1/26. Asymptomatic rupture of an aortoiliac aneurysm.The rupture of an abdominal aortic aneurysm is one of the most feared complications confronted by cardiovascular surgeons. Such ruptures are usually catastrophic, but in some instances the rupture is posterior and remains sealed. These chronic ruptures may manifest with any of a variety of clinical presentations. This report describes an uncommon presentation of a chronic rupture of an aortoiliac aneurysm in a patient with generalized aneurysmal disease. The rupture presented as an asymptomatic giant pulsatile mass in the patient's abdomen. The mass had developed over a period of several years. The literature is also reviewed.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
2/26. Immediate endovascular repair for descending thoracic aortic transection secondary to blunt trauma.PURPOSE: To report the immediate endovascular treatment of a thoracic aortic tear secondary to blunt trauma. methods AND RESULTS: A 39-year-old man was injured in a motor vehicle collision. In addition to significant trauma to the head, chest, and abdomen, there were signs of a deceleration injury to the thoracic aorta. After urgent celiotomy to repair a lacerated spleen, the thoracic aortic transection was treated intraluminally using an endograft made of Gianturco Z-stents covered with polytetrafluoroethylene. The patient recovered from his injuries, and the thoracic endograft shows no evidence of endoleak 7 months after treatment. CONCLUSIONS: Endoluminal techniques can be used successfully in the immediate repair of thoracic aortic injuries.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
3/26. Combined blunt thoracic aortic and abdominal trauma: diagnostic and treatment priorities.Combined blunt trauma to the thoracic aorta and abdomen challenges the surgeon from a diagnostic and therapeutic standpoint. Appropriately prioritizing diagnostic workup and treatment is critical to assuring patient survival. A management approach that considers the patient's injuries and clinical condition as well as the availability of aortography and cardiac surgery are essential. patients with blunt aortic injury who are hemodynamically unstable with signs of intra-abdominal injury should have immediate abdominal exploration. Further assessment of the aortic injury and surgical repair can be delayed until after the critical intra-abdominal bleeding has been addressed. The stable patient who has both blunt abdominal trauma and blunt thoracic aortic injury but has no signs of ongoing abdominal hemorrhage should initially have arch aortography. Additional abdominal diagnostic studies may be done but should not delay indicated surgical repair of the aortic injury.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
4/26. Aortic nonanastomotic pseudoaneurysm eroding lumbar vertebra--a case report.Nonanastomotic pseudoaneurysms are uncommon complications of prosthetic grafts, which are mostly associated with axillofemoral grafts. The case presented describes a pseudoaneurysm secondary to a previously placed end-to-side aortobifemoral bypass. back pain developed 3 years after the original bypass and was not relieved with narcotics and muscle relaxants. The patient also complained of a 20-pound weight loss, night sweats, and frequent emesis. Approximately 1 year after the onset of back pain, left leg claudication developed. He eventually underwent magnetic resonance imaging of the lumbosacral spine, which depicted a tumorlike mass eroding the vertebral bodies of L2 and L3. Full oncologic workup was pursued preoperatively. The patient also underwent aortography, computed tomography of the abdomen and pelvis, and an inferior venacavogram to elucidate the relationships between the mass and the major vascular structures. On exploration, no malignancy was present. A hole in the native aorta approximately 2 cm above the level of the end-to-side aortic anastomosis was discovered. This was contiguous with the vertebral bodies and the left psoas muscle. The pseudoaneurysm was repaired by conversion of the proximal anastomosis to an end-to-end aorto right iliac and left femoral bypass. All of the preoperative symptoms resolved after repair of the pseudoaneurysm. Chronic aortic rupture or pseudoaneurysms are difficult to diagnose due to the unusual clinical presentations. Despite complete radiologic evaluation, preoperative diagnosis may be difficult or impossible without a high degree of suspicion. Surgical repair will depend on the cause of the pseudoaneurysm--all but infected aneurysms may be repaired in line by creating a proximal anastomosis above the level of the pseudoaneurysm. Atypical back pain in patients with previous aortic reconstructions should alert the clinician to the possibility of vascular involvement. patients with aortic pseudoaneurysms should undergo prompt repair to avert the potential risk for rupture when the surrounding structures are no longer able to contain the pulsatile flow.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
5/26. A novel use of ultrasound in pulseless electrical activity: the diagnosis of an acute abdominal aortic aneurysm rupture.We report a case of a patient who presented to the Emergency Department with pulseless electrical activity. A rapid diagnosis of ruptured abdominal aortic aneurysm was made by emergency medicine bedside ultrasonography. On arrival, the patient was without palpable pulses and bradycardic. Therapy with epinephrine, fluids, and atropine was initiated. A bedside ultrasound was immediately performed and revealed coordinated cardiac motion with empty ventricles. A rapid search for signs of blood loss in the abdomen revealed a large abdominal aortic aneurysm. Pulses were restored with fluid, blood, and epinephrine and surgical intervention was begun within 30 min of patient arrival.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
