Aortic Aneurysm, Abdominal ; therapy ; Humans

Aortic Aneurysm, Abdominal ; therapy ; Humans

Aortic Aneurysm, Abdominal ; therapy ; Humans ; Treatment Outcome

PURPOSE: To evaluate the effectiveness of treatment of aortic aneurysm with endoluminal stent-grafts usingGianturco stent and poly-tetra-fluoro ethylene (PTFE). MATERIALS AND METHODS: In ten patients with aorticaneurysm, eleven procedures were performed using tubular (n=7) or bifurcated (n=4) Gianturco Z-stents covered withPTFE to treat aortic disease (six atherosclerotic aortic aneurysms, four pseudoaneurysms of abdominal aorta inthree patients with Behcet's disease, and one penetrating atherosclerotic ulcer). Spiral CT angiography was usedfor follow-up from 14 days to 31 months (mean, 12 months). The effectiveness of stent-grafts was evaluated duringfollow-up. RESULTS: In all cases, implantation of stent-grafts was technically successful ; in five, perigraftleakage was detected on completion of aortography. On initial post-procedural CT images obtained 4 - 24 days afterinsertion of the stent-graft, complete thrombosis of the aneurysm was seen in seven cases and perigraft leakage infour. Two of the four cases in which leakage was seen on initial CT improved spontaneously during follow-up.Procedure-related thromboembolism occurred in one case, which was managed by thrombolytic therapy without residualsequelae. During follow-up CT, the size of aortic aneurysms of atherosclerotic disease did not change. Thepseudoaneurysms of Behcet's disease decreased and eventually completely disappeared, with only residual periaorticsoft tissue. CONCLUSION: For the treatment of aortie diseases, stent grafting using a Gianturco stent and PTFE isclinically feasible, safe, and effective.
Aneurysm ; Aneurysm, False ; Angiography ; Aorta, Abdominal ; Aortic Aneurysm ; Aortic Diseases ; Aortography ; Blood Vessel Prosthesis ; Follow-Up Studies ; Humans ; Polytetrafluoroethylene ; Stents* ; Thromboembolism ; Thrombolytic Therapy ; Thrombosis ; Tomography, Spiral Computed

OBJECTIVETo describe our surgical experience on rupture of abdominal aortic aneurysm.

METHODSTwo cases of ruptured aortic aneurysms with severe complication were analysed. Aorta reconstruction procedures were performed using bifurcated e-PTFE grafts during emergency operation. Diagnosis, preoperative resuscitation, emergency surgical intervention, and postoperative complications of these patients were summarized and discussed.

RESULTSRupture of aortic aneurysm in both patients presented as a huge retroperitoneum haematoma by computed tomography scan. They were successfully saved by prompt body fluid compensation, emergency procedure, intraoperative resuscitation, and postoperative intensive care.

CONCLUSIONSCorrect diagnosis, prompt surgical management, immediate intraoperative proximal aorta clamping during procedure, and effective management of postoperative complications were the key points to successful treatment of ruptured aortic aneurysm.

Aged ; Aortic Aneurysm, Abdominal ; diagnosis ; surgery ; Aortic Rupture ; diagnosis ; surgery ; Follow-Up Studies ; Humans ; Male ; Postoperative Complications ; therapy

OBJECTIVETo compare the efficacy between endovascular aneurysm repair versus open surgery in patients with abdominal aortic aneurysms (AAA).

METHODSA systematic review was performed to identify clinical outcomes of randomized controlled trials for AAA patients receiving endovascular aneurysm repair or open surgery. The Cochrane Library (issue 7 of 2011), MEDLINE (1996 to 2011), EMBASE (1974 to 2011), CBM (1989 to 2011), CNKI (1997 to 2011), Wanfang data (1989 to 2011) were searched. Randomized trials that compared open or endovascular AAA repair and published clinical outcomes were selected. The outcome included all-cause mortality, aneurysm-related mortality, technical complications and re-open surgery. Data analyses were performed with the RevMan5.1 software. Publication bias was assessed by STATA software. A meta-regression model was used to describe between study variability. A total of 123 trials were excluded according to criteria. Four randomized controlled trials with 2607 patients met the inclusion criteria.

RESULTSThere were no publication bias (Begg's test, Z = 1.02, P > 0.05; Egger's test, t = 0.98, P > 0.05). The meta-analysis showed that the incidence of all-cause mortality of endovascular repair was significantly lower than that of open repair up to 30 days post procedures [ RR = 0.32, 95%CI (0.18 - 0.56), P < 0.01] while long-term all-cause mortality was similar: DREAM study: [RR = 1.18, 95%CI (0.88 - 1.58), P > 0.05], EVAR study: [RR = 1.04, 95%CI (0.88 - 1.22), P > 0.05]. The incidence of aneurysm-related mortality of endovascular repair was lower than that of open repair in two studies [RR = 0.53, 95%CI (0.33 - 0.85), P < 0.01]. Technical complication between open repair group and endovascular repair group was similar [RR = 1.43, 95%CI (0.68 - 2.98), P > 0.05]. Incidence of re-open surgery was higher in endovascular repair group than in open surgery group [RR = 2.03, 95%CI (1.14 - 3.62), P < 0.05].

