Abdominal Aortic Aneurysms

Anatomical repair of a congenital aneurysm of the distal abdominal aorta in a newborn

Primary aortoenteric fistula following endovascular aortic repair due to type II endoleak

Dartmouth Atlas of Vascular Health Care review: Impact of hospital volume, surgeon volume, and training on outcome

The modern open surgical management of abdominal aortic aneurysm (AAA) has changed little since its inception in the 1950s. Endoaneurysmorrhaphy, first described by Rudolph Matas in 1888, involved ligating the branches of an aneurysm from within the aneurysm sac. Approximately 25 years later at the

Aortic diseases are common in many populations and are receiving increasing research focus. There are a broad spectrum of aortic diseases that occur in specific regions and appear to have different causes. For example, abdominal aortic aneurysms (AAAs) are most common in aged men.1 In contrast, many forms of thoracic aortic aneurysms (TAAs) occur early in life with a strong genetic basis and no sex discrimination.2 Both aortic aneurysms are amenable to surgical repair. Although surgical approaches have become increasingly sophisticated and less invasive,3 there remains an urgent need to determine factors that predispose to susceptibility and to divert treatment from surgical to medical approaches.4,5 This switch to medical treatment will require an increased knowledge of the mechanisms for several facets of aneurysms that cover the span of initiation, progression, and rupture. In this regard, many recent publications in ATVB have provided further insight into established pathways contributing to aneurysm development such as proteolysis, inflammation, and attenuation of the medial smooth muscle cell population, and a few publications have raised the possibility of new pathways such as adipokines and mineralocorticoid signaling. This article highlights these recent publications within a brief context of the literature. Cigarette smoking remains the major risk factor for development and progression of AAAs.6,7 Several experimental studies have demonstrated that smoke exposure augments AAA induced in mice by either subcutaneous angiotensin II (AngII) infusion or intra-aortic elastase perfusion.8,9 However, it is unclear whether cessation of smoking impacts the development of AAAs. The study of Jin et al10 demonstrated that cessation of cigarette smoking exposure did not immediately decrease the augmentation of AAAs. This sustained effect was attributable to regulation of leukocytic metabolism. Also of note is that cigarette smoking–induced augmentation of AAAs was unaffected …

Comparison of the effects of open and endovascular aortic aneurysm repair on long-term renal function using chronic kidney disease staging based on glomerular filtration rate

