Aortic Aneurysm In Association Research Articles

先天性第ＸＩ因子欠乏症を伴った腹部大動脈瘤症例に対する１治験例

稀な先天性凝固因子欠乏症である第XI因子欠乏症を伴う腹部大動脈瘤症例を経験したので報告する．症例は67歳，男性．術前検査で活性化部分トロンボプラスチン時間（APTT）の延長を認めたため，先天性第XI因子欠乏症と診断した．手術前日に新鮮凍結血漿（FFP）を6単位投与後，腹部大動脈人工血管置換術を施行した．術中出血傾向は認めず，術後もFFPを投与し，術後13病日に合併症なく退院した．第XI因子活性は検査結果判明まで数日を要するため，周術期においてはAPTT値が凝固因子活性値の指標になると考えられた．

Abdominal aortic aneurysm in association with horseshoe kidney

We report the preoperative diagnosis and surgical treatment of an abdominal aortic aneurysm (AAA) in association with a horseshoe kidney (HSK) in a 70-year-old man. Through a median laparotomy a vascular tube graft was successfully used for repair the AAA. The extensive parenchymal isthmus overlying the aneurysm remained intact.

Descending Thoracic and Thoracoabdominal Aortic Aneurysm in Patients with Takayasu's Disease

From June 1974 to December 2001 we performed operative treatment on 33 patients with descending thoracic or thoracoabdominal aortic aneurysm in association with Takayasu disease. There were 25 men and 8 women with a mean age of 40.2A years (range 16-64A years). Nineteen patients came from North Africa, 6 were from France, and 8 were from various locations in the world. The revealing symptom was hypertension in 12 cases, thoracic or abdominal pain in 7, isolated inflammatory syndrome in 5, neurologic or ocular manifestations in 3, rupture in 3, and embolization to the lower extremity in 1. In the remaining two cases discovery was coincidental. The aneurysm was confined to the thoracic aorta in 10 cases and involved both the thoracic and abdominal aorta in 23 cases. There were 8 type I, 6 type II, 4 type III, and 5 type IV aneurysms according to Crawford's classification. Two patients had undergone previous repair of the thoracoabdominal aorta. Four patients required first-stage treatment of a renal artery lesion to control hypertension. Six patients had associated aneurysms of the proximal aorta, including five treated via the distal elephant trunk technique in first-stage procedures. Aneurysm repair consisted of prosthetic replacement of the thoracoabdominal aorta in 31 cases, exclusion bypass in 1 case, and stent graft placement in 1 case. The procedure was performed with cross-clamping alone in 13 cases, distal perfusion in 17 cases, and deep hypothermic circulatory arrest in 3 cases. Twenty patients (61%) had associated renal and/or intestinal artery lesions that were treated during the same procedure as that for the thoracoabdominal aorta in 19 patients (58%). A total of 24 procedures were performed on renal arteries (17 revascularizations, 7 nephrectomies). Associated supraaortic trunks lesions were present in 15 patients (45%) and were treated in 12 patients, including 8 in first-stage procedures prior to thoracoabdominal aortic aneurysm repair. Three patients died of multiple organ failure, after reoperation in two cases and infection in one case involving prior long-term corticosteroid therapy. Three patients developed paraplegia, including one who had undergone emergency treatment following rupture. Two patients required reoperation, for hematoma in one case and bowel necrosis in one. Four patients developed respiratory complications requiring artificial ventilation for more than 48 hr. During follow-up, two patients died from complications after repair of the proximal aorta and one patient required nephrectomy. Despite the extent of aneurysmal lesions and high frequency of association with visceral and supraaortic vessel lesions, the outcome of surgery in patients presenting with descending thoracic or thoracoabdominal aortic aneurysm in association with Takayasu disease was satisfactory.

Abdominal Aortic Aneurysm in Association with Horseshoe Kidney

The presence of a horseshoe kidney (HSK) may complicate an anterior approach to reconstructive surgery of aorta and iliac vessels, because the isthmus of the HSK lies across the aorta and because HSK is often associated with anomalous renal vessels. Routine preoperative assessment may not reveal the presence of HSK. We report two cases of abdominal aortic aneurysm (AAA) associated with HSK, which were diagnosed intra-operatively. Authoritative textbooks of vascular surgery advise against division of the isthmus of the HSK. In the cases reported here, division of the isthmus was helpful in simplifying successful repair of the AAA.

“Marsupial cava” and ruptured abdominal aortic aneurysm

A patient with a ruptured abdominal aortic aneurysm underwent an emergency operation. A rare anomaly of inferior vena cava, known as “marsupial cava,” was found. The iliac vein confluence crossed anteriorly (rather then posteriorly) the right common iliac artery. Even though the patient had undergone a computed tomography scan, this rare anomaly had not been detected and therefore was unexpected by the surgeon. The aim of this report is to describe the technical details required to perform the aortic reconstruction and to stress the importance of routine computed tomography scans and their careful reading in the case of stable patients before retroperitoneal operation. This is, to our knowledge, the first report of an aortic prosthetic grafting for ruptured aortic aneurysm in association with a marsupial cava. (J Vasc Surg 1998;28:719-22.)

A case of ruptured abdominal aortic aneurysm in association with congenital kyphoscoliosis

We present the case of a 36-year-old woman with severe kyphoscoliosis in whom the diagnosis of ruptured abdominal aortic aneurysm was not made preoperatively and who died in the operating theatre. We think the presence of an abdominal aortic aneurysm in this relatively young patient was resultant upon irregular flow patterns in the grossly deformed aorta.

Descending Thoracic Aneurysm Rupture with a Known Abdominal Aortic Aneurysm

The association of abdominal aortic aneurysms with aneurysmal disease of the thoracic aorta is well established. However, rupture of a descending atherosclerotic thoracic aortic aneurysm in association with an infrarenal abdominal aortic aneurysm can present a difficult diagnostic and therapeutic problem to the treating physician. This article presents a case of rupture of an atherosclerotic descending thoracic aortic aneurysm in the face of what clinically appeared to be a leaking or ruptured abdominal aortic aneurysm.

AORTIC ANEURYSM SURGERY IN THE PRESENCE OF A HORSESHOE KIDNEY

A review of three cases of aortic aneurysm in association with a horseshoe kidney is presented. Both the transperitoneal and retroperitoneal approaches to the aneurysm are detailed and the relative advantages and disadvantages outlined. The conventional approach of transection of the renal isthmus is not recommended because of the possibility of damage to the collecting system of the horseshoe kidney. The place of specialized investigations is outlined.