Successful management for a ruptured abdominal aortic aneurysm using resuscitative endovascular balloon occlusion of the aorta via the brachial artery route—a case report

Aortic Aneurysm ◽

Minimally Invasive ◽

Vital Signs ◽

Ruptured Abdominal Aortic Aneurysms

Aortic Aneurysms ◽

Ruptured Abdominal Aortic Aneurysm ◽

Resuscitative Thoracotomy ◽

Abdominal Aortic ◽

Ruptured abdominal aortic aneurysms pose a challenge to anesthesiologists. Resus-citative thoracotomy and aorta-cross clamping are used to prevent cardiopulmonary collapse during ruptured abdominal aortic aneurysm repair. Recently, resuscitative endovascular balloon obstruction of the aorta has been introduced as an alternative to resuscitative thoracotomy and aorta-cross clamping. Resuscitative endovascular balloon obstruction of the aorta is a minimally invasive and low risk procedure compared to resuscitative thoracotomy and aorta-cross clamping, with minimal blood-borne pathogen exposure to healthcare workers. A 63-year-old man was scheduled for emergency repair of a ruptured abdominal aortic aneurysms. The patient’s vital signs were unstable, and aggressive treatment with transfusion and vasopressor infusion was not effective. Resuscitative endovascular balloon obstruction of the aorta was performed using the brachial artery. After initiation of resuscitative endovascular balloon obstruction of the aorta, the patient’s vital signs immediately stabilized, and hematoma evacuation and aorta reconstruction were completed successfully. The total balloon inflation time during resuscitative endovascular balloon obstruction of the aorta was approximately 45 min. The patient was discharged on the 62nd postoperative day. Resuscitative endovascular balloon obstruction of the aorta is a promising minimally invasive alternative to resuscitative thoracotomy and aorta-cross clamping in patients with ruptured abdominal aortic aneurysms. Resuscitative endovascular balloon obstruction of the aorta may also be a good treatment option for patients with non-compressible torso bleeding under the diaphragm.

The effect of endograft device on patient outcomes in endovascular repair of ruptured abdominal aortic aneurysms

Vascular ◽

10.1177/1708538117711348 ◽

2017 ◽

Vol 25 (6) ◽

pp. 657-665 ◽

Cited By ~ 3

Author(s):

Vinay Kansal ◽

Sudhir Nagpal ◽

Prasad Jetty

Keyword(s):

Aortic Aneurysm ◽

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Ruptured Abdominal Aortic Aneurysm ◽

Abdominal Aortic ◽

Ruptured Abdominal Aortic Aneurysms ◽

Instructions For Use ◽

Aneurysm Repair

Objective Endovascular aneurysm repair for ruptured abdominal aortic aneurysm is being increasingly applied as the intervention of choice. The purpose of this study was to determine whether survival and reintervention rates after ruptured abdominal aortic aneurysm vary between endograft devices. Methods This cohort study identified all ruptured abdominal aortic aneurysms performed at The Ottawa Hospital from January 1999 to May 2015. Data collected included patient demographics, stability index at presentation, adherence to device instructions for use, endoleaks, reinterventions, and mortality. Kruskal–Wallis test was used to compare outcomes between groups. Mortality outcomes were assessed using Kaplan–Meier survival analysis, and multivariate Cox regression modeling. Results One thousand sixty endovascular aneurysm repairs were performed using nine unique devices. Ninety-six ruptured abdominal aortic aneurysms were performed using three devices: Cook Zenith ( n = 46), Medtronic Endurant ( n = 33), and Medtronic Talent ( n = 17). The percent of patients presented in unstable or extremis condition was 30.2, which did not differ between devices. Overall 30-day mortality was 18.8%, and was not statistically different between devices ( p = 0.16), although Medtronic Talent had markedly higher mortality (35.3%) than Cook Zenith (15.2%) and Medtronic Endurant (15.2%). AUI configuration was associated with increased 30-day mortality (33.3% vs. 12.1%, p = 0.02). Long-term mortality and graft-related reintervention rates at 30 days and 5 years were similar between devices. Instructions for use adherence was similar across devices, but differed between the ruptured abdominal aortic aneurysm and elective endovascular aneurysm repair cohorts (47.7% vs. 79.0%, p < 0.01). Notably, two patients who received Medtronic Talent grafts underwent open conversion >30 days post-endovascular aneurysm repair ( p = 0.01). Type 1 endoleak rates differed significantly across devices (Cook Zenith 0.0%, Medtronic Endurant 18.2%, Medtronic Talent 17.6%, p = 0.01). Conclusion Although we identified device-related differences in endoleak rates, there were no significant differences in reintervention rates or mortality outcomes. Favorable outcomes of Cook Zenith and Medtronic Endurant over Medtronic Talent reflect advances in endograft technology and improvements in operator experience over time. Results support selection of endograft by operator preference for ruptured abdominal aortic aneurysm.

