Impending Rupture Of Abdominal Aortic Aneurysm Research Articles

Spinal Cord Ischemia Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm.

Spinal cord injury (SCI) following endovascular aortic repair (EVAR) for an abdominal aortic aneurysm (AAA) is a rare but serious complication. Case 1 presented with ruptured AAA and shock and underwent emergency EVAR. The patient developed incomplete paraplegia 2 days following EVAR. Case 2, diagnosed with impending rupture of AAA with extremely shaggy aorta, was treated with emergency EVAR. The patient was diagnosed with complete paraplegia soon after EVAR. Case 3 underwent elective EVAR and developed delayed paraplegia 2 weeks later. In EVAR, the etiology of SCI leading to paraplegia is often multifactorial. Surgeons must consider the possibility of SCI-induced paraplegia.

A case of impending abdominal aortic aneurysm rupture with increased 18F-fluorodeoxyglucose uptake

A case of impending abdominal aortic aneurysm rupture with increased ¹⁸F-fluorodeoxyglucose uptake

Rupture signs on computed tomography, treatment, and outcome of abdominal aortic aneurysms.

ObjectivesAbdominal aortic aneurysm (AAA) rupture has a high mortality rate. Although the diagnosis of a ruptured AAA is usually straightforward, detection of impending rupture signs can be more challenging. Early diagnosis of impending AAA rupture can be lifesaving. Furthermore, differentiating between impending and complete rupture has important repercussions on patient management and prognosis. The purpose of this article is to classify and illustrate the entire spectrum of AAA rupture signs and to review current treatment options for ruptured AAAs.MethodsUsing medical illustrations supplemented with computed tomography (CT), this essay showcases the various signs of impending rupture and ruptured AAAs. Endovascular aneurysm repair (EVAR) and open surgical repair are also discussed as treatment options for ruptured AAAs.ResultsCT imaging findings of ruptured AAAs can be categorised according to location: intramural, luminal, and extraluminal. Intramural signs generally indicate impending AAA rupture, whereas luminal and extraluminal signs imply complete rupture. EVAR has emerged as an alternative and possibly less morbid method to treat ruptured AAAs.ConclusionsAAA rupture occurs at the end of a continuum of growth and wall weakening. This review describes the CT imaging findings that may help identify impending rupture prior to complete rupture.Teaching Points AAA rupture occurs at the end of a continuum of growth and wall weakening. Intramural imaging findings indicate impending AAA rupture. Luminal and extraluminal imaging findings imply complete AAA rupture. Some imaging findings are not specific to AAA ruptures and can be seen in other pathologies. EVAR has emerged as an alternative and possibly less morbid method of treating ruptured AAAs.

In-Hospital Efficacy of Endovascular Aortic Repair in Patients With Impending Rupture versus Contained Rupture of Abdominal Aortic Aneurysms

The purpose of our study was to compare the efficacy of endovascular aortic repair (EVAR) in patients with impending rupture of abdominal aortic aneurysm (IRAAA) versus contained rupture of abdominal aortic aneurysm (CRAAA). Of the 21 patients who underwent EVAR for infrarenal AAA from January 2009 toMay 2011, 11 did so for IRAAA and 10 for CRAAA. We compared their demographic andaneurysmal characteristics, comorbidities, complications, and clinical outcomes during hospitalization. The CRAAA group was younger than the IRAAA group. There were no group differences in AAA size, operation time, volume of contrast agent, length of hospital stay (LOHS), or preoperative LOHS. A small difference in mean intraoperative blood loss of ∼4 mL was noted, but was recognized as clinically insignificant. ICU stay and postoperative LOHS were greater in the CRAAA than in the IRAAA. One patient in the IRAAA group had a mild headache after EVAR. Four patients in the CRAAA group had postoperative complications: 1 had acute renal dysfunction; 1 had retroperitoneal infection; 1 had respiratory failure and myocardial infarction; and 1 died of respiratory tract infection and respiratory and cardiac failure. Patients undergoing EVAR for CRAAA have a higher incidence of postprocedural severe complications and death than patients undergoing EVAR for IRAAA.

Novel technique for endovascular salvage of a folded aortic endograft

Endovascular aneurysm repair (EVAR) has been established as a safe and effective treatment modality for infrarenal abdominal aortic aneurysms. Endograft migration resulting in a proximal type I endoleak can be one of the most difficult challenges following EVAR. Often, this precludes endovascular treatment and necessitates conversion to open surgical repair. We report a case of a high-risk patient who presented with impending abdominal aortic aneurysm rupture as a result of endograft migration following EVAR performed 5 years prior. The endograft had folded over on itself within the aneurysm sac and was successfully repaired using a total endovascular approach.

The hyperattenuating crescent sign.

The crescent-shaped area of hyperattenuation within the aortic wall or mural thrombus of an abdominal aortic aneurysm (AAA) is known as the hyperattenuating crescent sign and suggests acute or impending AAA rupture (1). The curvilinear area paralleling the aortic wall is best demonstrated on nonenhanced computed tomographic (CT) images and is of higher attenuation than the intraluminal aortic blood (Figure) (2). At contrast material–enhanced CT, the hyperattenuating crescent is of higher attenuation compared with the adjacent psoas muscle (1).

High-attenuating crescent in abdominal aortic aneurysm wall at CT: a sign of acute or impending rupture.

To determine whether a peripheral high-attenuating crescent in an abdominal aortic aneurysm (AAA) on unenhanced computed tomographic (CT) scans is a sign of impending or active aneurysm rupture. CT scans were reviewed of 149 consecutive patients operated on because of AAA who had undergone preoperative unenhanced CT scanning. The presence of a peripheral high-attenuating crescent on CT scans was correlated with surgical findings of aneurysm complication. Aneurysm diameter was correlated with presence or absence of pain at the time of CT, high-attenuating crescent, and aneurysm complication. Sensitivity of the high-attenuating crescent sign as an indication of complicated aneurysm was 77%; specificity, 93%; and positive predictive value, 53%. The sign showed a statistically significant correlation with large aneurysm size (P < .001) and presence of pain at the time of CT (P < .003). In patients without CT evidence of frank aneurysm leak, the high-attenuating crescent sign should be regarded as a sign of impending AAA rupture, particularly in patients with pain.