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Vascular surgery is a challenging discipline and complex aneurysms can present an entire range of technical difficulties. To overcome these problems good technical skills are mandatory. However, it is also worth remembering a few basic rules:

? The simplest solution is often the best.

? All cases need careful planning, including that of the approach

? A successful anastomosis requires good aortic tissue

? Minimal dissection reduces morbidity.  相似文献   

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OBJECTIVES: To investigate symptoms and early mortality (<30 days) following open surgery for emergency, symptomatic non-ruptured abdominal aortic aneurysm (AAA). DESIGN: Retrospective cohort study. PATIENTS AND METHODS: During the period 1983-1994, 129 patients had an emergency admission, followed by surgery, for symptomatic non-ruptured AAA. Sixty-one received surgery within 24 h of admission and 68 received surgery more than 24 h after admission (median 135 h, inter-quartile range: 51-239 h). During the same period 239 patients had elective surgery for non-ruptured AAA. Early mortality (<30 days), symptoms and co-morbidities were recorded. Data were retrieved from the patient records. RESULTS: Mortality (30 days) was 18% in the 61 patients having surgery within 24 h of emergency admission for non-ruptured AAA. Mortality following either delayed surgery (semi-elective) after emergency admission or elective surgery was 4.2% (p=0.0002). Four out of 11 patients who died within 30 days following an acute operation had previously been declared unfit for elective surgery. One additional emergency patient had been found unfit for open surgery, but survived a delayed operation. CONCLUSION: The high mortality rate of patients with non-ruptured, symptomatic AAA undergoing surgery within 24 h of admission appears to be influenced by several factors, including co-morbidities and the acute operation. We propose that the 30-day mortality for non-ruptured AAA should be reported in two categories: mortality rate for elective surgery and mortality for surgery performed within 24 h of emergency admission. The term 'emergency non-ruptured' is a suitable term for the latter group.  相似文献   

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Percutaneous Endovascular Abdominal Aortic Aneurysm Repair   总被引:3,自引:0,他引:3  
In this prospective, nonrandomized study, we compared outcome with percutaneous femoral artery closure to that with open femoral arteriotomy in 95 patients who underwent endovascular AAA repair. Devices were introduced using 22 Fr and/or 16 Fr sheaths. The 8 Fr/10 Fr Perclose devices (Perclose Inc., Redwood City, CA) were used in an off-label "preclose technique." Thirty-three patients had bilateral open femoral arteriotomies, 44 patients had bilateral attempted percutaneous closure, and 18 patients had open femoral arteriotomy on one side and attempted percutaneous closure on the other side. Percutaneous closure was successful in 85% (47/55) of 16 Fr sheaths and 64% (29/45) of 22 Fr sheaths (p <0.027). BILATERAL PERCUTANEOUS CLOSURE WAS SUCCESSFUL IN 63% (28/44) OF PATIENTS. CONVERSION TO OPEN FEMORAL ARTERIOTOMY DUE TO BLEEDING OCCURRED IN 24 OF 106 PERCUTANEOUS ATTEMPTS. THERE WERE NO DISSECTIONS, ARTERIAL THROMBOSES, OR PSEUDOANEURYSMS ASSOCIATED WITH PERCUTANEOUS ARTERIAL CLOSURE. WOUND COMPLICATIONS WERE SEEN IN 3.6% (3/84) OF OPEN ARTERIOTOMIES AND 0.9% (1/106) OF ALL PERCUTANEOUS ATTEMPTS AND ARTERIAL CLOSURES (P > 0.05). Gender, previous femoral access, obesity, and iliac occlusive disease were not predictive of percutaneous failure. Procedural success for percutaneous AAA repair is affected by sheath size. Devices delivered through 16 Fr or smaller sheaths will have successful femoral artery closure rates of at least 85%.  相似文献   

