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G J Akkersdijk

Publications and source records attributed to G J Akkersdijk.

14 recordsLinked to original sources
PubMed1998

Complications of standard elective abdominal aortic aneurysm repair.

OBJECTIVE: To evaluate complications of standard elective repair of infrarenal abdominal aortic aneurysms. DESIGN: Prospective multicentre study. MATERIALS: Two-hundred and ninety-one consecutive patients undergoing standard elective surgery for an infrarenal aortic aneurysm. METHODS: Recording adverse events according to the recommendations of the Ad Hoc Committee on Reporting Standards. RESULTS: Seventy-five patients (26%) experienced some complication following elective aortic aneurysm surgery. Twenty-two patients had a mild complication (7.6%, 95% C.I. 4.8-11.2%), 27 a moderate (9.3%, 95% C.I. 6.2-13.2%) and 26 patients had a severe and/or fatal complication (8.9%, 95% C.I. 5.9-12.8%). The in-hospital mortality was 4.1% (12 patients, 95% C.I. 2.2-7.1%). Cardiac failure was the commonest primary cause for death (58%). Twenty-two per cent of the patients had a non-fatal complication: the most frequent being pulmonary (10%) and cardiac (10%). Patients with a history of cardiac events had a five times higher risk of a fatal outcome (95% C.I. 1.1-24.0) and a two and a half times higher risk of any severe fatal or non-fatal complication (95% C.I. 1.0-6.5). Other risk factors were advancing age and the presence of pulmonary disease. CONCLUSIONS: In addition to mortality, morbidity figures of standard aneurysm operations are important, as well as associated risk factors. This is especially true when evaluating early repair of small aneurysms and new endovascular techniques.

Age Factors↗
PubMed1998

Results of aortic screening in the brothers of patients who had elective aortic aneurysm repair.

BACKGROUND: Brothers of patients with an abdominal aortic aneurysm (AAA) are at high risk. In the present study brothers of patients who underwent elective AAA surgery were invited for aneurysm screening and the psychological consequences studied. METHODS: All brothers over the age of 50 years were invited for abdominal ultrasonography. They were asked to complete a standard psychological well-being questionnaire both before, and 3 months after screening. RESULTS: Some 571 brothers were identified: 251 were dead, 35 lived abroad, 16 could not be contacted for other reasons, 46 refused to participate and 13 were already known to have an AAA. Some 210 subjects (37.8 per cent) accepted the offer of screening. A new AAA was detected in 26 (12.3 per cent, 95 per cent confidence interval 8-18 per cent) of the men screened resulting in an overall prevalence of 18 per cent (95 per cent confidence interval 13-26 per cent). Eight (3.8 per cent) aneurysms were 5 cm or more in diameter and elective surgery was performed in five patients (2.4 per cent). The psychological dimensions of well-being (depression, anxiety, energy, and positive well-being) had not changed significantly 3 months after screening. CONCLUSION: The prevalence of AAA in brothers of patients with AAA is far higher than in the overall male population of the same age. Screening does not seem to have a negative influence on psychological well-being.

Aged↗
PubMed1998

Ruptured abdominal aortic aneurysm: initial misdiagnosis and the effect on treatment.

OBJECTIVE: To evaluate the incidence of misdiagnosis in ruptured abdominal aortic aneurysm and its effect on treatment and outcome. DESIGN: Retrospective study. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 97 consecutive patients admitted with ruptured abdominal aortic aneurysm during the 5-year period, 1 January 1989--31 December 1993. MAIN OUTCOME MEASURES: Initial diagnosis, interval between onset of symptoms and admission, and mortality. RESULTS: 38 Patients (43%) presented with symptoms of their aneurysm exceeding nine hours prior to admission (range 10 hours to 14 days, median 2 days). Fifty patients (60%) were initially misdiagnosed by the referring practitioner. Ultrasonography was consistent with rupture in only 36/70 (51%). 52 Patients died (54%), (operative mortality 45 (46%)), and was not affected by delay in diagnosis or treatment. CONCLUSIONS: Although delay in diagnosis or treatment did not seem to affect mortality, improved awareness of non-specific presentations of (imminent) rupture will result in fewer misdiagnoses and earlier treatment. A group of patients will undoubtedly benefit from this as they can be operated on at a stage when expected mortality is lower.

Aged↗
PubMed1994

Mortality rates associated with operative treatment of infrarenal abdominal aortic aneurysm in The Netherlands.