Mortality outcomes of ruptured abdominal aortic aneurysms and rural presentation

Vascular ◽

10.1177/1708538115599315 ◽

2016 ◽

Vol 24 (5) ◽

pp. 449-453 ◽

Cited By ~ 1

Author(s):

Emily Munday ◽

Stuart Walker

Keyword(s):

Aortic Aneurysm ◽

Vascular Surgery ◽

Endovascular Repair ◽

Public Hospitals ◽

Aortic Aneurysms ◽

Ruptured Abdominal Aortic Aneurysm ◽

Abdominal Aortic ◽

Ruptured Abdominal Aortic Aneurysms ◽

Transfer Times

Objectives Centralisation of vascular surgery services has coincided with a move towards endovascular repair of ruptured abdominal aortic aneurysms with the goal to improve patient outcomes. The aim of this study was to assess the effect of rural presentation and transfer times on survival from ruptured abdominal aortic aneurysm. Design A retrospective review. Materials All patients presenting with ruptured abdominal aortic aneurysm to public hospitals in Tasmania between July 2006 and April 2013. Methods Demographic data, Glasgow aneurysm score, Hardman index, transfer times, operative technique and 30-day mortality were collected from medical records. Results Over the study period 127 patients presented to public hospitals in Tasmania with ruptured abdominal aortic aneurysm. A total of 27 presented to north west hospitals where no vascular surgery service is provided (NWRH), 23 to a northern hospital where an intermittent vascular surgery service is provided (LGH) and 77 to the state tertiary vascular surgery service (RHH). Of these, 4 (14.8%) died at NWRH, 6 (26.1%) died at LGH and 43 (55.8%) died at RHH without operation. Of the 35 patients transferred from NWRH and LGH to RHH, 5 died without operation. Median time from presentation to theatre at RHH if transferred from NWRH was 6.25 hours, from the LGH 4.75 hours, compared to 2.75 hours when presenting directly to RHH. Open repair was performed in 41 patients and endovascular repair in 23 patients. Overall 30-day mortality in those treated at RHH was 26.6% (39.0% for open repair, 4.3% for endovascular repair). Mortality for intended operative patients initially presenting to non-RHH hospitals was 33.3% vs. 32.3% for those initially presenting to RHH. p Value 0.93. Conclusion There was no clinical or statistical disadvantage to rural presentation and transfer for patients presenting with ruptured abdominal aortic aneurysm in Tasmania. Endovascular repair has a role despite long transfer times.

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):

Aortic Aneurysm ◽

Abdominal Mass ◽

Ruptured Abdominal Aortic Aneurysms

Aneurysm Rupture ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

Acute Back Pain ◽

History Of ◽

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.

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):

Aortic Aneurysm ◽

Medical Treatment ◽

Endovascular Treatment ◽

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.

Morphological and Biomechanical Features in Abdominal Aortic Aneurysm with Long and Short Neck—Case-Control Study in 64 Abdominal Aortic Aneurysms

Annals of Vascular Surgery ◽

10.1016/j.avsg.2017.06.054 ◽

2017 ◽

Vol 45 ◽

pp. 223-230

Author(s):

Igor B. Koncar ◽

Dalibor Nikolic ◽

Zarko Milosevic ◽

Nikola Ilic ◽

Marko Dragas ◽

...

Keyword(s):

Aortic Aneurysm ◽

Case Control Study ◽

Case Control ◽

Aortic Aneurysms ◽

Short Neck ◽

Abdominal Aortic ◽

Biomechanical Features ◽

Control Study

A Case Report on the Successful Treatment ofStreptococcus pneumoniae-Induced Infectious Abdominal Aortic Aneurysm Initially Presenting with Meningitis

Case Reports in Surgery ◽

10.1155/2015/825069 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6

Author(s):

Yohei Kawatani ◽

Yoshitsugu Nakamura ◽

Yujiro Hayashi ◽

Tetsuyoshi Taneichi ◽

Yujiro Ito ◽

...

Keyword(s):

Computed Tomography ◽

Back Pain ◽

Streptococcus Pneumoniae ◽

Aortic Aneurysm ◽

Successful Treatment ◽

Aortic Aneurysms ◽

Limb Weakness ◽

Abdominal Aortic

Infectious abdominal aortic aneurysms often present with abdominal and lower back pain, but prolonged fever may be the only symptom. Infectious abdominal aortic aneurysms initially presenting with meningitis are extremely rare; there are no reports of their successful treatment. Cases withStreptococcus pneumoniaeas the causative bacteria are even rarer with a higher mortality rate than those caused by other bacteria. We present the case of a 65-year-old man with lower limb weakness and back pain. Examination revealed fever and neck stiffness. Cerebrospinal fluid showed leukocytosis and low glucose levels. The patient was diagnosed with meningitis and bacteremia caused byStreptococcus pneumoniaeand treated with antibiotics. Fever, inflammatory response, and neurologic findings showed improvement. However, abdominal computed tomography revealed an aneurysm not present on admission. Antibiotics were continued, and a rifampicin soaked artificial vascular graft was implanted. Tissue cultures showed no bacteria, and histological findings indicated inflammation with high leukocyte levels. There were no postoperative complications or neurologic abnormalities. Physical examination, blood tests, and computed tomography confirmed there was no relapse over the following 13 months. This is the first reported case of survival of a patient with an infectious abdominal aortic aneurysm initially presenting with meningitis caused byStreptococcus pneumoniae.