Exercise, Vascular Health, and Abdominal Aortic Aneurysms

Article1 June 1956THE CLINICAL PICTURE OF ANEURYSM OF THE ABDOMINAL AORTACHARLES D. ENSELBERG, M.D., F.A.C.P.CHARLES D. ENSELBERG, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-44-6-1163 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAlthough aneurysms (chiefly traumatic) were known to Galen, discussions of this subject in the medical literature began to increase in the 16th Century along with the increasing appearance of syphilis. Abdominal aneurysms were described by Fernelius in 1542 and by Vesalius in 1595.2, 3Lancisi4in 1728 observed the relationship between syphilis and aneurysm, and published clinical and pathologic descriptions of ruptured abdominal aortic aneurysm. Monro,5describing a case he saw in 1760, wrote: "At that time he was troubled with a hiccup, which had begun the day before I saw him. The pain of his belly was almost constant,...Bibliography1. Klotz O: Concerning aneurysms, U. of Toronto Studies, Path. Series, No. 7, 1926. Google Scholar2. Erichsen JE: Observations on aneurism, 1844, The Sydenham Society, London. Google Scholar3. Osler W: Aneurysm of the abdominal aorta, Lancet 2: 1089, 1905. CrossrefGoogle Scholar4. Lancisi GM: De Aneurysmatibus, Rome, 1745, revised and translated by W. C. Wright, 1952, Macmillan Co., New York. Google Scholar5. Monro D: Cases of aneurisms, with remarks. Essays and observations, physical and literary, Edinburgh 1771. Google Scholar6. Nixon JA: Abdominal aneurysm in a girl aged twenty due to congenital syphilis, with tables of collected cases of abdominal aneurysm, St. Barth. Hosp. Rep. 17: 43, 1912. Google Scholar7. LuckeRea BMH: Studies on aneurysm. I. General statistical data on aneurysms, J. A. M. A. 77: 935, 1921. CrossrefGoogle Scholar8. Kampmeier RH: Aneurysm of the abdominal aorta: a study of 73 cases, Am. J. M. Sc. 192: 97, 1936. CrossrefGoogle Scholar9. MillsHorton JHBT: Clinical aspects of aneurysm, Arch. Int. Med. 62: 949, 1938. CrossrefGoogle Scholar10. SaleebyMcCarthy ERPA: Aneurysms. A statistical study of 84 cases from the surgical department of the Philadelphia General Hospital, Pennsylvania M. J. 41: 969, 1938. Google Scholar11. HubenyPollak MJS: Saccular abdominal aortic aneurysm. An analysis of forty-eight cases, Am. J. Roentgenol. 43: 385, 1940. Google Scholar12. RuffinCastlemanWhite MdBPD: Arteriosclerotic aneurysms and senile ectasia of the thoracic aorta, Am. Heart J. 22: 458, 1941. CrossrefGoogle Scholar13. Scott V: Abdominal aneurysms. A report of 96 cases, Am. J. Syph., Gonor. and Ven. Dis. 28: 682, 1944. Google Scholar14. Uhle CA: The significance of aneurysm of the abdominal aorta masquerading as primary urologic disease, J. Urol. 45: 13, 1941. CrossrefGoogle Scholar15. Karabin JE: Retroperitoneal hemorrhage with special reference to the accompanying paralytic ileus, Am. J. Surg. 56: 471, 1942. CrossrefGoogle Scholar16. EliasonMcNamee ELHG: Abdominal aneurysm. A report of twenty four cases, Am. J. Surg. 56: 590, 1942. CrossrefGoogle Scholar17. Pratt-Thomas HR: Aneurysm of the abdominal aorta. An analysis of 17 cases, J. South Carolina M. A. 40: 251, 1944. Google Scholar18. Epstein J: Aneurysms of the abdominal aorta, Ann. Int. Med. 22: 252, 1945. LinkGoogle Scholar19. Estes JE: Abdominal aortic aneurysm: a study of one hundred and two cases, Circulation 2: 258, 1950. CrossrefMedlineGoogle Scholar20. Gold H: Abdominal aortic aneurysm, Canada. M. A. J. 65: 427, 1951. MedlineGoogle Scholar21. HirschowitzBagg BIL: Aneurysm of the abdominal aorta with a report of four unusual cases, Gastroenterology 18: 361, 1951. CrossrefMedlineGoogle Scholar22. DeTakatsMarshall GMR: Surgical treatment of arteriosclerotic aneurysms of the abdominal aorta, Arch. Surg. 64: 307, 1952. CrossrefGoogle Scholar23. ManigliaGregory RJE: Increasing incidence of arteriosclerotic aortic aneurysms. Analysis of six thousand autopsies, Arch. Path. 54: 298, 1952. Google Scholar24. Baird IM: Saccular aneurysms of the abdominal aorta. Report of three cases and review, Arch. Int. Med. 91: 626, 1953. CrossrefGoogle Scholar25. CooleyDeBakey DAME: Surgical considerations of excisional therapy for aortic aneurysms, Surgery 34: 1005, 1953. MedlineGoogle Scholar26. Copping GA: Spontaneous rupture of abdominal aorta, J. A. M. A. 151: 374, 1953. MedlineGoogle Scholar27. CowleyYeager RAGH: Treatment of aneurysms with follow-up studies on dicetyl phosphate, Surgery 34: 1032, 1953. MedlineGoogle Scholar28. Bahnson HT: Treatment of abdominal aortic aneurysm by excision and replacement by homograft, Circulation 9: 494, 1954. CrossrefMedlineGoogle Scholar29. BlakemoreVoorhees AHAB: Aneurysm of the aorta: a review of 365 cases, Angiology 5: 209, 1954. CrossrefMedlineGoogle Scholar30. Bryant JH: Aneurysm of the abdominal aorta, Clin. J. 23: 71, 89, 1903. Google Scholar31. CranleyHerrmannPreuninger JJLGRM: Natural history of aneurysms of the aorta, Arch. Surg. 69: 185, 1954. CrossrefGoogle Scholar32. DeTakatsPirani GCI: Aneurysms: general considerations, Angiology 5: 173, 1954. CrossrefMedlineGoogle Scholar33. Blakemore AH: The clinical behavior of arteriosclerotic aneurysm of the abdominal aorta: a rational surgical therapy, Ann. Surg. 126: 195, 1947. CrossrefMedlineGoogle Scholar34. KlotzSimpson OW: Spontaneous rupture of the aorta, Am. J. M. Sc. 184: 455, 1932. CrossrefGoogle Scholar35. AntzisDunnSchilero EJAJ: Rupture of abdominal aneurysm into the gastrointestinal tract, Am. J. Med. 11: 531, 1951. CrossrefMedlineGoogle Scholar36. ViarLombardo WNTA: Abdominal aortic aneurysm with rupture into the inferior vena cava, Circulation 5: 287, 1952. CrossrefMedlineGoogle Scholar37. DubostAllaryOeconomos CMN: Anévrysme de l'aorte abdominale traité par resection et greffe, Arch. d. mal. du cœur 44: 848, 1951. MedlineGoogle Scholar38. Boyd DP: Surgical treatment of abdominal aortic aneurysms, Lahey Clin. Bull. 9: 6, 1954. MedlineGoogle Scholar39. CooleyDeBakey DAME: Ruptured aneurysms of the abdominal aorta. Excision and homograft replacement, Postgrad. Med. 16: 334, 1954. CrossrefMedlineGoogle Scholar40. DeBakeyCooley MEDA: Surgical treatment of aneurysm of abdominal aorta by resection and restoration of continuity with homograft, Surg., Gynec. and Obst. 97: 257, 1953. MedlineGoogle Scholar41. FreemanLeeds NEFH: Resection of aneurysms of the abdominal aorta with anastomosis of the splenic to the left iliac artery, Surgery 34: 1021, 1953. MedlineGoogle Scholar42. Mahorner H: Editorial, the treatment of aortic aneurysms, Surg., Gynec. and Obst. 100: 110, 1955. MedlineGoogle Scholar43. SchlossKaplan WABJ: Spontaneous extravasation from the ureter secondary to aneurysm of the abdominal aorta, New England J. Med. 249: 802, 1953. CrossrefMedlineGoogle Scholar44. Petersen GF: Atherosclerosis of the abdominal aorta, Acta radiol. 37: 356, 1952. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: New York, N. Y.*Read at the Twenty-eighth Scientific Session, American Heart Association, New Orleans, October 24, 1955. Received for publication January 17, 1956.From the Department of Cardiology, New York Polyclinic Medical School and Hospital, and the Medical Division, Montefiore Hospital, New York, N. Y. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAn Unusual Case of Testicular PainReferred scrotal painThe blue scrotum sign of Bryant: A diagnostic clue to ruptured abdominal aortic aneurysmRuptured abdominal aortic aneurysm causing obstructive jaundiceAneurysmen 1 June 1956Volume 44, Issue 6Page: 1163-1181KeywordsAbdominal aortic aneurysmAbdominal painAneurysmsAortaHeartHemorrhageHipReflexesSyphilisUreter ePublished: 1 December 2008 Issue Published: 1 June 1956 PDF downloadLoading ...

