共查询到20条相似文献,搜索用时 0 毫秒
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R Toda Y Iguro Y Moriyama Y Hisashi H Masuda R Sakata 《Annals of thoracic and cardiovascular surgery》2001,7(2):113-115
Double left renal vein is a rare venous anomaly. We operated on 72-year-old man of abdominal aortic aneurysm (AAA) with double left renal vein. Massive hemorrhage was encountered during encircling the tape around the abdominal aorta. One vein passing posterior to the aorta was injured. Further dissection revealed the presence of double left renal vein forming a ring around the aorta. The patient underwent an abdominal aortic replacement following prompt repair of the injured vein. He had an uneventful postoperative course without renal complication. We missed that preoperative computed tomographic (CT) scan had demonstrated double left renal vein. Preoperative contrast-enhanced CT scan is useful and essential not only for evaluation of AAA, but also for establishing the presence of venous anomalies. Venous anomalies should be taken into consideration on the AAA operation. 相似文献
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Inufusa A Mikawa Y Morita I Fujiwara T 《Archives of orthopaedic and trauma surgery》2002,122(5):306-307
A case of abdominal aortic aneurysm infected by Salmonella dublin is presented. Computed tomography (CT) revealed an abdominal aortic rupture associated with a psoas abscess. An axillo-femoral bypass was performed. The aneurysm and the psoas abscess were resected. 相似文献
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K J Halazun K A Bofkin S Asthana C Evans M Henderson J I Spark 《European journal of vascular and endovascular surgery》2007,33(4):391-4; discussion 395-6
OBJECTIVES: Previous literature has suggested an association between AAA and the presence of elevated plasma homocysteine levels (HCY). Homocysteine can stimulate elastolysis in the arterial media via activation of elastase and matrix metalloproteinases. No evidence in the literature exists correlating aneurysm expansion and HCY. The study objective is to identify whether the rate of AAA expansion is related to HCY. METHODS: 108 patients undergoing surveillance for AAA were identified at our vascular surgical unit. AAA size and growth rate were assessed by serial ultrasonographic measurements. Fasting total HCY levels were measured using fluorescence polarisation immunoassays. Demographic details and atherosclerotic risk factors were noted all AAA patients. A multivariate analysis was performed for growth rate vs. HCY, hypertension and hypercholesterolaemia. The correlation between AAA growth rate, AAA size and HCY levels were calculated. RESULTS: 60% of patients with AAA had some degree of hyperhomocysteinaemia (> 15 micromol/l). Multivariate analysis showed HCY to be the only significant factor affecting AAA growth rate. A positive correlation was demonstrated between HCY levels and AAA growth rate using a linear regression model (R=0.28, p=0.003). Median growth rate among patients with hyperHCY was double that of patients with normal HCY (0.5 mm/month vs. 0.25 mm/month, p=0.003). A growth rate of > 10 mm/year was seen in 25% of hyper HCY patients and in only 2% of patients with normal HCY. In addition patients with hyper HCY and larger AAAs (> 4 cm) had a growth rate twice as fast as patients with hyper HCY and AAAs < 4 cm. CONCLUSIONS: A correlation between HCY and growth rate exists, although this is weak due to the multifactorial aetiology of AAAs. HyperHCY patients have faster expansion rates than patients with normal HCY, with significant numbers demonstrating rapid expansion (> 10 mm/year) and therefore an increased risk of rupture. 相似文献
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M Matsushita H Kobayashi K Oda N Nishikimi T Sakurai Y Nimura 《European surgical research. Europ?ische chirurgische Forschung. Recherches chirurgicales européennes》1999,31(4):305-313
A model of abdominal aortic aneurysm with intimal thickening was developed in the rabbit. A segment of the abdominal aorta just proximal to the bifurcation (1 or 2 cm in length) was dissected and isolated with clamps. This segment was perfused by injecting physiologic saline or 100 U/ml of hog pancreatic elastase from the lumen. Perfusion was performed manually for 5 min and the peak pressure in the segment was between 300 and 400 mm Hg in order to cause aortic wall injury. After 4 weeks, animals that had received perfusion with elastase had aneurysms in the perfused segment on arteriography. None of the other animals developed aortic aneurysms. Histologically, the segments of aorta perfused with saline exhibited intimal hyperplasia. In addition to the intimal hyperplasia, the segments of aorta perfused with elastase solution showed lysis of the elastic lamellae in the media that resulted in aneurysm formation. 相似文献
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Yauhen A. Tarbunou Jamie B. Smith Robin L. Kruse Todd R. Vogel 《Journal of vascular surgery》2019,69(3):763-773.e3
