Case Of Aortic Aneurysm Research Articles

F-18 FDG PET/CT in the Management of Infected Abdominal Aortic Aneurysm Due To Salmonella

Mycotic aneurysm is a rare and life-threatening disorder. Computed tomography (CT) is considered to be the best diagnostic imaging modality that can detect an abdominal aortic aneurysm and changes in the surrounding structures. More recently, F-18 fluorodeoxyglucose (FDG) PET would seem to hold promise for the diagnosis of focal infection and during the follow-up after antibiotic treatment. We present a case of an infected abdominal aortic aneurysm due to Salmonella enteritidis. In this case, a combination of CT and FDG PET/CT provided accurate information for the diagnosis of the infected abdominal aortic aneurysm. Moreover, FDG PET/CT made an important contribution for monitoring response to antibiotic therapy.

Concomitant pulmonary carcinoma and abdominal aortic aneurysm: Therapeutic strategies

A diagnosis of concomitant pulmonary carcinoma and abdominal aortic aneurysm is rare (<1% of treated cases). However, such an association makes the therapeutic decisions critical, especially regarding the priority and timing of treatment. This article reports on our experience of 14 cases of concomitant pulmonary carcinoma and abdominal aortic aneurysm. From April 1987 to June 2006 we observed 14 cases of concomitant pulmonary carcinoma and abdominal aortic aneurysm. In patients for whom simultaneous treatment was not indicated due to a poor general condition, priority was given to lung cancer except for cases in which the aneurysm needed an urgent approach. Patients observed after 2000 and scheduled for a two-stage treatment were treated with endovascular procedures whenever possible. Only one patient was treated by a simultaneous aneurysmectomy and a left lower lobectomy, while in the other 13 patients two-stage treatment was performed. Lung carcinoma was operated on first in 7 cases but one patient underwent an urgent aneurysmectomy after chest surgery due to a rupture of the aneurysm. Priority was given to an aneurysmectomy in 2 patients. An endovascular approach was performed in 4 patients, thus allowing a pulmonary resection during the same period of hospitalization, 2 days after 2 uneventful endovascular procedures and on the 6th and 7th postoperative days in 2 cases due to an intraoperative rupture of right iliac artery and type I postoperative endoleak, respectively. An endovascular exclusion of the aneurysm may therefore be proposed in order to achieve a concomitant treatment of both diseases. Such an approach excludes complications due to a postoperative rupture of the aneurysm when a pulmonary resection would be first performed; moreover, it does not delay the performance of a pulmonary resection when treatment of the aneurysm is considered to have priority.

IgG4-positive Plasma Cells in Inflammatory Abdominal Aortic Aneurysm: The Possibility of an Aortic Manifestation of IgG4-related Sclerosing Disease

Inflammatory abdominal aortic aneurysm (IAA) is associated with autoimmune disease. However, the precise mechanism of IAA remains unclear. There is increasing evidence that IgG4 is involved in the autoimmune mechanism of various idiopathic sclerosing lesions, including sclerosing pancreatitis and retroperitoneal fibrosis. The present study investigated the hypothesis that the IgG4-related autoimmune reaction is involved in the formation of IAA. The study group consisted of 11 cases of IAA (69.2 +/- 8.59y) and 12 age-matched cases of atherosclerotic abdominal aortic aneurysm (AAA, 69.6 +/- 5.94y), which were used in the previous report. A clinicopathologic examination of these lesions was performed, including histology and immunohistochemistry, in relation to the involvement of IgG4-positive plasma cells in the formation of IAA. No difference in the incidence of risk factors for atherosclerosis was observed between the patients with IAA and AAA. Autoimmune diseases were diagnosed in 2 patients with IAA, including rheumatoid arthritis and polyarteritis nodosa. A patient with IAA had pulmonary fibrosis. In contrast, autoimmune diseases were absent in patients with AAA. However, there was no significant difference in the incidence of autoimmune diseases between the patients with IAA and AAA. Lymphocyte and plasma cell infiltration and fibrosis were significantly more intense and extensive in IAA than in AAA. In addition, lymph follicle formation and vasculitis of small veins and arteries were frequently found in the affected lesions of IAA. Immunohistochemically, IAA showed a significant increase in the number of infiltrating IgG4-positive plasma cells and the incidence of a disrupted follicular dendritic cell network in lymph follicles, in comparison with AAA. These findings suggest that IAA may be an aortic lesion reflecting the presence of IgG4-related sclerosing disease, and not a simple inflammatory aneurysm of the aorta.

