Aneurysms of the abdominal aorta in elderly patients]

Aneurysms of the abdominal aorta are often diagnosed in the over-75s. Although for many Authors the presence of risk factors such as cardiopathies, cerebrovascular problems, renal or respiratory insufficiency, which are clearly more frequent in elderly patients, represent a contraindication to the intervention of choice, personal experience has shown that surgery remains the best solution. In fact, in a group of patients operated on for aneurysm of the abdominal aorta in a heart, no significant differences in age-related mortality were observed. Surgery therefore remains the treatment of choice in the elderly too for it must also be remembered that the natural history of the disease has shown that, in a comparatively short time, the aneurysm ruptures and operating mortality is markedly higher.     

Aneurysms of the abdominal aorta in the neonate and infant

We report a case of aneurysm of the infrarenal abdominal aorta from septic umbilical artery catheterization in a one-month old female infant. In spite of spontaneous thrombosis, the patient's course was uneventful. During the five-year follow-up period no further complications developed and operation was not required. Aneurysms of the aorta are rare in the very young and the infrarenal location is rarer. Sixteen other cases published in the literature are reviewed. Etiologic considerations and therapeutic modalities are discussed.     

Aneurysms and dissections of the thoracal and abdominal aorta]

One to four per cent of all deaths in patients over 65 are caused by aneurysmatic diseases of the abdominal or thoracic aorta. For elective surgery in abdominal aneurysms, open surgery and endovascular treatment both demonstrate brilliant overall results. In the thoracic aorta, new endovascular procedures have led to considerable reductions of postoperative morbidity and mortality. Nevertheless, in view of the endovascular procedure's high cost and the still unclear long-term behaviour of the stent device, a second opinion from a specialised centre is an absolute necessity.     

Aneurysms of the thoracic aorta

Selected radiographs from 40 patients with thoracic aortic aneurysm serve to illustrate most of the radiographic features of this disease. Surgical techniques are outlined and were used to modify the natural course of the disease in 14 patients, with three postoperative deaths. The remaining 26 patients were either moribund on admission and died shortly afterwards or declined operations and died later.     

Aneurysms of the abdominal aorta. Incidence in blacks and whites in North Carolina

We examined race and sex relative to the unexpected finding of an abdominal aortic aneurysm (AAA) at 1,665 autopsies plus 545 abdominal computed tomographic scans in subjects over the age of 50 years. We compared our demographic data with those of North Carolina and our hospital to determine if the data base was representative. White males had a higher incidence (4.2%) of AAA than any other group of race and sex (1.2% to 1.6%) or combination of groups. Although whites (2.9%) had a higher incidence than blacks (1.5%) and males (3.4%) had a higher incidence than females (1.3%), this can be attributed to the influence of the white male. The demographic data of the group studied were similar to those of our institution's admissions and to the North Carolina population. We conclude that (1) there is an increased incidence of AAA in the white male compared with the white female, black male, and black female in North Carolina; (2) there is no difference in the incidence of AAA in the white female, black male, and black female; (3) race alone may not influence the incidence of AAA as there was no difference between white and black females.     

Aneurysms of the abdominal aorta: familial and genetic aspects in three hundred thirteen pedigrees

Purpose: Familial clustering of abdominal aortic aneurysm was first noticed in 1977.Methods: Through questionnaire and phone inquiry, familial data on 324 probands with abdominal aortic aneurysms allowed the establishment of 313 multigenerational pedigrees including 39 with multiple affected patients.Results: There were 276 sporadic cases (264 men, 12 women); 81 cases belonged to multiplex pedigrees (76 men; 5 women). We compared familial and sporadic male cases; the ages at diagnosis were 64.1 ± 7.9 years and 66.0 ± 7.3 years (p < 0.05), respectively, the ages at rupture were 65.4 ± 6.6 years and 75.2 ± 8.6 years (p < 0.001), and the rupture rate was 32.4% and 8.7% (p < 0.001). Survival curves were computed. Relative risk for male siblings of a male patient was 18. We performed a segregation analysis with the mixed model, the most likely explanation for occurrence of abdominal aortic aneurysm in our families was a single gene effect showing dominant inheritance. The frequency of the morbid allele was 1:250, and its age-related penetrance was not higher than 0.4.Conclusion: This analysis indicates the preeminence of genetic factors on multifactorial/environmental effects of the pathogenesis of abdominal aortic aneurysm. (J VASC SURG 1995;21:646-55.)     

Aneurysms of the abdominal aorta. Fissures in the vena cava. Apropos of 4 cases

Four cases of aortico-caval fistulae of atheromatous origin have been treated over a period of 5 years, a frequency (4.8%) much higher than that reported in the international literature. Diagnosis in each of these 4 cases was suggested by clinical features associating signs of a complicated aneurysm with those of a high-output arteriovenous fistula, angiography showing the arteriovenous communication in one patient only. Treatment of choice is by graft to aneurysm sac and suturing of fistula by an endosaccular approach. Prognosis is much more favorable (mortality 25%) than that of rupture into the free peritoneum (mortality 77,4%).