured in different levels, constituted 74.5-90.2% and 77.5-92.5% of systolic and mean intraluminal pressure and 73-88.4% and 76.5-91.3% of systemic pressure, respectively. Our findings show that there may be a continuing risk of rupture in cases of a thrombosed abdominal aortic aneurysm.Although thrombus formation is common within an abdominal aortic aneurysm, there is still controversy over the role that aneurysmal mural thrombus plays in the risk of rupture. Complete thrombosis of an aneurysm is extremely rare and its role in abdominal aortic aneurysm rupture is still not clear. We report our findings regarding intrathrombotic pressures of a completely thrombosed infrarenal aneurysm and their implications for the risk of rupture.A 56-year-old Caucasian man with a known 5-year history of an infrarenal abdominal aortic aneurysm was admitted due to critical ischemia of his right lower limb. The patient's left leg had been amputated at the left common femoral artery level (very high femoral amputation) following a car accident 25 years previously. Abdominal computed tomography (CT) 8 months earlier showed a 4 cm infrarenal aneurysm and severe atherosclerosis of both common iliac arteries. Physical examination on admission revealed absent femoral pulses bilaterally with an ankle-brachial index (ABI) on the right of 0.50. A contrast-enhanced CT scan demonstrated complete aneurysm thrombosis extending from the aortic neck to both common, external and internal iliac arteries. Maximal aneurysm diameter was 4.3 cm (Figure 1). Digital subtraction angiography (DSA) confirmed complete aneurysm thrombosis and obstruct
Silent Contained Rupture of an Inflammatory IgG4-Related Abdominal Aortic Aneurysm  [PDF]
Elpiniki Tsolaki, Francesca Papadopulos, Vincenzo Gasbarro, Pierfilippo Acciarri, Francesco Mascoli
World Journal of Cardiovascular Surgery (WJCS) , 2013, DOI: 10.4236/wjcs.2013.34025
Abstract: This report describes a case of a 66-year-old male patient with accidental diagnosis of chronic contained rupture of an aortic aneurysm. Surgery was performed through a median laparotomy. A thick periaortic tissue with fibrosis and lymphnodes covered the AAA. Immunohistochemical examination of the aneurismatic aortic wall revealed intense positivity for inflammatory markers and a large number of immunoglobulin G4 (IgG4) positive cells. The postoperative course was uneventful and patient was discharged in the fifth postoperative day. Patient was then followed periodically at the outpatient rheumatologic clinic. No adverse events occurred during 3 and 6 months follow up. Conclusion: Identification of IgG4-inflammatory aneurysms as an expression of the IgG4-related systemic disease is essential both for clinical follow up and surgical and pharmacological treatment considering the possibility of aneurysm rupture and the involvement of other organs.
Can We Predict Abdominal Aortic Aneurysm (AAA) Progression and Rupture by Non-Invasive Imaging?—A Systematic Review  [PDF]
Abeera Abbas, Rizwan Attia, Alberto Smith, Matthew Waltham
International Journal of Clinical Medicine (IJCM) , 2011, DOI: 10.4236/ijcm.2011.24083
Abstract: Introduction: The most commonly used predictor of aneurysm behavior in clinical decision-making is size. There are however small aneurysms that rupture and certain large aneurysms remain asymptomatic. There is growing evidence to suggest that other variables may provide better information on metabolic and physiological properties of aortic wall and therefore better predict aneurysm behavior. Methods: The literature was systematically reviewed from 1975-May 2011 to examine the evidence to support the use of non-invasive imaging modalities that might predict aneurysm behavior. Results: Ultrasound can be used to measure multiple dynamic aortic properties (i.e. distensibility and compliance) in addition to diameter. These parameters better predict aneurysm behavior. Computer tomography can utilize assessment of aortic calcification, presence of intra-luminal thrombus and distensibility. Finite element analysis model has been validated in-vivo to calculate peak wall stress, assess effects of intra-luminal thrombus and calcification. It however relies on assumptions related to aneurysm properties and therefore remains relatively inaccurate in the clinical setting. Small numbers of observational human studies have evaluated the role of 18F-FDG PET/CT in aneurysms. Larger studies are needed, as 18F-FDG uptake is patchy and heterogeneous even in small number of patients. It varies in the same patient with time, as aneurysms grow in intermittently. We discuss functional magnetic resonance imaging with novel tracers such as 99 mTc-annexin-V and nanoparticles. Conclusion: Multimodality imaging with complementary methods such as CT, functional MRI (fMRI), ultrasound and physiological measurements improve the definition of aneurysm pathobiology. Larger-scale clinical validation is beginning to promise a new paradigm in cardiovascular diagnostics.
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