1/52. Percutaneous fenestration of the aortic dissection membrane in malperfusion syndrome.We present two cases of malperfusion syndrome due to aortic dissection type-B. A supra-renal blind sac phenomenon resulted in renal failure and absent femoral pulses in both patients. Additionally, one patient suffered from spinal cord ischemia, the other from severe abdominal pain. By interventional techniques, catheter perforation of the blind sac was achieved. The resulting re-entries were enlarged with a balloon catheter. Distal perfusion without pressure gradients was restored by this technique in both patients and resulted in complete relief of symptoms. Percutaneous fenestration of the aortic dissection membrane may be an alternative to operative treatment in malperfusion syndrome.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/52. Abdominal pulsatile tumor after endovascular abdominal aortic aneurysm repair.A 70 years old patient was successfully treated for infrarenal aortic aneurysm by an endovascular bifurcated prosthesis. Three months later, because of dysuria, he underwent urological examination revealing an abdominal pulsatile tumor. Thereafter, the patient was sent to our emergency ward with suspected symptomatical endoleak. Radiological screening by computer tomography and magnetic resonance angiography showed good post-operative results without endoleak. Patient was treated with antispasmodic medication and is doing well today. Because endovascular repair of aortic aneurysm, in contrast to an open approach, does not eliminate the aneurysm itself, post-operative abdominal palpation can be ambiguous. magnetic resonance angiography--without the need of nephrotoxic contrast medium--compares favourably to CT and provides excellent pictures with less artefacts for post-operative screening of endoleak. If reperfusion can be excluded, pulsation is due to the transmission of the blood-pressure wave to the thrombosed aneurysm.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/52. 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 = 1keywords = pressure (Clic here for more details about this article) |
4/52. Two-step approach for the operation of male breast cancer: report of a case at high risk for surgery.We report herein the rare case of a 61-year-old man with a history of dissecting aortic aneurysm as well as right breast cancer. He complained of abdominal pain due to a progress of aortic dissection in preparation for the radical operation for breast cancer. blood pressure was initially controlled and he was administered a simple mastectomy under local anesthesia. One month after the first operation, a radical operation for breast cancer was successfully performed. The tumor was in stage II, and two years after the operation, the patient remained free of recurrent disease. This two-step approach for the operation of male breast cancer may be used as a treatment of breast cancer if a patient is too frail for normal surgery.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/52. Unsuspected pheochromocytoma with abdominal aortic aneurysm--a case report.This case report describes the peri-operative management of a 65-year-old man with an unsuspected pheochromocytoma. He underwent emergent surgery for a rupturing abdominal aortic aneurysm. During surgery his blood pressure changed dramatically and was resistant to drug treatment. A pheochromocytoma was suspected, but the emergency precluded immediate investigation. A second hypertension episode occurred in the intensive care unit, and CT revealed an abnormal adrenal mass. Surgery for the pheochromocytoma was carried out successfully later, with the hypertension being managed very carefully. We considered that exposure to extraordinary catecholamine levels from the pheochromocytoma might have contributed to the development of the abdominal aortic aneurysm.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/52. Intraoperative rupture of an abdominal aortic aneurysm during an endovascular stent-graft procedure.PURPOSE: To highlight the risk of intraoperative rupture as a complication of endovascular aortic repair. CLINICAL FEATURES: An 81-yr-old man was admitted for endovascular aortic repair of a 6 cm infrarenal abdominal aortic aneurysm. After establishment of a conduction blockade using a combined spinal-epidural technique, a balloon-activated endovascular stent-graft was advanced to the proximal aneurysmal neck. Approximately four minutes after the stent-graft was deployed, the mean arterial pressure decreased to 30 mmHg and the heart rate increased to 135 bpm. While fluid and vasoactive medications were administered and the airway was secured, repeat aortography confirmed contrast extravasation into the retroperitoneal space at the junction of the proximal aortic neck and the aneurysm sac. The angioplasty deployment balloon was repositioned and inflated proximal to the presumed site of aortic rupture, thus providing aortic control until an open repair of the aorta was undertaken. CONCLUSION: Although endovascular stent-graft placement may be a less invasive method than conventional open aortic reconstruction, it must be recognized that the potential for devastating consequences such as aortic rupture is present.