Abdominal aortic aneurysms.

The dangers of any abdominal aortic aneurysm are discussed, and the disastrous combination of an aneurysm and abdominal pain emphasised. These anerysms can be divided into 4 groups. The presentation and operative mortality for each group is discussed, as is the long term survival, state of the peripheral circulation and general health after operation. How results can be improved is considered. It is concluded that all such aneyrysms should be operated upon because of the good immediate and long term results in comparison with those not operated upon.     

Abdominal aortic aneurysm in women.

OBJECTIVE: The purpose of this study was to compare abdominal aortic aneurysm (AAA) associations in men and women. METHODS: Veterans aged 50 to 79 years without a previous history of AAA underwent ultrasound screening for AAA after completing a questionnaire on demographic information and potential risk factors. RESULTS: A total of 122,272 men and 3450 women were successfully screened. An AAA of 3.0 cm or greater in diameter was found in 4.3% of men and 1.0% of women (P <.001). Contrary to a previous report, we did not find suprarenal aortic enlargement accompanying AAA to be more common in women. The principal associations that we have previously reported for AAA in this cohort (age, smoking, family history of AAA, and a negative association with diabetes) were all similar in women compared with men. In age- and smoking-adjusted models, the interaction terms indicated that black race and cancer were more strongly associated with AAA in women than men (P <.05). Height and cerebral vascular disease were also more strongly associated with AAA in women than in men, but these interaction terms did not reach statistical significance (P <.10). Although the other differences were unexpected and require confirmation, the trend toward a stronger association of cerebral vascular disease with AAA in women is consistent with two previous reports. CONCLUSIONS: Despite the much lower prevalence of AAA in women, the most important associations with AAA are similar to those seen in men. Our data provide some support for a previous finding that cerebrovascular disease may be more closely associated with AAA in women than in men.     

Abdominal aortic coarctation inducing aortic occlusion and renovascular hypertension.

Abdominal aortic coarctation is a rare, non-atherosclerotic disease. It is a functionally significant at an early age when associated with aortic branch stenosis and renovascular hypertension. The pathogenesis of aortic constrictive lesions remains unknown, but may be related to developmental error or aortic growth arrest and various hypotheses have been reported. When the renal arteries are involved by the coarctation, severe hypertension is common at an early age and in untreated patients, life-threatening complications commonly occur. Patients who reach the age of 40 years generally have the coarctation below the renal arteries but even when the renal arteries are not involved by the coarctation, renovascular disease may still occur due to secondary atherosclerosis. Aortic thrombosis secondary to abdominal aortic coarctation with renovascular disease and lower limb ischemia, occurring in a 63-year old woman, is reported.     

Abdominal aortic aneurysm

Between 1981 and 1986, 282 cases of abdominal aortic aneurysm were diagnosed in Waltham Forest. Rupture had occurred in 183, 15 underwent urgent operation for intact aneurysm, and 84 had elective surgery. The incidence of rupture increased from 13 to 21 per 100,000 population during the 6-year period. Operative mortality for patients with rupture was 54.7 per cent, but the mortality overall was 81.4 per cent. In 59 per cent of patients with rupture no operation was performed, and 35.0 per cent of all deaths occurred in the community. The mortality for rupture in women was significantly higher than in men, although the operative mortality was comparable. Fifty patients (27 per cent) were found to have attended hospital within 2 years of rupture and many had documented evidence of an aneurysm. One-third of all patients admitted with rupture were undiagnosed. This study complements the previous small number of community studies and suggests that the incidence of rupture is increasing nationally particularly in women, where the mortality was exceptionally high. Early elective surgery is the key to the problem and improved clinical awareness could save many patients without elaborate and expensive programmes to screen the 'at risk' population.     

Abdominal aortic aneurysm

The most common site for an arterial aneurysm, i.e. the focal dilatation of the original blood vessel, is the abdominal aorta. Studies have suggested that abdominal aortic aneurysms (AAAs) are rare in women under the age of 55 and in men under the age of 60. However, in men older than 60, AAAs are nearly 10 times more common in men than in women, and many of these affected men will be asymptomatic. This article reviews the prevalence, diagnosis, including screening guidelines, and treatment options for AAA, with reference to a case study of a 72 year old male smoker diagnosed with an AAA.     

Abdominal aortic coarctation and segmental hypoplasia.

