彩色多普勒超声在腹主动脉瘤破裂诊断中的应用价值

目的探讨彩色多普勒超声在腹主动脉瘤破裂诊治中的价值。方法回顾性分析14例腹主动脉瘤破裂患者的灰阶和彩色多普勒超声图像,从腹主动脉瘤发生部位、瘤体大小、瘤壁厚度、瘤体破裂部位、瘤体破裂时血管内异常回声、血管周边形成血肿、出现腹腔游离液及瘤体内彩色多普勒表现等方面进行分析,并与手术结果、CT血管成像或磁共振检查结果进行对比。结果腹主动脉瘤超声检出率100%,肾上型2例,肾下型12例,瘤体最大直径6.1～1 3.2 cm,超声诊断腹主动脉瘤壁破裂处显示率14.3%,腹主动脉瘤旁腹腔血肿显示率66.7%,腹腔积液显示率80.0%,腹膜后血肿显示率12.5%。结论超声作为可移动简便无损伤的检查方法 ,可以快速的对腹主动脉瘤破裂和其他腹腔器官肿物引起的急腹症进行鉴别,在腹主动脉瘤的发现、随访监测、腹主动脉瘤破裂急诊入院有较高的临床应用价值。     

Abdominal aortic aneurysm associated with horseshoe kidney

The optimal approach to abdominal aortic aneurysm with horseshoe kidney is still debated. We describe a successful abdominal aortic aneurysm repair through a left retroperitoneal approach in a 77-year-old woman with a horseshoe kidney.     

Ex vivo repair of renal artery aneurysm associated with repairing of abdominal aortic aneurysm. Case report.

A case of right renal artery distal aneurysm associated with juxtarenal abdominal aortic aneurysm in a 75-year-old male, who presented with abdominal and back pain and chronic renal failure, is reported. The abdominal aortic aneurysm was repaired with a bifurcated Dacron graft. The right kidney was simultaneously explanted, ex vivo reconstruction of the renal artery with PTFE graft was performed, followed by autotransplantation of the kidney into the right iliac fossa. In the postoperative course the renal function returned to normal.     

Inflammatory abdominal aortic aneurysm

A 58-years-old man, with no medical past history, was examined for abdominal pain and weight loss. An enlarged kidney could be palpated, and abdominal echography showed left hydronephrosis due to ureteral compression by abdominal aortic aneurysm. Laboratory data showed an inflammatory syndrome. CT scan suggested the diagnosis of inflammatory abdominal aortic aneurysm. The use of corticosteroids brought about the regression of the symptoms and the resolution of the ureteral obstruction, permitting aneurysmectomy and prosthesis replacement without ureterolysis. This report shows the interest of preoperative radiological diagnosis of the inflammatory character of abdominal aneurysm. For uncomplicated cases, preoperative treatment using corticosteroids could allow partial regression of the periaortic inflammation and easier surgical repair.     

Management of Patients with Colorectal Cancer and Concomitant Abdominal Aortic Aneurysm

PURPOSE: The aim of this study was to determine the optimal management of patients with colorectal cancer and abdominal aortic aneurysm in the elective situation. METHODS: All patients with a history of colorectal cancer and abdominal aortic aneurysm between 1986 and July 2000 were identified, and charts of those with concomitant disease were reviewed. RESULTS: A total of 435 patients with available charts were reviewed. Eighty-three patients with concomitant abdominal aortic aneurysm and colorectal cancer were identified. In 64 patients the colorectal cancer was treated first, and 44 of these patients had an abdominal aortic aneurysm less than 5 cm in diameter (average = 3.8 cm). No abdominal aortic aneurysm ruptured in the postoperative period. Median delay to colorectal cancer surgery from diagnosis was four days. Twenty patients with abdominal aortic aneurysm of 5 cm or greater (average = 5.4 cm) were treated for colorectal cancer first. In two of these patients (with abdominal aortic aneurysms sized 5 and 6.4 cm), the abdominal aortic aneurysm ruptured in the early postoperative period. Median delay to colorectal cancer resection was eight days. Twelve patients had both abdominal aortic aneurysm and colorectal cancer treated at the same time. The average size of the abdominal aortic aneurysm was 6.4 cm. Median delay from colorectal cancer diagnosis to resection was 15 days. No documented cases of graft infection occurred in this group; median follow-up was 3.2 years. Seven patients underwent abdominal aortic aneurysm repair before resection of colorectal cancer; in two patients, colorectal cancer was found at the time of resection. The average size of abdominal aortic aneurysm was 6 cm and median delay to treatment of colorectal cancer was 122 days, a statistically significant longer delay than in the other two groups (P < 0.0001). CONCLUSION: In patients with colorectal cancer and abdominal aortic aneurysm of 5 cm or more, treatment of colorectal cancer first may result in life-threatening rupture, whereas treatment of abdominal aortic aneurysm first may significantly delay treatment of colorectal cancer. Concomitant treatment seems to be a safe alternative. If anatomically suitable, the abdominal aortic aneurysm may be considered for endovascular repair followed by a staged colon resection. The presence of an abdominal aortic aneurysm less than 5 cm does not affect colorectal cancer treatment.     

