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PubMed1975

[Profuse hemorrhage into the digestive tract in aortic diseases].

Four observations of the aortic aneurysm rupture with hemorrhage into the jejunum (2 cases), duodenum (1 case), esophagus (1 case) are reported. The causes of development of pathological changes in the aortic wall were as follows; atherosclerosis - in 3 patients, tuberculosis - in 1.

Aged↗
PubMed1989

[Postoperative results and follow-up of thoracic aortic diseases using magnetic resonance tomography].

Operations of the thoracic aorta for aneurysms, dissections, or congenital malformations may lead to early or late complications. Therefore, postoperative control for documentation of the surgical results, for exclusion of early changes and for comparison with later controls is mandatory. To demonstrate that magnetic resonance imaging (MRI), which we already had used with good results for preoperative studies is also able to detect postoperative abnormalities, we examined 30 patients with thoracic aortic disease (20 male, 10 female, mean age 53 +/- 13.7 years) with this diagnostic tool. There were 19 arteriosclerotic aneurysms, 10 dissections, and one aortic tumor. With MRI it was possible in all patients to visualize the results of the surgical treatment postoperatively. Early postoperative complications could be excluded, or demonstrated in one case of a retrograde aortic dissection or a hematopericardium. These pathological findings could also be shown by arterial digital subtraction angiography or echocardiography. Using MRI for follow-up of aortic dissections, the development of an aneurysm of the aortic root in a Marfan-patient could be detected. In all these patients, it was possible to differentiate true and false lumen and to detect the origin of major side branches. The diagnostic advantages of MRI, which we compared with other imaging methods, as echocardiography, computed tomography or angiography are that postoperative complications of thoracic aortic aneurysm surgery can be reliably detected and visualized in 3 different planes. Non-invasiveness, the omission of ionizing radiation and no risk of contrast media application underline that magnetical resonance imaging is an ideal method for follow-up after operation of the thoracic aorta.

Aortic Dissection↗
PubMed1994

Retroperitoneal approach used exclusively with epidural anesthesia for infrarenal aortic disease.

BACKGROUND: The retroperitoneal approach for elective infrarenal aortic procedures is an attractive alternative to the standard transperitoneal approach. In an effort to limit the number of extraneous influences on patient outcome, this approach was performed using epidural anesthesia without the use of endotracheal intubation or general anesthesia. METHODS: From June 1991 through July 1993, 62 consecutive patients with aorto-occlusive or aorto-iliac disease underwent infrarenal aortic repair using the retroperitoneal approach. Epidural anesthesia was used exclusively in all cases. Patients were evaluated for age, sex, comorbid conditions, morbidity, operating time, blood loss, ileus, and length of hospital stay. RESULTS: There were 29 aortobiiliac bypasses, 18 aortobifemoral bypasses, and 15 aortic tube grafts. Three patients had an associated renal artery procedure performed. There were 48 men and 14 women. The average age was 74.2 years (range 30 to 88). Comorbid conditions including smoking (69%), coronary artery disease (61%), hypertension (61%), prior myocardial infarction (43%), chronic obstructive pulmonary disease (35%), prior surgery (27%), diabetes mellitus (24%), and a history of cancer (8%) were identified. The average length of surgery was 2 hours and 10 minutes (range 1 hour 20 minutes to 3 hours 15 minutes). The average blood loss was 510 mL (range 200 to 4,000). A nasogastric tube was not used in any patient perioperatively, and oral feeding was started on average by postoperative day 2. The average intensive care unit stay was 1.3 days (range 1 to 7). A mortality rate of 1.6%, and major complication rate of 11% were found. None were of pulmonary nature, which may be ascribed to the absence of endotracheal intubation or general anesthesia. A minor complication rate of 19% was achieved under the presented method. The average hospital stay was 7.7 days (range 5 to 15). CONCLUSION: No large series using the retroperitoneal approach exclusively under epidural anesthesia has been reported. Recent literature on the retroperitoneal approach makes use of general anesthesia with/without epidural anesthesia. This review supports our contention that the procedure of choice for elective infrarenal aortic surgery is the retroperitoneal approach utilizing epidural anesthesia in the absence of endotracheal intubation and general anesthesia. There is a decrease in the physiologic disturbances associated with general anesthesia, notably pulmonary and gastrointestinal, when only epidural anesthesia is used. This translated into a low complication rate, improved patient comfort, early hospital discharge, and subsequent lower costs.

