Aortic anastomotic pseudoaneurysms: US, CT, MR, and angiography.

Correlation of imaging and anatomic findings in seven men with abdominal aortic graft prostheses (four "end-to-end" anastomoses and three "end-to-side" anastomoses) was done to compare the value of different imaging modalities in detecting postoperative complications, especially aortic anastomotic pseudoaneurysms (AAPs). In all cases, angiographic and CT studies were carried out. In six patients ultrasound and MR examinations were also performed. Anatomic verification was obtained by surgery in six patients and autopsy in one case. Five patients had an AAP (four at surgery and one at autopsy), one had a true abdominal aortic aneurysm above the anastomosis, and one a nondetectable abnormality of the aortic suture line. Digital subtraction angiography diagnosed one of five AAPs, missed the true aneurysm in the sixth patient, and was normal in the patient without any aneurysm. Computed tomography correctly diagnosed the five AAPs and the true aneurysm and was normal in the last patient. Ultrasound correctly diagnosed the AAPs in three of four patients, incorrectly diagnosed an AAP in the patient who had the true aneurysm, and was normal in the patient without any aneurysm. Magnetic resonance diagnosed four of four AAPs and the true aneurysm and was normal in the last patient. Computed tomography seems to be the best imaging modality with which to diagnose and evaluate an aortic AAP in patients with aortoiliofemoral graft prosthesis.     

Endovascular Stent-Graft Repair as a Late Secondary Procedure After Previous Aortic Grafts

Thoracic and abdominal aortic endovascular procedures as alternatives to aortic reoperations were studied in three different cases. An anastomotic aneurysm after previous thoracic aortic graft for coarctation, a second-stage elephant trunk repair (descending thoracic aortic aneurysm), and a secondary aneurysm proximal to a previous abdominal aortic graft were successfully treated with endovascular stent-grafts. During the follow-up period no lethal events or major aortic or graft-related complications were observed, except a type II endoleak in the anastomotic aortic aneurysm case. An endovascular stent-graft can be safely deployed into a previously implanted vascular graft, avoiding repeat surgery.     

Abdominal CT angiography before surgery as a predictor of postoperative death in acute aortic dissection

OBJECTIVE: The purpose of our study was to search for a relationship between postoperative death in acute aortic dissection and abdominal helical CT findings before surgery. MATERIALS AND METHODS: We retrospectively included 48 patients admitted to our institution for emergent surgery of acute aortic dissection diagnosed with helical CT angiography. We recorded postoperative deaths and analyzed abdominal helical CT vessels and parenchymal abnormalities, including the presence of dissected abdominal aortic branches, a compressed aortic lumen, and low enhancement of the parenchyma in abdominal organs. RESULTS: Among the 48 patients, 11 died after surgery. Postoperative death occurred in one of five patients with low enhancement of the parenchyma in one abdominal organ and in seven of eight patients with low enhancement of the parenchyma in at least two abdominal organs. The postoperative death rates strongly correlated with the number of low-enhanced abdominal organs per patient (p < 0.00005) but did not correlate with the number of dissected abdominal aortic branches. CONCLUSION: The rate of abdominal organs with low enhancement of the parenchyma seen on CT before surgery is a strong factor in outcome in patients with acute aortic dissection. Additional analysis of low enhancement of the parenchyma in abdominal organs on CT might be a useful tool to detect, before surgery, patients at risk of postoperative death.     

Infrarenales Bauchaortenaneurysma

As an alternative to surgery, endovascular therapy with stent grafts has become the second main treatment option for infrarenal abdominal aortic aneurysms. Unlike surgery, endovascular treatment with stent grafts is also applicable in patients unfit for open repair. Despite current improvements in endovascular repair devices, significant anatomic barriers still exclude this technique for a large number of patients. Computed tomography, magnetic resonance imaging, and ultrasound are essential for diagnostics, preintervention planning, and postintervention follow-up of abdominal aneurysms treated with stent grafts. This review covers etiology, pathology, and diagnostic aspects. Materials and methods for endovascular treatment of abdominal aortic aneurysms are presented in detail, and clinical results and complications are discussed.     