Aortic aneurysms remain a challenging problem for patients and physicians. There have been major advances in the treatment of large-vessel aneurysms during the past 10 years. The surgical armamentarium used to treat these aneurysms now includes an endovascular approach that allows the insertion of a graft to exclude the aneurysm sac from blood flow. The endovascular repair of abdominal and thoracic aortic aneurysms has become a viable alternative to open repair and is often the approach of choice for high-risk patients. In this review, we examine the endovascular treatment of abdominal and thoracic aortic aneurysms. Abdominal aortic aneurysms (AAAs) are a formidable diagnosis for patients. This is a life-threatening condition that mandates consideration of repair. A ruptured AAA has a mortality rate approaching 90%; however, when an AAA is repaired electively, the mortality drops to less than 5%.1–3 There is, therefore, a clear advantage to treating these aneurysms before they rupture. Because this disease affects 4% to 7% of adults over the age of 65 years, with a far greater prevalence in males than females, clinicians will encounter this problem more frequently as the population ages.4 AAAs usually develop in patients with a history of arteriosclerosis or smoking. Patients present for repair when it is discovered that there is a dilation of their abdominal aorta to a diameter 1.5 times normal. The result is a weakened aortic wall that is at increased risk of rupture. The pathogenesis of this aortic wall change likely involves enzymes responsible for elastin and collagen breakdown.5 Recent research has focused on the role of metalloproteinase-9 (MMP-9). Aneurysm presence and size have been correlated with MMP-9 levels. Other investigators are looking into the inflammatory and autoimmune mechanisms involved in aneurysmal disease.6 Another area of research is in the molecular genetics of AAAs, …

Hospital Readmissions Following Abdominal Aortic Aneurysm Repair

Cardiac Medical Therapy among Patients Undergoing Abdominal Aortic Aneurysm Repair