Information on surgery for non-ruptured and ruptured infrarenal abdominal aortic aneurysm (AAA) in all hospitals in The Netherlands in 1990 was obtained from the Dutch National Medical Registration Foundation. The operation rate in the population over the age of 50 years was 30.3 per 100,000 for non-ruptured AAA and 16.8 per 100,000 for ruptured aneurysm. The hospital operative mortality rate for non-ruptured AAA surgery was 6.8 per cent in 1289 patients and for ruptured aneurysm 43.6 per cent in 709. For non-ruptured AAA the mortality rate almost doubled per age group of 10 years, whereas the influence of age was less significant for ruptured lesions. The operative mortality rate for non-ruptured aneurysm in university hospitals exceeded that in other hospitals, but no difference was found for emergency surgery on ruptured AAA. Nationwide results give a more representative picture of the true mortality rate associated with operation for aortic aneurysm. Such data are important for planning future treatment strategy and for evaluating the efficacy of screening.

Adolescent↗
PubMed1992

[Abdominal aortic aneurysm as incidental finding in abdominal ultrasonography].

Abdominal aortic aneurysm is a life-threatening condition, which usually remains without symptoms until rupture occurs. The only way to reduce the high mortality rate (estimated at over 80%) is elective surgery on suitable patients. Therefore the presence of such an aneurysm has to be detected. For this ultrasonography is the method of choice. We studied 4399 consecutive patients aged 50 years and older, who underwent abdominal ultrasonography for the first time. According to the recommendation of the Dutch Society for Radiodiagnostics the whole abdomen was screened. In 4026 patients (1717 men and 2309 women) the ultrasound examination was performed for non-vascular reasons. In 199 of these patients (4.9%) an abdominal aortic aneurysm was an adventitious finding (133 men (7.7%) and 66 women (2.9%)). In men aged 60 years and older it was even found in 10.2%. When abdominal ultrasonography is performed for the first time in a patient aged 50 years or older, the aorta has to be screened for presence of an aneurysm.

Abdomen↗
PubMed1992

[A patient with Salmonella aortitis].

Bacterial aortitis is a rare but serious condition. Even when treated surgically, the prognosis is poor. Prompt diagnosis is mandatory. In the absence of specific clinical signs, radiological assessment by means of ultrasound and CT is most valuable. The treatment of choice is early surgical drainage, debridement and arterial reconstruction, preferably through uncontaminated tissue combined with antibiotic therapy. We report the case of a man aged 80 with Salmonella aortitis in whom the diagnosis of bacterial aortitis was made by means of ultrasound and CT, following which successful intervention was carried out.

Aged↗
PubMed1991

Abdominal aortic aneurysm as an incidental finding in abdominal ultrasonography.

The difference between the mortality rate from ruptured abdominal aortic aneurysm (overall mortality rate 85-95 per cent and operative mortality rate 23-63 per cent), and that for elective aneurysm repair (less than 5 per cent) is dramatic. Awareness of the existence of an abdominal aortic aneurysm is therefore essential. Of 1800 consecutive patients aged greater than or equal to 50 years referred for their first abdominal ultrasonography, 113 who had been referred specifically for suspected abdominal aortic aneurysm or vascular screening were excluded. The remaining 1687 patients (693 men and 994 women) form the study group. Apart from the symptom-directed examination, the entire abdomen of every patient was routinely studied by ultrasonography. The definition of an abdominal aortic aneurysm was a local dilatation of the aorta with an anteroposterior diameter greater than 30 mm or greater than 1.5 times the anteroposterior diameter of the proximal aorta. In 82 cases (4.9 per cent) an abdominal aortic aneurysm was disclosed; 61 were in men (8.8 per cent) and 21 were in women (2.1 per cent). The prevalence of abdominal aortic aneurysm as an incidental finding in men aged greater than or equal to 60 years was 11.4 per cent. In every patient aged greater than or equal to 50 years undergoing their first abdominal ultrasonography examination, the aorta should be screened for the presence of an aneurysm.

Age Factors↗
PubMed1990

Malignant leiomyomatosis peritonealis disseminata.

Leiomyomatosis peritonealis disseminata is a rare condition characterized by the presence of multiple intraabdominal nodules that consist of benign smooth muscle. We found 42 documented cases in the literature. Malignant degeneration appears to be extremely rare. We describe the second case with proved malignancy.

Abdominal Neoplasms↗