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PubMed1977

Occlusion of the abdominal aorta in a 29-year-old patient.

Following a period of two years with gradually increasing dyspnoe, the patient, a 29-year-old man, suddenly developed acute respiratory distress. On admission to hospital, blood pressure was 260/110, and there were no femoral pulses. Cine-angiography of the aorta revealed a total occlusion from the level of the first lumbar vertebra to the renal arteries. An extensive collateral circulation was visualized. Kidney function was normal. At operation, the aorta was as hard as stone, but the calibre was normal from the diaphragm down to the renal arteries. A dacron graft was inserted, end-to-side between the thoracic aorta and the abdominal aorta distal to the inferior mesenteric artery. Postoperatively, the systemic and ankle blood pressure became near normal. The aetiology of the aortic changes remains unknown. Several possibilities are considered, among them abdominal aortitis and cystic necrosis of the media. Coarctation of the abdominal aorta is less likely, as no narrowing of the aorta was seen at operation.

Adult↗

PubMed1978

Transdiaphragmatic approach to the descending thoracic aorta for proximal control during surgery on the abdominal aorta.

A technic of mobilizing and clamping the lower descending thoracic aorta from the abdomen through the incision in the diaphragm is described. This technic is simple and may be useful when it is difficult to obtain proximal control of the abdominal aorta during surgery. In addition, certain surgical procedures on the upper abdominal aorta may be facilitated by the use of this technic.

Aorta, Abdominal↗

PubMed2003

Total descending thoracic and abdominal aorta grafting in type III aortic dissection with aneurysm.

Single-stage complete replacement of the descending thoracic aorta and the abdominal aorta is a surgical challenge. A 65-year-old man developed acute DeBakey type IIIB aortic dissection and was treated medically. The affected aorta dilated progressively, reaching a maximal diameter of 7 cm 2 years later. Computed tomography revealed a Crawford type II thoracoabdominal aortic aneurysm and an additional infrarenal abdominal aortic aneurysm below the dissected aorta. The descending thoracic aorta and the abdominal aorta were completely replaced with a Hemashield graft under deep hypothermic circulatory arrest. The postoperative course was complicated with transient left hemiparesis and upper gastrointestinal bleeding which were successfully treated by transarterial embolization. The results of this case indicate that complete replacement of the descending thoracic and abdominal aorta can adequately and safely treat type III aortic dissection.

Aged↗

PubMed1984

Ascending-distal abdominal aorta bypass for treatment of hypoplastic aortic arch and atypical coarctation in the adult.

Repair of aortic coarctation is usually an easy operation. However, it can be very difficult under certain circumstances. These include operating on an adult or operating when specific anatomical variations, such as hypoplasia of the transverse aortic arch or calcification of the coarctation area, are present. We recommend that in such cases the situation be handled using ascending aorta-lower abdominal aorta bypass grafts rather than conventional resection and anastomosis of the coarctation itself. The cases of 2 patients are presented in whom a hypoplastic aortic arch associated with atypical coarctation was repaired using such a procedure.

Adult↗

PubMed1988

Coarctation of the abdominal aorta.

Coarctation of the abdominal aorta constitutes a rare group of vascular abnormalities, including segmental stenoses and extended hypoplasia. Hypertension is the usual solitary clinical finding and contrasts with the diversity of anatomic lesions and surgical techniques used for treatment. It is often difficult to determine whether the lesion is congenital or due to Takayasu's aortitis. Three cases of hypoplasia in adolescents are reported. Treatment consisted of an aortoaortic bypass in all cases. Vein angioplasty of the renal arteries was performed concomitantly in one case of inter- and infrarenal hypoplasia associated with stenosis of the two renal arteries. In one of the two cases of suprarenal hypoplasia, the celiac axis was reimplanted after excision of an associated aneurysm. In all three cases, blood pressure returned to normal values without medical treatment.

Adolescent↗

PubMed1979

Spontaneous mycotic aneurysm of the abdominal aorta.

Aneurysms of the abdominal aorta may dissect, become infected, and rupture spontaneously. Since the mortality of infected mycotic aneurysm is high, a rapid diagnosis is a must. We describe a patient with a spontaneous mycotic aneurysm accurately diagnosed by computed tomography.

Aged↗

PubMed1993

[2D-time-of-flight MR angiography in the diagnosis of abdominal aorta aneurysms].

