جستجوی مقالات مرتبط با کلیدواژه « aortic aneurysm » در نشریات گروه « پزشکی »

Marfan syndrome is an autosomal dominant genetic disorder owing to insufficient fibrillin-1 that involves connective tissue, with an incidence rate of approximately 2–3/10000 in most populations. Almost 25% of cases are caused by new mutations and are sporadic. Marfan syndrome leads to not only skeletal and ocular complications (eg, ectopia lentis and retinal detachment) but also cardiac complications, which are the most significant. Critical cardiovascular complications that can occur include mitral valve prolapse, mitral regurgitation, aortic regurgitation, aortic aneurysms, dilation of the sinus of Valsalva, aortic dissection, and rupture. The diagnosis of Marfan syndrome is based on the Ghent nosology. Since cardiac manifestations are life-threatening, they need to be diagnosed and treated promptly. The treatment of cardiac complications comprises surgical and pharmacological therapy. Here, we introduce an asymptomatic case of Marfan syndrome with blurred vision and severe cardiac manifestations discovered during cardiac assessments before eye surgery. (Iranian Heart Journal 2024; 25(1): 112-117)

An aneurysm or aortic dissection occurs when the walls of the blood vessels lose their initial strength, resulting in a middle layer gap between elastic and smooth muscle fibers. Approximately95% of individuals with an aneurysm indicate no symptoms until a rupture occurs, which is life-threatening.  The current research is a cross-sectional study carried out on 100 patients who were hospitalized in Shahid Sadoughi and Afshar hospitals in Yazd, Iran, with confirmed diagnoses of arterial aneurysm or dissection between 2011 and 2017. Individuals with aneurysms caused by dialysis-related shunts were not included. The study evaluated demographic and clinical factors along with their respective outcomes. Data analysis was performed utilizing SPSS software version 17 through chi-square and Fisher exact tests.  Seventy-one patients (71%) were male, and patients aged over 60 accounted for approximately 53%. Abdominal aortic aneurysm was the most prevalent at 27%. The aneurysm was located in the Femoral artery in 23% of patients and in the ascending aorta artery in 12%. Dissection was diagnosed in 27% of patients, all of which occurred in the aortic artery. Coronary artery disease was reported by 41 patients (60.3%). The distribution of patient outcomes based on the location of the aneurysm and dissection was statistically significant (p value: 0.002).  The characteristics of the arterial aneurism population in our findings were similar to previous studies. Coronary artery disease was the most prevalent comorbidities, and men's gender was dominant. Also, the abdominal aortic and femoral artery was the most prevalent location of aneurysm.

Hemicorporectomy is a life-saving operation to maintain the survival of patients with severe and irreversible pelvis and lower extremities injuries. In the typical procedure, removing lower extremities and pelvic viscera in the two stages might result in hemodynamic instability, intraoperative and postoperative morbidities, and more deficient patients' survival. In this study, we aim to describe our experience with a new technique for one-stage hemicorporectomy, which minimizes surgical time and intraoperative bleeding.

Case Report: 

A 77-year-old male patient with lower limb gangrene after previous vascular surgery for an abdominal aortic aneurysm in an unstable situation underwent hemicorporectomy in one step.

We believe that achieving a one-step procedure, especially in non-malignant cases or in the absence of severe trauma lesions, may be a viable option in emergency surgery cases or hemodynamic instability. However, there is still a need to modify the single-stage surgical technique in later experiments.

Ligation of the left innominate vein (LIV) expands the surgeon’s surgical field for ascending aorta and aortic arch procedures. Although it is considered a safe technique by most surgeons in that it is associated with only minor drawbacks, conflicting views exist regarding this method. We herein describe a 70-year-old woman who underwent ascending aorta replacement due to an aneurysm with subsequent cerebral dysfunction caused by extended brain edema, possibly related to LIV ligation, leading to her death.

Aortic Stenosis (AS) and Abdominal Aortic Aneurysm (AAA) typically affect elderly patients, both being associated with adverse outcomes if not adequately managed. Notably, these conditions can be present simultaneously in a significant percentage of cases. Choosing the optimal treatment for these patients is challenging and no clear recommendations are available. Yet, simultaneous treatment by the percutaneous intervention, especially in high surgical risk patients, appears attractive.

Herein, three cases of AAA and severe AS treated via Transcatheter Aortic Valve Implantation (TAVI) and Endovascular Aortic Repair (EVAR) within the same procedure have been reported in details for the first time.

The results indicated that one-stage intervention was an effective, safe, and feasible treatment for these two pathologies, especially in frail patients.

