Combined coronary artery bypass grafting and abdominal aortic aneurysm repair

The purpose of this paper was to assess the results and feasibility of simultaneous coronary artery bypass grafting and abdominal aortic aneurysm repair. Twenty nine patients with a mean age of 65 years underwent simultaneous coronary artery bypass grafting and abdominal aortic aneurysm repair between June 1990 and March 2002. All patients had significant coronary artery disease and were considered as indicated for coronary artery bypass grafting. This was performed first in 28 patients and simultaneously with abdominal aortic aneurysm repair in one, with a mean number of grafts of 2.5, a mean aortic cross-clamp time of 40 minutes, and a mean bypass time of 115 minutes. Eight straight and 21 bifurcated grafts were employed. The total operating time averaged 400 minutes. The median postoperative hospital stay was 18 days. One patient died of stroke and mediastinitis, for a mortality rate of 3.5%. This experience suggests that combined coronary artery bypass grafting and abdominal aortic aneurysm repair is both safe and effective.     

Combined coronary artery bypass grafting on the beating heart and abdominal aortic aneurysm repair.

Abdominal aortic aneurysm (AAA) is commonly associated with coronary artery disease (CAD). Eleven patients underwent the combined operation of coronary artery bypass grafting (CABG) on the beating heart and AAA repair: 10 underwent off pump CABG and 1 patient required centrifugal pump and pulmonary assist with closed circuit because of unstable hemodynamics. All cases were discharged without severe complications and with patent coronary bypass grafts.     

One-stage repair of a massive aortic arch aneurysm

A 61-year-old woman with a massive aortic aneurysm extending from the aortic root to the proximal descending thoracic aorta required urgent surgical intervention. She underwent successful replacement of her ascending aorta, transverse arch and descending aorta in a single operation.     

Endovascular infrarenal abdominal aortic aneurysm repair

Abdominal aortic aneurysm repair has undergone a revolution since Volodos and Parodi described endoluminal repair in the early 1990s. Subsequent data from large registries have confirmed its efficacy. Randomised controlled trials have shown that although endoluminal repair may not be as cost effective as open repair, it can be performed with a lower mortality in patients fit for open repair. Some European countries (eg, Belgium) have taken the results of these trials to rationalise the number of hospitals able to do endovascular repair. The devices continue to improve and although most require open surgical access at present, in future percutaneous access will become the norm. This article reviews the current state of endoluminal aortic aneurysm repair in the infrarenal aorta.     

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.     

ST-segment elevation after abdominal aortic aneurysm repair

We describe a case of post-operative inferior myocardial infarction after abdominal aortic aneurysm repair due to compromise of a gastroepiploic coronary arterial graft.     

Venous abnormalities encountered in abdominal aortic aneurysm repair

The coexistence of abdominal aortic aneurysm (AAA) and venous abnormalities is unusual. In this article two cases of AAA with concomitant abnormalities of a retroaortic left renal vein and left-sided inferior vena cava are presented.     

Review of interventional repair for abdominal aortic aneurysm

Abdominal aortic aneurysm is associated with high mortality rate. For over 50 years, open surgical repair was the standard approach for large aneurysms. However, over the past decade, endovascular aneurysm repair (EVAR) has emerged as a viable alternative. EVAR is associated with lower operative and short-term morbidity and mortality and similar long-term survival (up to 4 years) compared with surgical repair. Endoleak remains a significant limitation associated with aneurysm expansion and reintervention. With newer, more versatile endograft designs, improvements in durability, and better surveillance techniques, the utilization of EVAR is likely to continue to expand.     

Gluteal compartment syndrome after abdominal aortic aneurysm repair

A 66-year-old man underwent emergency surgery for a ruptured abdominal aortic aneurysm associated with right common and internal iliac aneurysms. Postoperatively, his right buttock was distended and tender to compression. A CT scan revealed an extremely swollen right gluteus maximus with decreased density. Macromyoglobinuria was noted, and creatine kinase and myoglobin were elevated: 87,800 IU/l and 144,300 ng/ml, respectively. Renal function had deteriorated and he was treated with hemodialysis until the 15th postoperative day. The patient recovered without any discomfort to the buttock or intermittent claudication. To our knowledge this is the first documented case of gluteal compartment syndrome after the repair of an abdominal aortic aneurysm.     

An update on the 'fast-track' abdominal aortic aneurysm repair

Patients who have unfavourable anatomy for endovascular repair of an abdominal aortic aneurysm require open repair. This is particularly the case for juxtarenal aortic aneurysms, or those patients with small or occluded iliac access vessels.An experience of 'fast-track' abdominal aortic aneurysm repair that was previously reported is updated in the present case. A retroperitoneal approach to the aorta is taken, using a small incision, and is followed by a patient care pathway protocol that demonstrated excellent results and a shortened length of stay. The present update on 56 patients is approximately double the previously reported experience.     

