1/385. Abdominal aortic aneurysm repair in patients with renal allografts.Aortic reconstruction is being reported in an increasing number of patients after renal transplantation as a result of improved renal graft survival and life expectancy. Aortic surgery in these patients places the pelvic allograft at risk for ischemic damage. We present two separate modalities that have been successfully used in protecting the renal transplant from prolonged warm ischemia during abdominal aortic aneurysm (AAA) repair in two cases. One technique involves an aortofemoral shunt using the perirenal aorta for proximal cannulation and the other technique utilizes an indwelling shunt through the prosthetic graft. Both patients had an uneventful recovery with no evidence of renal dysfunction and their renal function has been stable on long-term follow-up. These cases illustrate two useful alternatives in providing pulsatile perfusion to a transplanted kidney in the iliac fossa during AAA repair. They have been used successfully as simpler alternatives to temporary axillofemoral bypass or extracorporeal pump oxygenation in preventing postoperative renal dysfunction.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
2/385. Small ruptured abdominal aneurysm diagnosed by emergency physician ultrasound.Ruptured abdominal aortic aneurysms currently have a high rate of both mortality and misdiagnosis. Aneurysms smaller than 4 cm are not commonly considered for surgical repair. This report describes the case of a ruptured abdominal aneurysm measuring less than 4 cm diagnosed by the emergency physician utilizing bedside ultrasound. Within 30 minutes of arrival at the emergency department the patient's abdominal pain resolved spontaneously after defecation. If the bedside ultrasound had not been performed it is possible the patient would have been discharged from the hospital without surgical intervention. Bedside ultrasound by emergency physicians may improve the diagnosis of ruptured aortic aneurysms, particularly if the presentation is atypical.- - - - - - - - - - ranking = 18.158937144004keywords = mortality, rate (Clic here for more details about this article) |
3/385. Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report.BACKGROUND: The short term experience of endovascular treatment of abdominal aortic aneurysms (AAA) seems promising but long term randomised data are lacking. Consequently, cases treated by endovascular procedures need to be closely followed for potential risks and benefits. CASE REPORT: A 70 year-old mildly hypertensive male without previous or present arteriosclerotic, pulmonary, or urological manifestations was subjected to endovascular treatment after his mass-screening diagnosed abdominal aortic aneurysm had expanded to above 5 cm in diameter, the aneurysm having been found by CT-scanning and arteriography to be endovascularly treatable. A Vanguard bifurcated aortic stent graft was implanted under epidural/spinal anaesthesia and covered by cephalosporine and heparin (8000 IE) protection. Apart from treatment of a groin haematoma and stenosis of the left superficial femoral artery, the postoperative period presented no problems. A few days before the monthly follow-up visit, the patient developed uraemia, gangrene of one foot and dyspnoea. blood glucose and LDH was elevated. Deterioration led to death a month and a half after stent implantation. autopsy showed extraordinary large, extensive soft, brown vegetations in the lower part of the thoracic aorta above the properly infrarenally-placed stent. Microscopic examination revealed multiple microemboli in the liver, spleen, pancreas, intestines, testes, and especially the kidneys. DISCUSSION: Early death from microemboli after aortic stent implantation has been reported. However, the present case developed fatal multiple microemboli so late that they could not have originated from the excluded mural thrombus. The sudden death of an otherwise healthy man of extensive microemboli is difficult to explain. The stent application may have altered the proximal flow and wall movements disposing to microemboli in the case of vegetations.- - - - - - - - - - ranking = 0.22185124782492keywords = death (Clic here for more details about this article) |
4/385. Primary aorto-duodenal fistula secondary to infected abdominal aortic aneurysms: the role of local debridement and extra-anatomic bypass.Gastrointestinal bleeding secondary to spontaneous rupture of an infected abdominal aortic aneurysm into the duodenum is a rare and highly lethal clinical occurrence, representing roughly a third of all primary aortoduodenal fistulas. diagnosis is problematic due to the subtleties in the clinical presentation and course, and surgical treatment is usually delayed, representing a challenge even for the experienced vascular surgeon. The overall mortality is over 30% and the operative approaches are still controversial. Two cases of ruptured infrarenal aortic aneurysms complicated with aortoduodenal fistula were recently treated at our institution. Bacterial aortitis was documented by arterial wall cultures positive for klebsiella and salmonella species respectively. The clinical courses and outcomes of the two patients (one survivor ) treated with retroperitoneal debridement and extra-anatomic bypass and a review of the modern surgical treatment are herein described.- - - - - - - - - - ranking = 17.658937144004keywords = mortality (Clic here for more details about this article) |
