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Journal of Central South University(Medical Sciences) ; (12): 213-220, 2023.
Article in English | WPRIM | ID: wpr-971388


OBJECTIVES@#Abdominal aortic aneurysm is a pathological condition in which the abdominal aorta is dilated beyond 3.0 cm. The surgical options include open surgical repair (OSR) and endovascular aneurysm repair (EVAR). Prediction of acute kidney injury (AKI) after OSR is helpful for decision-making during the postoperative phase. To find a more efficient method for making a prediction, this study aims to perform tests on the efficacy of different machine learning models.@*METHODS@#Perioperative data of 80 OSR patients were retrospectively collected from January 2009 to December 2021 at Xiangya Hospital, Central South University. The vascular surgeon performed the surgical operation. Four commonly used machine learning classification models (logistic regression, linear kernel support vector machine, Gaussian kernel support vector machine, and random forest) were chosen to predict AKI. The efficacy of the models was validated by five-fold cross-validation.@*RESULTS@#AKI was identified in 33 patients. Five-fold cross-validation showed that among the 4 classification models, random forest was the most precise model for predicting AKI, with an area under the curve of 0.90±0.12.@*CONCLUSIONS@#Machine learning models can precisely predict AKI during early stages after surgery, which allows vascular surgeons to address complications earlier and may help improve the clinical outcomes of OSR.

Humans , Aortic Aneurysm, Abdominal/complications , Endovascular Procedures/methods , Retrospective Studies , Blood Vessel Prosthesis Implantation/adverse effects , Acute Kidney Injury/etiology , Machine Learning , Treatment Outcome , Postoperative Complications/etiology , Risk Factors
Rev. méd. Chile ; 149(1): 132-136, ene. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1389347


Primary aortoenteric fistula is the spontaneous communication between the lumen of the aorta and a portion of the digestive tract. The most common cause is the erosion of an abdominal aortic aneurysm into the 3rd or 4th portion of the duodenum. It manifests clinically as gastrointestinal bleeding, with or without abdominal pain and a pulsatile abdominal mass on physical exam. Gastrointestinal bleeding is initially recurrent and self-limiting and progresses to fatal exsanguinating hemorrhage. Endoscopic examination diagnoses only 25% of aortoenteric fistulas because these are usually located in the distal duodenum. Contrast computed tomography of the abdomen and pelvis is diagnostic in only 60% of cases. We report three cases with this condition. A 67-year-old male presenting with an upper gastrointestinal bleeding. He was operated and a communication between an aortic aneurysm and the duodenum was found and surgically repaired. The patient is well. A 67-year-old male with an abdominal aortic aneurysm presenting with abdominal pain. He was operated and anticoagulated. In the postoperative period he had a massive gastrointestinal bleeding and a new CAT scan revealed an aorto enteric fistula that was surgically repaired. The patient is well. An 82-year-old male with an abdominal aortic aneurysm presenting with hematochezia. A CAT scan revealed a communication between the aneurysm and the third portion of the duodenum, that was surgically repaired. The patient died in the eighth postoperative day.

Humans , Male , Aortic Diseases , Aortic Rupture , Vascular Fistula/surgery , Vascular Fistula/complications , Vascular Fistula/diagnostic imaging , Intestinal Fistula/complications , Intestinal Fistula/diagnostic imaging , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnostic imaging , Duodenal Diseases/surgery , Duodenal Diseases/complications , Duodenal Diseases/diagnostic imaging , Aorta, Abdominal , Duodenum , Gastrointestinal Hemorrhage/etiology
Rev. Assoc. Med. Bras. (1992, Impr.) ; 67(1): 101-106, Jan. 2021. tab, graf
Article in English | LILACS | ID: biblio-1287786


SUMMARY OBJECTIVE: We aimed to demonstrate the clinical utility of CHA2DS2-VASc and anticoagulation and risk factors in atrial fibrillation risk scores in the assessment of one year mortality in patients with abdominal aortic aneurysm. METHODS: We designed a retrospective cohort study using data from Suleyman Demirel University Hospital for the diagnosis of abdominal aortic aneurysm. The study included 120 patients with abdominal aortic aneurysm who underwent aortic computed tomography. Patients were divided into two groups according to presence of abdominal aortic aneurysm and the development of mortality. Predictors of mortality were determined by multiple logistic regression analysis. RESULTS: Multivariate regression analysis showed that CHA2DS2-VASc score, advanced age, female gender and elevated white blood cell counts were independent predictors of abdominal aortic aneurysm development while CHA2DS2-VASc score and elevated glucose levels were independent predictors of one year mortality in patients with abdominal aortic aneurysm. The concordance statistics for anticoagulation and risk factors in atrial fibrillation risk Score and CHA2DS2-VASc risk score respectively were 0.96 and 0.97 and could significantly predict one year mortality in patients with abdominal aortic aneurysm (p<0.001, and p<0.001, respectively). CONCLUSIONS: CHA2DS2-VASc and anticoagulation and risk factors in atrial fibrillation risk scores are easily obtained in an emergency setting and can accurately predict one year mortality as a noninvasive follow-up in patients with abdominal aortic aneurysm. These simple scores could be used as a point of care decision aid to help the clinician in counseling patients presenting with abdominal aortic aneurysm and their families on treatment protocols.