Mini-laparotomy for repair of infrarenal abdominal aortic aneurysm.

AIM: In this study, we evaluated the surgical results of minimal incision aortic surgery (MIAS) compared with the transabdominal approach (TPA) and the retroperitoneal approach (RPA) to repair non-ruptured infrarenal abdominal aortic aneurysm (AAA). METHODS: Three different surgical techniques were studied prospectively in 72 consecutive patients with non-ruptured infrarenal AAA. These patients were randomized into 3 groups of 24 patients each. Group I comprised of patients who underwent MIAS repair. They were compared with group II patients, who underwent the traditionally long midline TPA, and group III patients, who underwent the left RPA to repair non-ruptured infrarenal AAA. All surgery was performed between January 2000 and December 2004. Demographic characteristics, including age, sex, body weight, aneurysm size, previous abdominal operations and comorbid factors of the three groups studied, were compared using the Fischer's exact test. Parameters including operative time, intraoperative fluid administration, and transfusion requirements were compared using the 2-tailed Student t test. Length of stay in the Intensive Care Unit (ICU), time to resumption of regular dietary feeding, and hospital length of stay were recorded and compared using the Wilcox rank sum test. The incidence of 30 day postoperative complications and mortality were compared between the three groups. All 72 patients who entered this study had informed consent. RESULTS: There was no significant difference between group I (MIAS), group II (TPA), and group III (RPA) with regard to age, sex distribution, aneurysm size, or body weight. There was male sex prevalence in all three groups. Surgical exposure of the common femoral arteries was more commonly required in group III (RPA) than in the other groups. Although the length of incision tended to be longer in group III (RPA) than in group II (TPA) and I (MIAS), there was no significant difference in intraoperative time, or aortic cross-clamped time among the three groups. There was a significant difference in the need for intraoperative fluid, the most being in group II (TPA) and the least in group I (MIAS). There was significantly less blood loss in group I (MIAS), as compared with the other 2 groups, but intraoperative blood transfusion for all groups was not significantly different. ICU stay, return to general dietary feeding, and hospital length of stay for group I (MIAS) and III (RPA) were significantly lower than in group II (TPA), which had a higher incidence of postoperative ileus. CONCLUSIONS: MIAS is as safe as retroperitoneal repair and standard transabdominal repair in the treatment of non-ruptured infrarenal AAA, and also more costefficient than retroperitoneal and standard transabdominal repair.     

近肾动脉腹主动脉瘤开窗及分支支架腔内修复术

目的：初步探讨开窗及分支支架腔内修复术,治疗近肾动脉性腹主动脉瘤的临床应用价值.方法：回顾性分析我院大血管疾病诊治研究中心自2011年11月至2012年6月间,完成的处于开放手术修复高度危险的3例腹主动脉瘤开窗及分支支架腔内修复术,所有患者均根据术前CT血管成像三维重建结果定制开窗支架.且手术成功的2例患者于出院前及术后1个月进行了CT血管成像和/或超声复查.结果：3例患者中1例围手术期死亡,死亡原因为支架节点内漏（Ⅲ型内漏）导致瘤腔内压力快速增高,瘤体破裂死亡,2例成功.2例成功病例手术平均时间191min（185 ～ 297min）,平均使用对比剂量165mL（150～ 200mL）,平均射线剂量为367（mGy· cm）,平均失血量不足200mL.成功的2例患者术后7d BUN、血肌酐分别为21 μmol/L、17 μmol/L和64μ mol/L及67 μmol/L,1例患者出现一过性肾功能损伤,血肌酐达183 μmol/L,经内科治疗恢复至正常值以下.成功的2例患者复查CT血管成像,均显示腹腔分支血管通畅、无内漏及支架移位,腹主动脉瘤隔绝确切,下肢血流通畅.结论：开窗及分支支架旨在拓展腹主动脉瘤腔内修复术微创腔内治疗的范围.国内临床应用经验较少,有待共同总结交流.     

Combined coronary artery bypass graft and abdominal aortic aneurysmectomy

Six cases of combined coronary artery bypass graft and abdominal aortic aneurysmectomy were performed in a 1-year period at the Washington Hospital Center. All cases except one were uncomplicated and the average hospital stay for patients with no complications was less than 10 days. We found that there were distinct advantages in combining these two procedures. Although our experience is limited and no definite criteria for combining such procedures have been established, we feel that this approach has potential as the treatment of choice in patients with severe coronary artery disease and abdominal aortic aneurysm.