Association of abdominal aortic aneurysm, horseshoe kidneys, and left-sided inferior vena cava: Report of two cases

Surgery for abdominal aortic aneurysm may be challenging when rare renal or venous anomalies are present. This article reports two similar cases of aortic abdominal aneurysm associated with horseshoe kidney and left-sided inferior vena cava treated with a transperitoneal approach. Preoperative knowledge of the anatomic situation enabled appropriate aneurysm repair. Operative strategy is discussed. This report describes an uncommon venous vascular malformation complex and stresses the importance of computed tomography imaging not only in assessing the characteristics of the aneurysmal disease but also in detecting variations in pertinent vascular or parenchymal anatomy.

Right iliac fossa pain: A case report of abdominal aorta mycotic aneurysm in a patient with methicillin-resistant Staphylococcus aureus

Mycotic aneurysms are uncommon and the pattern of causative organism appears to have changed with time. This condition is associated with a high mortality rate. Here we present a case of an infrarenal mycotic abdominal aortic aneurysm, where the causative organism was methicillin-resistant Staphylococcus aureus (MRSA).

十二指腸閉塞を併発した巨大腹部大動脈瘤の１例

十二指腸閉塞を併発した巨大腹部大動脈瘤の１例

IgG4 が関与した尿管狭窄を伴う炎症性腹部大動脈瘤の1例

IgG4 が関与した尿管狭窄を伴う炎症性腹部大動脈瘤の1例

Total arch replacement for a distal arch aneurysm with aberrant right subclavian artery

Aberrant right subclavian artery is a rare condition with a prevalence of 0.5%-2.0% of the population. We report a case of distal aortic arch aneurysm with right subclavian artery. A 75-year-old man who was asymptomatic was referred to our hospital for a thoracic aortic aneurysm. Computed tomography showed a 55-mm fusiform aneurysm of the distal arch and an aberrant right subclavian artery. Total arch replacement was performed via median sternotomy with antegrade selective cerebral perfusion and hypothermic circulatory arrest. We reconstructed the aberrant right subclavian artery in the normal position to avoid compression of the esophagus and trachea caused by future aneurysmal dilatation of the orifice of the aberrant right subclavian artery and potential high risk for rupture.

Surgery of infrarenal inflammatory aneurysm of abdominal aorta infected with methicillin resistant Staphylococcus aureus in a patient undergoing haemodialysis

Inflammatory abdominal aortic aneurysm accounts for 5% to 10% of all cases of abdominal aortic aneurysm and differs from typical atherosclerotic abdominal aortic aneurysm in many important ways. Although both inflammatory and atherosclerotic abdominal aortic aneurysms most commonly affect the infrarenal portion of the abdominal aorta, patients with the inflammatory variant are younger and usually symptomatic, chiefly from back or abdominal pain. Unlike patients with atherosclerotic abdominal aortic aneurysm, most with the inflammatoryvariant have an elevated erythrocyte sedimentation rate or abnormalities of other serum inflammatory markers. Computed tomography and magnetic resonance imaging are both sensitive for demonstrating the cuff of soft tissue inflammation surrounding the aneurysm that is characteristic of inflammatory abdominal aortic aneurysm. Inflammatory abdominal aortic aneurysm can be primarily infected by degenaration of an infected artery (in less than 1% of cases), or can become secondary infected in the already existing aneurysm. Seconadary infection of the pre-existing aneurysm has big inffluence on treatment choice, but is also rare. Clinically non-symptomatic infection, also known as bacterial collonisation, can be very frequent, regarding a greatly increased number of positive intraoperative findings (10-15%). Prolonged intravascular catheterization, vascular grafting, repeated punctures with large bore needles, and decreased immune defence mechanism make uraemic patients undergoing haemodialysis more likely to develop Staphylococcus aureus bacteraemia and its complications. The case shows a gigantic inflammatory aneurysm of the abdominal aorta, localized infrarenally, which was solved successfully by resection of the aneurysm of the abdominal aorta, and interposition of Dacron tubular graft 22 mm. Bacterial examination of the aneurysmal sac was positive: methicillin-resistent Staphylococcus aureus was detected. There were no postoperative complications, and the final outcome was fully satisfactory. Control CT scans after 3, 6 and 12 months were regular, with signs of regression fibrosis of the retroperitoneum.,