Abdominal aortic aneurysm in association with horseshoe kidney.

The authors report 3 cases of infra-renal abdominal aortic aneurysms resected in the presence of horseshoe kidney. In all these cases the diagnosis of the renal anomaly was done before the aneurysmectomy. In the first case, the diagnosis of horseshoe kidney was done by an aortography. In the second case by a previous operation to remove an urinary calculi. Three years after this surgery the diagnosis of abdominal aortic aneurysm was done when a computed tomography, an intravenous pyelography and an aortography, confirmed the diagnosis of horseshoe kidney. The third case come to our hospital in the fourth day after an exploratory laparotomy done in another hospital, when was observed the aneurysm and the horseshoe kidney. The second case had two anomalous arteries. One of them arose from the aneurysm to the renal isthmus and the other one from the common iliac to the isthmus. The three patients had an uncomplicated postoperative course. Only in the second case we had the necessity to reattache an anomalous artery directly to the graft.     

Chronic contained rupture of an abdominal aortic aneurysm presenting as a lower extremity neuropathy

Rupture of an abdominal aortic aneurysm often presents with a pulsatile abdominal mass, abdominal pain, and hypotension. Recent clinical reports describe patients with less apparent clinical signs and symptoms who were found later in their evaluation to have a contained rupture of an abdominal aortic aneurysm. Even more unusual is a chronic contained rupture of an abdominal aortic aneurysm. Our patient had a chronic contained rupture of an abdominal aortic aneurysm that presented with erosion into the lumbar vertebral bodies and subsequent lumbar neuropathy. CT scan confirmed the contained rupture of the aortic aneurysm and the patient underwent successful repair of his aortic aneurysm. Our report discusses the significance of atypical presentations of abdominal aortic aneurysm rupture and the importance of prompt diagnosis and definitive repair.     

Role of wrapping in concomitant intra-abdominal aneurysm and colorectal carcinoma

The therapeutic measure against concomitant intraabdominal aneurysm and colorectal carcinoma is still a dilemma. Here we report the clinical courses of three cases of colorectal carcinoma coincidental with moderate-sized abdominal aortic or iliac artery aneurysm in those who underwent operations during a recent three-year period. Resection of malignant lesion and wrapping of aneurysm were carried out in all three patients simultaneously. Carcinoma was staged by Dukes classification as A in one patient and B in two patients. All tolerated surgery well without any signs of complications. Two-year or three-year follow-up shows that they have continued to do well, with no further symptoms of abdominal aortic aneurysm, peripheral vascular disease, or recurrence of colorectal carcinoma. We conclude that, if the aneurysm is not about to rupture and the carcinoma is in an advanced stage, then the carcinoma should be resected, associated with interim aneurysmal wrapping. However, both lesions need to be resected eventually for long-term survival.     

Abdominal aortic aneurysm in association with a congenital pelvic horseshoe kidney: sentinel report and technical consideration

A case of an abdominal aortic aneurysm in the presence of a congenital pelvic horseshoe kidney is described and the technical approach discussed. Renal function was preserved by 'double clamping' during the proximal anastomosis and infusing cold crystalloid into cannulated renal arteries originating from the aneurysm sac.     

Time to revisit role of transcatheter balloon aortic valvuloplasty: a bridge-therapy to subsequent treatment case report

Recently there has been a noticeable resurgence in the usage of percutaneous balloon aortic valvuloplasty (BAV) by the development of less invasive endovascular therapies including transcatheter aortic valve implantation (TAVI). We performed BAV in a 91-year-old man with end-stage severe symptomatic aortic stenosis (AS) and an impending abdominal aortic aneurysm (AAA) rupture who had been refused surgical treatment because of the comorbidities with stage V chronic kidney disease (CKD) and severe left ventricular dysfunction. Improvement in hemodynamics and kidney function was observed after BAV. Subsequently, we performed endovascular aneurysm repair (EVAR) successfully for AAA using iodinated contrast. No deterioration of kidney function was confirmed after the procedure. The patient was discharged without any adverse events. At present, the possibilities of TAVI or surgical aortic valve replacement (s-AVR) are under consideration as the definitive therapy for the upcoming aortic valve restenosis. In conclusion, this inoperable patient with multiple comorbidities was successfully treated, at lower risk, by catheter-based two-stage therapy.     

