Endovascular repair of abdominal aortic aneurysms.

In September 1999, the Food and Drug Administration approved two devices for the endovascular repair of abdominal aortic aneurysms. The endografts are placed from within the arteries using fluoroscopic guidance. The minimally invasive technique is performed using bilateral femoral artery cut-downs and has significant advantages over open surgical repair, including a reduction in morbidity, hospital stay and blood loss, with a much quicker return to normal activities. Endoleaks are the main complication following endovascular repair, and close follow-up of patients with CT is recommended to confirm adequate exclusion of the aneurysm.

Outpatient surveillance of abdominal aortic aneurysm.

Rupture of abdominal aortic aneurysm (AAA) continues to be an important treatable cause of death. It is estimated that 28,000 new patients are diagnosed each year with AAA and 5,000 patients present with rupture. Health care costs escalate enormously when surgical treatment is delayed until the time of aneurysm rupture, the hospitalization is lengthy, and mortality rates are unacceptably high. Increasing physician awareness of the need for early detection and elective aneurysm repair before rupture are of clear benefit in reducing mortality from this disease. Primary care physicians and other specialists are often the first to discover abdominal aortic aneurysms. The task becomes how to minimize the risk of AAA rupture while avoiding unnecessary surgery in patients who would have died from other causes before AAA rupture. Recent clarification of several issues, including size of the normal adult abdominal aorta, definition of aneurysm, natural history, familial tendencies, risk factors for rupture, and surgical outcome have heightened the responsibility we have to the general population in knowing who to screen and who needs surgical treatment when the screening studies are positive.

Thoracoabdominal aortic aneurysm associated with umbilical artery catheterization: case report and review of the literature.

Aneurysms in infants and children are rare and are usually associated with cardiovascular malformations or connective tissue disorders. A new subgroup of patients has become recognized over the past two decades--those with aneurysms associated with umbilical artery catheterization. Critically ill newborns who have required umbilical artery catheterization and have developed sepsis, usually staphylococcal, are at risk for the development of mycotic aneurysm disease of the aorta or its major branches or both. Since first described in 1970, 34 cases have been reported in the literature, 14 involving the descending thoracic aorta, 10 the abdominal aorta, 6 the iliac arteries, and 4 either the thoracoabdominal aorta or multiple aneurysms involving both the thoracic and abdominal aorta. This report presents a case we recently treated of a 15-month-old-boy with a large thoracoabdominal aortic aneurysm and aneurysms of the infrarenal abdominal aorta and proximal right common iliac artery. It includes a review of the recent literature to analyze pathogenesis, clinical manifestations, and to formulate methods of treatment.