Humans , Female , Atrial Fibrillation/complications , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnostic imaging , Stroke , Predictive Value of Tests , Retrospective Studies , Risk Factors , Risk Assessment
J. vasc. bras ; 20: e20200174, 2021. tab, graf
Article in English | LILACS | ID: biblio-1287083


Abstract Ruptured abdominal aortic aneurysms (RAAA) evolving aortocaval fistula (AF) can have catastrophic hemodynamic effects. Surgical repair is imperative, but the optimal technical approach is still under debate. Our objective is to present 3 cases treated with endovascular repair (EVAR) at a University Hospital. Case #1, a 71-year-old man presenting a 7.1cm RAAA with AF, repaired with a monoiliac stent graft and femoral-femoral bypass; Case #2, a 76-year-old man presenting a 9.9cm RAAA with AF, repaired with a bifurcated stent graft; Case #3, a 67-year-old man with previous history of EVAR, presenting a type 3 endoleak with late rupture related to AF, repaired with a tubular stent graft. All cases unfolded with delayed recovery and significant complication rates, although AF symptoms had resolved by hospital discharge. EVAR techniques for AF may require secondary interventions but are feasible, despite the lack of consensus, considering the rarity of this RAAA presentation.

Resumo Aneurismas de aorta abdominal rotos (AAAR) com evolução para fístula aorto-cava (FAC) podem apresentar consequências hemodinâmicas catastróficas. A correção cirúrgica é mandatória, embora não haja consenso sobre a técnica operatória. Apresentamos uma série de três casos operados em hospital universitário pela técnica endovascular. No primeiro caso, um homem de 71 anos apresentou AAAR de 7,1 cm com FAC, submetido a correção por endoprótese monoilíaca e enxerto femoral cruzado. No segundo, um homem de 76 anos apresentou AAAR de 9,9 cm com FAC submetido a colocação de endoprótese bifurcada. O terceiro caso era de um homem de 67 anos com histórico de EVAR e endoleak tipo 3, com ruptura tardia para veia cava, tratado com extensão aórtica. Todos apresentaram evolução pós-operatória prolongada com significativas complicações, entretanto com boa resolução dos sintomas à alta hospitalar. A EVAR é uma técnica promissora para o tratamento de FAC, embora com taxa de reintervenção significativa.

Humans , Male , Aged , Aortic Rupture , Aortic Aneurysm, Abdominal/surgery , Endovascular Procedures , Postoperative Period , Prostheses and Implants , Venae Cavae , Arteriovenous Fistula , Aortic Aneurysm, Abdominal/complications
J. vasc. bras ; 20: e20210122, 2021. graf
Article in English | LILACS | ID: biblio-1351011


Abstract Candida is a rare cause of infected aortic aneurysms. We report the case of a diabetic patient with end stage kidney disease who underwent repair of a leaking abdominal aortic aneurysm. He was on long-term antibiotic treatment for malignant otitis externa. Candida albicans was isolated from the culture of the excised aneurysm wall. An infected aortic aneurysm due to Candida has not been previously reported in a patient with malignant otitis externa. This case report aims to highlight that Candida should be suspected as a cause of infected aortic aneurysms in patients with debilitation and chronic immunosuppression. Management of such cases can be extremely challenging, especially in resource-poor settings, and we will be touching upon the advantages and disadvantages of various treatment options.

Resumo A cândida é uma causa rara de aneurismas da aorta infecciosos. Relatamos o caso de um paciente diabético com doença renal terminal, que foi submetido a reparo de aneurisma da aorta abdominal com vazamento. Ele estava em tratamento de longo prazo com antibióticos para otite externa maligna. A Candida albicans foi isolada da cultura da parede do aneurisma que sofreu a excisão. Não há relatos prévios de aneurisma da aorta infeccioso causado por cândida em pacientes com otite externa maligna. Este relato de caso visa reforçar que a cândida deve ser uma das suspeitas de causa de aneurisma da aorta infeccioso em pacientes debilitados e com imunossupressão crônica. O manejo desses casos pode ser extremamente desafiador, principalmente em contextos em que os recursos são escassos, e mencionaremos as vantagens e desvantagens das diversas opções de tratamento.