Objective
We evaluated the association between postoperative hyperglycemia and outcomes after abdominal aortic aneurysm (AAA) repair.Methods
We used diagnosis and procedure codes (International Classification of Diseases, Ninth Revision, Clinical Modification) to identify patients who underwent open or endovascular repair of a nonruptured AAA from September 2008 to March 2014 from the Cerner Health Facts database (Cerner Corporation, North Kansas City, Mo). We evaluated the association between postoperative hyperglycemia (glucose concentration >180 mg/dL) and infections, in-hospital mortality, readmission, patients' characteristics, length of hospital stay, and medications. Multivariable logistic models examined the association of postoperative hyperglycemia with in-hospital infection and mortality.Results
Of 2478 patients, 2071 (83.5%) had good postoperative glucose control (80-180 mg/dL), and 407 (16.5%) had suboptimal control (hyperglycemia). Patients who had postoperative hyperglycemia experienced longer hospital stays (9.5 vs 4.7 days; P < .0001), higher infection rates (18% vs 8%; P < .0001), higher in-hospital mortality (8.4 vs 1.2%; P <.0001), and more acute complications (ie, acute renal failure, fluid and electrolyte disorders, respiratory complications). After adjusting for patients' characteristics and medications, multivariable logistic regression models demonstrated that patients receiving postoperative insulin had nearly 1.6 times the odds of having an infectious complication (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.12-2.2; P = .007) than those who did not. Hyperglycemic patients had 3.5 times the odds of in-hospital mortality (OR, 3.48; 95% CI, 1.78-6.80 [P = .0003]; 2.3% vs 1.2%; P < .001). When stratified by procedure type, patients with hyperglycemia who underwent endovascular repair had nearly 2 times the odds of an infectious complication (OR, 1.85; 95% CI, 0.98-3.51; P = .05) and 7.5 times the odds of in-hospital mortality (OR, 7.54; 95% CI, 1.95-29.1; P = .003). Patients who underwent an open AAA repair and who had hyperglycemia had three times the odds of dying in the hospital (OR, 3.05; 95% CI, 1.29-7.21; P = .01).Conclusions
Among patients undergoing elective AAA repair, approximately one in six had postoperative hyperglycemia. After AAA repair in patients with and without diabetes, postoperative hyperglycemia was associated with adverse events, including in-hospital mortality and infections. Compared with those who had open surgery, patients undergoing endovascular repair who had postoperative hyperglycemia had greater risk of infection and death. After controlling for insulin administration and postoperative hyperglycemia, a diabetes diagnosis was associated with lower odds of both infection and in-hospital mortality. Our study suggests that hyperglycemia may be used as a clinical marker as it was found to be significantly associated with inferior outcomes after elective AAA repair. This retrospective study, however, cannot imply causation; further study using prospective methods is needed to elucidate the relationship between postoperative hyperglycemia and patient outcomes. 相似文献12.
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O Schouten J H H van Laanen E Boersma R Vidakovic H H H Feringa M Dunkelgrün J J Bax J Koning H van Urk D Poldermans 《European journal of vascular and endovascular surgery》2006,32(1):21-26
OBJECTIVE: To evaluate the effect of statins on aneurysm growth in a group of consecutive patients under surveillance for infrarenal aortic aneurysms (AAA). MATERIALS AND METHODS: All patients (59 statin users, 91 non-users) under surveillance between January 2002 and August 2005 with a follow-up for aneurysm growth of at least 12 months and a minimum of three diameter evaluations were retrospectively included in the analysis. Multiple regression analysis, weighted with the number of observations, was performed to test the influence of statins on AAA growth rate. RESULTS: During a median period of 3.1 (1.1-13.1) years the overall mean aneurysm growth rate was 2.95+/-2.8 mm/year. Statin users had a 1.16 mm/year lower AAA growth rate compared to non-users (95% CI 0.33-1.99 mm/year). Increased age was associated with a slower growth (-0.09 mm/year per year, p = 0.003). Female gender (+1.82 mm/year, p = 0.008) and aneurysm diameter (+0.06 mm/year per mm, p = 0.049) were associated with increased AAA growth. The use of non-steroidal anti-inflammatory drugs, chronic lung disease, or other cardiovascular risk factors were not independently associated with AAA growth. CONCLUSIONS: Statins appear to be associated with attenuation of AAA growth, irrespective of other known factors influencing aneurysm growth. 相似文献
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R C Darling D M Shah W R McClellan B B Chang R P Leather 《The Journal of cardiovascular surgery》1992,33(1):65-69