5/385. Abdominal aortic aneurysm rupture in systemic lupus erythematosus.Many cardiovascular complications have been described in systemic lupus erythematosus (SLE), however, aortic involvement is very rare. We are reporting abdominal aortic aneurysm rupture in a 47-year old woman with SLE. The patient was admitted to our hospital with severe abdominal pain. Emergency computed tomography of the abdomen demonstrated ruptured abdominal aortic aneurysm. The restoration of aortic flow with vascular prosthesis was performed in emergency. Postoperative course was uneventful.- - - - - - - - - - ranking = 0.5keywords = rate (Clic here for more details about this article) |
6/385. Pseudoaneurysm of the abdominal aorta diagnosed by color duplex Doppler sonography.A pseudoaneurysm of the abdominal aorta is rare, accounting for only 1% of all abdominal aneurysms. More than 1 imaging method may be needed to demonstrate an abdominal aortic pseudoaneurysm. We report a case in which the presence of continuous bidirectional flow in the neck of a pseudoaneurysm on color duplex Doppler sonography confirmed the diagnosis.- - - - - - - - - - ranking = 0.5keywords = rate (Clic here for more details about this article) |
7/385. Aortocaval fistula in ruptured aneurysms.OBJECTIVES: to study incidence, clinical presentation and problems in management of aortocaval fistula in our series. DESIGN: retrospective study. MATERIALS: during a seven-year period, 112 patients operated on for abdominal aortic aneurysm, including four patients with aortocaval fistula. methods: standard repair of aortocaval fistula from inside the aneurysmal sac was the preferred operative technique. RESULTS: the incidence of aortocaval fistula was 3.6%. Three cases were found incidentally during emergency surgery for ruptured aneurysms; the fourth case was an isolated aortocaval fistula associated with inferior vena cava thrombosis, diagnosed preoperatively by angiography. In this case, inferior vena cava ligation instead of standard aortocaval repair was performed. CONCLUSIONS: Aortocaval fistulas, although rare, should be kept in mind, because clinical diagnosis is often difficult. Furthermore, unsuspected problems during repair may necessitate appropriate change in operative technique.- - - - - - - - - - ranking = 0.5keywords = rate (Clic here for more details about this article) |
8/385. Application of trauma concepts in the medical-surgical client.Concepts related to fluid administration, hemodynamic monitoring, bladder pressure monitoring, acid-base status, and temperature management are applicable in all clients, not just those with traumatic injury. Two case studies are illustrated showing how trauma care concepts are also relevant to the acutely ill client. nurses are challenged to identify how the content presented in this symposium can be used for all clients.- - - - - - - - - - ranking = 0.5keywords = rate (Clic here for more details about this article) |
9/385. Repair of abdominal aortic aneurysm in severe factor vii deficiency.Congenital factor vii deficiency is a rare disorder associated with reduced levels of Factor VII activity. Replacement therapy is necessary to control hemorrhaging or if surgery is needed. We report operative treatment of one case of chronic abdominal aortic aneurysm in a patient affected by a severe form of congenital factor vii deficiency (endogenous FVII level <1%). The operation was carried out after the administration of Factor VII concentrate raised the Factor VII concentration to hemostatic levels. The patient continued to receive the concentrate every 6 hrs during the first three postoperative days. Dosage was assessed to obtain Factor VII levels not lower than 25%. No postoperative bleeding or thrombotic events were observed. The patient was discharged in excellent condition.- - - - - - - - - - ranking = 1keywords = rate (Clic here for more details about this article) |
10/385. salmonella mycotic aneurysms: traditional and "alternative" surgical repair with arterial homograft.salmonella infection of the abdominal aorta with formation of mycotic aneurysm is rare, but associated with a high mortality and morbidity. Prompt surgical treatment and selective and prolonged antibiotic therapy are required because of its rapid and impredictable evolution in a short period of time, even if an infectivous etiology is only suspected. methods of revascularization can be different: the traditional two are in situ or extraanatomic bypass using synthetic graft. Both these solutions are subject to complications. An "alternative" method of revascularization with low risk of infection and good patency is the use of arterial homograft in situ. We report two cases of salmonella mycotic aortic aneurysms successfully treated with revascularization respectively by extraanatomic bypass using synthetic graft and in situ arterial homograft. The reasons for our choice are also discussed.- - - - - - - - - - ranking = 17.658937144004keywords = mortality (Clic here for more details about this article) |
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