In abdominal aortic aneurysm ultrasonography, contrast-enhanced CT, and digital subtraction angiography (DSA) are the preoperative diagnostic methods of choice accepted today. It was the goal of this study to evaluate time-of-flight magnetic resonance angiography (MRA) in comparison with other radiographic procedures in different types of aneurysms. In 24 patients with proven aortic aneurysm, projection angiograms (MIP algorithm) of the abdominal aorta and pelvic arteries were performed using two-dimensional gradient echo multi slice sequence (FLASH, TE/TR = 10/51 ms; three slices; breathhold technique; flip angle = 30 degrees) in coronal orientation. In addition, renal arteries were imaged in axial slices. The information provided by MRA was comparable to that of DSA (perfused vascular lumen) and contrast-enhanced CT (alteration of vascular wall). Thus dilatation, thrombus, dissection, or inflammation could be analysed safely. Extension of the aneurysm to pelvic arteries could be evaluated in most cases by rotation of the projection angiograms; ostial renal artery disease could be visualized on axial slices. If further technical improvement of MRA is presupposed, this noninvasive method may completely replace the invasive procedures of contrast-enhanced CT and DSA in the future.

Aged↗

PubMed1982

[Coarctation of the thoraco-abdominal aorta. Problems of surgical methodology].

Coarctations of the thoraco-abdominal aorta are rare malformations. Whilst determining the need for surgery, in general because of hypertension, raises few problems, the choice of surgery tactics gives rise to discussion. The choice must above all take into account the risks of visceral ischaemia, in particular affecting the spinal cord, the causes of which are at one and the same time technical (total aortic clamping, sacrifice of the intercostal arteries) and haemodynamic (blood pressure variations). Under such conditions, it would seem necessary to reject resection-suture. Discussion is thus limited to aortoplasty with a widening patch, which is suitable in particular for short stenoses of easy access and to by-pass from ascending aorta to abdominal aorta, electively more indicated in cases of extensive coarctation with severe periaortitis, though the long-term fate of such by-passes remains uncertain.

Adult↗

PubMed2000

[Obstructive uropathy caused by retroperitoneal fibrosis secondary to an aneurysm of the abdominal aorta].

Inflammatory abdominal aortic aneurysms are known to be associated with retroperitoneal fibrosis and ureteral complications. We report a case of an inflammatory aneurysm that produced bilateral ureteral envelopment and obstructive renal failure. Incidence, pathogenesis and clinical onset of this kind of aneurysms and management of the ureteral complications are reviewed.

Aortic Aneurysm, Abdominal↗

PubMed1979

Distribution of intimal smooth muscle cell masses and their relationship to early atherosclerosis in the abdominal aortas of young swine.

In the abdominal aortas of young mash-fed swine, intimal cell masses (pads, cushions) are located predominantly away from blood vessel orifices. They are found scattered throughout the aorta but nevertheless have a definite pattern of distribution. In the distal one half of the abdominal aorta, they are more frequent in the ventral quandrant than in the dorsal or either lateral quadrant. In the proximal half, intimal cell masses are more frequent in the dorsal quadrant. When experimental atherosclerosis is induced in the abdominal aortas of young swine by either a hypercholesterolemic diet or by aortic ballooning followed by a hypercholesterolemic diet, the distribution of early lesions is similar. The lesions are found predominantly in quadrants where intimal cell masses were found to be most frequent in the control group of swine. The results suggest that most of the lesions, though not necessarily all, arose from pre-existing intimal cell masses beneath the aortic surface.

Animals↗

PubMed1984

Comparison of fenestrations in internal elastic laminae of canine thoracic and abdominal aortas.

All non-elastin tissue was removed from canine aortas by placing them in 0.1 N NaOH at 75 degrees C for varying periods of time. The segments of aorta were weighed in a Mettler Chemical Balance at intervals. In 10 dogs the average weight of the thoracic aorta was 5.01 +/- 0.388 (SE) g while that of the abdominal aorta was 3.08 +/- 0.346 g. After digestion, the thoracic aorta weighed 3.34 +/- 0.0275 g and the abdominal aorta 0.85 +/- 0.085 g. Thus, the elastin makes up 67% of the thoracic aorta but only 28% of the abdominal aorta. These are equivalent to 0.334 g/kg body weight for the thoracic aorta and 0.224 g/kg body weight for the abdominal aorta. The values were always stable between 5 and 7 h and usually between 3 and 12 h. Aortic elastin was obtained from 5 dogs after 5-7 h of digestion and prepared for analysis by scanning electron microscopy. The dimensions of the fenestrations in the internal elastic laminae were quantified as described previously. The lower abdominal aorta had the largest holes (2.227 +/- 0.048 micron), and the upper thoracic aorta the smallest holes (0.954 +/- 0.032 micron). There was no significant difference in the size of the fenestrations along the thoracic aorta, but those in the lower abdominal aorta were larger than those in the upper abdominal aorta. The possible significance of the fenestrations in the genesis of aortic disease is discussed briefly.