Aortoduodenal fistula and aortic aneurysm secondary to biliary stent-induced retroperitoneal perforation

Duodenal perforations caused by biliary prostheses are not uncommon, and they are potentially life threatening and require immediate treatment. We describe an unusual case of aortic aneurysm and rupture which occurred after retroperitoneal aortoduodenal fistula formation as a rare complication caused by biliary metallic stent-related duodenal perforation. To our knowledge, this is the first report describing a lethal complication of a bleeding, aortoduodenal fistula and caused by biliary metallic stent-induced perforation.

馬蹄腎を合併した腹部大動脈瘤の 1 例

馬蹄腎を合併した腹部大動脈瘤の 1 例

Management of simultaneous abdominal aortic aneurysm and colorectal cancer: The rationale of mini-invasive approach

The concomitant occurrence of abdominal aortic aneurysm and malignancy represents a therapeutic dilemma. Both lesions should be treated to achieve best life expectancy; the main controversy remains whether to treat them simultaneously or as staged procedures. Recently, endovascular repair has been suggested as a potential alternative to open standard intervention. We present a case of synchronous abdominal aortic aneurysm and colorectal cancer treated simultaneously by minimally invasive surgery.

Preliminary Results of Anaconda™ Aortic Endografts: A Single Center Study

To evaluate the peri-operative results of Anaconda endograft in the first 49 cases treated in a single centre. The study was carried out prospectively on cases of infrarenal abdominal aortic aneurysm (AAA) treated with Anaconda endograft. The characteristics of the proximal aortic neck and of the iliac access vessels were considered. The following operative results were assessed: the main body oversizing, the need to correct the positioning of the main body, the use of iliac extensions, the use of ballooning, the covering of patent hypogastric arteries, the presence of endoleaks and the need for conversion. Peri-operative (30 days) mortality and morbidity were also considered. Of the 49 cases treated, 44 were males with a mean age of 73 years (range: 55-89 yrs; SD+/-7 yrs). The mean diameter of the AAA was 56 mm (range 45-91 mm; SD+/-11); 4 cases had common iliac aneurysms with a diameter >3 cm. The mean neck diameter and length were 23 mm (range 19-28 mm; SD+/-3) and 25 mm (range 15-50 mm; SD+/-10) respectively. An aortic neck angle between 40 degrees and 70 degrees was present in 10 cases (20%) (mean 58 degrees; SD+/-15 degrees), and 20 cases (41%) had iliac tortuosity with an angle greater than 60 degrees (mean 85 degrees; SD+/-25 degrees). There were no cases of conversion or intra-operative death. One (2%) peri-operative death occurred, for reasons not related to the endograft. There were two cases of iliac limb thrombosis. CT at one month showed 12 cases (25%) of type II endoleak. There were no cases of type I or type III endoleaks. The preliminary data of this series demonstrates that the Anaconda endograft has good peri-operative results in the treatment of infrarenal AAAs with a neck length not less than 15 mm.