Humans , Male , Aged , Otitis Externa/complications , Aneurysm, Infected/complications , Aortic Aneurysm, Abdominal/complications , Aneurysm, Infected/etiology , Candida albicans/pathogenicity , Aortic Aneurysm, Abdominal/therapy , Immune Tolerance/immunology , Anti-Bacterial Agents/adverse effects
J. vasc. bras ; 20: e20200082, 2021. graf
Article in Portuguese | LILACS | ID: biblio-1250239


Resumo Os aneurismas de aorta abdominal (AAA) são os mais frequentes, mesmo quando comparados a outros segmentos da aorta. A prevalência e a história natural de aneurismas arteriais em receptores de transplante de órgão abdominal permanecem incertas. Relatamos a abordagem de um caso de aneurisma de aorta abdominal em um paciente transplantado renal e com alergia ao contraste. Foi realizado o tratamento convencional do aneurisma de aorta abdominal com um by-pass aorto bi-ilíaco. Para manutenção do enxerto renal, foi confeccionado um by-pass temporário da artéria axilar direita até a artéria ilíaca comum direita. O paciente foi encaminhado para a unidade de terapia intensiva, onde permaneceu estável hemodinamicamente e recebeu alta no 2º pós-operatório. A cirurgia convencional aberta com derivação extra-anatômica temporária é uma alternativa para o tratamento do AAA em pacientes com transplante renal.

Abstract Abdominal aortic aneurysms (AAA) are the most common type, even when compared to those involving other segments of the aorta. The prevalence and natural history of arterial aneurysms in abdominal organ transplant recipients remain uncertain. We report a case of abdominal aortic aneurysm in a kidney transplant patient with contrast allergy. Conventional abdominal aortic aneurysm repair was performed, constructing a bi-iliac aortic bypass. A temporary bypass was constructed from the right axillary artery to the right common iliac artery to maintain the renal graft. The patient was transferred to the intensive care unit, where he remained hemodynamically stable, and he was discharged on the 2nd postoperative day. Conventional open surgery with temporary extra-anatomic bypass is an alternative option for treatment of AAA in patients with transplanted kidneys.

Humans , Male , Middle Aged , Vascular Surgical Procedures/methods , Kidney Transplantation/adverse effects , Aortic Aneurysm, Abdominal/surgery , Renal Circulation , Anastomosis, Surgical , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnosis , Iliac Artery
Rev. cir. (Impr.) ; 72(1): 59-63, feb. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1092891


Resumen Introducción Las fístulas aorto-entéricas (FAE) son una causa infrecuente de hemorragia digestiva. El pronóstico, generalmente ominoso, depende de una alta sospecha clínica y diagnóstico oportuno. Caso clínico Reportamos el caso de una mujer de 66 años intervenida por un aneurisma sacular aórtico abdominal (AAA) yuxtarrenal, con rotura contenida, fistulizado al duodeno. Presentó una hemorragia digestiva en el preoperatorio; sin embargo, el diagnóstico de la fístula se hizo en el intraoperatorio. La paciente fue sometida a reparación quirúrgica urgente con instalación de una prótesis aórtica bifemoral y resección duodenal. En el postoperatorio inmediato presentó una trombosis parcial de las ramas de la prótesis aórtica e isquemia de extremidades, siendo reintervenida exitosamente. Discusión La FAE es una causa potencialmente fatal de hemorragia digestiva. El diagnóstico continúa siendo un desafío debido a su presentación inespecífica y siempre debiese ser considerado frente a una hemorragia digestiva sin causa aparente. Existen varias opciones para el enfrentamiento quirúrgico que deben ser analizadas caso a caso, sin retrasar la reparación de la fístula. Es preferible la resección duodenal ante la simple duodenorrafia.

Introduction Aorto-enteric fistulae (AEF) are a rare cause of gastrointestinal bleeding. The prognosis tends to be ominous, depending greatly in a high level of clinical suspicion and prompt diagnosis. Clinical case We report a case of a 66-year-old female with a saccular juxta-renal abdominal aortic aneurysm (AAA), with a contained rupture. The patient was urgently submitted to surgical repair using an bifemoral aortic prosthesis. A duodenal partial resection was performed. During the immediate postoperative time she presented partial thrombosis of prosthesis and ischemia of lower extremities so she was reoperated successfully. Discussion AEF is a potentially fatal cause of gastrointestinal bleeding. Diagnosis is still troublesome due to its vague presentation and it should always be considered when facing gastrointestinal haemorrhage with no apparent cause. There are several surgical approaches that should be pondered case to case without delaying the repair of the defect.