腹主动脉瘤的外科诊疗

目的：总结腹主动脉瘤的诊断和外科治疗方法.方法：回顾性分析2003-01～2005-04我院治疗的23例肾下型腹主动脉瘤的临床资料.男21例,女2例,年龄54～76岁.均为肾动脉下型腹主动脉瘤,瘤体直径4.0～7.5 cm.采取常规的腹主动脉瘤切除和原位人造血管移植术20例,腔内人造血管移植术3例.结果：全组无术后早期死亡,无严重出血、肾功能衰竭和下肢动脉栓塞等,术后并发心律失常2例,腹泻2例,切口裂开1例.全组患者随访1～27个月,无晚期死亡和肾功能衰竭.结论：常规外科手术和腔内人造血管移植治疗腹主动脉瘤均获得良好效果.早诊断、合理选择手术时机和手术方式是提高手术成功率、减少术后并发症和死亡率的关键.     

Die interventionelle/endovaskuläre Therapie des infrarenalen abdominellen Aortenaneurysmas

The catheter-based interventional therapy (endovascular aortic repair EVAR) of abdominal aortic aneurysms (AAA) has gained an established place in the spectrum of therapeutic options. The procedure is characterized by low peri-interventional morbidity and mortality. Multislice computed tomography (CT) has a dominant role in defining the correct indications and in selecting an appropriate stent graft prior to the intervention. The rate of acute conversions could be reduced from 2.9 % to 0?% in our own elective patient population since 2010. In our vascular centre the proportion of patients treated by EVAR was 39.5?% (102 out of 258). The procedure is used routinely in patients who have an increased risk for general anesthesia or open surgery due to concomitant diseases. It is also used in patients with a reduced local operability due to prior surgery, abdominal diseases or radiation therapy. Arterial closure devices allow a completely percutaneous approach in a certain group of patients. However, after EVAR a life-long surveillance is mandatory because delayed therapy failure has been described. In younger patients who do not have a higher risk open surgery is still an option. The paper describes techniques, results und complications of EVAR.     

Preoperative Embolization of a Tumor-Bearing Horseshoe Kidney Via Both Channels of a Concomitant Aortic Dissection

Renal cell carcinoma arising in a horseshoe kidney is a rare entity. Preoperative tumor embolization can be performed to prevent massive bleeding complications during organ-preserving surgery. We report the first case of a patient with a tumor-bearing horseshoe-kidney in whom the preoperative embolization, already complex because of the abnormal vascular supply, was additionally complicated by an aortic dissection. An aberrant, horseshoe-kidney-supplying artery originated from the false dissection channel of the aorta, and thus had to be catheterized separately while the other tumor-supplying vessels could be reached via the true aortic lumen. After devascularization of the tumor, organ-preserving surgery was performed without bleeding complications.     

Juxtarenal aortic aneurysm: endoluminal transfemoral repair?

Endoluminal transfermoral repair of an abdominal aortic aneurysm by a stent graft placement requires a segment of the nondilated infrarenal aorta of at least 15 mm long for safe stent graft attachment. The possibility of endoluminal treatment of a juxtarenal abdominal aortic aneurysm with partially covered spiral Z stent was assessed in experiment and in three clinical cases. In the experiment, the noncovered spiral Z stent was placed into the abdominal aorta, across the origins of renal arteries and mesenteric arteries, in six dogs. In the clinical cases, a partially covered stent graft was attached in 3 patients with the juxtarenal abdominal aortic aneurysm (of the group of 12 patients with abdominal aortic aneurysm). The stent grafts were attached with proximal uncovered parts across the origins of the renal arteries. In experiment, the renal artery occlusions or stenoses were not observed 36 months after stent placement, and in clinic 3 patients with the juxtarenal aortic aneurysm were successfully treated by stent graft placement. There were no signs of flow impairment into the renal arteries 14 months after stent graft implantation. This approach can possibly expand the indications for endoluminal grafting in the treatment of juxtarenal aortic aneurysms in patients who are at high risk for surgery.     