Animals↗

PubMed2005

Treatment options for traumatic pseudoaneurysms of the paravisceral abdominal aorta.

Penetrating gunshot wounds (GSWs) to the abdominal aorta are frequently lethal. Alternative management options for treatment of traumatic pseudoaneurysms of the abdominal aorta are illustrated by three patient case histories. Patient A sustained two GSWs to the abdomen (midepigastrium, right subcostal region). He was hypotensive in the field. Emergent laparotomy was undertaken with suture ligature of a celiac injury and distal pancreatectomy/splenectomy for a pancreatic injury. Postoperative abdominal CT for an intraabdominal infection with leukocytosis revealed a 4 cm traumatic pseudoaneurysm of the abdominal aorta that extended from the suprarenal aorta to the level of the renal arteries. Six weeks later, he underwent an open repair. Patient B sustained multiple GSWs to his right arm and right upper quadrant. He was hemodynamically stable. He underwent abdominal exploration for a grade 3 liver laceration. Postoperative abdominal CT revealed a supraceliac abdominal aortic pseudoaneurysm. An aortogram demonstrated a 1.5 cm defect in the aortic wall above the celiac trunk communicating with the inferior vena cava (IVC). He underwent endovascular repair with covered aortic stent graft. Patient C sustained multiple thoracoabdominal GSWs. He was hemodynamically stable. Emergent laparotomy revealed multiple left colonic perforations, two duodenal lacerations, and an unsalvageable left kidney laceration. Postoperatively, he developed a duodenal-cutaneous fistula with multiple intraabdominal abscesses. Serial CT scans revealed an enlarging infrarenal aortic pseudoaneurysm. He underwent angiographic coil embolization and intraarterial injection of thrombin into the pseudoaneurysm sac. The average time from injury to surgical treatment was 46 days (range 29-67). Postoperatively, none of the patients developed paraplegia. Advances in endovascular techniques have provided options to deal with traumatic pseudoaneurysms of the abdominal aorta. In a hemodynamically stable patient with a traumatic pseudoaneurysm, careful selection of a specific intervention can be tailored to the clinical scenario electively.

Adolescent↗

PubMed1988

Seatbelt injury to the abdominal aorta.

Seatbelt injury to the abdominal aorta is a rare finding with an unresolved mechanism. We present a case in which a rear-seat passenger wearing a lap belt was involved in a motor vehicle accident. Injuries sustained included a contused abdominal aorta. At the time of aortic repair, the involved segment was found to be atheromatous, had an intimal tear, and a flap that caused complete occlusion. Graft replacement was carried out employing a 12-mm DeBakey woven dacron prosthesis, which restored satisfactory circulation to both lower limbs. The patient developed myoglobinemia and subsequently died due to multiple organ failure 19 days following the accident. Tearing against the vertebral column, and bowel loop entrapment, in high-speed deceleration have been implicated as injury mechanisms as well as impingement by the belt or metal buckle, in such injuries. Also, our patient had existing atheromatous plaque, which was ruptured.

Accidents, Traffic↗

PubMed1985

Proliferation of smooth muscle cells in the thoracic aorta after injury to the abdominal aorta: evidence for a humoral mediator in experimental arteriosclerosis.

We tested the hypothesis that circulating humoral material(s) can induce vascular smooth muscle cells to synthesize DNA and to proliferate. Either the entire aorta or its abdominal segment was balloon de-endothelialized in four groups of rabbits. In the first group (control), the entire aorta was injured, and no further procedures were carried out. In a second group (reinjury), the abdominal aortic segment was reinjured 4 days after the initial de-endothelialization procedure. A third group (sham) had a second sham operation 4 days after initial injury. In a fourth group (abdominal only), the abdominal aortic segment was injured on two occasions 4 days apart. There was a rise in the specific activity of 3H-thymidine incorporation into smooth muscle cell DNA (DNA-SA) of the thoracic segments, which began 12 hours after reinjury, peaked within 24 hours at 335 +/- 63 dpm/micrograms DNA (+/- SEM), and returned to control level within 72 hours. The DNA-SA of the thoracic aorta of control rabbits and sham-operated animals 4.5 days after the initial injury was 86 +/- 19 and 48 +/- 8 dpm/micrograms DNA, respectively. There was no rise in DNA-SA in the thoracic aorta of animals in which the abdominal aorta was injured twice. Intimal cell nuclei per 0.1 mm internal elastic lamina were counted 3 days after the second injury and showed similar differences between doubly injured and control animals. Platelet accumulation, as measured by chromium 51 platelet attachment to the aortic surface, was increased in the abdominal segment 12 hours after reinjury.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

[Mycotic aneurysm of the abdominal aorta].

