A giant abdominal aortic aneurysm (AAA) renders surgical treatment much more difficult by deforming the proximal infrarenal aortic neck (shortened length and disturbed angulation), by altering the iliac arteries (marked tortuosity and aneurysmal dilatation), and by displacing abdominal organs. Because the retroperitoneal rupture of giant AAA makes the mesentery more elongated and deformed, compromising its blood flow and thus increasing the risk of mesenteric ischemia such as colon ischemia. We describe here the surgical repair of a large infrarenal AAA with a ruptured huge left common iliac artery aneurysm of 13.5 cm in diameter, accompanied by colostomy due to colon ischemia which occurred during the operation. We discuss the pathophysiology and preventive strategy of colon ischemia during ruptured giant AAA repair.
Aneurysm* ; Aneurysm, Ruptured ; Aortic Aneurysm, Abdominal ; Colitis, Ischemic ; Colon* ; Colostomy ; Iliac Artery ; Ischemia* ; Mesentery ; Neck ; Rupture

We experienced a case of ruptured aneurysm of the sinus of Valsalva, and this resulted in simultaneous aortic and tricuspid valve endocarditis through a shunt. The echocardiography showed a ruptured sinus of Valsalva aneurysm to the right atrium with a shunt. The aortic non-coronary cusp was fibro-thickened with vegetation. Vegetations of the septal leaflet and the anterior leaflet of the tricuspid valve were also found. The blood culture grew Enterococcus garllinarum. We replaced both tricuspid and aortic valve with successful surgical result.
Aneurysm ; Aneurysm, Ruptured ; Aortic Valve ; Echocardiography ; Endocarditis ; Enterococcus ; Heart Atria ; Rupture ; Sinus of Valsalva ; Tricuspid Valve

OBJECTIVE: The goal of this study was to compare several parameters, including wall shear stress (WSS) and flow pattern, between unruptured and ruptured anterior communicating artery (ACoA) aneurysms using patient-specific aneurysm geometry.METHODS: In total, 18 unruptured and 24 ruptured aneurysms were analyzed using computational fluid dynamics (CFD) models. Minimal, average, and maximal wall shear stress were calculated based on CFD simulations. Aneurysm height, ostium diameter, aspect ratio, and area of aneurysm were measured. Aneurysms were classified according to flow complexity (simple or complex) and inflow jet (concentrated or diffused). Statistical analyses were performed to ascertain differences between the aneurysm groups.RESULTS: Average wall shear stress of the ruptured group was greater than that of the unruptured group (9.42% for aneurysm and 10.38% for ostium). The average area of ruptured aneurysms was 31.22% larger than unruptured aneurysms. Simple flow was observed in 14 of 18 (78%) unruptured aneurysms, while all ruptured aneurysms had complex flow (p < 0.001). Ruptured aneurysms were more likely to have a concentrated inflow jet (63%), while unruptured aneurysms predominantly had a diffused inflow jet (83%, p=0.004).CONCLUSION: Ruptured aneurysms tended to have a larger geometric size and greater WSS compared to unruptured aneurysms, but the difference was not statistically significant. Flow complexity and inflow jet were significantly different between unruptured and ruptured ACoA aneurysms.
Aneurysm ; Aneurysm, Ruptured ; Arteries ; Hydrodynamics ; Intracranial Aneurysm

A retrospective study on 14 case of ruptured cerebral cranial carotid aneurysm operated in Viet Duc Hospital during 1998 - 2000 has shown that the clinical outcome and method of operation found well in 78.6% of patients. The time for operation was usually late (often 2-3 weeks of bleeding).
Aneurysm, Ruptured ; Cerebral Arterial Diseases

About 1,000 patients undergo aortic surgery annually in Korea. Unlike Western countries, emergency surgery for dissection or ruptured aneurysm is more frequent than elective cases. Because timely diagnosis and intervention are essential for improving the treatment outcome, medical professionals should be provided with accurate knowledge about the nature of the diseases and currently available treatment modalities along with their results. Aortic dissection is the most frequent among the acute aortic diseases. Although there is a wide variation in surgical results between hospitals, experienced centers are reporting early survival rates higher than 90% after a surgery for acute type A dissection. The majority of the patients with acute type B dissection can be treated medically. For those who have serious complications such as rupture or malperfusion, catheter-based intervention became a promising alternative to surgery. Aortic intramural hematoma and penetrating atherosclerotic ulcer are known to have better prognosis than dissection. However, treatment plans should be decided individually, because many of such lesions can progress into dissection or rupture. Because the result of surgery for ruptured degenerative aneurysm is poor, surveillance and timely intervention is of utmost importance. The mortality rate after elective aortic surgery has come into a satisfactory range; <10% for the thoracic and <5% for the abdominal aorta. Endovascular repair has been established as an effective treatment for the abdominal aortic aneurysm. However, its effectiveness and proper indications for thoracic aortic diseases are not fully determined. Refinement of device and combination with surgical repair (hybrid technique) will widen the indication of stent-grafting.
Aneurysm ; Aneurysm, Ruptured ; Aorta ; Aorta, Abdominal ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Aortic Diseases ; Emergencies ; Hematoma ; Humans ; Korea ; Prognosis ; Rupture ; Survival Rate ; Treatment Outcome ; Ulcer

