A case of successful surgical treatment of a ruptured giant aneurysm of the infrarenal aorta in an elderly patient

Today, abdominal aortic aneurysm surgery is a fairly well-studied area of medicine. Nevertheless, some questions remain rather debatable. No clear criteria for giant aneurysms have been developed so far. The available foreign and domestic literature reports about 40 cases of surgical treatment of giant abdominal aortic aneurysms, 16 of which are cases of aneurysm rupture. Open surgery remains the method of choice in the treatment of giant aneurysms due to the pronounced technical difficulties of endovascular intervention. The authors present a case of successful surgical treatment of a giant aneurysm rupture in an elderly patient. The peculiarity of this patient's condition is the occurrence of aneurysm rupture after hospital admission. The patient refused surgical treatment for two years after aneurysm detection. On examination after admission, multispiral computed tomography revealed an aneurysm size of 101 mm. On the eve of surgery, pain syndrome in the left abdomen and tachycardia appeared. Aneurysm rupture was suspected and the patient was urgently admitted to the operating room. The surgery was performed under the conditions of machine reinfusion of autoblood. The patient underwent abdominal aortic aneurysm resection with linear prosthesis and retroperitoneal hematoma removal. The postoperative period had no peculiarities. On the 10th day after the operation the patient was discharged in satisfactory condition to the outpatient treatment. This clinical case demonstrates the possibility of successful surgical treatment of giant aneurysm rupture in elderly patients.

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ASSESSMENT OF CLINICAL PRESENTATION OF ABDOMINAL AORTIC ANEURISM

Inter Collegas ◽

10.35339/ic.5.4.161-164 ◽

2018 ◽

Vol 5 (4) ◽

pp. 161-164

Author(s):

V. Boiko ◽

O. Buchneva ◽

Ya. Shafer ◽

Yu. Pisklova ◽

A. Krylova

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Clinical Manifestations ◽

Aneurysm Rupture ◽

Aortic Aneurysms ◽

Vascular Involvement ◽

Urgent Surgery ◽

Abdominal Aortic ◽

Abdominal Aortic Aneurism ◽

Causes Of Mortality

Boyko V., Buchneva O. Shafer Ya., Pisklova Yu., Krylova O.To date, vascular disease rank first (more than 50%) among the causes of mortality in Ukraine. Atherosclerotic vascular involvement, being the most frequent etiological factor of abdominal aortic aneurysm, in the absence of timely diagnosis and treatment, causes severe complications, early disability and death. Clinical and functional diversity of abdominal aortic aneurysm causes difficulties in diagnosing, defining different therapeutic approaches, methods of operation and protection of visceral organs and spinal cord. The article analyzes various clinical manifestations of abdominal aortic aneurysms in 264 patients who underwent surgical treatment at the State Facility V.T Zaytsev Institute of General and Urgent Surgery from 2010 to 2018.Key words:a bdominal aortic aneurysm, rupture of abdominal aortic aneurysm РезюмеАНАЛІЗ КЛІНІЧНОГО ПЕРЕБІГУ АНЕВРИЗМ ЧЕРЕВНОГО ВІДДІЛУ АОРТИБойко В., Бучнєва О., Шафер Я., Пісклова Ю., Крилова О.На сьогоднішній деньзахворювання судин займають перше місце (більше 50%) серед причин смертності в Україні. Атеросклеротичнеураженнясудин, будучи найбільш частим етіологічним фактороманевризм черевного відділу аорти, за відсутності своєчасної діагностики і лікування викликає важкі ускладнення, ранню інвалідизацію і смерть. Клінічне і функціональне різноманіття аневризм черевної аорти викликає труднощі в діагностиці, визначає різну тактику лікування, способи операції тазахисту внутрішніх органів і спинного мозку. У статті проаналізовані різноманітні клінічні презентації аневризм черевного відділу аорти у 264 пацієнтів, яким було проведено хірургічне лікування на базі ДУ "ІЗНХ ім.В. Т.Зайцева" з 2010 по 2018 рік. Ключові слова: аневризма черевної аорти, розрив аневризми черевної аорти РезюмеАНАЛИЗ КЛИНИЧЕСКОГО ТЕЧЕНИЯ АНЕВРИЗМ БРЮШНОГО ОТДЕЛА АОРТЫБойко В., Бучнева О., Шафер Я., Писклова Ю., Крылова А.На сегодняшний день заболевания сосудов занимают первое место (более 50%) среди причин смертности в Украине. Атеросклеротическом поражении сосудов, являясь наиболее частым этиологическим фактором аневризм брюшного отдела аорты, при отсутствии своевременной диагностики и лечения вызывает тяжелые осложнения, раннюю инвалидизацию и смерть. Клиническое и функциональное многообразие аневризм брюшной аорты вызывает трудности в диагностике, определяет разную тактику лечения, способы операции и защиты внутренних органов и спинного мозга. В статье проанализированы разнообразные клинические презентации аневризм брюшного отдела аорты у 264 пациентов, которым было проведено хирургическое лечение на базе ДУ "ІЗНХ ім.В. Т.Зайцева" с 2010 по 2018 год.Ключевые слова: аневризма брюшной аорты, разрыв аневризмы брюшной аорты