Giant size abdominal aortic aneurysm repair using open proximal anastomosis under hypothermic circulatory arrest: A report of two cases

Hypothermic total circulatory arrest and open proximal anastomosis techniques are not commonly used in abdominal or juxtarenal abdominal aortic aneurysm repair. Proximal aortic clamping is usually adequate for surgical repair of abdominal aortic pathologies. We present two cases of giant-sized abdominal aortic aneurysms, one was juxtarenal and one was a Crawford type IV thoracoabdominal aneurysm, that were repaired by using open proximal anastomosis under hypothermic total circulatory arrest and a transabdominal approach. This technique may be useful for both thoracoabdominal and large abdominal aortic aneurysms because it offers the opportunity to not clamp the aorta and operate in bloodless surgical field.

PCA-induced respiratory depression simulating stroke following endoluminal repair of abdominal aortic aneurysm: a case report.

AimTo report a case of severe respiratory depression with PCA fentanyl use simulating stroke in a patient who underwent routine elective endoluminal graft repair for abdominal aortic aneurysm (AAA)Case presentationA 78-year-old obese lady underwent routine endoluminal graft repair for AAA that was progressively increasing in size. Following an uneventful operation postoperative analgesia was managed with a patient-controlled analgesia (PCA) device with fentanyl. On the morning following operation the patient was found to be unusually drowsy and unresponsive to stimuli. Her GCS level was 11 with plantars upgoing bilaterally. A provisional diagnosis of stroke was made. Urgent transfer to a high-dependency unit (HDU) was arranged and she was given ventilatory support with a BiPap device. CT was performed and found to be normal. Arterial blood gas (ABG) analysis showed respiratory acidosis with PaCO2 81 mmHg, PaO2 140 mmHg, pH 7.17 and base excess -2 mmol/l. A total dose of 600 mcg of fentanyl was self-administered in the 16 hours following emergence from general anaesthesia. Naloxone was given with good effect. There was an increase in the creatinine level from 90 μmol/L preoperatively to 167 μmol/L on the first postoperative day. The patient remained on BiPap for two days that resulted in marked improvement in gas exchange. Recovery was complete.

Thoracoabdominal Aortic Aneurysm Associated With Abdominal Aortic and Visceral Arterial Occlusion in a Hemodialysis Patient

We report an extremely rare case of saccular thoracoabdominal aortic aneurysm associated with high abdominal aortic occlusion including the superior mesenteric and bilateral renal arteries in a patient requiring hemodialysis. Successful repair of the aneurysm and concomitant revascularization of the lower extremities was achieved using femoro-femoral bypass for perfusion of the lower body along with the visceral and intercostal arteries.

Two cases of colonic necrosis following aortoiliac surgery due to coronary-induced cardiogenic shock

We report two cases of abdominal aortic aneurysm in which the patent inferior mesenteric arteries were ligated. The patient in Case 1, with occlusion of the right coronary artery, developed sudden bradycardia during surgery, resulting in cardiac arrest. The patient was successfully resuscitated and the operation was completed. In Case 2, acute thrombotic obstruction occurred postoperatively in the stent previously implanted in the left anterior descending coronary artery. Although the thrombus was removed by aspiration, hypotension was sustained. In both cases, colonic necrosis extending from the descending colon to the rectum developed following cardiogenic shock. The affected portion of the colon was resected and a colostomy was constructed. The incidence of coronary arterial disease is high in patients with abdominal aortic aneurysm. The occurrence of cardiac complications is not rare, and may result in catastrophic consequences. Therefore the inferior mesenteric artery should be reimplanted, especially in patients with concomitant heart disease.

Hybrid Repair of Aortic Arch Aneurysms: A Totally Extrathoracic Approach with Branched Endografts in Two Patients

Of all of the aortic segments, the aortic arch is the last frontier for endovascular treatment. The main difficulty for arch repair is the lack of an appropriate proximal landing zone of at least 2 to 3 cm required for endograft sealing and anchoring to diminish the risk of endoleaks or migration. We used branched endografts to treat two cases of aortic aneurysms that required complete arch endografting, with successful aneurysm exclusion.

