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ruptured abdominal aortic aneurysm

Betty Leclerc, Lucie Salomon Du Mont, Anne-Laure Parmentier, Guillaume Besch, Simon Rinckenbach
BACKGROUND: The abdominal compartment syndrome (ACS) has been clearly identified as being one of the main causes of mortality after ruptured abdominal aortic aneurysm (rAAA). The ACS is defined as a sustained intra-abdominal pressure > 20 mm Hg associated with a new organ dysfunction or failure. A pilot study was conducted and found that the threshold of 3 among 8 selected criteria, we would predict an ACS occurrence with a 54% positive predictive value and a 92% negative predictive value...
June 2018: Medicine (Baltimore)
Yohei Kawatani, Hirotsugu Kurobe, Yoshitsugu Nakamura, Takaki Hori
A 78-year-old man with no history of allergy, underwent endovascular aortic repair for abdominal aortic aneurysm rupture. Postoperatively, he had low-grade fever and persistently raised white blood cell counts, but tests showed no infection. A skin rash appeared on the trunk and upper arms; we suspected a drug allergy. Despite withdrawal and/or change of medications, the symptoms remained. Finally, a patch test for nickel showed a strongly positive result. Oral prednisone 5 mg·day-1 was started, and the clinical findings resolved thereafter...
January 1, 2018: Asian Cardiovascular & Thoracic Annals
Melanie R Hoehn, Natasha Z Hansraj, Amelia M Pasley, Megan Brenner, Samantha R Cox, Jason D Pasley, Jose J Diaz, Thomas Scalea
BACKGROUND: Hemorrhagic shock is the second leading cause of death in blunt trauma and a significant cause of mortality in non-trauma patients. The increased use of resuscitative endovascular balloon occlusion of the aorta (REBOA) as a bridge to definitive control for massive hemorrhage has provided promising results in the trauma population. We describe an extension of this procedure to our hemodynamically unstable non-trauma patients. METHODS: This is a retrospective review of patients requiring REBOA for end stage non-traumatic abdominal hemorrhage from our tertiary care facility...
June 19, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Masamichi Nogi, Kimio Satoh, Shinichiro Sunamura, Nobuhiro Kikuchi, Taijyu Satoh, Ryo Kurosawa, Junichi Omura, Md Elias Al-Mamun, Mohammad Abdul Hai Siddique, Kazuhiko Numano, Shun Kudo, Satoshi Miyata, Masatoshi Akiyama, Kiichiro Kumagai, Shunsuke Kawamoto, Yoshikatsu Saiki, Hiroaki Shimokawa
Background -Thoracic aortic aneurysm (TAA) and dissection (TAD) are fatal diseases, which cause aortic rupture and sudden death. The small GTP-binding protein GDP dissociation stimulator (SmgGDS) is a crucial mediator of the pleiotropic effects of statins. Previous studies revealed that reduced force generation in AoSMCs causes TAA and TAD. Methods -To examine the role of SmgGDS in TAA formation, we employed an angiotensin II (AngII, 1,000 ng/min/kg, 4 weeks)-induced TAA model. Results -33% Apoe-/- SmgGDS+/- mice died suddenly due to TAA rupture, whereas there was no TAA rupture in Apoe-/- control mice...
June 19, 2018: Circulation
Masaru Kimura, Katsuyuki Hoshina, Kazuhiro Miyahara, Jun Nitta, Masaharu Kobayashi, Sota Yamamoto, Marie Ohshima
OBJECTIVE: The objective of this study was to use parameters to determine the geometric differences between ruptured abdominal aortic aneurysms (AAAs) and nonruptured AAAs. METHODS: Computed tomography data of 38 ruptured AAAs and 215 electively repaired (nonruptured) AAAs were collected from multiple institutes. We compared the ruptured AAA group and nonruptured AAA group with 1:1 matching by using the Mahalanobis distance, which was calculated using the patient's age, sex, and AAA diameter...
June 15, 2018: Journal of Vascular Surgery
Vivekanand Rajendran, Krishnaswamy Sundararajan, Alice Sawka
Aortocaval fistulas (ACFs) are rare with varied etiologies. Symptoms can be acute or delayed with predominant manifestations being high output cardiac failure. Acute coronary syndrome due to ACF has not been widely reported. We present a case of a 68-year-old male who presented with signs and symptoms suggestive of acute coronary syndrome. This was confirmed by electrocardiogram changes and a rise in cardiac enzymes. A large abdominal aortic aneurysm was diagnosed initially by imaging without evidence of leak or rupture...
