Is the Size of an Abdominal Aortic Aneurysm Associated with Coagulopathy?

Abdominal aortic aneurysm (AAA) volume and intraluminal thrombi were analyzed with respect to the number and function of platelets, blood cells, and coagulation factors. A group of 43 patients who underwent repair of an AAA were enrolled in this study. The maximum diameter and volume of the AAA, and the volume of intraluminal thrombi and lumen were measured by computed tomography with planimetry. The platelet count and platelet function, prothrombin time, activated partial thromboplastin time, fibrinogen, plasminogen, antithrombin 3, fibrin degradation products (FDP), D-dimer, and blood cell counts were measured. Spontaneous platelet aggregation and the FDP, and D-dimer levels were elevated; all other factors remained within the normal range. Intraluminal thrombus volume was strongly correlated with the volume and diameter of the AAA. However, no correlation was observed between the size of the AAA and coagulating factors, including the number and aggregation value of platelets. AAAs are frequently associated with a coagulating disorder. However, its size and thrombus volume are not correlated with coagulation changes. Although an intraluminal thrornbus increases along with fee enlargement of the AAA, the clinical manifestation of bleeding is rarely associated with an AAA. Therefore coagulopathy in patients with an AAA is not fully explained by its morphology.     

Treatment of a Left Common Iliac Aneurysm with Endovascular Powerlink® Stentgraft in a Patient with an Occlusion of a Left Common Iliac Stent

Isolated iliac aneurysms are uncommon and account for only 2% of all abdominal aneurysms. Typically, patients presenting with this pathology are operated on surgically. In our patient, however, surgery could have been an option but the patient had undergone a laparotomy more than 50 years earlier because of a gun-shot wound, so we preferred an endovascular repair. Furthermore, regular endovascular repair with a straight tube stentgraft was impossible due to the absence of a proximal neck. Consequently, we opted for placing a bifurcated stentgraft to exclude the iliac aneurysm.     

Surgery for Left Ventricular Aneurysm: Is There Still Any Role for Simple Linear Repair?

Abstract   The aim of left ventricular aneurysm (LVA) surgery is to eliminate the diskinetic portion of the left ventricle and to restore the patient's clinical condition. This can be obtained with two surgical procedures: linear repair and endoventricular patch technique. We investigated early- and long-term results in patients who underwent both procedures. From January 1980 to December 2004, 158 patients underwent surgical repair of LVA: 86 had linear repair and 72 patch repair. Operative mortality was 6.9%, with no differences between the two groups. Logistic regression revealed older age, higher left ventricular end-diastolic volume, and an ejection fraction (EF) less than 30% as independent risk factors for in-hospital mortality; the type of operation "per se" did not influence the early mortality. At the follow-up extending up to 25 years, there was no statistically significant difference in survival between the two study groups, as well as in New York Heart Association and Canadian Cardiovascular Society classes. Cox regression revealed older age, EF less than 30%, urgent operation, and a history of cerebrovascular accident as independent risk factors for late mortality: the type of operation did not influence mortality at follow-up. We conclude that aneurysm resection associated with myocardial revascularization is the best treatment for LVA. The choice of the technique should be tailored on an individual basis, according to aneurism location, extension, residual ventricular function, and septal involvement.     

Are we Ignoring the Importance of Ankle Pressures in Patients with Abdominal Aortic Aneurysm?

BACKGROUND AND PURPOSE: the ankle/brachial pressure index (ABPI) has been shown to be a reliable marker of cardiovascular risk in population studies. We investigated whether the ABPI was a useful prognostic index for patients with abdominal aortic aneurysm. METHODS: patients entered into the U.K. Small Aneurysm Trial and Study had their ABPI measured in both legs at baseline (mean ABPI reported) and were followed up until 30 June 1998, with information about cause of death being obtained from the Office of National Statistics. This study focussed on cardiovascular and all-cause mortality. RESULTS: a total of 1827 men and 478 women, mean age 69 years, median aneurysm diameter 4.4 cm, were followed up for a median of 5.7 years. A total of 829 deaths were reported (rate 8.1 per 100 person-years), 546 (66%) from cardiovascular causes. The all-cause mortality risk increased as the ABPI decreased, hazard ratio 1.25 per 0.2 unit decrease in ABPI (95% CI 1.17 to 1.34, p<0.001). For patients in the lowest tertile group (ABPI <0.87) there were 11.6 deaths per 100 person-years. This increased risk persisted after adjustment for age, sex, evidence of ischaemia on resting ECG and initial aneurysm diameter, adjusted hazard ratio 1.17 per 0.2 unit decrease in ABPI (95% CI 1.07 to 1.28, p<0.001). CONCLUSION: the ankle/brachial pressure index is an important prognostic indicator for patients with abdominal aortic aneurysm. Patients with an ABPI below 0.87 (limit of lowest tertile) have the highest mortality risk and best clinical practice demands that attention is focussed on active treatment to minimise their cardiovascular risk factors.     

Endovascular Aneurysm Repair or Open Surgery for Treatment of Abdominal Aortic Aneurysm with Involvement of Both Common Iliac Arteries ?

Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) involving the entire common iliac arteries requires proximal coil embolisation of both internal iliac arteries and extension of the stent graft into the external iliac arteries (type E according to the Eurostar classification). A potential complication of this treatment is pelvic ischemia. Therefore, this type of aneurysm is a relative contra-indication for EVAR.

In this case-report we describe a hybrid procedure preserving antegrade circulation in one of the internal iliac arteries in a patient with a type E aneurysm who was unfit for open surgery.     

Are the Left and Right Proximal Femurs Symmetric?

Background

The contralateral femur frequently is used for preoperative templating for THA or hemiarthroplasty when the proximal femur is deformed by degenerative changes or fracture. Although femoral symmetry is assumed in these situations, it is unclear to what degree the contralateral femur is symmetrical.

Questions/purpose

We therefore defined the degree of asymmetry between left and right proximal femurs and determined whether it was affected by demographics and proximal femoral anatomy.

Methods

We obtained 160 paired femurs from individuals (20–40 years old), evenly distributed for gender and ethnicity (African-American and Caucasian). The height and weight of the individuals were recorded. We measured the femoral head diameter, minimal femoral neck diameter in the AP and cephalocaudal (CC) planes, and the AP femoral diaphyseal diameter. The absolute and percent differences were determined.

Results

All femoral measurements showed an absolute difference less than 2 mm and a percent asymmetry and difference less than 2% for the femoral head, less than 4% for the femoral neck, and less than 3.5% for the femoral shaft. We found no correlation or predictive value between absolute differences and asymmetry and age, ethnicity, gender, or weight. Height was negatively associated with femoral head differences and thus increased symmetry of the femoral head.

Conclusions

Our data support assumptions of substantial symmetry of the proximal femur and highlights that asymmetry is not affected by demographics or the size of the proximal femur. Asymmetry tends not to occur in isolated segments of the femur.