A prospective randomized study has been carried out to compare the retroperitoneal (RP) and the transperitoneal (TP) approaches to infrarenal abdominal aortic aneurysms (AAA). From November 1988 to July 1989, 27 patients were randomized to one or the other group. Twelve patients underwent TP resection of their AAA; 11 of these were performed using the open aneurysmorrhaphy technique. The RP approach was used in 15 patients, 12 of whom had the exclusion technique performed. Enteral feeding was resumed on the second postoperative day in the RP group compared to the fourth postoperative day in the TP group; the difference was statistically significant (p less than 0.02). Statistically significant differences were also present in the estimated blood loss (516 cc in the RP group versus 1127 cc in the TP group) in the blood transfusion requirement (p less than 0.05). This prospective randomized study comparing TP and RP approaches to AAA showed that the RPE approach had less blood loss, less transfusion requirement, and earlier resumption of enteral feeding than the TP approach. We feel the RPE technique is safe and efficient in the treatment of infrarenal abdominal aortic aneurysm. 相似文献
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D. J. Parry H. S. Al‐Barjas L. Chappell T. Rashid R. A. S. Ariëns D. J. A. Scott 《The British journal of surgery》2009,96(8):870-877
Background:
The presence of an abdominal aortic aneurysm (AAA) independently predicts cardiovascular disease (CVD) and its complications. Levels of plasma markers of fibrin turnover are raised in men with a large AAA (at least 5·5 cm) and predict CVD risk in healthy subjects. This study examined fibrin turnover in men with a small AAA.Methods:
Seventy‐five men with a small AAA (30–55 mm) were compared with 90 controls matched for age, sex and race. Haemostatic and fibrinolytic parameters were assessed.Results:
Men with a small AAA had higher mean levels of fibrinogen (2·92 versus 2·59 g/l; P = 0·019), thrombin–antithrombin (TAT) complex (4·57 versus 1·89 ng/ml; P < 0·001), prothrombin F1 + 2 (1·13 versus 0·82 ng/ml; P = 0·004) and D‐dimer (346·7 versus 120·2 ng/ml; P < 0·001). All markers correlated with maximum aortic diameter determined by ultrasonography. On multivariable regression the association between presence of an AAA and fibrinogen, TAT complex, prothrombin F1 + 2 and D‐dimer levels remained significant after adjustment for confounding influences.Conclusion:
Fibrin turnover was increased in these men with a small AAA, independently of concomitant CVD, conventional risk factors and inflammatory markers. Enhanced fibrin turnover may contribute to the risk of cardiac complications in this group. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. 相似文献16.
H Ogino Y Ueda T Sugita Y Sakakibara K Matsuyama K Matsubayashi 《The Japanese Journal of Thoracic and Cardiovascular Surgery》1999,47(5):226-228
A 69-year-old man with coronary artery disease associated with abdominal aortic aneurysm underwent a one-stage operation utilizing a low-flow cardiopulmonary bypass. Ordinary cardiopulmonary bypass was abandoned as a result of severe atheromatous finding in the entire aorta. However, coronary artery bypass grafting without cardiopulmonary bypass was hazardous as a result of heart enlargement and deteriorating function. Therefore, the abdominal aortic aneurysm was first replaced with a bifurcated graft. Coronary artery bypass grafting with two arterial grafts was then performed successfully on the beating heart with the support of a low-flow cardiopulmonary bypass connected to the bifurcated graft. 相似文献
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Ruptured abdominal aortic aneurysm. 总被引:2,自引:0,他引:2
A total of 131 surgically treated ruptured abdominal aortic aneurysms have been reviewed. Factors affecting morbidity and mortality rates have been analyzed. In our experience very little improvement has occurred in the last 10 years and the question is raised whether a plateau has been reached in the management of this catastrophic disease. Patient selection is not considered to be the key to better results, since some operated patients inevitably die. Improved technique with better, more rapid control of blood loss, especially from venous tears, will continue to yield better results. Eighty-six nonoperative cases have been studied. Diagnostic accuracy is lower than it should be, often leading to delayed surgery or death. 相似文献
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Stewart H Lambie Mario De Nunzio J Huw Williams Christopher W McIntyre 《Nephrology, dialysis, transplantation》2004,19(3):745-746
A 72-year-old male presented with claudication in the rightleg. Clinical examination suggested an abdominal aortic aneurysm(AAA). Computed tomography (Figure 1) demonstrated an infrarenalAAA with a maximum diameter of 7 cm, and 相似文献
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Toshiro Ito Nobuyoshi Kawaharada Yoshihiko Kurimoto Tetsuya Koyanagi Takeshi Uzuka Mayuko Uehara Takayuki Hagiwara Yohsuke Yanase Toshiyuki Maeda Tetsuya Higami 《Surgery today》2013,43(9):1019-1024