May 2018: Indian Journal of Critical Care Medicine
Bartosz Symonides, Andrzej Śliwczyński, Zbigniew Gałązka, Jarosław Pinkas, Zbigniew Gaciong
OBJECTIVES: The aim of the study was to compare short and long-term mortality and readmissions in patients with non-ruptured abdominal aortic aneurysm (AAA) treated with endovascular aortic repair (EVAR) or open aneurysm repair (OAR). DESIGN: Retrospective survival analysis based on prospectively collected medical records of the national Polish public health insurer. MATERIALS: In the National Health Fund database we identified all patients who underwent elective open or endovascular treatment of AAA between January 1st 2011 and March 22nd 2016...
2018: PloS One
Daniel H Moreno, Daniel G Cacione, Jose Cc Baptista-Silva
BACKGROUND: An abdominal aortic aneurysm (AAA) is the pathological enlargement of the aorta and can develop in both men and women. Progressive aneurysm enlargement can lead to rupture. The rupture of an AAA is frequently fatal and accounts for the death from haemorrhagic shock of at least 45 people per 100,000 population. The outcome of people with ruptured AAA varies among countries and healthcare systems, with mortality ranging from 53% to 90%. Definitive treatment for ruptured AAA includes open surgery or endovascular repair...
June 13, 2018: Cochrane Database of Systematic Reviews
Zonglin Han, Tangshan Zhang, Yuxiang He, Gang Li, Gang Li, Xing Jin
The risk of rupture, the most feared clinical consequence of abdominal aortic aneurysm, increases with the enlargement of aorta. MicroRNA-29b (miR-29b) has emerged as a key modulator of extracellular matrix (ECM) homeostasis and thereby is proposed to play a crucial role in vascular remodeling. However, agents that alter miR-29b expression are relatively inefficient in the aorta, likely due to inferior uptake. Herein we found that miR-29b was upregulated in aortic smooth muscle cells upon prostaglandin E2 (PGE2 ) stimulation whereas indomethacin treatment downregulated miR-29b expression...
July 2018: Experimental and Therapeutic Medicine
A S Ribner, A K Tassiopoulos
The abdominal aorta is the most common site of an aortic aneurysm. The visceral and most proximal infrarenal segment (aneurysm neck) are usually spared and considered more resistant to aneurysmal degeneration. However, if an abdominal aortic aneurysm (AAA) is left untreated, the natural history of the aortic neck is progressive dilatation and shortening. This may have significant implications for patients undergoing endovascular repair of AAAs (EVAR) as endograft stability and integrity of the repair are dependent on an intact proximal seal zone...
June 2018: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Davide Carino, Timur P Sarac, Bulat A Ziganshin, John A Elefteriades
Abdominal aortic aneurysm (AAA) is defined as a permanent dilatation of the abdominal aorta that exceeds 3 cm. Most AAAs arise in the portion of abdominal aorta distal to the renal arteries and are defined as infrarenal. Most AAAs are totally asymptomatic until catastrophic rupture. The strongest predictor of AAA rupture is the diameter. Surgery is indicated to prevent rupture when the risk of rupture exceeds the risk of surgery. In this review, we aim to analyze this disease comprehensively, starting from an epidemiological perspective, exploring etiology and pathophysiology, and concluding with surgical controversies...
June 2018: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Ivika Heinola, Karl Sörelius, Thomas R Wyss, Nikolaj Eldrup, Nicla Settembre, Carlo Setacci, Kevin Mani, Ilkka Kantonen, Maarit Venermo
BACKGROUND: The treatment of mycotic abdominal aortic aneurysm requires surgery and antimicrobial therapy. Since prosthetic reconstructions carry a considerable risk of reinfection, biological grafts are noteworthy alternatives. The current study evaluated the durability, infection resistance, and midterm outcome of biological grafts in treatment of mycotic abdominal aortic aneurysm. METHODS AND RESULTS: All patients treated with biological graft in 6 countries between 2006 and 2016 were included...
June 9, 2018: Journal of the American Heart Association
Mathias Peirlinck, Matthieu De Beule, Patrick Segers, Nuno Rebelo
Patient-specific biomechanical modeling of the cardiovascular system is complicated by the presence of a physiological pressure load given that the imaged tissue is in a pre-stressed and -strained state. Neglect of this prestressed state into solid tissue mechanics models leads to erroneous metrics (e.g. wall deformation, peak stress, wall shear stress) which in their turn are used for device design choices, risk assessment (e.g. procedure, rupture) and surgery planning. It is thus of utmost importance to incorporate this deformed and loaded tissue state into the computational models, which implies solving an inverse problem (calculating an undeformed geometry given the load and the deformed geometry)...
May 28, 2018: Journal of the Mechanical Behavior of Biomedical Materials
O Martinelli, C Fenelli, J Ben-Hamida, M Fresilli, F G Irace, V Picone, A Malaj, B Gossetti, L Irace
OBJECTIVE: Treatment of ruptured abdominal aortic aneurysms (rAAAs) is still burdened by high morbidity and mortality. Although endovascular aortic repair (EVAR) offers encouraging results in elective setting, its role as first line strategy to treat rAAA is still debated. Our aim was to compare early and late outcomes in patients undergoing open surgical repair (OSR) compared with those submitted to vs EVAR for rAAAs. METHODS: A retrospective review of data extracted from medical records identified 105 consecutive patients with rAAA who were submitted to open or endovascular repairs from 2008 to 2016...