Humans , Female , Aged , Aortic Diseases/complications , Intestinal Fistula/surgery , Intestinal Fistula/complications , Duodenal Diseases/complications , Gastrointestinal Hemorrhage/surgery , Intestinal Fistula/diagnosis , Treatment Outcome , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/complications , Blood Vessel Prosthesis Implantation/methods , Perioperative Period , Gastrointestinal Hemorrhage/diagnosis
J. vasc. bras ; 19: e20200088, 2020. graf
Article in Portuguese | LILACS | ID: biblio-1143211


Resumo O rim em ferradura é a anomalia congênita renal mais comum, ocorrendo em 0,15 a 0,25% de nascidos vivos. A associação de rim em ferradura com aneurisma de aorta abdominal é rara, estando presente em apenas 0,12% dos pacientes submetidos a tratamento dos aneurismas de aorta abdominal. Este desafio terapêutico consiste em um caso de um paciente portador de um aneurisma de aorta abdominal sintomático associado a rim em ferradura. A irrigação do rim em ferradura dava-se por meio de quatro artérias, sendo que duas delas emergiam diretamente do saco aneurismático. O caso foi solucionado por meio de cirurgia aberta, em caráter de urgência, com acesso transperitoneal, interposição de enxerto de Dacron bifurcado aorto bi-ilíaco e reimplante das duas artérias renais anômalas no corpo principal do Dacron. O paciente teve boa evolução pós-operatória, recebendo alta da unidade de tratamento intensivo no 3º dia e alta hospitalar no 8º dia, mantendo níveis normais de creatinina sérica.

Abstract Horseshoe kidney is the most common congenital renal anomaly, occurring in 0.15-0.25% of newborns. The association of a horseshoe kidney with an abdominal aortic aneurysm is rare. Only 0.12% of patients requiring abdominal aortic repair have a horseshoe kidney. This therapeutic challenge constitutes a patient presenting with a symptomatic abdominal aortic aneurysm and a horseshoe kidney. The horseshoe kidney was supplied by 4 renal arteries, 2 of which emerged from the aneurysmal sac. The patient underwent urgent open repair, with transperitoneal exposure, interposition of a bifurcated aorto-bi-iliac Dacron graft and re-implantation of the 2 anomalous renal arteries on the Dacron main body. Postoperatively, the patient was discharged from the intensive care unit on day 3, and discharged home on day 8, maintaining normal serum creatinine.

Humans , Male , Aged , Aortic Aneurysm, Abdominal/complications , Fused Kidney/complications , Aorta, Abdominal , Renal Artery , Aortic Aneurysm, Abdominal/surgery , Creatinine , Kidney/abnormalities
Rev. Hosp. Ital. B. Aires (2004) ; 39(3): 94-97, sept. 2019. ilus.
Article in Spanish | LILACS | ID: biblio-1048277


Las fístulas arteriovenosas durales medulares son malformaciones vasculares adquiridas que constituyen una causa muy infrecuente de mielopatía progresiva (5-10 casos por millón de habitantes por año). La resonancia magnética es el estudio por imágenes de elección para su diagnóstico. A continuación presentamos el caso de una paciente femenina de 89 años, que consultó a la guardia de nuestra institución por un cuadro de paraparesia moderada asociada a parestesias e incontinencia urinaria posterior a esfuerzo físico. Se le diagnosticó una fístula arteriovenosa dural medular como causante de su cuadro. (AU)

Spinal dural arteriovenous fistulas (SDAVF) are acquired spinal vascular malformations and a rare cause of progressive myelopathy (5-10 new cases per year and per 1 million inhabitants). Magnetic resonance imaging is the diagnosis modality of choice. We present a case of a 89-year-old female patient who consulted the emergency department of our institution because of paraparesis and lower extremities paresthesias associated with urinary incontinence post physical effort. With the final diagnosis of spinal dural arteriovenous fistula, as a cause of the clinical symptoms. (AU)

