Chronic false aneurysm of the sub-renal abdominal aorta after abdominal contusion

A case of aortic false aneurysm after blunt trauma of the abdomen is presented. Unlike traumatic lesions of the thoracic aorta this condition seems to be extremely rare. To our knowledge, our case is the nineteenth one reported in the literature successfully repaired by surgery.     

Dissecting aneurysm of the abdominal aorta

A case of aneurysm of the abdominal aorta, diagnosed ante mortem, is reported; this is the thirty-fifth dissecting aneurysm, and the second beginning in the abdominal aorta, on record.     

Mortality and size of abdominal aortic aneurysm at long-term follow-up of patients not treated surgically and treated with and without statins

Of 130 patients with abdominal aortic aneurysms (AAAs) not treated surgically, 75 (58%) were treated with statins. The sizes of the AAAs were 4.6 +/- 0.6 cm at baseline and 4.5 +/- 0.6 cm at 23-month follow-up in patients treated with statins (p = NS) and 4.5 +/- 0.6 cm at baseline and 5.3 +/- 0.6 cm at 24-month follow-up in patients not treated with statins (p < 0.001). Four of 75 patients (5%) treated with statins died at 45-month follow-up, and 9 of 55 patients (16%) not treated with statins died at 44-month follow-up (p < 0.05).     

Surgical treatment of dissecting aneurysm of the ascending aorta: immediate and late results

The authors describe experience gained with surgical treatment of dissecting aneurysm of the ascending aorta in the period from 1978 to 1987. 30 patients were operated on using the techniques proposed by Bentall, De Bono and Carbrol. All patients exhibited the presence of annulo-aortic ectasia. Hospital mortality in the past four years was 20%. On the basis of an analysis of immediate and late results the authors come to the conclusion that Bentall's, De Bono's and Cabrol's technique is the method of choice for surgical corrections of annulo-aortic ectasia and Marfan's syndrome.     

Ultrasonic diagnosis in aneurysm of the abdominal aorta

The sonographic diagnostics of an aneurysm of the abdominal aorta has obtained a high value on account of the high reliability and the rapid availability of the investigation in connection with the absolute safety of the method. Form, extension, calcification, haemodynamics, thrombosis and dissection of an aneurysm of the aorta can sonographically be demonstrated and measured by longitudinal and transversal sections. As non-invasive approach the ultrasound tomography in the order of the graduated diagnostic method stands before the computed tomography which is not always at once available and before the angiography which have their qualification in the case of a planned operative approach above all for the purpose of the exact topographic differentiation between suprarenal and infrarenal extension.     

Current surgical treatment and results for aneurysm of the thoracic aorta in elderly patients

During the period from January, 1983 to December, 1986, a total of 199 patients with thoracic aortic aneurysm underwent surgical treatment in our Cardiovascular Surgical Service. During this period, criteria for surgical indications were established and general surgical principles and techniques were standardized. As a consequence, surgical results appeared to stabilize during this period. It was clearly established that the surgical result for patients over 65 years was poor with high mortality compared to the younger age group (38.6% vs 7.2%). This tendency was in sharp contrast to that of abdominal aortic aneurysm surgery where low mortality (3%) was obtained regardless of age. Other factors influencing high mortality were as follows: 1) atherosclerosis as an etiological background, 2) aneurysm situated at the aortic arch, 3) Urgency for surgery, 4) pre- and postoperative status of respiratory and renal function. Late follow-up results showed that 25% of patients died, while 66% are in fair condition.     

So-called "primary" infected aneurysms of the sub-renal abdominal aorta. Five observations

The authors describe 5 cases of mycotic aneurysms of the infrarenal abdominal aorta. These relatively rare lesions raise problems which are not so much diagnostic but above all therapeutic and etiopathogenic. They are rare lesions, with a striking clinical picture and often very spectacular radiological appearances, in particular by CT scan and angiography. Indications for surgery as well as the technique used thus comply with rigorous norms. However, despite everything, and in particular despite increasingly early positive diagnosis, rapid surgical management and advances in vascular surgery techniques, the mortality associated with such lesions remains very high, even in the context of cold aneurysm surgery, when compared with ordinary atherosclerotic aneurysms, dealt with under the same conditions.     