A comparison of haemophagocytic syndrome signs in aortic aneurysm and angina pectoris cases at postoperative death: HPS diagnosis and prediction

Although hemophagocytic syndrome (HPS) signs are more severe in aortic aneurysm cases than in angina pectoris cases, HPS-associated postoperative death should be considered more in both cases. This study analyzed a total of 183 Japanese patients, with 101 aneurysms, 79 anginas, and 3 with both, who underwent aortic replacement (AR) or/and aortocoronary bypass grafting (ACBG) during a period of 1.92 years. In seven aneurysm and eight angina cases with 7.6–12.1 g/dl of hemoglobin (Hb), iron metabolism was studied. As clinical outcomes, diabetes, chronic renal failure (CRF), and thrombosis were more prevalent in the angina cases than in the aneurysm cases. In six cases of aneurysm (6:101) who died after AR, five who died of acute myocardial infarction (AMI) or pulmonary embolism (PE) during postoperative 3–101 days developed HPS, and no detail data was available for one case. Among the five diabetic cases of angina (5:79) who died 7–74 days after ACBG, four cases with cerebral infarction (CI) had infection-associated HPS, and one case had severe kidney atrophy without CI and HPS. Postoperative HPS signs in the aneurysm cases were also generally more severe than those of the angina cases. The aneurysm case with no CRF showed mostly typical HPS and died of AMI. She had pancytopenia, anemia with anisocytosis and nucleated red cells, leukopenia with immature myeloid cells, thrombocytopenia with coagulopathy, elevated lactate dehydrogenase, hyperbilirubinemia, liver dysfunction, and numerous phagocytes containing hemosiderin in the specimen of the aorta examined before the operation. Preoperatively, she also showed high levels of serum ferritin (SF) and low levels of both serum iron (S–Fe) and total iron-binding capacity (TIBC). All the 15 patients in whom iron metabolism was evaluated had low levels of S–Fe. Low levels of TIBC and high levels of SF were observed in 11:15 patients. Cardiac hemophagocytosis with no CRF was a suggestive of HPS. AR and ACBG operations became a direct trigger of HPS. Postoperative AMI, sepsis, and PE became a HPS trigger, but CI alone and CRF did not. For postoperative survival, it was important to protect the patients from infections.

Time‐related Histopathologic Analyses of Immunologically Untreated Porcine Valved Conduits Implanted in a Porcine‐to‐Goat Model

This study was performed to evaluate the clinical feasibility of use of immunologically nontreated xenogenic valves, using a porcine-to-goat pulmonary valved conduit implantation model. Porcine pulmonary valve conduits were prepared with no specific immunological treatment and implanted in the right ventricular outflow tract of goats under cardiopulmonary bypass. The goats were assigned at predetermined intervals (1 day, 1 week, and 3, 6, and 12 months) as two animals for each interval. Echocardiographic examinations of the valves were performed before sacrifice. Upon retrieving the xenograft specimens, they were inspected visually and microscopically. Ten of the 12 animals survived the predetermined observation periods. Variable degrees of pulmonary regurgitation were the main findings on echocardiographic evaluations. On gross examination of the explanted specimens, all leaflets, except in one animal that prematurely died, were fairly well preserved. They were slightly shortened but free of thrombosis or vegetation. Aneurysmal dilatations of the anterior wall of the implanted pulmonary artery were observed in one of 12-month-survival animals and in another one of 3-month-survival animals. Microscopically, the three components of implanted xenografts (the pulmonary artery, valve, and infundibulum) were shown to be gradually replaced with host cells in time, while maintaining structural integrity. The nuclei of the donor tissue disappeared through pyknosis and karyolysis. In conclusion, immnunologically untreated xenogenic pulmonary valved conduits can be an alternative potential as valve substitutes with distinctive advantages of providing self-healing potential, despite a few problems observed in the current study such as occurrences of pulmonary regurgitation and sporadic cases of aortic aneurysm.