CONCLUSIONCompared with open surgery, endovascular repair is associated with lower 30-day all-cause mortality and aneurysm-related mortality, similar technical complication and long-term all-cause mortality, but higher risk for re-open surgery.

Angioplasty, Balloon ; Aortic Aneurysm, Abdominal ; surgery ; therapy ; Humans ; Laparotomy ; Randomized Controlled Trials as Topic ; Treatment Outcome

Aged ; Aortic Aneurysm, Abdominal ; diagnostic imaging ; therapy ; Aortic Aneurysm, Thoracic ; diagnostic imaging ; therapy ; Female ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography ; Stents

The aim of this paper is to report a salvage treatment for malpositioned stent graft due to mislabeled product during thoracic endovascular aortic repair (TEVAR) in descending thoracic aneurysm (DTA). A 78-year-old male presented with 6.7×4.1 cm sized saccular DTA and 7.1×7.3 cm sized abdominal aortic aneurysm (AAA). DTA was initially treated by TEVAR and 2 months later AAA was treated by open aortic repair. Unfortunately, although the stent graft was correctly labeled for DTA, the actual size of product wrapped in a box was different contrary to our expectations. On completion angiography, proximal sealing zone showed no endoleak, however, celiac trunk and superior mesenteric artery (SMA) was found to be accidentally occluded. Through an emergent thoracotomy, distal part of stent graft was removed by cutting distal segment of stent graft and pulling out maneuver to restore blood flow. The completion angiography presented no endoleak, and celiac trunk and SMA were secured. Cutting distal segment of stent graft and pulling out maneuver is one of feasible rescue technique to maintain blood flow of occluded celiac trunk during TEVAR.
Aged ; Aneurysm ; Angiography ; Aortic Aneurysm, Abdominal ; Blood Vessel Prosthesis ; Endoleak ; Humans ; Male ; Mesenteric Artery, Superior ; Salvage Therapy ; Stents ; Thoracotomy

Abdominal aortic aneurysm(AAA)is a common aortic degenerative disease in the elderly,and its incidence is gradually increasing with the aging of the population.There are no specific drugs available to delay the expansion of AAA.Once the aneurysm ruptures,the mortality will exceed 90%,which seriously threatens the life of patients.Given the high incidence of AAA in the elderly,this review discusses the role of vascular aging in the pathogenesis of AAA,involving chronic inflammation,oxidative stress,mitochondrial dysfunction,protein homeostasis imbalance,increased apoptosis and necrosis,extracellular matrix remodeling,nutritional sensing disorders,epigenetic changes,and increased pro-aging factors.Meanwhile,several potential aging-related drug targets of AAA are listed.This review provides new ideas for basic and translational medical research of AAA.
Aged ; Aging ; Animals ; Aorta, Abdominal ; Aortic Aneurysm, Abdominal/drug therapy* ; Disease Models, Animal ; Humans ; Muscle, Smooth, Vascular/metabolism* ; Oxidative Stress

Aortoenteric fistula (AEF) developed after treatment for an abdominal aortic aneurysm (AAA) is a rare but usually fatal complication. We report a rare case of AEF bleeding after endovascular stent grafting for AAA which was managed angiographically. An 81-year-old man presented with hematochezia and acute abdominal pain for 1 day ago. Four years ago, an aortic stent was implanted in the infrarenal aorta for AAA. Endoscopies were performed to evaluate the hematochezia. Evidence of gastrointestinal bleeding was observed, but a clear bleeding point was not detected on upper endoscopy and colonoscopy. Contrast-enhanced computed tomography performed subsequently showed that the bleeding point was located in the fourth portion of the duodenum as an AEF caused by an inflammatory process in the stent-graft. Intra-arterial angiography showed a massive contrast leakage into the bowel via a small fistula from around the aortic stent graft site. Embolization was successfully performed by injecting a mixture of glue and lipiodol into the AEF tract. The patient was discharged with no evidence of gastrointestinal bleeding after the embolization.
Aged, 80 and over ; Angiography ; Aortic Aneurysm, Abdominal/*therapy ; Aortic Diseases/*etiology/radiography/therapy ; Embolization, Therapeutic ; Endoscopy, Gastrointestinal ; Fistula/*etiology/radiography/therapy ; Gastrointestinal Hemorrhage/therapy ; Humans ; Male ; Stents/*adverse effects ; Tomography, X-Ray Computed