Adult↗
PubMed2001

[Epidemiology of aortic disease: aneurysm, dissection, occlusion].

The physiological infrarenal aortic diameter varies between 12.4 mm in women an 27.6 mm in men. As defined, an aneurysmatic dilatation begins with 29 mm. According to that, 9% of all people above the age of 65 are affected by an abdominal aortic aneurysm (AAA). Compared with the female sex, the male sex predominates at a rate of about 5:1. The disease is predominant in men of the white race. In black men, black and white women the incidence of AAA is identical. 38 to 50 percent of the AAA patients (patients) suffer from hypertension, 33 to 60% from coronary, 28% from cerebrovascular and 25% from peripheral occlusive disease. The AAA expansion rate varies between 0.2 and 0.8 cm per year and is exponential from a diameter of 5 cm on. In autopsy studies, the rupture rates with AAA diameters of < 5 cm, between 5.1 and 6.9 cm, and of > 7 cm were below 5%, 39% and 65%, respectively. 70% of the AAA patients do not die of a rupture, but of a cardiac disease. Serum markers, such as metalloproteinases and procollagen peptides are significantly increased in AAA patients. Thoraco-abdominal aneurysms (TAA) make up only 2 to 5% of all degenerative aneurysms. 20 to 30% of the TAA patients are also affected by an AAA. 80% of the TAA are degenerative, 15 to 20% are a consequence of the chronic dissection--including 5% of Marfan patients--, 2% occur in case of infections and 1 to 2% in case of aortitis. The TAA incidence in 100,000 person-years is 5.9% during a monitoring period of 30 years. In case of TAA, an operation is indicated with a maximum diameter of 5.5 to 6 cm and more and, in case of a Marfan's syndrome (incidence of 1:10,000), with a maximum diameter of 5.5 cm and more. With regard to aorto-iliac occlusive diseases, there are defined 3 types of distribution. Type I refers to the region of the bifurcation itself. Type II defines the diffuse aorto-iliac spread of the disease. Type III designates multiple-level occlusions also beyond the inguinal ligament. Type I patients in most cases are female and more frequently suffer from hyperlipidaemia, while Type II patients are affected by hypertension and diabetes. Compared to Type II patients, Type I patients have a life expectancy that is 10 years higher. Type I and Type II patients often suffer from a pelvic claudication and, unlike Type III patients, are more frequently affected by arterio-arterial embolisms.

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PubMed2004

Endovascular therapy for aortic disease.

Minimally invasive repair of thoracic and abdominal aortic aneurysms (AAAs) is rapidly becoming a vital tool in the arsenal of the vascular specialist. Historically, surgical replacement of the aorta has been the "gold standard" for treatment of aortic aneurysms. However, transfemoral placement of an endovascular stent graft, first described by Dr. Parodi and colleagues in 1991, marked the beginning of a new era in treatment of aortic aneurysms. This approach has evolved, allowing success with significantly less morbidity. Over time, if the long-term results continue to prove favorable, endovascular stent graft repair of aortic aneurysms may become the most effective means to treat this life-threatening disease.

Angiography↗
PubMed2002

Modified bypass procedure and apicoaortic conduit. Management of coronary artery disease, aortic valve stenosis and porcelain aorta.