No abstract available.
Aneurysm ; Aneurysm, Ruptured* ; Cerebral Veins* ; Veins*

In an attempt to decide the surgical approach to basilar tip aneurysms, 27 cases of ruptured aneurysms were retrospectively analysed for size of aneurysm, direction of fundus and height of bifurcation. The fundus pointed superiorly in 18 cases, posteriorly in six, and anteriorly in three. The aneurysm neck was positioned as follows : very high(more than 20mm above midsellar) in one case, high(between 10mm and 20mm above midsellar) in 13, mid(from midsellar to 10mm above it) in nine, low(from midsellar to sellar floor) in two, and very low(below the sellar floor) in two. In 11 cases, surgery followed the conventional pterional approach ; in eight, the orbitozygomatic ; in three, the pterional-anterior temporal ; in two, the subtemporal ; in two, the anterior transpetrosal ; and in one, the temporopolar. In complex aneurysms or basilar bifurcation was at an unusual height, surgery involved a skull-base or modified technique based on a conventional pterional and subtemporal approach. On the basic of our surgical data and related findings, our suggestious are as follows : surgery involving basilar tip aneurysms with an extremely high-positioned neck should follow the transsylvian route above the carotid bifurcation, or use a transventricular or intravascular approach ; in cases with a high positioned-neck, the orbitozygomatic temporopolar or transzygomatic subtemporal approach should be used ; in cases with a normal-positioned neck, the combined pterional-anterior temporal approach, which has a much wider operative field and wider angle of vision than the classic pterional and subtemporal approach ; in cases with a low-positioned neck, the subtemporaltranstentorial) pterional, with resection of the posterior clinoid process ; and in cases with a very low-positioned neck, the transpetrosal approach.
Aneurysm* ; Aneurysm, Ruptured ; Neck ; Retrospective Studies

Fenestrations of anterior cerebral arteries are rare anomalies, which may be associated with saccular aneurysms at the fenestration itself or other intracranial vessels. This association is not infrequently the cause of angiographic diagnostic problem, as well as surgical difficulties. We report a case of aneurysm arising from a fenestrated proximal anterior cerebral artery that was confirmed at surgery and discuss together with a review of the literature.
Aneurysm ; Aneurysm, Ruptured* ; Anterior Cerebral Artery*

The purpose of this study was to investigate whether early surgery benefits in the treatment of the patients with ruptured aneurysm by comparing the outcome in relation to the timing of surgery. The autho rs analyzed 81 patients with ruptured aneurysm who underwent operation during one year from January 1996 through December 1996. Among these, sixty patients(74%) underwent operation within 72 hours after first bleeding, and 21 patients (26%) after 72 hours following first bleeding. Thirtysix patients(82%) recovered without se rious neurological deficits in 44 patients with initial Hunt and Hess g rade I to III who were operated upon in early period, and four out of 16 patients with initial Hunt and Hess grade IV to V. Sixteen patients (84%) recovered without serious neurological deficits in 19 patients with initial Hunt and Hess grade I to III who received late operation but none in 2 patients in Hunt and Hess grade IV to V. Seven out of 60 (12%) patients died after early operation, one of 21(5%) patient died after late operation. The causes of morbidity were vasospasm (19 cases), rebleeding (5 cases), hydrocephalus (1 case) in early operation and vasospasm (2 cases), hydrocephalus (1 case) in late operation. It is concluded that early operation is mandatory even in the patients with poor clinical status prior to surgery since early aneurysmal surgery can minimize the chance of rebleeding, permit more aggressive treatment against vaso-spasm and improve the clinical outcome.
Aneurysm* ; Aneurysm, Ruptured ; Hemorrhage ; Humans ; Hydrocephalus

Preoperative diagnosis of an aneurysm of the right coronary sinus of Valsalve with rupture into the right ventricle was made by echocardiography in a patient who also had a small ventricular septal defect. In this case of ruptured sinus of Valsalva aneurysm, the cardinal echocardiographic finding is a defect in the anterior aortic root through which the right coronary cusp appeared to prolapse. After surgical correction the echo from the herniated right coronary cusp of the aortic valve and discontinuity in the echo from anterior aortic wall disappeared.
Aneurysm ; Aneurysm, Ruptured* ; Aortic Valve ; Coronary Sinus ; Diagnosis ; Echocardiography* ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Humans ; Prolapse ; Rupture ; Sinus of Valsalva*