Aneurysm ruptures of the abdominal aorta

Rupture of an abdominal aortic aneurysm remains a dramatic complication and its operative mortality is still about 50%. The authors reviewed 41 cases of ruptured abdominal aortic aneurysms which were operated from 1978 to 1983. On arrival at the hospital and after clinical diagnosis, the patients were rapidly brought to the theatre without specialized complementary examinations. Coated Dacron prostheses were used in all cases. The operated patients were brought to the intensive care unit where special attention was given to central venous pressure, arterial pressure and capillary wedge pressure (Swan-Ganz-catheter). The authors tried to determine the influence of shock, preoperative delay, blood loss, age and associated diseases on the mortality rate. In this series the perioperative mortality (30 days) could be reduced to 39%.     

Aneurysm of the infrarenal abdominal aorta

Preoperative and postoperative treatment as well as standardisation of surgical techniques over the past 20 years have helped to bring about considerable reduction of operative mortality in cases of asymptomatic aortic aneurysm. Yet, with all improvement, rupture of aneurysm has continued to be associated with high rates of mortality. At the Department of Surgery of Cologne University, between 1963 and 1985, operations were performed on 681 patients for abdominal aortic aneurysm. Asymptomatic aneurysm were surgically removed from 41.7 per cent of them, while 27.5 per cent underwent surgery in symptomatic stages. Aneurysm had ruptured in 210 patients. Operative mortality accounted for 5.3 per cent of all asymptomatic patients. High mortality rates among patients with ruptured aortic aneurysms were attributable to preoperative shock. Only 16.3 per cent of patients survived in this group. The mortality rate among patients without shock amounted to 39.5 per cent.     

Successful renal transplantation after endovascular bifurcated stent graft repair of an abdominal aortic aneurysm

Renal transplantation after repair of aortoiliac aneurysms with traditional prosthetic vascular grafts has been shown to be effective. Vascular surgery continues to rapidly evolve, most notably with the advancement of endovascular repair of abdominal aortic aneurysms. Controlled trials continue to support the trend toward the use of endovascular bifurcated aortic stent grafts. For this we describe the first renal transplant in a patient with an endovascular bifurcated aortoiliac stent graft. No intraoperative difficulties were encountered. At 1-year follow-up, the transplanted kidney is functioning well with a normal serum creatinine level of 1.3 mg/dl, and the patient has no worsening of peripheral vascular disease. We recommend that the presence of an endovascular aortic graft not be a contraindication to renal transplantation.     

Aneurysm of the ascending aorta after cardiac transplantation.

We report the case of a 57-year-old female cardiac transplant patient in whom an aneurysm of the recipient side of the ascending aorta developed 1 year after transplantation. Although a mycotic origin was the likely cause, histologic examination diagnosed an atherosclerotic aneurysm.     

Endovascular stent graft repair of abdominal aortic aneurysms after liver transplantation.

It is estimated that 1.7% of orthotopic liver transplant recipients will develop abdominal aortic aneurysms (AAAs) after transplantation. It has been observed that these aneurysms expand faster in transplant recipients; therefore, aggressive surveillance for AAAs in transplant recipients is required. Endovascular aneurysm repair is rapidly becoming the standard of care, especially in patients with previous abdominal surgery and other significant comorbidities. This article describes our experience with AAAs in orthotopic liver transplant recipients treated successfully by endovascular stent graft repair.     

Serious duodenitis concomitant with graft dysfunction following renal transplantation

A 48-year-old woman underwent a renal transplantation from her sister. The graft functioned immediately. She received induction immunosuppressive therapy, including basiliximab, tacrolimus hydrate, mycophenolate mofetil and methylprednisolone. Her urinary output decreased on the first postoperative morning. Plasma exchange for 3 days and conversion from tacrolimus hydrate to cyclosporine partially improved graft function. Graft biopsies on the fifth postoperative day suggested an acute humoral rejection. On the seventh postoperative day, she experienced high fever, disorientation, hypertension and severe upper abdominal pain with a bulk of bloody stool. Graft function deteriorated again. Gastrointestinal fibroscopy showed severe duodenitis with bleeding. Following seven successive daily plasma exchanges with hemodialysis and reconversion to low dose tacrolimus hydrate, the systematic symptoms and graft function gradually improved. Two years after transplantation, graft function was good with a serum creatinine level of 1.0 mg/dL. The patient did not experience any further gastrointestinal symptoms.     

Surgical repair of localized dissecting aneurysm originating from the infrarenal abdominal aorta

Aortic dissection commonly affects the thoracic aorta and is associated with high morbidity and mortality rates. Localized dissections originating from the infrarenal abdominal aorta are extremely rare. We report a rare case of localized dissecting aneurysm originating from the infrarenal abdominal aorta in a 62-year-old man. Open surgical repair was successfully performed without any complications.     

Stent graft of abdominal aortic aneurysm after renal transplantation

The necessity of operative treatment of abdominal aortic aneurysm (AAA) is reported in an increasing number of patients after renal transplantation as a result of improved renal graft long-term survival. In these patients, aortic surgery however, places the allograft at risk for ischemic damage. We present a first case of AAA stenting in a kidney-grafted patient. This procedure helped us avoid ischemia of the graft, which showed excellent function pre- and postoperatively. The patient had an uneventful recovery with no evidence of renal dysfunction and was discharged in good condition 7 days after stenting. This case demonstrates a useful alternative for the repair of AAA in kidney-grafted patients.     

Endovascular repair of abdominal aortic aneurysm in renal transplantation

Successful endovascular correction of a 12-cm abdominal aortic aneurysm (AAA) is described in a 76-year-old man with a functional pelvic renal transplant and 18-month follow-up. Endovascular treatment is a safe alternative to surgery for AAA correction in the elderly post-transplantation patient since it does not require flow interruption during the procedure.