Humans , Male , Female , Middle Aged , Aged, 80 and over , Arteriovenous Fistula/diagnostic imaging , Dura Mater/abnormalities , Paresthesia , Atrial Fibrillation/complications , Spinal Cord Diseases/diagnostic imaging , Tobacco Use Disorder/complications , Urinary Incontinence , Arteriovenous Fistula/etiology , Arteriovenous Fistula/epidemiology , Low Back Pain/complications , Aortic Aneurysm, Abdominal/complications , Paraparesis , Fecal Incontinence , Hypertension/complications , Hypesthesia , Erectile Dysfunction , Anticoagulants/therapeutic use
Rev. bras. cir. cardiovasc ; 33(5): 522-524, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-977446


Abstract This paper presents a case study of a patient that underwent surgery for a ruptured abdominal aneurysm. The postoperative course was complicated by resistant hypertension and tachycardia. A suprarenal mass was detected in the computed tomography scan with radiological suspicion of pheochromocytoma. Few cases of pheochromocytoma coexisting with aneurysms have been reported. Management of cardiovascular stability is crucial in such cases. Despite the lack of evidence, pheochromocytomas might have a role in the etiology of aortic aneurysms.

Humans , Male , Middle Aged , Pheochromocytoma/surgery , Aortic Aneurysm, Abdominal/surgery , Adrenal Gland Neoplasms/surgery , Hypertension/etiology , Pheochromocytoma/complications , Pheochromocytoma/diagnostic imaging , Tomography, X-Ray Computed , Aortic Aneurysm, Abdominal/complications , Adrenal Gland Neoplasms/complications , Adrenal Gland Neoplasms/diagnostic imaging
Rev. cuba. angiol. cir. vasc ; 19(1)ene.-jun. 2018. ilus, tab
Article in Spanish | LILACS, CUMED | ID: biblio-960324


Introducción: El síndrome metabólico está relacionado con el incremento de la morbilidad y mortalidad de las enfermedades. Objetivo: Determinar la influencia del síndrome metabólico sobre los resultados de la cirugía revascularizadora del sector aorto-ilíaco. Métodos: Se realizó un estudio descriptivo en dos etapas, en 114 pacientes atendidos en un período de cuatro años (2010-2014) en el Hospital Hermanos Ameijeiras con el diagnóstico de aneurisma de la aorta infrarrenal o enfermedad esteno-oclusiva aorto-ilíaca. Las variables fueron: presencia del síndrome metabólico y tipo de sus criterios positivos, enfermedad al ingreso, complicaciones posoperatoria, condición al alta (vivo /fallecido) y estancia hospitalaria. Se realizó el análisis estadístico correspondiente. Resultados: El 64 por ciento presentó el síndrome metabólico (p= 0,004), que predominó en la enfermedad esteno-oclusiva (48,2 por ciento) y en el aneurisma de la aorta abdominal infrarrenal (15,8 por ciento) sin diferencias significativas entre ambas entidades (p= 0,466). El 43,8 por ciento presentó cuatro criterios positivos, donde la hipertensión arterial fue la más frecuente (94,5 por ciento). Las complicaciones posquirúrgicas (relacionadas con la cirugía y respiratorias) se produjeron en el 64,4 por ciento. Hubo cinco fallecidos (5,3 por ciento) por enfermedades cardiovasculares y vasculares periféricas. El 50,7 por ciento de los enfermos con síndrome metabólico complicado acumuló más de 10 días de estadía posoperatoria. Conclusiones: El síndrome metabólico influye de forma negativa en los resultados de la cirugía revascularizadora del sector aorto-ilíaco en los pacientes con aneurisma de la aorta abdominal infrarrenal o con enfermedad esteno-oclusiva aorto-ilio-femoral, por el incremento de la frecuencia de complicaciones posoperatorias(AU)

Introduction: The metabolic syndrome is related to the increase of the morbidity and the mortality of diseases. Objective: To determine the influence of the metabolic syndrome on the results of the revascularization surgery performed in the aortic-iliac sector. Methods: A two-phase descriptive study was conducted in 114 patients, who were diagnosed with infrarenal aortic aneurysm or steno-occlusive aortic-iliac disease and treated in Hermanos Ameijeiras hospital from 2010-2014. The study variables were presence of metabolic syndrome and type of positive criteria of the same, disease on admission, postoperative complications, patient´s condition on discharge (alive/dead) and hospital length of stay at hospital. The corresponding statistical analysis was made. Results: Sixty four percent presented with the metabolic syndrome (p= 0.004), predominating in steno-occlusive disease (48.2 percent) and the infrarenal abdominal aorta aneurysm (15.8 percent) without significant differences between the two conditions (P= 0.466). In the group, 43.8 percent showed four positive criteria, being hypertension the most common (94.5 percent). Post-surgical complications (related to surgery and respiratory problems) occurred in 64.4 percent. There were five deaths (5.3 percent) due to cardiovascular disease and peripheral vascular diseases. The 50.7 percent of patients with complicated metabolic syndrome had stayed more than 10 days at hospital after surgery. Conclusions: The metabolic syndrome has negative impact on the results of the revascularization surgery of the aortic-iliac sector in patients with infrarenal abdominal aorta aneurysm or with aortic-iliac-femoral steno-occlusive disease, due to increased frequency of postoperative complications(AU)