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Late Rupture of an Abdominal Aortic Aneurysm after Parodi's Endoprosthesis Replacement

Swiss Surgery ◽

10.1024/1023-9332.7.4.190 ◽

2001 ◽

Vol 7 (4) ◽

pp. 190-193 ◽

Cited By ~ 4

Author(s):

De Monti ◽

Ghilardi ◽

Gobatti ◽

Labagnara ◽

Scorza

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Surgical Procedures ◽

Aneurysm Rupture ◽

Endovascular Surgery ◽

Aortic Aneurysms ◽

Retroperitoneal Haematoma ◽

Abdominal Aortic ◽

Prosthesis Replacement

Endovascular surgery as a whole, and specifically in the context of aortic aneurysms, is a very interesting methodology the potential of which is increasingly being recognized. Follow up information on patients who underwent these procedures will be critical to validate the different techniques which have been developed and to identify the most appropriate situations for this type of surgical procedures. The authors present a case of aortic aneurysm rupture who had undergone Parodi's endoprosthesis placement two years before. CT angiographic evaluation showed a wide endoleak due to distal stent detachment, a complete dislodging of the endoprosthesis itself and retroperitoneal haematoma. Prosthesis replacement through a laparotomic approach was carried out and the patient was discharged 10 days postoperatively, surgically cured.

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3D Modeling of Blood Flow in Simulated Abdominal Aortic Aneurysm

Vascular and Endovascular Surgery ◽

10.1177/15385744211012926 ◽

2021 ◽

pp. 153857442110129

Author(s):

Mauricio Gonzalez-Urquijo ◽

Raul Garza de Zamacona ◽

Ana Karen Martinez Mendoza ◽

Miranda Zamora Iribarren ◽

Erika Garza Ibarra ◽

...

Keyword(s):

Fluid Dynamics ◽

Computational Fluid Dynamics ◽

Shear Stress ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Abdominal Aortic Aneurysms ◽

Aneurysm Rupture ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

Computer Aided

Background: Besides biological factors, abdominal aortic aneurysm rupture is also caused by mechanical parameters, which are constantly affecting the wall’s tissue due to their abnormal values. The ability to evaluate these parameters could vastly improve the clinical treatment of patients with abdominal aortic aneurysms. The objective of this study was to develop and demonstrate a methodology to analyze the fluid dynamics that cause the wall stress distribution in abdominal aortic aneurysms, using accurate 3D geometry and a realistic, nonlinear, elastic biomechanical model using a computer-aided software. Methods: The geometry of the abdominal aortic aneurysm; was constructed on a 3D scale using computer-aided software SolidWorks (Dassault Systems SolidWorksCorp., Waltham MA). Due to the complex nature of the abdominal aortic aneurysm geometry, the physiological forces and constraints acting on the abdominal aortic aneurysm wall were measured by using a simulation setup using boundary conditions and initial conditions for different studies such as finite element analysis or computational fluid dynamics. Results: The flow pattern showed an increase velocity at the angular neck, followed by a stagnated flow inside the aneurysm sack. Furthermore, the wall shear stress analysis showed to focalized points of higher stress, the top and bottom of the aneurysm sack, where the flow collides against the wall. An increase of the viscosity showed no significant velocity changed but results in a slight increase in overall pressure and wall shear stress. Conclusions: Conducting computational fluid dynamics modeling of the abdominal aortic aneurysm using computer-aided software SolidWorks (Dassault Systems SolidWorksCorp., Waltham MA) proves to be an insightful approach for the clinical setting. The careful consideration of the biomechanics of the abdominal aortic aneurysm may lead to an improved, case-specific prediction of the abdominal aortic aneurysm rupture potential, which could significantly improve the clinical management of these patients.