Value and results of coronary surgery before the repair of abdominal aortic aneurysm

Seventeen polyarteriosclerotic patients underwent coronary bypass surgery before repair of an abdominal aortic aneurysm between December 1979 and November 1988 in the Cardiovascular Surgical Department of the Pitié Hospital. Sixteen patients had triple vessel disease and 1 patient had single vessel disease but with mitro-aortic valvular disease. The abdominal aortic aneurysm was asymptomatic in 9 cases. The diameter of the aneurysm was over 5 cm in all patients. The average time between the two operations was 6.3 +/- 5.4 months. One myocardial infarction was observed following the coronary bypass surgery. There were no complications related to the coronary artery disease or operative deaths after repair of the abdominal aortic aneurysm. Two late deaths occurred, one due to an aortoduodenal fistula and the other to extra cardiovascular causes. One patient underwent femoro-popliteal bypass surgery 4 years after repair of the aortic aneurysm. One patient had successful percutaneous transluminal angioplasty of an aorto-coronary venous bypass graft 8 years after its implantation. All the other patients are asymptomatic from the coronary and peripheral arterial points of view. The 7 year survival was 85.7 +/- 9.4 per cent. These results seem to justify immediate and late preventive myocardial revascularisation in patients with coronary artery disease requiring surgery prior to repair of an abdominal aortic aneurysm.     

Initial and late results of coronary angioplasty for early postinfarction unstable angina

Unstable angina that occurs in the early postinfarction period is associated with an increased incidence of unfavorable cardiac events despite aggressive medical therapy. We examined the results of coronary angioplasty in 47 consecutive patients with postinfarction unstable angina who were referred for the procedure 12.9 +/- 7 days following myocardial infarction, 14 of which were Q wave and 33 of which were non-Q-wave. Coronary angioplasty was performed on a total of 55 arteries with a mean predilatation stenosis of 95 +/- 8%. These included 46 infarct-related arteries and nine noninfarct arteries. Double-vessel angioplasty was performed in eight patients. Successful coronary angioplasty (greater than 30% reduction of predilatation stenosis) was achieved in 43 patients (91%), with a mean residual stenosis of 33 +/- 28%. There was one in-hospital death, one patient required emergency bypass surgery, and two patients had early reocclusion resulting in myocardial infarctions. The 39 patients who had successful angioplasty procedures and who were discharged from the hospital without an unfavorable outcome were followed for 16.3 +/- 7 months, and repeat coronary angioplasty was required in five patients from 45 to 105 days after the initial procedure. Two patients had subsequent elective bypass surgery, one had a recurrent myocardial infarction, and one patient had a noncardiac death. For selected patients with suitable coronary anatomy, coronary angioplasty appears to offer an efficacious therapeutic option for early postinfarction unstable angina.     

Marfan's syndrome and isolated aneurysm of the abdominal aorta

A 43 year old woman presented with an aneurysm of the abdominal aorta. Marfan's syndrome was diagnosed as the underlying cause of the aneurysm. An isolated aneurysm as presenting sign of Marfan's syndrome is rare. In a review of published reports about 30 cases were found.     

Prognosis of chronic non-dystrophic and surgically treated aortic insufficiency

Between January 1972 and March 1983, 123 patients with isolated non dystrophic aortic insufficiency underwent aortic valve replacement. During a mean follow-up period of 4.3 years per patient, 25.6 p. 100 of the patients died, including a 4.1 p. 100 hospital death rate. The actuarial survival rate was 74 p. 100 at 5 years and 62 p. 100 at 10 years. The main causes of mortality were heart failure, dysrhythmias and sudden death. A study of prognostic factors based on the preoperative data showed that clinical, radiological, electrocardiographic and haemodynamic signs were informative. In agreement with other authors, we found that preoperative cardiac dilatation and left ventricular dysfunction were predictive of a poor prognosis.     

Mycotic aneurysm of the subrenal abdominal aorta: extra anatomical reconstruction in five patients

Between 1988 and 2001, five patients with mycotic aneurysm of the abdominal aorta underwent surgery. Extra-anatomical reconstruction with axillo-bifemoral bypass grafting was performed in all patients. The hospital mortality rate was 20%. During the follow-up period two patients presented thrombosis of the axillo-bifemoral bypass, descending aorto-bifemoral bypass was performed in one. Extra-anatomic revascularization is a satisfactory procedure in the treatment of mycotic abdominal aortic aneurysm. The results are acceptable and the prognosis is mainly related to the underlying pathology and the severity of the infection.