BACKGROUND: In case of severely calcified ascending aorta, modified operative strategies are required in order to avoid manipulations of the aorta and minimize subsequent cerebral vascular accidents. CASE REPORT: A 73-year-old woman, with a coronary two-vessel disease and aortic stenosis was scheduled for coronary artery bypass grafting and aortic valve replacement. Due to severed calcification of the ascending aorta including the transverse arch, neither cannulation, clamping nor incision of the aorta or its replacement was feasible. Therefore bypass operation was performed using a modified approach. After 1 month, implantation of a valved conduit between the left ventricular apex and the descending aorta through a lateral thoracotomy followed. CONCLUSION: Only in few cases the surgical treatment of a coronary artery disease in combination with left ventricular outflow tract obstruction and heavily calcified ascending aorta has been described. Undoubtedly, creation of an apicoaortic connection is today only indicated in the adult population in a small collective with multiple previous operations or porcelain aorta.

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PubMed2003

Incision and abdominal wall hernias in patients with aneurysm or occlusive aortic disease.

INTRODUCTION: Patients undergoing midline incision for abdominal aortic reconstruction appear to be at greater risk for postoperative incision hernia compared with patients undergoing celiotomy for general surgical procedures. Controversy exists as to whether incidence of abdominal wall hernia and increased risk for incision hernia is higher in patients with abdominal aortic aneurysm (AAA) than in patients operated on because of aortoiliac occlusive disease (AOD). We conducted a prospective multi-institutional study to assess frequency of incision hernia after aortic surgery through a midline laparotomy and of previous abdominal wall hernia. METHODS: Patients with AAA (n = 177) or AOD (n = 82) from three major institutions were prospectively enrolled in the study and examined. Data collected included demographic data, cardiopulmonary risk factors, smoking status, history of previous or current abdominal wall hernia (incision, inguinal, umbilical, femoral), previous midline incision, suture type, and postoperative complications. At a minimum of 6 months after laparotomy, patients were evaluated clinically for a new incision hernia. Differences were tested with the unpaired t test, X(2) test, or Fisher exact test, and multiple logistic regression was used to control for confounding variables. RESULTS: Mean follow-up of the cohort was 32.8 +/- 2.3 months. Rate of abdominal wall hernia and inguinal hernia in patients with AAA versus AOD was 38.4% versus 11% (P =.001) and 23.7% versus 6.1% (P =.003), respectively. Rate of postoperative incision hernia in patients with AAA was 28.2%, and in patients with AOD was 11.0% (P =.002). Adjusting for age, smoking, chronic obstructive pulmonary disease, body mass index, diabetes, bowel obstruction, and suture type, patients with AAA had almost a ninefold risk for postoperative incision hernia formation (odds ratio [OR], 8.8; P =.0049). CONCLUSION: Compared with patients with AOD, patients with AAA have a higher frequency of abdominal wall hernia and inguinal hernia, and are at significant increased risk for development of incision hernia postoperatively. The higher frequency of hernia formation in patients with AAA suggests the presence of a structural defect within the fascia. Further studies are needed to delineate the molecular changes of the aorta and its relation to the abdominal wall fascia.

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PubMed1989

[Surgical treatment for aortic diseases associated with coronary artery stenosis].

Three hundred and one patients undergoing aortic surgery (247 aneurysm cases and 54 arteriosclerotic obstruction cases) were evaluated in respect to the treatment for the associated coronary artery stenosis. Twenty-four among total cases (8%) showed the presence of coronary artery stenosis; 16 cases among aneurysm cases (6.5%) and 8 cases among arteriosclerotic obstruction cases (14.8%). Coronary revascularization was performed in 10 cases and the early operate death was observed in one case. Two abdominal aneurysm cases and 4 arteriosclerotic obstruction cases received two-staged aortic and coronary operation, since either aortic or coronary lesion was considered lethal. However, 3 cases of dissecting aneurysm (type I or II), and case of arteriosclerotic obstruction case having left ventricular aneurysm received simultaneous aortic and coronary surgery, since both of the lesions were highly lethal. These data are consistent with the conclusion that the combined aortic and coronary lesion should be treated with the two-staged operation, and that the simultaneous aortic and coronary surgery should be performed only when the both lesions are lethal.

Adult↗