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The Future of Abdominal Aortic Aneurysm Treatment and the Role of Totally Percutaneous Endografting

Interventional Cardiology Review ◽

10.15420/icr.2010.5.1.86 ◽

2010 ◽

Vol 5 (1) ◽

pp. 86

Author(s):

Laura Capoccia ◽

Vincent Riambau ◽

◽

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Abdominal Aortic Aneurysm Repair ◽

Aneurysm Rupture ◽

Aortic Aneurysms ◽

Mortality And Morbidity ◽

Low Profile ◽

Abdominal Aortic ◽

Distal Migration ◽

Randomised Controlled

Endovascular abdominal aortic aneurysm repair (EVAR) has experienced a continuous spread worldwide as a result of the constant drive to develop innovative methods and devices that enable physicians to achieve therapeutic aims while reducing procedural risks and patient discomfort. Randomised controlled studies have demonstrated clear early benefits over open repair in terms of mortality and morbidity, but a high reintervention rate jeopardised the EVAR outcome. Complications in EVAR, such as endoleaks, separation of modular components, stent or hook fractures and distal migration of the endograft, can lead to aneurysm enlargement and thus to the native risk of aneurysm rupture. In order to prevent such complications and minimise potential re-interventions, new-generation stent grafts, low-profile delivery systems and new percutaneous closing devices have been developed and adopted, making a totally percutaneous approach possible and desirable. Nevertheless, operators must be aware and trained to face every complication that could possibly develop during and after the procedure. Given these circumstances, EVAR is under consideration as the first line of treatment for abdominal aortic aneurysms.

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SURGICAL TREATMENT OF ABDOMINAL AORTIC ANEURYSM

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2016-175-6-24-27 ◽

2016 ◽

Vol 175 (6) ◽

pp. 24-27

Author(s):

V. V. Shlomin ◽

A. V. Gusinskiy ◽

M. L. Gordeev ◽

I. V. Mikhailov ◽

D. N. Maistrenko ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Surgical Treatment ◽

Aortic Aneurysm ◽

Comparison Group ◽

Aneurysm Rupture ◽

Aortic Aneurism ◽

Abdominal Aortic ◽

Abdominal Aortic Aneurism ◽

Surgical Methods ◽

Results Of Surgery

The article analyzed the results of surgical treatment of 140 patients with surgery of abdominal aortic aneurism. The comparison group consisted of 80 patients with aortic aneurism more than 4,5 cm, who didn’t undergo surgery. The conventional method of Khardi-Pokrovskiy resection was complemented by a number of surgical methods in these cases. The results of surgery were improved due to application of these methods. All the patients (100%), who didn’t undergo surgery, passed away during 5 years, though 70% of them died because of aneurysm rupture. The early postoperative lethality was 5% in the main group, but 5-year survival was 81%.

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Prospective Ultrasound Screening of Men with Cerebrovascular Disease for Abdominal Aortic Aneurysms

Scandinavian Journal of Surgery ◽

10.1177/1457496920917269 ◽

2020 ◽

pp. 145749692091726

Author(s):

V. Vänni ◽

J. Turtiainen ◽

U. Kaustio ◽

J. Toivanen ◽

M. Rusanen ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Cerebrovascular Disease ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Maximum Diameter ◽

Infrarenal Aorta ◽

Ultrasound Screening ◽

Abdominal Aortic ◽

Male Patients

Background: The prevalence of abdominal aortic aneurysms is higher in population with other vascular comorbidities, especially among men. Utility of screening among patients with cerebrovascular disease is unclear. Objective: To determine the prevalence of abdominal aortic aneurysm in male patients with diagnosed cerebrovascular disease manifested by transient ischemic attack or stroke. Material and Methods: Between May 2013 and May 2014, all consecutive male patients undergoing carotid ultrasound in single tertiary center with a catchment area of 179,000 inhabitants were evaluated for ultrasound screening of abdominal aortic aneurysm. Abdominal aortic aneurysm was defined as maximum diameter of infrarenal aorta 30 mm or more. Results: Of 105 (n = 105) consecutively evaluated male patients, only 69% (n = 72) were eligible for the study and underwent aortic screening. Reason for ineligibility was most often poor general medical condition (n = 29). Mean age of screened patients was 66 years (SD 9.8 years). Half of the screened patients suffered stroke (n = 36). The incidence of abdominal aortic aneurysm was 5.6% (n = 4). All found abdominal aortic aneurysms were small and did not require immediate surgical intervention. During a follow-up period of over 4 years, none of the aneurysms exhibited tendency for growth. Conclusion: The male population with cerebrovascular disease is comorbid and frail. Only, moderate prevalence of abdominal aortic aneurysms can be found in this subpopulation.

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Aortic Aneurysm Eroding into the Spine

Aorta ◽

10.1055/s-0038-1669416 ◽

2018 ◽

Vol 06 (02) ◽

pp. 068-069

Author(s):

T. Rajab ◽

Miriam Beyene ◽

Farhang Yazdchi ◽

Matthew Menard

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Abdominal Mass ◽

Abdominal Aortic Aneurysms ◽

Aneurysm Rupture ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

Acute Back Pain ◽

History Of ◽

Ruptured Abdominal Aortic Aneurysms

AbstractAortic aneurysms are usually asymptomatic until catastrophic rupture occurs. Ruptured abdominal aortic aneurysms classically present with acute back pain, shock, and a pulsatile abdominal mass. The natural history of some aortic aneurysms also includes a stage of contained rupture. This occurs when extravasation of blood from the ruptured aneurysm is contained by surrounding tissues. Here, the authors report the case of a chronic contained abdominal aortic aneurysm rupture that resulted in erosion of the spine.