Abdominal aortic aneurysms are responsible for a substantial public health burden in developed countries. In 1991, abdominal aneurysm was cited as the primary or secondary cause of 12,711 deaths in the United States (1). Aortic aneurysms of unspecified site, many of which were probably abdominal, were cited for a further 4,108 deaths. It has been estimated that abdominal aneurysms cause 1-2 percent of all deaths among men over the age of 65 in the United States (2). In Canada, vital statistics data show that there are approximately 1,000 deaths attributable to abdominal aneurysm annually (3). Since abdominal aneurysms often escape clinical detection, these vital statistics data probably underestimate the true magnitude of mortality related to abdominal aneurysm. Abdominal aneurysms are also responsible for considerable morbidity and health care costs. In the United States in 1992, abdominal aneurysm was cited as the primary diagnosis for approximately 53,000 hospital discharges, and there were approximately 40,000 surgical operations for this aneurysm (1). In Canada in 1990, abdominal aneurysm was cited as the primary diagnosis for 5,638 hospitalizations (3). Mortality and morbidity related to abdominal aneurysm has increased substantially in recent decades. In the United States, the number of deaths due to abdominal aneurysm increased by almost 20 percent between 1979 and 1991, and the number of related hospitalizations more than doubled (1). In England and Wales, the number of deaths due to abdominal aneurysm increased by 53 percent between 1974 and 1984 (4). In Canada, the number of hospitalReceived for publication May 26, 1998, and accepted for publication July 6, 1999. Abbreviations: HDL, high density lipoprotein; LDL, low density lipoprotein; VLDL, very low density lipoprotein. 1 Epidemiology Unit, Public Health Branch, Manitoba Health, Winnipeg, Manitoba, Canada. 2 Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. 3 Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. Reprint requests to Dr. James F. Blanchard, Manitoba Health, 4058-300 Carlton Street, Winnipeg, Manitoba R3B 3M9, Canada. izations related to abdominal aneurysm increased almost fourfold between 1970 and 1990 (3). Similarly, in Western Australia, the number of surgical operations for abdominal aneurysm more than doubled between the early 1970s and the early 1980s (5). Despite the public health importance of abdominal aneurysms, much is still unknown with respect to their etiology. Historically, they have been considered simply a manifestation of atherosclerosis (6-8). However, this conventional theory has come under increasing challenge in the past two decades. Whereas aortic atherosclerosis is common, a relatively small proportion of persons develop aneurysmal disease. Furthermore, epidemiologic, genetic, and biochemical research indicates that the etiology of abdominal aneurysm is distinct from atherosclerosis per se. The first part of this review provides an overview of the definition, pathophysiology, and natural history of abdominal aneurysm. In the second part, descriptive and analytic epidemiologic studies are reviewed with an emphasis on their implications for etiology.

Trends in aortic aneurysm surgical training for general and vascular surgery residents in the era of endovascular abdominal aortic aneurysm repair.

Background and objectives: The aim of this systematic review is to explore the current evidence surrounding the changes in functional status following open or endovascular abdominal aortic aneurysm (AAA) repair and the role of postoperative exercise-based rehabilitation programmes. Methods: The proposed study will incorporate two separate systematic reviews within it, one to assess changes in functional status (component 1) and another to consider the role of exercise-based rehabilitation for improving functional status (component 2), both following AAA repair. The Medline, EMBASE and Cochrane CENTRAL databases will be searched using two separate search strategies including the terms “aortic aneurysm”, “functional capacity”, “functional decline” and” exercise therapy”. We plan to include all prospective randomised and non-randomised trials that have considered the impact of AAA repair on functional status and/or the effect of exercise-based rehabilitation following AAA repair. For component 1, the primary outcome will be changes in objective measures of functional capacity or physical function following AAA repair and, for component 2, it will be changes in physical function or functional capacity following exercise-based rehabilitation after AAA repair. The extracted data will include study characteristics – ie, sample size, a description of the intervention and control conditions (where applicable), outcome measures, length of follow-up and main findings related to outcome measures. For both components a narrative synthesis will be produced, supported by a summary table. We intend to conduct quantitative meta-analyses for both components. For each selected outcome we plan to evaluate the certainty of evidence based on the GRADE approach and risk of bias of included studies will be assessed using the Cochrane tool. Conclusions: Based on a lack of current evidence, we present a protocol for a systematic review to investigate the functional changes associated with open and endovascular AAA repair and the potential value of postoperative exercise rehabilitation.

The Agency for Healthcare Research and Quality Inpatient Quality Indicator #11 overall mortality rate does not accurately assess mortality risk after abdominal aortic aneurysm repair