A mycotic aortic aneurysm (MAA), synonymously known as infected aortic aneurysm, is an aortic aneurysm due to infection. Mycotic aortic aneurysm most commonly develops through microbial inoculation of the diseased aortic endothelium during bacteremia. In this study we presented 2 Mycotic aortic aneurysm cases. In the first case the patient is a 50-year-old farmer who presented with a complaint of abdominal pain. The patient was consulted with the vascular surgery service for the diagnosis of ruptured abdominal aneurysm. The patient was prepared for surgery of a ruptured abdominal aortic aneurysm. After surgery, the patient's blood culture was reported negative after 72 hours, but the patient's aneurysm sac tissue culture reported Citrobacter freundii. The patient's antibiotic treatment regimen was changed according to the performed antibiogram. In another case A 65 year’s old male who was admitted in neurology ward was consulted with us, because of a pulsatile abdominal mass. The patient had Alzheimer disease and Brucellosis and didn’t receive a complete duration treatment for his Brucellosis. On surgery, we bypassed the defect and covered the graft with peritoneum. In first case the patient's blood culture was reported negative after 72 hours, but the patient's aneurysm sac tissue culture reported Citrobacter freundii. The patient's antibiotic treatment regimen was changed according to the performed antibiogram. In second case he was discharged without any surgical complication and on follow –up visit (7 months later) he didn’t have any complaint.

Aortic aneurysm is a cardiovascular disease that has a great deal of notoriety all over the world. If the diagnosis is postponed, there is a strong risk for rupture, leading to 90% mortality even before the patient arrives to the hospital. Treatment of aortic aneurysm is usually surgery in the form of open surgery or endovascular grafting. However, this type of surgery still has some disadvantages, including the safety profile and the risk of failure. Nanorobot surgery is a potential approach as a standard treatment for aortic aneurysm. The existence as a precision surgery will provide a better method of delivery. A combination with canonical Particle Swarm Optimization (PSO) and bionanocomposite could improve its effectiveness, operation and stability, creating a better nanorobot for aortic aneurysm therapy.

Although classic and standard procedure for patients with ascending Aorta aneurysm with Sever aortic Regurgitation is Bentall surgery but in some selected cases this complex surgery was not performed with different reason like advanced age and coexisting comorbidity involving renal and hepatic and lung Function. In our cases 75 years old man with chronic renal failure ( Cr= 3.2 ) who was known case of sever aortic Regurgitation and Ascending Aortic Aneurysm with 5.5 diameter.replacement of Aortic Valve with Biologic Prosthesis Aortic Valve and Reduction Aortoplasty with Mesh prosthesis was done successfully with good result with early follow up.

Abdominal aortic aneurysm (AAA, triple A) is one of the less common but important causes of abdominal pain. This study aimed to evaluate the characteristics and outcome of patients presenting to emer- gency department with triple A.

In this retrospective cross-sectional study, all cases with confirmed triple A, who were presented to the emergency department of Shohadaye Tajrish Hospital, Tehran, Iran from 2006 to 2017 (10 years) were enrolled using census sampling method.

500 cases with the mean age of 68.11 ± 11.98 (25 - 94) years were studied (84% male). The mean duration of symptoms was 2.32 ± 9.58 months and mean aneurysmal size was 63.91 ± 20.08 mm. In 4 (0.8%) cases, atrial fibrillation (AF) was found during cardiac monitoring. Patients stayed in the hospital for an average of 7.06 ± 6.32 days. Aneurysmal leak was seen in 130 (26%) cases based on abdominal computed tomography (CT) scan findings. 369 (73.8%) cases underwent aneurysmorrhaphy, 126 (25.2%) were treated with non-surgical approaches, and 5 (1%) underwent grafting. 104 (20.8%) died and 396 (79.2%) were treated successfully. Older age (p = 0.017), shock state at the time of presenta- tion (p < 0.0001), leakage of aneurysm (p < 0.001), larger size of aneurysm (p = 0.024), and aneurysmorrhaphy (p < 0.001) were among the factors significantly associated with mortality.

Based on the findings, the most frequent presenting symptom of patients was abdominal pain. The mortality rate of this series was 21% and older age, shock state, leakage of aneurysm, larger size of aneurysm, and performing aneurysmorrhaphy were among the factors significantly associated with mortality.

The aim of this study is to investigate the renoprotective effect of erythropoietin (EPO) on hypovolemic shock and ischemia/reperfusion (IR) injury on kidneys as end-organs in an experimentally-created ruptured abdominal aortic aneurysm (rAAA) model. Thirty anesthetized Sprague-Dawley male rats were randomized to sham ((Sh n:6) (Sh+EPO n:6)) or shock and I/R groups ((S/IR n:9) (S/IR+EPO n:9)). Additional surgical procedure except aortic exploration was not performed on Sh and Sh+EPO groups. 60 min of shock, 60 min of ischemia, and 120 min of reperfusion were applied on S/IR and S/IR+EPO groups. In the S/IR and S/IR+EPO groups, hemorrhagic shock, lower torso ischemia, and reperfusion were created. At the end of the shock period, saline solutions were separately and equally administered to Sh and S/IR groups, whereas 2000 U/kg EPO was intraperitoneally administered to Sh+EPO and S/IR+EPO groups. At the end of the experimental study, some biochemical and histological parameters were studied in serum and kidney tissues. Biochemical parameters were all significantly increased in the S/IR group compared with the Sh group. These parameters were not statistically significantly different between S/IR+EPO and Sh+EPO groups. In histopathologic examination, EPO prevented high-grade injury. Our data indicate that EPO may have a renoprotective effect and reduce the systemic inflammatory response that resulted from shock and I/R in an experimental model of rAAA.