Abdominal aortic aneurysm screening programme

British Journal of Healthcare Assistants ◽

10.12968/bjha.2019.13.9.430 ◽

2019 ◽

Vol 13 (9) ◽

pp. 430-434

Author(s):

Ian Peate

Keyword(s):

Aortic Aneurysm ◽

Abdominal Aorta ◽

Screening Programme ◽

Aortic Aneurysms ◽

Ultrasound Scan ◽

Abdominal Aneurysm ◽

Abdominal Aortic ◽

The Uk

This is the second article in a series of articles regarding screening programmes. In this article, an overview of the abdominal aorta is provided. The article also considers the abdominal aortic aneurysm screening programme. Aortic abdominal aneurysm is described. The majority of abdominal aortic aneurysms are asymptomatic; however, if there are any symptoms, these are explained. All four UK countries offer men aged 65 years and over a screening opportunity using an ultrasound scan, the fundamental aspects of abdominal aortic aneurysm screening programmes is offered. It is emphasised that screening is not mandatory in the UK; the man has a right to decline the invitation to attend any screening programme.

The similarities and differences among patients with abdominal aortic aneurysms referred to a tertiary hospital and found at necropsy

Vascular ◽

10.1177/1708538114552095 ◽

2014 ◽

Vol 23 (4) ◽

pp. 411-418 ◽

Cited By ~ 5

Author(s):

Erasmo S da Silva ◽

Vitor C Gornati ◽

Ivan B Casella ◽

Ricardo Aun ◽

Andre EV Estenssoro ◽

...

Keyword(s):

Risk Factors ◽

Aortic Aneurysm ◽

Protective Factor ◽

Aortic Aneurysms ◽

Maximum Diameter ◽

Transverse Diameter ◽

Abdominal Aortic ◽

Tertiary Center

Objective To analyze the characteristics of patients with abdominal aortic aneurysms referred to a tertiary center and to compare with individuals with abdominal aortic aneurysm found at necropsy. Methods We have retrospectively analyzed the medical records of 556 patients with abdominal aortic aneurysm and 102 cases abdominal aortic aneurysm found at necropsy. Results At univariated analysis, hypertension, tobacco use and maximum diameter were significant risk factors for symptomatic aneurysm, while diabetes tended to be a protective factor for rupture. By logistic regression analysis, the largest transverse diameter was the only one significantly associated with abdominal aortic aneurysm rupture ( p < .0001, odds ratio 1.7, 95% confidence interval 1.481–1.951). Intact abdominal aortic aneurysm found at necropsy showed similarities with outpatients in relation to abdominal aortic aneurysm diameter and risk factors. Conclusion Intact abdominal aortic aneurysm at necropsy and at outpatients setting showed similarities that confirmed that abdominal aortic aneurysm repair is less offered to women, and they died more frequently with intact abdominal aortic aneurysm from other causes.

Prevalence of Renal Masses Suspected of Malignancy and Adrenal Incidentalomas in Patients With Abdominal Aortic Aneurysm

Vascular and Endovascular Surgery ◽

10.1177/15385744211022603 ◽

2021 ◽

pp. 153857442110226

Author(s):

Dorota Studzińska ◽

Mateusz Kózka ◽

Kamil Polok ◽

Katarzyna Gronostaj ◽

Maciej Chwała ◽

...

Keyword(s):

Aortic Aneurysm ◽

Aortic Aneurysms ◽

Renal Tumors ◽

Type Ii ◽

Adrenal Incidentalomas ◽

Renal Masses ◽

Abdominal Aortic ◽

Study Population

Objective: The aim of our study was to assess the prevalence of renal masses suspected of malignancy and adrenal incidentalomas in patients with abdominal aortic aneurysm based on the computed tomography angiography (CTA). Methods: In the retrospective cross-sectional study, the CTA scans of patients with abdominal aortic aneurysms and thoraco-abdominal aortic aneurysms type II-IV were assessed. Patients with thoraco-abdominal aortic aneurysms type I and V and history of abdominal aortic surgery were excluded from the study. Results: Study group comprised 937 patients with a median age of 73.0 years, 83.8% of whom were male. CTA revealed renal tumors in 11 patients (1.2% of the study population) with a median size of 26 mm (interquartile range 20-50). Adrenal incidentalomas were found in 61 patients (6.5% of the study population). In 20 patients (2.1%) adrenal lesions were found bilaterally. Conclusion: In the described cohort, the renal and adrenal tumors were relatively common findings among patients with abdominal aortic aneurysm and thoraco-abdominal aortic aneurysms type II-IV. Both anaesthesiologists and surgeons should be vigilant about the possibility of such coexistence in order to provide the patients with the best possible perioperative care and an optimal surgical modality.