Abdominal aortic aneurysm in association with horseshoe kidney

We report the preoperative diagnosis and surgical treatment of an abdominal aortic aneurysm (AAA) in association with a horseshoe kidney (HSK) in a 70-year-old man. Through a median laparotomy a vascular tube graft was successfully used for repair the AAA. The extensive parenchymal isthmus overlying the aneurysm remained intact.     

A comparative study of iliac and abdominal aortic aneurysms.

BACKGROUND: The aim of the paper is to compare the epidemiology, risk factors and manifestations of iliac and abdominal aortic aneurysms. METHODS: Two studies were used: 1. 5,470 65-73-year-old men invited for screening for abdominal aortic aneurysms. 2. Review of all 350 patients operated on for central aneurysms in the county of Viborg, Denmark from 1989-1997. RESULTS: 4,176 attended for screening. One hundred and seventy (4.0%) had an abdominal aortic aneurysm. Twenty-one (0.56%) needed operation. The proportion of patients with common iliac aneurysms requiring surgery was 0.17%. The operative incidence of iliac aneurysm was 18.4 per million per year, and 92.4 per million per year were operated on for abdominal aortic aneurysm. The mean serum cholesterol level for isolated iliac aneurysm and combined aneurysms was significantly lower compared to isolated abdominal aortic aneurysm (p<0.05). Urological symptoms were present in 42% of cases with isolated iliac aneurysm, and 25% of combined aneurysms compared to 8% of isolated abdominal aortic aneurysms. Fifty-eight percent of the isolated iliac aneurysms were ruptured, as against 27% of the abdominal aortic aneurysms. The peri- and postoperative mortality was 57% in ruptured isolated iliac aneurysms, 47% in ruptured combined aneurysms, and 31% in ruptured isolated aortic aneurysms. CONCLUSIONS: Iliac aneurysms seem to be more underdiagnosed than abdominal aortic aneurysms, and are often diagnosed because of clinical manifestations, especially urological, or rupture. Iliac aneurysms seem more lethal than those of the abdominal aorta in cases of rupture.     

铁死亡：腹主动脉瘤防治新靶点?

铁死亡是一种铁依赖性的、非凋亡型的程序性细胞死亡方式,其主要特征是铁代谢紊乱导致细胞内铁超载,通过芬顿反应诱导脂质过氧化,激活铁死亡。铁死亡与诸多疾病相关,其中与腹主动脉瘤的关系近来受到关注。腹主动脉瘤是一种以腹主动脉壁结构破坏、不可逆性扩张为主要特征的退行性病变,其发病机制与氧化应激、炎症反应、血管平滑肌细胞丢失及血管钙化有关。铁死亡可能通过上述途径参与腹主动脉瘤的发生。因此,本文对铁死亡和腹主动脉瘤的致病机制进行综述,为腹主动脉瘤的治疗提供新思路和新靶点。     

老年髂动脉多发炎性动脉瘤的临床特点分析

目的了解髂动脉多发炎性腹主动脉瘤的临床特点,提高对本病诊断及药物治疗的认识。方法对1例发生于髂动脉的炎性腹主动脉瘤老年患者的临床资料进行分析,并复习有关文献。结果炎性腹主动脉瘤好发于70岁左右老年人,临床表现为突发腹痛或背痛,体重下降,C反应蛋白和红细胞沉降率升高,影像学检查可见动脉瘤壁增厚,炎症累及输尿管可引起肾盂积水,常规治疗需手术,早期经糖皮质激素及免疫抑制剂联合治疗可避免或推迟手术。结论突发严重腹痛的腹主动脉瘤患者,应尽早行影像学检查,发现动脉瘤壁增厚及肾盂积水支持本病诊断。早期糖皮质激素及免疫抑制剂治疗能显著缓解症状,并消除尿路梗阻。     

