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Infected abdominal aortic aneurysms are uncommon but not rare (1–3% of all abdominal aortic aneurysms). This life-threatening disease can lead to rapid uncontrolled sepsis and/or aortic rupture. We report one case that underlines two notions. Firstly computed tomography is effective to detect early stages of the pathology providing complete depiction of the anatomical abnormalities. Secondly infected aortic aneurysm can be successfully treated by antibio-therapy and in situ replacement with cryopreserved arterial homograft. 相似文献
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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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Percutaneous Endovascular Abdominal Aortic Aneurysm Repair 总被引:3,自引:0,他引:3
Rachel ES Bergamini TM Kinney EV Jung MT Kaebnick HW Mitchell RA 《Annals of vascular surgery》2002,16(1):43-49
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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Background Inflammation is integral to the pathogenesis of abdominal aortic aneurysm (AAA). This study examines preoperative biomarkers
of systemic inflammation in patients undergoing open repair of intact and ruptured AAA.
Methods One-hundred twelve patients were entered into a prospective observational study. Preoperative POSSUM physiology score, C-reactive
protein (CRP), white blood count (WBC), platelet count, fibrinogen, and albumin were recorded and related to clinical variables
using univariate analysis.
Results Sixty-one patients with a ruptured AAA, 39 with an asymptomatic intact AAA, and 12 with an acutely symptomatic intact AAA
underwent attempted repair. There were two inflammatory asymptomatic aneurysms and one inflammatory ruptured aneurysm. No
patient had clinical evidence of coexistent inflammatory disease. Patients with a symptomatic intact AAA had a significantly
greater level of CRP and fibrinogen, higher WBC, and lower serum albumin, than those with an asymptomatic intact AAA. Patients
with a ruptured aneurysm had a significantly greater level of CRP, higher WBC, and lower serum albumin than those with an
asymptomatic intact aneurysm. Patients with a symptomatic intact AAA had a significantly higher CRP level, but lower WBC,
than those with a ruptured AAA. There was no difference in CRP level, WBC, or serum albumin between survivors and non-survivors
of attempted repair of asymptomatic, symptomatic and ruptured AAA.
Conclusions Acutely symptomatic and ruptured AAAs are associated with an early elevation in systemic inflammatory biomarkers. This early
activation of the inflammatory response might influence perioperative outcome.
Presented to the Association of Surgeons of Great Britain & Ireland Annual Meeting, Edinburgh, 2006, and published in abstract
form in Br J Surg 2006; 93 (S1):126–127. 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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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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Wolff T Koller MT Eugster T Rouden C Marti R Gürke L Stierli P 《World journal of surgery》2011,35(4):905-910
Background
Fluid around the graft in the original aneurysm sac after open abdominal aortic aneurysm (AAA) repair is a poorly researched phenomenon. If large, such perigraft seroma can cause symptoms of compression, and cases of rupture have even been described. We assessed whether endarterectomy of the aneurysm sac reduces the incidence of perigraft fluid and improves graft incorporation. 相似文献14.
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P. Opfermann R. von Allmen N. Diehm M.K. Widmer J. Schmidli F. Dick 《European journal of vascular and endovascular surgery》2011,42(4):475-483
Objective
To determine whether advanced age was independently associated with prohibitive surgical risks or impaired long-term prognosis after ruptured aortic aneurysm repair.Design
Post-hoc analysis of prospective cohort.Materials
Consecutive patients undergoing ruptured aneurysm repair between January 2001 and December 2010 at a tertiary referral centre.Methods
Surgical mortality (i.e., <30 days) was compared between octogenarians and younger patients using logistic regression modelling to adjust for suspected confounders and to identify prognostic factors. Long-term survival was compared with matched national populations.Results
Sixty of 248 involved patients were octogenarians (24%) and almost all were offered open repair (n = 237). Surgical mortality of octogenarians was 26.7% (adjusted odds ratio (OR) 2.1; 95% confidence interval (CI), 0.9–5.2) and confounded by cardiac disease. Hypovolaemic shock predicted perioperative death of octogenarians best (OR 5.1; 95%CI, 1.1–23.4; P = 0.037). After successful repair, annual mortality of octogenarians averaged 13.7% vs. 5.2% for younger patients. At 2 years, octogenarian survival was at 94% of the expected ‘normal’ survival in the general population (vs. 96% for younger patients).Conclusions
Surgical mortality of ruptured aneurysm repair was not independently related to advanced age but mainly driven by cardiac disease and manifest hypovolaemic shock. An almost normal long-term prognosis of aged patients after successful repair justifies even attempts of open repair, particularly in carefully selected patients. 相似文献19.
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Chun-Ku Chen Hsiao-Ting Chang Yu-Chun Chen Tzeng-Ji Chen I-Ming Chen Chun-Che Shih 《World journal of surgery》2013,37(10):2360-2371