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Advancements in identifying biomechanical determinants for abdominal aortic aneurysm rupture

Vascular ◽

10.1177/1708538114532084 ◽

2014 ◽

Vol 23 (1) ◽

pp. 65-77 ◽

Cited By ~ 13

Author(s):

Nikolaos Kontopodis ◽

Eleni Metaxa ◽

Yannis Papaharilaou ◽

Emmanouil Tavlas ◽

Dimitrios Tsetis ◽

...

Keyword(s):

Growth Rate ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Abdominal Aortic Aneurysms ◽

Aneurysm Rupture ◽

Aortic Aneurysms ◽

Maximum Diameter ◽

Rupture Risk ◽

Abdominal Aortic Aneurysm Rupture ◽

Abdominal Aortic

Abdominal aortic aneurysms are a common health problem and currently the need for surgical intervention is determined based on maximum diameter and growth rate criteria. Since these universal variables often fail to predict accurately every abdominal aortic aneurysms evolution, there is a considerable effort in the literature for other markers to be identified towards individualized rupture risk estimations and growth rate predictions. To this effort, biomechanical tools have been extensively used since abdominal aortic aneurysm rupture is in fact a material failure of the diseased arterial wall to compensate the stress acting on it. The peak wall stress, the role of the unique geometry of every individual abdominal aortic aneurysm as well as the mechanical properties and the local strength of the degenerated aneurysmal wall, all confer to rupture risk. In this review article, the assessment of these variables through mechanical testing, advanced imaging and computational modeling is reviewed and the clinical perspective is discussed.

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Current evidence and prospects for medical treatment of abdominal aortic aneurysms

VASA ◽

10.1024/0301-1526.34.4.217 ◽

2005 ◽

Vol 34 (4) ◽

pp. 217-223 ◽

Cited By ~ 11

Author(s):

Diehm ◽

Schmidli ◽

Dai-Do ◽

Baumgartner

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Medical Treatment ◽

Endovascular Treatment ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Current Evidence ◽

Significant Morbidity ◽

Abdominal Aortic ◽

Risk Of Rupture

Abdominal aortic aneurysm (AAA) is a potentially fatal condition with risk of rupture increasing as maximum AAA diameter increases. It is agreed upon that open surgical or endovascular treatment is indicated if maximum AAA diameter exceeds 5 to 5.5cm. Continuing aneurysmal degeneration of aortoiliac arteries accounts for significant morbidity, especially in patients undergoing endovascular AAA repair. Purpose of this review is to give an overview of the current evidence of medical treatment of AAA and describe prospects of potential pharmacological approaches towards prevention of aneurysmal degeneration of small AAAs and to highlight possible adjunctive medical treatment approaches after open surgical or endovascular AAA therapy.

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Gender differences in abdominal aortic aneurysm therapy – a systematic review

VASA ◽

10.1024/0301-1526/a000703 ◽

2018 ◽

Vol 47 (4) ◽

pp. 267-272 ◽

Cited By ~ 9

Author(s):

Konstanze Stoberock ◽

Tilo Kölbel ◽

Gülsen Atlihan ◽

Eike Sebastian Debus ◽

Nikolaos Tsilimparis ◽

...

Keyword(s):

Gender Differences ◽

Abdominal Aortic Aneurysm ◽

Survival Rate ◽

Aortic Aneurysm ◽

Endovascular Treatment ◽

Aortic Aneurysms ◽

Lower Survival Rate ◽

Lower Survival ◽

Abdominal Aortic ◽

Risk Of Rupture

Abstract. This article analyses if and to what extent gender differences exist in abdominal aortic aneurysm (AAA) therapy. For this purpose Medline (PubMed) was searched from January 1999 to January 2018. Keywords were: “abdominal aortic aneurysm”, “gender”, “prevalence”, “EVAR”, and “open surgery of abdominal aortic aneurysm”. Regardless of open or endovascular treatment of abdominal aortic aneurysms, women have a higher rate of complications and longer hospitalizations compared to men. The majority of studies showed that women have a lower survival rate for surgical and endovascular treatment of abdominal aneurysms after both elective and emergency interventions. Women receive less surgical/interventional and protective medical treatment. Women seem to have a higher risk of rupture, a lower survival rate in AAA, and a higher rate of complications, regardless of endovascular or open treatment. The gender differences may be due to a higher age of women at diagnosis and therapy associated with higher comorbidity, but also because of genetic, hormonal, anatomical, biological, and socio-cultural differences. Strategies for treatment in female patients must be further defined to optimize outcome.

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