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目的分析破裂型腹主动脉瘤(ruptured abdominal aneurysm,r AAA)行腔内修复术(endovascular aortic aneurysm repair,EVAR)与开放手术早期结果,评价EVAR治疗的效果。方法回顾性收集我院2004年1月~2014年1月收治的48例r AAA患者临床资料,根据其手术与否、手术方式的不同分为术前死亡组(n=20)、EVAR组(n=14)和开放手术组(n=14),三组性别、年龄等一般资料比较无统计学差异(P0.05),EVAR组和开放手术组在瘤体直径、收缩压、舒张压方面比较差异均无统计学意义(P0.05)。结果 EVAR组入院至检查时间为(1.2±0.8)h,与开放手术组(7.5±7.1)h比较差异有统计学意义(P=0.006);EVAR组检查至手术时间为(1.8±1.3)h,与开放手术组(16.8±17.7)h比较差异有统计学意义(P=0.007)。死亡组入院至死亡时间与EVAR组比较差异有统计学意义(P0.009)。EVAR组手术时间为(2.3±0.7)h,与开放手术组(5.6±2.0)h比较差异有统计学意义(P0.001);EVAR组的术中出血量为(142.9±279.3)ml,与开放手术组的(3 528.6±3 252.3)ml间差异有统计学意义(P0.001);EVAR组的输血量为(985.7±2 148.7)ml,与开放手术组的(3 100.0±2 285.1)ml间差异有统计学意义(P=0.018);EVAR组的住院时间为(7.1±2.7)d,与开放手术组的(13.7±4.9)d间差异有统计学意义(P0.001);EVAR组的总费用为(20.9±5.8)万元,与开放手术组的(10.1±11.5)万元间差异有统计学意义(P=0.005)。两组并发症率比较,差异无统计学意义(P=0.430)。结论缩短院内抢救准备时间,是r AAA成功救治的要点。EVAR应作为r AAA的一线治疗方案。  相似文献   

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x = 55.4 mm) underwent bifurcated endovascular grafting (Guidant/EVT, Menlo Park, CA) over an 18-month period. We concluded that bifurcated endovascular grafting with the EVT? device provides reliable and reproducible aneurysm exclusion with short hospital recovery and low morbidity.  相似文献   

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Surgical repair of an abdominal aortic aneurysm (AAA) concomitant with a horseshoe kidney (HSK) may be technically demanding because of the complex anomalies of the kidney and of its collecting system and arteries, the greater risk of HSK-related complications, and the often unexpected intraoperative finding of HSK itself. We reviewed a database of more than 500 patients with AAA observed in our surgical department from 1994 to the time of writing. Five patients had AAA concomitant with HSK. Two of these patients did not undergo surgery because of the small dimension of the aneurysm or because of their poor health. The other three underwent successful repair of AAA with different techniques; namely, an aortobifemoral bypass via a thoracoabdominal retroperitoneal incision in one, a straight graft via an emergency median laparotomy in one, and an endovascular repair followed by open surgery 4 years later for endotension in one. Abnormal minor renal arteries were deliberately occluded and only one of these caused a minor renal infarct, but without functional impairment. These data and a review of the literature indicate that HSK should not preclude repair of coexistent AAA, as imaging procedures provide the information necessary to plan the best approach for each patient. Up-to-date surgical procedures, a posteriori retroperitoneal approach or endovascular repair, and deliberate occlusion of the minor renal arteries appear feasible and safe as they avoid most of the anatomical problems and provide results equivalent to those of uncomplicated aortic surgery.  相似文献   

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There is now sufficient published evidence to describe with confidence much but not all of the natural history of AAA. AAA of 4.0–5.5 cm in diameter have a rupture rate of 0.7–1.0% per year and for AAA < 4.0 cm this rate is even lower. Women appear to have a higher rupture rate than men for small aAa, but there is no evidence of this for AAA > 5.5 cm. Median enlargement rate of AAA 4.0–5.5 cm is about 0.3 cm per year. Enlargement rate is influenced by AAA diameter, being approximately half this rate for AAA 3.0–4.0 cm and half again faster for AAA > 5.5 cm. There is, however, considerable individual variability in enlargement rates and a variety of diseases and conditions appear to influence these rates. Rupture rates of AAA > 5.5 cm in fit individuals are unknown and unlikely to be known in the future. However, for unfit individuals with AAA > 5.5 cm, the rupture rate is high, starting at about 10% per year and increasing by several fold in the largest AAA. The search is on for drugs to favorably alter this natural history, and if successful, will doubtless shed much light on the pathophysiology of AAA enlargement.  相似文献   