Functionally significant, nonatherosclerotic, noninflammatory, concentric and tubular stenoses of the abdominal aorta, 4 to 16 cm in length, were encountered in five male and five female patients 11 to 49 years old. Seven patients were younger than 19 years of age. Aortic branch stenoses were common, affecting splanchnic vessels in seven patients and renal arteries in eight patients. The pathogenesis of the aortic constrictive lesions remains unknown, but it may be related to developmental error or aortic growth arrest. Existence of multiple renal arteries in 70% of these patients lends support to the developmental hypothesis. Intimal fibroplasia characterized stenotic aortic tissue. Severe hypertension was common, with the mean preoperative arterial pressure being 200/119 mm Hg. Thoracoabdominal bypass was undertaken in eight patients, being combined with renovascular reconstruction on five occasions. Two patients underwent patch graft aortoplasty with bilateral renal revascularization. Therapeutic results were classified as excellent six times and as good four times. Single-stage arterial reconstructions are the preferred method of treatment for abdominal aortic coarctation or segmental hypoplasia with associated aortic branch disease.     

Abdominal aortic aneurysms after heart transplantation.

BACKGROUND: In recent years abdominal aortic aneurysms were diagnosed in several heart transplant recipients at our center. Only case reports or small series have been reported previously and little is known about abdominal aortic aneurysms after heart transplantation. Therefore, the goals of this study were to estimate the incidence of this condition after heart transplantation, to identify risk factors for its development, and to assess its clinical consequences. METHODS: Our investigation was a retrospective, single-center cohort study of 368 consecutive patients transplanted between 1984 and 1999. RESULTS: During a mean follow-up of 75 +/- 49 months, 37 of the 368 (10%) transplant recipients and 36 of 202 (18%) of the sub-group with a history of ischemic heart disease were found to have an abdominal aortic aneurysm. All patients were male, and all except 1 had a history of ischemic heart disease. A history of ischemic heart disease prior to heart transplantation was the sole independent risk factor for developing an aneurysm by multivariate analysis. Aneurysm-related events occurred earlier and more frequently in the 7 transplant recipients who already had a dilated abdominal aorta prior to transplantation. The abdominal aortic aneurysm was the direct or indirect cause of death in at least 9 patients. CONCLUSIONS: Abdominal aortic aneurysms are relatively frequent after heart transplantation, occur at a younger age than in the general population, and have serious clinical consequences. Close ultrasonographic follow-up of patients with a history of ischemic heart disease or with an abnormal abdominal aorta prior to heart transplantation seems indicated.     

Abdominal aortic aneurysms and ureteric obstruction.

Ureteric obstruction is rarely encountered in abdominal aortic aneurysms and is due to perianeurysmal fibrosis. 3 cases are described in which aortic aneurysm and retroperitoneal fibrosis are found. Excision of the aneurysm and ureterolysis with intraperitonization of the ureter is the most appropriate surgical procedure but treatment must be individualized according to the patient's condition and the operative discoveries.     

Abdominal aortic aneurysm in a neonate.

This is the second reported case of abdominal aortic aneurysm in neonates to be presented in the English language literature. The first case was reported by Howorth in 1967. In addition to the presence of abdominal aortic aneurysm, this neonate has nesidioblastosis and sequestration of the lungs. The combination of these three rare anomalies in one infant is fascinating and has not been reported.     

Abdominal aortic aneurysms presenting as renal colic.

In a 6-year period, 9 patients were referred by their General Practitioners to the urology unit with a clinical diagnosis of renal colic but were subsequently found to have leaking abdominal aortic aneurysms (AAA). In all cases of loin pain, especially in the elderly patient, the possibility of a leaking abdominal aneurysm must be considered. If no intrinsic urological cause for the pain is found or patterns suggestive of ureteric obstruction are seen on urography, ultrasound examination of the aorta-iliac vessels should be performed. Magnetic resonance imaging (MRI) and computed tomography (CT) scans may be useful adjuncts to this investigation.     

Abdominal aortic aneurysms. Results of surgical treatment

One hundred and twenty-one aneurysms of the abdominal aorta were operated on during a ten year period (1971-1981). Elective surgery was carried out in 89 patients (73.5%). Thirty-two patients were operated on for impending or frank rupture. Most of the patients treated electively had no symptoms on admission. The mortality of this group of patients was 6.7% (6 patients). All the patients treated as emergencies had acute abdominal or back pain. Six cases presented with shock and acute renal failure. The hospital mortality was high in this group of 11 patients (34.3%). Nine of them were operated on because of suspected rupture but this was not confirmed at operation. Only one patient in this group died after the operation (11.1%). The hospital mortality of the 23 patients with ruptured aneurysms was 43.4% (10 patients). Six of them died in the operating room. While elective surgery carries an acceptable mortality, the emergency procedure involves a high risk. All the aneurysms must be resected electively in spite of the absence of symptoms.