Humans , Male , Female , Iliac Aneurysm/complications , Aortic Aneurysm, Abdominal/complications , Metabolic Syndrome/mortality , Epidemiology, Descriptive
Rev. Assoc. Med. Bras. (1992, Impr.) ; 63(8): 681-684, Aug. 2017. graf
Article in English | LILACS | ID: biblio-896387


Summary Objective: To investigate the positive association between the presence of simple renal cysts (SRCs) and abdominal aortic aneurysm (AAA). Method: In a retrospective case-control study including subjects aged > 50 years, we evaluated the incidence of SRCs on computed tomography (CT) scan. We compared 91 consecutive patients with AAA referred from the Division of Vascular Surgery and 396 patients without AAA, randomly selected after being matched by age and gender from 3,186 consecutive patients who underwent abdominal CT. SRC was defined as a round or oval low-attenuation lesion with a thin wall and size > 4 mm on CT without obvious evidence of radiographic enhancement or septations. Patients were considered as having AAA if the size of aorta was greater than 3.0 cm. Results: Patients with AAA and without AAA were similar in terms of age (67.9± 8.41 vs. 68.5±9.13 years) (p=0.889) and gender (71.4 vs. 71.2% of male subjects, respectively) (p=0.999). There was no difference in the prevalence of SRC between case and controls. Among individuals with AAA, 38 (41.8%; [95CI 32.5-52.6]) had renal cysts compared to 148 (37.4%; [95CI 32.7-42.2]) in the control group (p=0.473), with a prevalence ratio (PR) of 1.16 (95CI 0.80-1.68). Conclusion: We found no significant differences in the prevalence of SRCs among patients with AAA and controls. Our findings suggest that the presence of SRCs is not a risk factor or a marker for AAA.

Resumo Objetivo: Avaliar uma possível associação entre presença de cistos renais simples (CRS) e aneurisma aórtico abdominal (AAA). Método: Em um estudo de caso versus controle com sujeitos com idade > 50 anos, avaliamos a prevalência de CRS detectados por tomografia computadorizada (TC). Comparamos os achados de 91 pacientes consecutivos com AAA oriundos da Divisão de Cirurgia Vascular com 396 pacientes sem AAA, randomicamente selecionados e ajustados por idade e gênero dentre 3.186 pacientes consecutivos que se submeteram a TC abdominal. Cisto simples foi definido como lesão hipodensa oval ou arredondada com paredes finas, maiores do que 4 mm em TC sem realce contrastual ou septação. Pacientes foram considerados com AAA quando o diâmetro da aorta era maior que 3,0 cm. Resultados: Pacientes com AAA e sem AAA eram semelhantes quanto a idade (67,9±8,41 vs. 68,5±9,13 anos) (p=0,889) e gênero (71,4 vs. 71,2% dos indivíduos masculinos, respectivamente) (p=0,999). Não havia diferença de prevalência de CRS entre casos e controles. Dentre indivíduos com AAA, 38 (41,8%; [IC95% 32,5-52,6]) tinham cistos renais, comparados com 148 (37,4%; [IC95% 32,7-42,2]) no grupo controle (p=0,473), com uma razão de prevalência (RP) de 1,16 (IC95% 0,80-1,68). Conclusão: Não observamos diferenças significativas na prevalência de CRS entre pacientes com AAA e controles. Nossos resultados sugerem que presença de CRS não é fator de risco ou preditor para AAA.

Humans , Male , Female , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/complications , Kidney Diseases, Cystic/complications , Tomography, X-Ray Computed , Case-Control Studies , Retrospective Studies , Aortic Aneurysm, Abdominal/diagnostic imaging , Kidney Diseases, Cystic/diagnostic imaging , Middle Aged
J. vasc. bras ; 16(2): 168-173, abr.-jun. 2017. ilus
Article in Portuguese | LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-859630