6/26. Endovascular repair of a ruptured abdominal aortic and iliac artery aneurysm with an acute iliocaval fistula secondary to lymphoma.Abdominal aortic aneurysms (AAA) are common and generally asymptomatic unless rupture occurs. A 3 to 4-cm AAA has a 1-2% risk of rupture over 5 years. We present the case of an 85-year-old male with a history of chronic lymphocytic leukemia, a 3-cm infrarenal AAA, and a 2-cm right common iliac artery aneurysm whose AAA ruptured and who developed an acute iliac artery-to-vena cava fistula secondary to eroding adenopathy from an aggressive low-grade lymphoma. Initially, an open repair was attempted but access to the aorta was not possible because of complete encasement of the infrarenal and suprarenal aorta with tumor that was clinically invading the aortic wall. Secondary tumor invasion into the aorta is a rare complication. An endovascular repair was accomplished with successful exclusion of both the aneurysm and the iliocaval fistula. Endovascular repair provides a valuable alternative in the "hostile abdomen" when standard open repair may be hazardous or impossible.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
7/26. Emergency endovascular treatment of thoracic aortic rupture in three accident victims with multiple injuries.PURPOSE: To report an experience with emergency endovascular treatment of traumatic thoracic aortic ruptures in multi-injured patients. case reports: Three victims of motor vehicle accidents with multiple head, chest, and abdominal injuries in addition to fractures were treated urgently for thoracic aortic lacerations with transluminal placement of an endovascular graft during the initial emergent laparotomy. In all cases, ruptured visceral organs were treated first and the abdomen closed. femoral artery access was gained through a cutdown, and the endografts were delivered with no systemic heparinization. The endovascular component of the surgical session took approximately 50 minutes. All patients survived to discharge. Two patients are alive at 5 and 12 months with sustained endovascular exclusion of the pseudoaneurysm, but one patient with severe brain damage died 9 months after treatment from respiratory insufficiency. CONCLUSIONS: Acute endovascular treatment of thoracic aortic ruptures is feasible and has the advantage of avoiding thoracotomy in otherwise severely injured patients.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
8/26. Abdominal aortic aneurysm with aorto-vena caval fistula and retroperitoneal rupture. Report of a case.One successfully treated case of ruptured aortic aneurysm with aorto-caval fistula is reported. At admission a large pulsating mass was present in the abdomen, and a prominent continuous bruit was heard by stethoscopy. Surgery revealed an aortic aneurysm with a retroperitoneal rupture and a large aorto-caval communication as well. The fistula was closed with continuous sutures, and after excision of the aneurysm the arterial continuity was re-established using a "Millinit" dacron graft. The postoperative course was uneventful.- - - - - - - - - - ranking = 1keywords = abdomen (Clic here for more details about this article) |
9/26. Gut feeling.An aneurysm is an abnormal dilatation of an artery, often as a result of atherosclerotic disease. hypertension, connective-tissue disease and a family history of aneurysms are predisposing risk factors. They may occur at any point in the vasculature from the aortic root to distal peripheral vessels, but they are most common in the abdominal aorta. Many times they are asymptomatic and undiagnosed, but as they progressively enlarge, they may compress on surrounding structures, release atherosclerotic debris or thrombi and possibly rupture. Aneurysms occur in approximately 3% of people older than 50; some of these do not rupture. An aneurysm is not typically painful until it dissects or ruptures. [table: see text] The abdominal aorta splits at the level of the umbilicus, so the abdomen must be palpated above the level of the umbilicus to feel for aortic enlargement. Obese patients make detection more difficult, as the presence of a pulsatile mass may be covered. An aneurysm will still conduct blood flow into the lower extremities, so pulses will not be compromised, and capillary refill and temperature will be normal. An acute rupture is a catastrophic event characterized by poor perfusion or frank shock and pain in the abdomen, back or groin. Accompanying symptoms may include a pulsatile abdominal mass, absence of distal pulses, and radiating pain into the lower back that is often described as "tearing" or "ripping." The risk of rupture has a direct correlation with an aneurysm's size. Generally, elective surgery is considered with an abdominal aneurysm larger than 4.5 centimeters, but there are many factors which may preclude repair. Non-surgical treatment of an aneurysm has been performed by percutaneously placing a prosthetic graft at the site, anchoring the graft above and below the aneurysm, thereby isolating the aneurysm from the circulation. Surgical treatment for elective repair of an aneurysm that is not ruptured is still very difficult and has a significant risk of complications. A ruptured abdominal aortic aneurysm has a very high incidence of mortality. Early identification and rapid transport to a facility with vascular surgery services are the keys to survival. This case demonstrates early recognition by the EMS crew and successful resuscitation from a cardiac arrest due to profound shock. In other cases, EMS providers may have the first and only opportunity to recognize a ruptured aneurysm and direct the ED and surgical teams to the cause of sudden shock or cardiac arrest.- - - - - - - - - - ranking = 2keywords = abdomen (Clic here for more details about this article) |
10/26. Compressive blunt trauma of the abdomen and pelvis associated with abdominal aortic rupture.Blunt trauma to the abdominal aorta is an uncommon but life-threatening injury. Its incidence and mortality are related to road traffic accidents and have increased during the last years mainly because of the compulsory use of seat belts. A high level of suspicion and medical knowledge is necessary for its diagnosis and appropriate management. We present a rare case of abdominal compression leading to pelvic fracture and disruption of the aortic wall with a fatal result. With this case study and a literature review, we would like to stress the importance of recognition, management and follow-up of the blunt abdominal injuries associated with pelvic trauma in order to improve the outcome.- - - - - - - - - - ranking = 4keywords = abdomen (Clic here for more details about this article) |
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