Initial experience with percutaneous transluminal angioplasty in the management of Takayasu's arteritis

We have performed percutaneous transluminal angioplasty (PTA) for 15 arterial stenoses in 11 patients with Takayasu's arteritis. The lesions included tight, proximally located renal artery stenosis (12 stenoses; nine patients), localized abdominal aortic stenosis (two patients) and occluded left common iliac artery (one patient). Clinically successful dilatation was achieved in seven patients (10 stenoses) with renal artery stenosis, in both the patients with abdominal aortic stenosis and in the only patient with an occluded left common iliac artery. No complications related to the procedure were encountered. The follow-up period (n = 7) ranged between 1 and 16 months, mean follow-up period after renal angioplasty was 5 months and after abdominal aortic angioplasty was 12.5 months. Initial success has been maintained in both the patients with abdominal aortic stenoses and in four out of five patients with renal artery stenosis. Percutaneous transluminal angioplasty offers an attractive alternative for the management of stenosing lesions in Takayasu's arteritis with good short term results.     

Treatment of acute thoracic aortic injury with commercially available abdominal aortic stent-grafts

Traumatic rupture of the thoracic aorta is a common cause of death after vehicle collisions. Associated injuries are common, and patients with lung injury, cardiac contusion, abdominal bleeding, and head injury comprise a group at high risk for conventional surgical or medical therapy. In this particular population, existing commercially available stent-grafts may provide a life-saving repair option. The Ancure and AneuRx stent-grafts, designed for abdominal aortic aneurysm application, were successfully placed in three patients. Accommodation for the short length of the delivery device was achieved by retroperitoneal iliac artery access. All patients had follow-up computed tomography (CT) without evidence of endoleak and were doing well with respect to their chest trauma after 5-9 months of follow-up.     

腹主动脉球囊封堵联合剖宫产术治疗凶险性前置胎盘的安全性随访研究

目的 探讨腹主动脉球囊封堵联合剖宫产术治疗凶险性前置胎盘的安全性和有效性,评估其对患者生育功能和新生儿健康状况的影响.方法 回顾性分析2013年1月至2019年1月我院收治的1018例凶险性前置胎盘患者的临床资料.所有患者均接受腹主动脉球囊封堵联合剖宫产术治疗.本研究旨在通过分析1018例患者的手术时间、术中出血量、输...     

Preoperative evaluation of abdominal aortic aneurysms by computed tomography

A prospective, preoperative study was conducted of 50 electively repaired abdominal aortic aneurysms comparing the CT and angiographic findings with those described at surgery. CT demonstrated all 50 aneurysms and correctly identified their proximal extent in relation to the takeoff of the renal arteries in 47 patients (94%), while angiography detected 48 aneurysms (96%) and their correct relation to the renal arteries in all (100%). CT correctly identified 40 (98%) of 41 patients with two renal arteries, but only two (29%) of seven with three and none of two patients with four arteries. Common iliac artery involvement or lack thereof was accurately predicted in 42 (84%) of the 50 patients and internal iliac artery aneurysms found in one (33%) of three patients. It was concluded that CT is not sufficiently accurate for documenting location and patency of the renal arteries to allow its routine substitution for angiography in patients undergoing preoperative assessment of abdominal aortic aneurysms.     

Imaging of complications after endoluminal treatment of abdominal aortic aneurysms

Endovascular repair of abdominal aortic aneurysm is becoming a valuable alternative to open surgery in selected patients. With the recognition of this new treatment, however, many complications, some of them life-threatening, are reported. Imaging plays a major role in the detection of these complications. This article reviews the role of imaging techniques in the detection of these complications.     

An autopsy case of unexpected sudden death due to rupture of a thoracic aortic aneurysm into the left lung

Ruptured aortic aneurysms present with various signs and symptoms depending on the site of rupture and bleeding, often causing sudden death; however, rupture into the lung with hemoptysis and blood aspiration is very rare. We report a case of unexpected sudden death due to blood aspiration from rupture of a thoracic aortic aneurysm into the lung. An 83 year old man, who had a past history of surgery for an abdominal aortic aneurysm about 17 years previously, was found dead on his bed with massive hemoptysis. Medico-legal autopsy revealed rupture of a thoracic aortic aneurysm into the left lung, causing massive blood aspiration. Tight, diffuse pleural adhesion and the vulnerable wall of an aortic aneurysm due to advanced atherosclerosis with active inflammation appeared to have predominantly contributed to the penetration of the ruptured aneurysm into the lung. This case suggests that long-term clinical follow-up and management are needed for a patient with aortic aneurysm, and that a ruptured aortic aneurysm should be taken into consideration to identify the source of bleeding for hemoptysis.     