As fístulas aorto-cava são entidades raras e de etiologia variada, estando frequentemente associadas a significativa morbimortalidade. Acredita-se que o aumento da tensão da parede nos grandes aneurismas resulte em reação inflamatória e aderência à veia adjacente, culminando na erosão das camadas aderidas e na formação da fístula. O tratamento cirúrgico convencional tem altas taxas de mortalidade. Embolia pulmonar paradoxal e o vazamento são complicações temidas do tratamento endovascular. O uso de oclusor vascular associado a endoprótese bifurcada é boa opção no tratamento do aneurisma de aorta abdominal com fístula aorto-cava

Aortocaval fistulae are rare entities with a variety of etiologies and are very often associated with significant morbidity and mortality. It is believed that increased tension in the walls of large aneurysms can cause an inflammatory reaction resulting in adhesion to the adjacent vein and culminating in erosion of the adherent layers and fistula formation. Conventional surgical treatment has high mortality rates. Paradoxical pulmonary embolism and endoleaks are the most concerning complications linked with endovascular treatment. Using a vascular occluder in combination with a bifurcated endograft is a good option for the treatment of an abdominal aortic aneurysm with aortocaval fistula

Humans , Male , Aged , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnosis , Endovascular Procedures/methods , Fistula/complications , Vascular Closure Devices , Prostheses and Implants , Thrombosis/diagnosis , Thrombosis/therapy , Echocardiography/methods , Ultrasonography, Doppler/methods , Lower Extremity , Femoral Artery , Catheters
J. vasc. bras ; 16(2): f:162-l:167, abr.-jun. 2017. ilus
Article in Portuguese | LILACS | ID: biblio-859626


A doença de Behçet é uma doença sistêmica, multifatorial e autoimune com diversas manifestações clínicas, entre elas o acometimento vascular. Aneurisma de aorta associado a erosão de vértebra lombar é condição rara na literatura, existindo apenas quatro relatos de caso nas bases de dados da PubMed. O presente artigo relata o caso de paciente do sexo feminino com diagnóstico de Doença de Behçet de longa data e aneurisma sacular de aorta abdominal infrarrenal com erosão de vértebra lombar. O caso foi tratado por meio de técnica endovascular com colocação de endoprótese monoilíaca e enxerto fêmoro-femoral cruzado, devido a limitações anatômicas da bifurcação aórtica. O artigo aborda a raridade desse tipo de apresentação da doença e o desfecho do tratamento e apresenta revisão da literatura sobre esse tema

Behçet's disease is an autoimmune, multifactorial, systemic condition with several clinical manifestations, including vascular disorders. An aortic aneurysm with vertebral erosion is rare in association with this pathology and there are only four case reports listed on the PubMed database. This article reports the case of a female patient with a long-standing diagnosis of Behçet's Disease who developed a saccular infrarenal abdominal aortic aneurysm with lumbar vertebral erosion. Her surgical treatment consisted of endovascular repair with a monoiliac endoprosthesis and a femorofemoral crossover bypass, because of limitations imposed by the anatomy of the aortic bifurcation. This paper discusses the rarity of this presentation of the disease and treatment outcomes and offers a brief review of the relevant literature

Humans , Female , Middle Aged , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnosis , Behcet Syndrome/complications , Behcet Syndrome/diagnosis , Endovascular Procedures/methods , Spine/surgery , Aneurysm/diagnosis , Iliac Artery , Low Back Pain/diagnosis , Low Back Pain/therapy , Prostheses and Implants , Treatment Outcome
Arq. bras. cardiol ; 107(4): 378-380, Oct. 2016. graf
Article in English | LILACS | ID: biblio-827856


Abstract A 78-year-old patient presented with shortness of breath after falling down. Transthoracic echocardiogram showed an extensive thrombus in the right atrium (RA), extensive thrombosis of the inferior vena cava (IVC), and abdominal aortic aneurysm (AAA). A magnetic resonance confirmed the thrombosis of the RA extending to the IVC, which was apparently fused to the abdominal aortic aneurysm (compression? erosion?). This case illustrates a severe and rare complication of a non-treated AAA. There probably was IVC erosion by the aortic aneurysm, leading to blood stasis and extensive thrombosis of the IVC and right cardiac chambers.

Resumo Uma paciente de 78 anos procurou o serviço de emergência apresentando dispneia após sofrer queda da própria altura. O ecocardiograma transtorácico mostrou um extenso trombo no átrio direito (AD), trombose extensa da veia cava inferior (VCI), e aneurisma de aorta abdominal (AAA). A ressonância magnética confirmou a trombose do AD estendendo-se até a VCI, a qual aparentemente apresentava fusão ao aneurisma da aorta abdominal (compressão? erosão?). Este caso ilustra uma complicação grave e rara de um AAA não tratado. Provavelmente houve uma erosão da VCI pelo aneurisma da aorta resultando em estase sanguínea e trombose extensa da veia cava inferior e cavidades cardíacas direitas.