June 6, 2018: Annals of Vascular Surgery
Lixin Wang, Shuangchao Liang, Xin Xu, Bin Chen, Junhao Jiang, Zhenyu Shi, Xiao Tang, Xiushi Zhou, Min Zhou, Daqiao Guo, Weiguo Fu
BACKGROUND: Bell-bottom technique (BBT) is one method to preserve the internal iliac artery during EVAR for abdominal aortic aneurysm(AAA) that extend to iliac artery. The data on the efficacy of this technique is still limited. We sought to evaluate the mid-term efficacy of BBT by using different stent-grafts in the treatment of AAA combined with iliac artery aneurysm (IAA). METHODS: From January 2011 to December 2016, AAA patients with IAA using BBT to preserve the internal iliac artery were retrospectively analyzed in our institution...
June 6, 2018: Annals of Vascular Surgery
Konstantinos G Moulakakis, Vangelis G Alexiou, Georgios Karaolanis, George S Sfyroeras, George Theoharopoulos, Andreas Lazaris, John Kakisis, George Geroulakos
AIM: Spinal cord ischemia (SCI) following endovascular abdominal aortic aneurysm (AAA) repair (EVAR) is a rare but devastating complication. The mechanism underlying the occurrence of SCI following EVAR seems to be multifactorial and is underreported and not fully elucidated. The aim of the study was to investigate the clinical outcomes in patients with this serious complication. MATERIAL-METHODS: A systematic review of the current literature, as per PRISMA statement guidelines, to evaluate the incidence of SCI following elective EVAR was performed...
June 6, 2018: Annals of Vascular Surgery
Kikuo Isoda, Koji Akita, Kenichi Kitamura, Yayoi Sato-Okabayashi, Tomoyasu Kadoguchi, Sarasa Isobe, Fumie Ohtomo, Motoaki Sano, Kazunori Shimada, Yoichiro Iwakura, Hiroyuki Daida
BACKGROUND: Angiotensin II (Ang II) activates components of the inflammatory cascade, which promotes hypertension and development of abdominal aortic aneurysm (AAA). This study aimed to elucidate the effects of an IL-1 receptor antagonist (IL-1Ra) and an anti-IL-1β antibody (01BSUR) on Ang II-induced AAA. METHODS AND RESULTS: Male wild-type (WT) and IL-1Ra-deficient (IL-1Ra- / - ) mice were infused with Ang II (1000 ng/kg/min) using subcutaneous osmotic pumps for 28 days...
June 5, 2018: International Journal of Cardiology
Nikesh Dattani, Robert D Sayers, Matthew J Bown
INTRODUCTION: Diabetes mellitus appears to be negatively associated with abdominal aortic aneurysm; however, the mechanisms underlying this relationship remain poorly understood. The aim of this article is to provide a comprehensive review of the currently understood biological pathways underlying this relationship. METHODS: A review of the literature ('diabetes' OR 'hyperglycaemia' AND 'aneurysm') was performed and relevant studies grouped into biological pathways...
June 1, 2018: Diabetes & Vascular Disease Research
Pinar Ulug, Robert J Hinchliffe, Michael J Sweeting, Manuel Gomes, Matthew T Thompson, Simon G Thompson, Richard J Grieve, Raymond Ashleigh, Roger M Greenhalgh, Janet T Powell
BACKGROUND: Ruptured abdominal aortic aneurysm (AAA) is a common vascular emergency. The mortality from emergency endovascular repair may be much lower than the 40-50% reported for open surgery. OBJECTIVE: To assess whether or not a strategy of endovascular repair compared with open repair reduces 30-day and mid-term mortality (including costs and cost-effectiveness) among patients with a suspected ruptured AAA. DESIGN: Randomised controlled trial, with computer-generated telephone randomisation of participants in a 1 : 1 ratio, using variable block size, stratified by centre and without blinding...
May 2018: Health Technology Assessment: HTA
Linda J Wang, Anand M Prabhakar, Christopher J Kwolek
Aortic aneurysms are the 13th leading cause of death in the United States. While aneurysms can occur along the entire length of the aorta, the infrarenal location is the most common. Targeted ultrasound screening has been found to be an effective and economical means of preventing aortic aneurysm rupture. The indication for repair includes either symptomatic aneurysms or aneurysms with a diameter greater than 5.4 cm. Treatment options for the repair of infrarenal aortic aneurysms are open surgical repair (OSR) and endovascular aneurysm repair (EVAR)...
April 2018: Cardiovascular Diagnosis and Therapy
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