Familial occurrence of abdominal aortic aneurysm

BACKGROUND: A family history of abdominal aortic aneurysm has been reported to increase the risk for developing the disease. OBJECTIVE: To determine the risk for abdominal aortic aneurysm in first-degree relatives of patients with the disease. DESIGN: Cross-sectional ultrasonographic screening study. SETTING: University Central Hospital, Helsinki, Finland. PATIENTS: 238 of 325 living first-degree relatives of patients having surgery for abdominal aortic aneurysm (age > 50 years; 98 men and 110 women) and 281 controls (135 men and 149 women) without a family history of abdominal aortic aneurysm. MEASUREMENTS: Ultrasonography was used to measure aortic diameter in 101 male relatives and 140 female relatives (241 of the 325 persons at risk [74%]) and in 281 controls. RESULTS: Three siblings had already undergone surgery for abdominal aortic aneurysm. Eleven siblings (all brothers) (11 of 101 [10.9%]) had ultrasonographic evidence of abdominal aortic aneurysm (aortic diameter > 30 mm). In the control group, 2 men (1.5%) and 2 women (1.3%) had an aneurysm. Thirty siblings and no controls had dilatation of the abdominal aorta (aortic diameter, 20 to 29 mm). Neither the age nor the sex of the proband affected risk for developing abdominal aortic aneurysm among first-degree relatives. Family history increased the risk for an aneurysm by 4.33-fold (95% CI, 1.32-fold to 14.23-fold), male sex increased the risk by 12.21-fold (CI, 2.63-fold to 56.64-fold), and age (by decade) increased the risk by 1.93-fold (CI, 1.15-fold to 3.25-fold). CONCLUSION: Aging brothers of patients with known abdominal aortic aneurysm have the highest risk for developing the disease; the prevalence of the disease in siblings older than 60 years of age is 18%.     

Abdominal aortic aneurysm and diastasis recti

Midline abdominal incisional hernias are common following open repair of abdominal aortic aneurysms. These may be caused by the weakness of connective tissue. This study sought to determine the prevalence of diastasis recti among unoperated Caucasian males with abdominal aortic aneurysm compared to a control group with atherosclerotic lower extremity peripheral arterial disease. Forty-two consecutive white males referred for evaluation of abdominal aortic aneurysm (n = 18) or peripheral arterial disease (n = 24) were examined by a single examiner at the Mayo Clinic. Both groups were similar in terms of age and smoking history, 2 major risk factors for both abdominal aortic aneurysm and peripheral arterial disease. Abdominal aortic aneurysm patients ranged in age from 59 to 89 (mean, 73.2) years. Seventeen of 18 (94.4%) had a history of smoking. Peripheral arterial disease patients ranged in age from 52 to 93 (mean, 70.8) years. Twenty-one of 24 (87.5%) had a history of smoking. Diastasis recti were present in 12 of 18 (66.7%) subjects with abdominal aortic aneurysm versus 4 of 24 (16.7%) subjects with peripheral arterial disease (P = .001, 2-tailed Fisher exact test). Diastasis recti are significantly more common in males with abdominal aortic aneurysm than peripheral arterial disease and may provide an important clue to screen for abdominal aortic aneurysm in those at risk.     

Abdominal aortic aneurysm with chronic contained rupture in a ninety-year-old woman: a case report

A 90-year-old woman was admitted to a local clinic with fever, anorexia, and right lower abdominal pain on March 25, 2004. She was referred to our hospital for detailed examination of an abdominal aortic aneurysm on May 18. Computed tomography revealed an abdominal aortic aneurysm measuring 78mm in maximal diameter and a retroperitoneal hematoma, suggesting chronic contained rupture of the abdominal aortic aneurysm. Emergency Y-shaped graft replacement was performed. The intraoperative findings included a perforation on the posterior wall of the abdominal aortic aneurysm and an organized thrombus on the retroperitoneum. The postoperative course was uneventful, and the patient was discharged 21 days after surgery.     

Abdominal aortic aneurysms

The mortality rate after the rupture of an abdominal aortic aneurysm is 80% to 90%; therefore, the main goal of treatment is to prevent rupture. Patients with abdominal aortic aneurysms smaller than 5 cm in diameter should be managed conservatively under close surveillance with either computed tomography or sonography every 3 to 12 months. Patients should be informed that most aneurysms continue to enlarge at an average rate of 2 to 4 mm per year and that there is a 1% to 5% annual risk for sudden rupture. Treatment of the aneurysm is generally recommended if it is larger than 5 cm in diameter, and the only effective treatment is replacement of the aneurysm with a prosthetic graft. This can be performed through a laparotomy or a groin incision using an endovascular graft. Open surgical repair carries a mortality rate of 2% to 8% and requires a hospital stay of 7 to 10 days. Patients receiving endovascular grafts can be discharged within 1 to 3 days. Long-term durability has yet to be proven, however.     

Aneurysm of the abdominal aorta and horseshoe kidney. Apropos of a case and review of the literature

A case report of a 75 year old man with abdominal aortic aneurysm and horseshoe kidney is presented. The diagnosis of this unusual association was made prior to surgery and the aneurysmectomy was carried out without great problems, by insertion of a dacron tube combined with reimplantation of an accessory right renal artery. There was an uneventful postoperative recovery and outcome. Previous publications are reviewed. The authors insist of the importance of CT-Scan, intravenous pyelogram and aortography to establish a complete preoperative diagnosis of this rare association with anomalous vasculature and pyeloureteral pattern. The prognosis of an aneurysm in association with a horseshoe kidney should not be worse than that of routine resection of an ordinary aneurysm.