Mycotic aneurysm of the abdominal aorta is an uncommon disease that carries a high mortality rate. In this report, two patients with this disease are presented. In the first case, Salmonella sp was cultured from an atherosclerotic aneurysm, and in the second patient, the aneurysm was a complication of Staphylococcus aureus bacterial endocarditis. Both presented suggestive clinical findings of the disease with fever, back pain, and pulsatile and expansive abdominal mass. The first patient was submitted to emergency aneurysmectomy with insertion of a dacron aorto-bi-iliac prosthesis and antibiotic therapy for a long period. He died two months after surgery due to upper gastrointestinal tract bleeding. The second patient was submitted to a successful and not yet described arterial reconstruction which included ligation of the aortic aneurysm and interposition of an aorto-bi-iliac sequential venous graft with reverse autologous saphenous vein. The authors consider this technique to be a good choice for the surgical treatment of mycotic aneurysm of the abdominal aorta particularly because it enables to avoid synthetic prosthesis.

Adult↗

PubMed1992

Effects of a thromboxane synthetase inhibitor (OKY-046) on vascular reactivity to angiotensin II after stricture of the abdominal aorta in pregnant rabbits.

The abdominal aorta of 20 pregnant rabbits was surgically constricted below the renal arteries on the 21st day of pregnancy, producing a stricture that decreased the blood flow by 60%. Four pregnant rabbits underwent sham operation and served as control. The pressor response to angiotensin II (A-II) was assessed by measuring the systolic blood pressure in the ear of rabbits. We intravenously administered 20 mg/kg of OKY-046, a thromboxane A2 (TXA2) synthetase inhibitor (OKY group: n = 13) or saline (n = 7) daily from the 23rd day of pregnancy until the day of delivery. After stricture of the abdominal aorta, the "effective pressor dose" (EPD:nanograms of A-II/kg/min necessary to cause a 20 mmHg rise in systolic pressure) was significantly lower in the saline group than in the control group. On the 27th and 29th day of pregnancy, the EPD in the OKY group was significantly higher than that in the control group. The plasma thromboxane B2 (TXB2) level in the OKY group was significantly lower than that in the saline group on the 27th day. The fetal birth weight in the saline group was significantly lower than that in the control group. These finding suggest that OKY-046 restores the vascular refractoriness induced by A II and suppresses TXA2 synthesis in pregnant rabbits with aortic constriction.

Angiotensin II↗

PubMed1995

Dissecting thoracic aorta and fusiform aneurysm of the abdominal aorta.

A 59-year-old woman with dissection of the thoracic aorta and a fusiform aneurysm of the abdominal aorta without evidence of Marfan's syndrome underwent aneurysmorrhaphy with a bifurcated expanded polytetrafluoroethylene graft. Histological specimens of the aneurysmal wall revealed the presence of idiopathic cystic medial necrosis. As typical findings of idiopathic cystic medial necrosis in the aortic wall are very rare except in cases of Marfan's syndrome, the present case is reported and the implications of this condition are discussed.

Aortic Dissection↗

PubMedDate not supplied

Finite element modeling of three-dimensional pulsatile flow in the abdominal aorta: relevance to atherosclerosis.

The infrarenal abdominal aorta is particularly prone to atherosclerotic plaque formation while the thoracic aorta is relatively resistant. Localized differences in hemodynamic conditions, including differences in velocity profiles, wall shear stress, and recirculation zones have been implicated in the differential localization of disease in the infrarenal aorta. A comprehensive computational framework was developed, utilizing a stabilized, time accurate, finite element method, to solve the equations governing blood flow in a model of a normal human abdominal aorta under simulated rest, pulsatile, flow conditions. Flow patterns and wall shear stress were computed. A recirculation zone was observed to form along the posterior wall of the infrarenal aorta. Low time-averaged wall shear stress and high shear stress temporal oscillations, as measured by an oscillatory shear index, were present in this location, along the posterior wall opposite the superior mesenteric artery and along the anterior wall between the superior and inferior mesenteric arteries. These regions were noted to coincide with a high probability-of-occurrence of sudanophilic lesions as reported by Cornhill et al. (Monogr. Atheroscler. 15:13-19, 1990). This numerical investigation provides detailed quantitative data on hemodynamic conditions in the abdominal aorta heretofore lacking in the study of the localization of atherosclerotic disease.

Algorithms↗