Percutaneous transluminal angioplasty of abdominal aortic stenoses

Percutaneous transluminal angioplasty (PTA) was performed on 25 patients with localized distal abdominal aortic stenoses. All patients were smokers and all complained of bilateral lower limb claudication. Eleven patients had small distal aortas and iliac vessels. Technically successful dilatation was achieved in all patients. Long-term follow-up was available on 17 of the patients. The mean follow-up period was 38 months. Cumulative patency at 5 years was 70%. Thirteen patients remain asymptomatic 15–83 months following PTA. Late failure occurred in 4 patients, 1–38 months following PTA. No complications related to PTA were experienced. PTA of localized aortic stenoses is a safe alternative to surgery and should be the treatment of choice in this condition.     

The CT appearances of ruptured abdominal aortic aneurysms

There is no place for investigative CT scans in patients who have the classical triad of abdominal aortic aneurysm rupture, namely excruciating abdominal pain or backache, a pulsatile mass and hypotension. These patients require immediate surgery. However, in the absence of this triad, CT scans play an important role in the diagnosis of abdominal aortic aneurysm rupture. The CT scan findings will dictate whether the patient requires immediate surgery as in the case of acute rupture, or, whether the surgery can be delayed up to 24 hours to allow for stabilisation and hydration, as in the case of subacute and chronic rupture.     

手术治疗腹部闭合性损伤80例

目的：探讨腹部闭合性损伤的手术治疗。方法：回顾性分析我院近年来收治的80例腹部闭合性损伤患者的临床资料。结果：80例腹部闭合性损伤的患者,经剖腹探查手术治疗,成功治愈74例,治愈率为92.5%,死亡6例,死亡率为7.5%。其中,2例患者死于肝破裂大出血,2例患者死于颅脑外伤,3例患者死于多脏器衰竭。结论：对于腹部闭合性损伤,临床医生必须细致检查和严密动态观察,以便于早期诊断,并提出合理的治疗方案,以提高手术治疗效果,减少术后并发症的发生,降低死亡率。     

介入治疗在腹部外科术后消化道大出血中的应用价值

目的确定介入治疗在腹部外科术后消化道大出血中的应用价值。方法回顾性分析11例腹部外科手术后急性消化道大出血并经内科保守治疗无效而介入治疗的病例,总结其DSA结果及介入治疗价值。结果11例腹部外科术后消化道出血患者中DSA发现胃左动脉出血1例,胃十二指肠动脉假性动脉瘤4例,肝动脉假性动脉瘤2例,脾动脉假性动脉瘤1例,肠系膜下动脉分支血管感染性假性动脉瘤1例,肠系膜上动脉小分支血管出血2例。结论介入治疗是治疗腹部外科术后消化道大出血的有效方法。     

Blunt traumatic abdominal aortic rupture: CT imaging

Blunt abdominal aortic trauma is a rare but potentially lethal event. It is commonly associated with high-speed motor vehicle accidents. Intimal flap, thrombosis, and pseudoaneurysm of the abdominal aorta are the more common findings. We present a case of blunt abdominal aortic trauma in which CT disclosed free aortic rupture with intraabdominal bleeding and a huge retroperitoneal hematoma, an extremely rare finding among patients reaching the hospital alive, due to its high and immediate mortality rate.     

Comparison of intravenous digital subtraction angiography to conventional aortography in patients with abdominal aortic aneurysm

Evaluation of intravenous digital subtraction angiography (IV DSA) in patients with abdominal aortic aneurysm was performed by obtaining catheter aortograms immediately before DSA studies in ten patients. Diagnostic images were obtained in nine of ten digital subtraction examinations. Although repeat injections were necessary in six DSA and three conventional aortography cases for adequate imaging of both cephalad and caudal extension of the aneurysm, average contrast dose was 53 cc (62 cc in standard catheter studies). Renal artery stenosis was diagnosed by DSA in two of three vessels, multiple renal arteries were demonstrated by both modalities in two cases. Digital subtraction and conventional aortographic findings were proved at surgery. Intravenous DSA was shown to be useful in the preoperative evaluation of patients with abdominal aortic aneurysm. This work was supported in part by U.S. Public Health Service Grant No. HL07334.