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Abdominal Aortic Aneurysm in Situs Inversus Totalis   总被引:1,自引:0,他引:1  
Situs inversus totalis refers to a mirror-image reversal of the normal position of the internal organs. The recognition of concomitant anomalies, such as in the cardiac, venous, gastrointestinal, and urinary systems, is extremely important because these anomalies may disturb the surgical procedure for the concurrent disease in situs inversus totalis. The authors describe a case of successfully repaired abdominal aortic aneurysm with a false aneurysm of the right external iliac artery in situs inversus totalis. The coexistence of abdominal aortic aneurysm has been seldom encountered. The presence of anatomical anomalies significantly increases operative risk. The surgical management of patients with abdominal aortic aneurysm in situs inversus totalis is discussed.  相似文献   

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In-hospital outcomes associated with abdominal aortic aneurysm (AAA) repair are well described. However, little is known about post-discharge readmission rates, lengths of stay, associated mortality, and costs. We examined 206 consecutive patients who underwent AAA repair at two American hospitals between 1998 and 2000. Index hospitalization and 6-month readmission data were extracted from a resource and cost accounting system used by both hospitals. Among the 206 patients, 183 survived until discharge (mortality rate 11.2%). Among the surviving patients, 38 (21.0%) were readmitted within 6 months. Half of the readmissions occurred within two weeks of discharge, with patients presenting with a diverse array of complications. Nonelective repair and diabetes mellitus were independent predictors of hospital readmission (OR=2.83, 95% CI=1.25-6.40, p=0.01; OR=6.60, 95% CI=1.02-42.4, p=0.047, respectively). For each readmission, the mean length of stay was 10.7±2.5 days and the mean cost was $13,397±3,381. The cumulative number of hospital days during the 6 months post-discharge was 17.7±3.5 days for each readmitted patient and the mean per-patient total cost was $23,262±5,478. The mortality rate among readmitted patients was 13.2%. Overall, readmissions following AAA repair accounted for a cost >50% over and above the cost of the readmitted patients index hospitalization. Hospital readmissions are common during the 6 months following AAA repair. Patients who are readmitted experience long lengths of stay and high mortality rates, and their care incurs high costs.Dr. Eisenberg is a Physician-Scientist of the Quebec Foundation for Health Research. Dr. Pilote is a Physician-Scientist of the Canadian Institutes for Health Research.  相似文献   

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Purpose : To assess the effect of in or out of city residence of patients with breast carcinoma, where breast surgery unit treatment and follow-up is made postoperatively.

Method : 234 patients operated on for breast carcinoma at the Breast Surgery Unit were retrospectively studied. Patients were divided into two groups; patients living in the major city where the Breast Surgery Centre is located and patients living in smaller cities, districts, towns and villages out of the city. The distance of patients’ residences from the Breast Centre has also been determined in kilometres. The number of patients and the frequency of check-up visits were compared in both groups.

Results : The number of patients residing in the city centre where the Breast Unit is located was 156 (66.7%). Comparing the frequency of patients’ visits for check-up during the postoperative period, there were no differences between the two groups during the first four years. However, the patients living out of the city did not visit the Breast Unit for check-ups during the fifth postoperative year. Moreover, when the patients were classified into two groups with known and unknown outcomes, it was observed that those patients with unknown outcomes lived further away from the city where the Breast Surgery Unit was located compared to those with known outcomes (p = 0.002). Discussion : Living within or out of the major city centre where the Breast Surgery Unit is located does not have any effect on the frequency of follow-up visits or the number of patients applying for check ups during the first four years postoperatively. However, there were gradual decreases over the course of time in both groups and these differences became apparent during the 5th year. In addition to this, the distance was also found to be an important factor for patients with unknown outcomes in the present study. The combination of living outside the city where The Breast Unit was located and the distance may have a negative effect on follow-ups. There is a need for new, larger scale, studies with longer follow-ups to show how this difference will change over a longer time period.  相似文献   

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