Humans , Female , Aged , Thrombosis/etiology , Thrombosis/diagnostic imaging , Vena Cava, Inferior/diagnostic imaging , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnostic imaging , Thrombosis/pathology , Vena Cava, Inferior/pathology , Magnetic Resonance Imaging/methods , Echocardiography/methods , Tomography, X-Ray Computed/methods , Aortic Aneurysm, Abdominal/pathology , Rare Diseases , Heart Atria/pathology , Heart Atria/diagnostic imaging , Heart Ventricles/pathology , Heart Ventricles/diagnostic imaging
Rev. bras. cir. cardiovasc ; 31(2): 132-139, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-792656


Abstract Introduction: Endovascular aneurysm repair (EVAR) is the therapy of choice in high risk patients with abdominal aortic aneurysm. The good results described are leading to the broadening of clinical indications to younger patients. However, reintervention rates seem higher and even with successful treatment sometimes there is growth of the aneurysm sac and rupture, meaning a failure of the therapeutic goal. This study proposes to analyse the impact of age in patients' selection and post-EVAR results. Methods: The clinical records of consecutive patients undergoing endovascular aneurysm repair, between 2001 and 2013, were retrospectively reviewed. Patients were divided according to age groups (<70, 70-80 and >80 years). Gender, body mass index, aneurysm anatomic features, neck characteristics, iliac morphology, surgical indication, endograft type, anesthesic risk classification, length of stay, reinterventions and mortality were analysed and compared. Results: The study included 171 patients, 161 (94.1%) men, and mean age 74.1±8.9 years. The age group under 70 had 32% of the patients. Only three characteristics were found different among age groups: 1) body mass index was higher in younger patients, with a considerable trend toward significance (P=0.06); 2) surgical indication, in the younger group, surgeon's and the patient's option were more proeminent (P<0.05); 3) erectile dysfunction was higher in elderly group (P<0.05). No other clinical and anatomical characteristics or final outcomes were found statisticaly different among age groups. Conclusion: The absence of statistically differences in mortality and reinterventions among age groups suggests that age by itself is not a relevant factor in endovascular aneurysm repair. Indeed, the three characteristics different in younger (obesity, sexual function and patient's choice) favor endovascular aneurysm repair.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Age Factors , Iliac Aneurysm/surgery , Aortic Aneurysm, Abdominal/surgery , Patient Selection , Endovascular Procedures/methods , Postoperative Period , Body Mass Index , Retrospective Studies , Treatment Outcome , Iliac Aneurysm/complications , Iliac Aneurysm/mortality , Aortic Aneurysm, Abdominal/complications , Endovascular Procedures/economics , Erectile Dysfunction/complications
Yonsei Medical Journal ; : 38-44, 2015.
Article in English | WPRIM | ID: wpr-201312


PURPOSE: Coronary artery disease (CAD) shares several risk factors with abdominal aortic aneurysm (AAA). We evaluated the prevalence during transthoracic echocardiography (TTE) and risk factors of AAA in patients with CAD. MATERIALS AND METHODS: A total of 1300 CAD patients were screened from August 2009 to May 2010, and measurement of abdominal aorta size was feasible in 920 patients (71%) at the end of routine TTE. An AAA was defined as having a maximal diameter of > or =30 mm. RESULTS: Of the 920 patients, 22 (2.4% of the study population) were diagnosed with AAA; of these AAA patients, 86% were male, and 82% were over 65 years-old. Abdominal aortic size was weakly correlated with aortic root diameter (r=0.22, p<0.01). Although the proportions of male gender, hypertension, and dyslipidemia were higher in AAA patients, such differences were not statistically significant. Advanced age [odds ratio (OR)=1.07; 95% confidence interval (CI): 1.01-1.12; p<0.01], smoking (OR=3.44; 95% CI: 1.18-10.04; p=0.02), and peripheral arterial disease (OR=5.88; 95% CI: 1.38-25.05; p=0.01) were found to be associated with AAA. CONCLUSION: Although prevalence of AAA is very low in the Asian population, the prevalence of AAA in Asian CAD patients is higher than the general population. Therefore, opportunistic examination of the abdominal aorta during routine TTE could be effective, especially for male CAD patients over 65 years with a history of smoking or peripheral arterial disease.

Aged , Female , Humans , Male , Middle Aged , Aorta, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/complications , Coronary Artery Disease/complications , Demography , Echocardiography , Electrocardiography , Prevalence , Risk Factors