Rupture Of Infrarenal Abdominal Aortic Aneurysm Research Articles

Mortality and risk factors for ruptured abdominal aortic aneurysm after repair endovascular (rARE).

The aim of this study was to characterize risk factors for infrarenal abdominal aortic aneurysm rupture after endovascular repair (rARE) and evaluate 30-day mortality in comparison to primary ruptured abdominal aortic aneurysm (rAAA). A retrospective review of all adult patients with rAAA at a single tertiary university care center between February 11, 2006, and December 31, 2018, was performed. A total of 267 patients with rAAA were identified, 11 of whom had rARE. Descriptive statistics were applied due to the small sample size. Overall 30-day mortality was similar between primary rAAA and rARE (31.5% vs 27.3%); however, patients with rARE were more likely to receive palliative care (3.9% vs 18.2%). Mortality of patients who underwent operative intervention was 11.1% for rARE and 28.7% for primary rAAA at 30days. All patients had an endoleak at the time of rupture. Type 1 and type 3 endoleaks resulting in direct aortic sac pressurization were the primary cause of rARE (9 of 11 patients); however, rupture occurred in two patients with only a type 2 endoleak. There was no sac expansion at the time of rupture in four of 11 patients with rARE. Four of 11 patients were lost to follow-up prior to rARE. rARE is an uncommon complication following EVAR and contributes to late aneurysm-related mortality following endovascular repair. Although the 30-day mortality rate was similar for rARE and primary rAAA, larger series are required to determine which patients with rARE will benefit from intervention. The presence of endoleak and sac expansion may alert surgeons to increased risk of rARE; however, a subset of patients with rARE did not have sac expansion or surveillance imaging on follow-up. Loss to lifelong imaging surveillance remains a risk factor for rARE.

Endovascular Iliac Artery Aneurysm Repair With Iliac Branch Endoprosthesis in Type III Loeys-Dietz Syndrome

Loeys-Dietz syndrome (LDS) type III is a rare connective tissue disorder caused by SMAD3 gene mutations that manifests with arterial tortuosity, systemic aneurysms, aortic root dilatation, and osteoarthritis. The endovascular treatment of iliac artery aneurysms with an iliac branch endoprosthesis (IBE) in LDS patients has not been described. We have presented the safety and technical feasibility of branched endovascular iliac artery aneurysm repair in a patient with a rare variant SMAD3 mutation resulting in LDS type III. A 52-year-old man with an ascending aortic root aneurysm, intercostal artery aneurysm, infrarenal abdominal aortic aneurysm, and bilateral common iliac artery (CIA) aneurysms underwent extended gene analysis. He was found to have a rare variant heterozygous autosomal dominant SMAD3 gene mutation (p.I396N) consistent with LDS type III. Because the patient was in extremis from infrarenal abdominal aortic aneurysm rupture, he underwent open replacement with a bifurcated Dacron graft and ligation of the right hypogastric artery at an unaffiliated hospital. Computed tomography angiography revealed a residual 4.7-cm left CIA aneurysm and an anatomic constraint for the IBE (proximal CIA diameter, <17 mm; Fig 1). The previously described alternative endograft aortoiliac reconstruction technique facilitated IBE repair by creation of an adequate proximal CIA landing zone with an Ovation limb (Endologix, Irving, Calif). The contralateral gate was cannulated through a left axillary cutdown. Because of a tortuous hypogastric artery, Viabahn endoprostheses (W.L. Gore & Associates, Flagstaff, Ariz) were used for hypogastric extensions, with a bridging Gore VBX stent graft. No perioperative complications occurred. At the 5-month follow-up visit, he was alive without cardiovascular morbidity. Computed tomography angiography showed branch vessel patency and sac regression, with no evidence of an endoleak or stent graft migration (Fig 2). Although branched endovascular iliac artery aneurysm repair is not the historical treatment of choice for patients with LDS type III, IBE repair can be a safe and effective minimally invasive treatment option for anatomically suitable patients.Fig 2Postoperative three-dimensional computed tomography angiogram showing patent left common iliac, external iliac, and hypogastric arteries with no evidence of endoleak or stent graft migration.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Atmospheric pressure and infra-renal abdominal aortic aneurysm rupture: A single observational study and a comprehensive review of literature

IntroductionThere have been various suggestions that abdominal aortic aneurysm rupture (rAAA) might have a seasonal variation depending on atmospheric pressure (AP) alteration. Despite above suggestions no study has yet examined the effect of fluctuation in AP on daily, seasonal, monthly, AAA size and co-morbidities to reach a conclusive outcome. MethodsA total of fifty (n = 50) ruptured AAA over a 5-year period were retrospectively studied. Local meteorological data on AP were obtained from UK Meteorological Office. The data was subjected to statistical analysis using Student's t-test, linear regression (Pearson correlation Coefficient) and Coefficient of determination to establish any casual link between AP and incidences of rAAA on daily, seasonal and monthly basis. The casual link was also assessed between AP, AAA size and co-morbidities. The outcome is presented in a format of comprehensive review of literature that detected only 6 papers in MEDLINE and EMBASE from 1951 to 2012 in UK. ConclusionThere appears to be a significant correlation between mean monthly pressures and mean monthly rupture incidence (Pearson)(n = 12; r = −0.61; p < 0.034; rsq = 0.37). The periods of low AP are associated with higher incidence of rupture (rAAA n = 29 at mean atmospheric pressure 1012 mB Vs rAAA n = 12 at mean atmospheric pressure 1016 mB Vs rAAA n = 9 at mean atmospheric pressure of 1020 mB) in our study and all reviewed literature. In addition, no casual link between AP to co-morbidities (diabetes mellitus, hypertension ischaemic heart disease, chronic obstructive pulmonary disease) and AAA size could be established or found in the literature.

Infrarenal abdominal aortic aneurysm rupture and severe symptomatic coronary artery disease: Rapid combined transdiaphragmatic off-pump coronary surgery and abdominal aortic aneurysm repair

Infrarenal abdominal aortic aneurysm rupture and severe symptomatic coronary artery disease: Rapid combined transdiaphragmatic off-pump coronary surgery and abdominal aortic aneurysm repair