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/52. Successful completion of endoluminal repair of an abdominal aortic aneurysm after intraoperative iatrogenic rupture of the aneurysm.PURPOSE: A method of achieving successful completion of endoluminal repair of an abdominal aortic aneurysm (AAA) in the presence of intraoperative iatrogenic rupture of the aneurysm is reported. methods: An 83-year-old woman with an AAA that was 7 cm in diameter was treated electively by means of endoluminal repair with a Vanguard bifurcated prosthesis (boston Scientific, Natick, Mass). No difficulty was experienced with the introduction of the delivery catheter, despite extreme angulation in the aneurysm. An acute episode of hypotension prompted an aortogram to be performed. Extravasation of contrast outside the aneurysm sac was demonstrated. The balloon on the delivery catheter was immediately advanced to the suprarenal aorta and inflated. hypotension was reversed, and hemodynamic stability was restored, thus enabling deployment of the prosthesis to proceed and the repair to be completed by means of the endoluminal method. RESULTS: The patient's blood pressure remained stable after deflation of the balloon, allowing a postprocedure aortogram to be performed. Exclusion of the aneurysm sac was demonstrated. Exclusion of the aneurysm sac from the circulation and a large retroperitoneal hematoma were confirmed by means of a postoperative contrast computed tomography scan. convalescence was complicated by acute renal failure, pneumonia, and prolonged ileus. The patient remained well and active at the follow-up examination 6 months after operation. CONCLUSION: Iatrogenic perforation of an AAA during endoluminal repair may be treated by endovascular means and does not necessarily require conversion to open repair, although this may be the safest option.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/52. cholesterol embolism in a patient with inflammatory abdominal aortic aneurysm.A 66-year-old man whose renal function had progressively deteriorated had an elevated blood pressure and also was found to have an inflammatory abdominal aortic aneurysm (AAA). Blood examination revealed that he had eosinophilia. livedo reticularis of the toes developed, and a skin biopsy specimen showed embolization of atheromatous plaques in the arterioles of the subcutaneous tissue. Progressive enlargement of inflammatory AAA may have dislodged the atheromatous plaques, resulting in cholesterol embolism.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/52. Reversal of twice-delayed neurologic deficits with cerebrospinal fluid drainage after thoracoabdominal aneurysm repair: a case report and plea for a national database collection.Delayed neurologic deficits are an uncommon yet devastating complication of thoracoabdominal aortic aneurysm repair. The mechanisms involved in the development of delayed spinal cord ischemia remain ill defined. We report a case of complete reversal of delayed neurologic deficits with postoperative cerebrospinal fluid (CSF) drainage. After a thoracoabdominal aneurysm extent I repair, the patient experienced delayed paraplegia at 6 hours and again at 34 hours after the operation, with elevated CSF pressure (>10 mm Hg) on both occasions. Prompt CSF decompression completely reversed the neurologic deficits within hours after onset. The findings in this case further support the role of CSF drainage in spinal cord protection for patients who undergo thoracoabdominal aneurysm repair and make a plea for a national database collection.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/52. Surgical treatment of Takayasu's arteritis: case report and literature review.Surgical intervention during the early stages of Takayasu's arteritis is rarely necessary. In the chronic stages of this disease, however, surgeons may be faced with difficult decisions regarding the timing of complex arterial reconstructions. These issues can be especially challenging in the pediatric population. We report the case of an 8-year-old girl with chronic Takayasu's arteritis complicated by malignant hypertension. Despite aggressive medical therapy, her blood pressure remained uncontrolled. Imaging studies demonstrated infrarenal aortic and right common iliac artery aneurysms with concomitant segmental stenosis of the right common iliac artery. Since her transplant kidney was based off the right external iliac artery, it was felt that this high-grade stenosis was responsible for her severe hypertension. Immediate surgical reconstruction was therefore recommended. Intraoperatively, the aneurysmal aorta and iliac arteries were found to be densely calcified. The transplant kidney was perfused during aortic clamping by placement of a suprarenal aorta to the right external iliac artery shunt. Endoaneurysmorrhaphy was then performed to reconstruct the aorta after extensive endarterectomy. In the early postoperative period, antihypertensive medications were decreased to two oral agents. She was discharged on the seventh postoperative day and placed on two agents. At a 1-year follow-up visit, she is on one antihypertensive medication. Her right leg complaints have resolved. Ultrasound surveillance revealed no evidence of recurrent aneurysmal or occlusive disease. A brief review of complications related to Takayasu's arteritis in the children and indications for surgical intervention completes this report.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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