We report a case of a type B aortic dissection with an aneurysm treated by the replacement of the proximal descending thoracic aorta via the reversed elephant trunk technique. A 48-year-old asymptomatic man was diagnosed with a type B aortic dissection, moderate aortic regurgitation, and a good biventricular function in March 2012. Four years later (April 2016), a contrast-enhanced computed tomography examination revealed an aneurysmal dilatation in the patient’s descending thoracic aorta with a thrombosis in the proximal part of the false lumen, which warranted surgical repair. He underwent type B aortic dissection repair through the left posterolateral thoracotomy. Three months after the surgery, the patient developed a type A aortic dissection with severe aortic regurgitation, which was successfully managed via a Bentall procedure with arch replacement facilitated by the reversed elephant trunk technique performed during the initial surgery through thoracotomy. At 2 years follow-up, the patient was doing well with a normal left ventricular function.

Concomitant replacement of the ascending aorta and heart transplantation are an infrequent procedure. This procedure was most often performed in patients with Marfan syndrome, however, it has its own technical difficulties. Hereby, we report on combined heart transplantation and aortic root replacement using donor’s ascending aorta in a 25-year-old man diagnosed with dilated cardiomyopathy and ascending aorta aneurysm. This procedure was successful and beneficial to patients with aortopathy who are candidates for heart transplantation.

Endovascular treatment of aortic diseases has improved in recent years. More complex thoracoabdominal and juxtarenal abdominal aortic aneurysms can now be treated with new stent grafts and techniques. Fenestrated endovascular aortic aneurysm repair (FEVAR) with fenestrated stent grafts was commenced in our center after hundred cases of endovascular aortic repair, and so far 4 serial complex cases deemed inoperable (2 juxtarenal abdominal aortic aneurysms, 1 thoracoabdominal aneurysm, and 1 thoracoabdominal pseudoaneurysm) have been treated with FEVAR. All these patients needed custom-made stent grafts, which were designed and implanted successfully under general anesthesia in the catheterization laboratory. They were followed up for more than 1 year, with a median follow-up period of 23.0 months. There were no major in-hospital or short-term complications. Only 1 patient had midterm unilateral iliac artery thrombosis, which was successfully managed interventionally. Computed tomography angiography at 1 year’s follow-up showed that the stent grafts were patent and their visceral branch cover stents had no endoleak.

Hughes-Stovin Syndrome (HSS) is a rare clinical disorder characterized by deep venous thrombosis and multiple pulmonary and/or bronchial aneurysms. Aneurysms in systemic circulation can also be seen.
We report the first case of HSS with aortic aneurysm in a 55-year-old man who initially presented with deep venous thrombosis. The diagnosis of HSS revealing Behçet’s disease was made given the history of recurrent oral and genital ulcers. Treatment consisted of 3 daily pulses of methylprednisolone (1g) followed by oral prednisone (1mg/kg daily) and 6 monthly pulses of cyclophosphamide. Oral anticoagulation treatment was held 3 months and then was stopped with good outcome.
Systemic aneurysms in Hughes Stovin is a worth knowing complication which may reveal Behçet’s disease.

Aortic wall with its poor blood supply is a very rare location of Hydatid Cyst (HC) infestation and mediastinal HC is a rare presentation of human hydatidosis. Here, we reported a case of primary mediastinal HC invading the ascending aorta, which initially presented as an aortic aneurysm. The patient underwent open cardiac surgery with cardiopulmonary bypass for resection of the aortic wall HC. During surgical exploration, it was found that the HC had ruptured into blood stream and residual cyst cavity contained a large thrombosis. Thus, the patient underwent ascending aorta replacement and removal of the cyst with thrombotic material. It seems that the signs and symptoms of stroke were related to emboli of cyst contents or thrombotic material into cerebral circulation. Invasion of aortic wall by hydatidosis is an exceedingly rare presentation of HC in the anterior mediastinum that may be wrongly diagnosed as a pseudoaneurysm of ascending aorta. Our study patient had an uneventful recovery and one-year follow-up revealed no recurrence of HC in mediastinum.

Aortic surgery hasmademuch progress recently. Yet the combination of aortic surgery and coronary artery bypass grafting has remained amajor issue for the surgeons.

Patient and Observation:

 Herein, we present a case of severe aortic insufficiency with aortic aneurysm concomitant with single coronary artery disease on the right coronary artery. The patient underwent Bentall procedure for the correction of severe AI and aortic aneurysm. Subsequently, due to the lack of proper site for proximal anastomosis of the saphenous veingraft on the ascending aorta, we decided to performcoronary-coronary artery bypass for the right coronary artery lesion instead of conventional implan- tation of saphenous vein graft on the ascending aorta.

Coronary-coronary artery bypass could be performed safely for special conditions like porcelain aorta and when the ascending aorta is not suitable for the proximal saphenous vein graft.