FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W1987814981> ?p ?o ?g. }

• W1987814981 endingPage "2219" @default.
• W1987814981 startingPage "2216" @default.
• W1987814981 abstract "We report an extremely rare case of saccular thoracoabdominal aortic aneurysm associated with high abdominal aortic occlusion including the superior mesenteric and bilateral renal arteries in a patient requiring hemodialysis. Successful repair of the aneurysm and concomitant revascularization of the lower extremities was achieved using femoro-femoral bypass for perfusion of the lower body along with the visceral and intercostal arteries. We report an extremely rare case of saccular thoracoabdominal aortic aneurysm associated with high abdominal aortic occlusion including the superior mesenteric and bilateral renal arteries in a patient requiring hemodialysis. Successful repair of the aneurysm and concomitant revascularization of the lower extremities was achieved using femoro-femoral bypass for perfusion of the lower body along with the visceral and intercostal arteries. Although the results of surgical repair of thoracoabdominal aneurysm (TAAA) continue to improve, associated complicated lesions, including visceral arterial occlusive disease or chronic renal failure have the potential to increase mortality and morbidity. We experienced an extremely rare case of saccular TAAA associated with high abdominal aortic occlusion, which included the superior mesenteric and bilateral renal arteries in a patient requiring hemodialysis. Femoro-femoral bypass was used for perfusion of the lower body and for selective visceral and intercostal arteries, as well as for hemodialysis, during the procedure. This enabled us to achieve successful repair of the aneurysm and concomitant revascularization of the lower extremities.A 50-year-old man was referred to our hospital for detailed examination of progressive thoracoabdominal aortic aneurysm and chronic bilateral limb ischemia. The patient had a 3-year history of hemodialysis for chronic renal failure and had pointed out abdominal aortic obstruction and proximal abdominal aortic dilatation before induction of regular hemodialysis. He had no symptoms, such as leg pain or intermittent claudication, due to leg ischemia. However, a recent computed tomographic scan showed duplicated saccular aneurysms, 35 mm and 69 mm in diameter, located on the thoracoabdominal aorta just below the diaphragm and associated with occlusion of the juxtarenal abdominal aorta (Figs 1A,1B). Although the celiac trunk was observed to branch from the anterior wall of the aneurysm, the superior mesenteric and bilateral renal arteries were not identified. Digital subtraction angiography revealed occlusion of the superior mesenteric artery and both renal arteries, and a collateral circulation connecting the celiac artery to the proximal superior mesenteric artery and the inferior mesenteric artery (Fig 2A). The bilateral iliac arteries were supplied by relatively good collateral flow, mainly from the inferior epigastric arteries (Fig 2B). Surgical resection of the aneurysm in combination with revascularization was electively conducted.Fig 2(A) Preoperative digital subtraction angiography revealed duplicated saccular thoracoabdominal aneurysms along with occlusion of the superior mesenteric artery, both renal arteries, and the proximal abdominal aorta. (B) The bilateral iliac arteries were supplied by relatively good collateral flow, mainly originating from the inferior epigastric arteries.View Large Image Figure ViewerDownload (PPT)After induction of anesthesia, the aneurysm and the involved visceral arteries were exposed through a thoracotomy at the eighth intercostal space and a retroperitoneal approach using a spiral skin incision. The bilateral femoral arteries were also exposed and an 8-mm prosthetic graft was sutured to the left femoral artery for establishing normothermic partial cardiopulmonary bypass in combination with femoral venous drainage after heparinization. After cross-clamping the aorta just below the relatively large intercostal arteries, the aneurysm was opened and a massive, old thrombus was removed. The celiac trunk and left first lumbar artery were perfused. Back bleeding from one intercostal artery and the right first lumbar artery was controlled using a balloon occlusion catheter. A composite graft was prepared using a “Y”-shaped prosthetic graft (18 × 9 mm in diameter) with a separate short graft sutured to the left limb. This graft was anastomosed to the aorta just below the twelfth intercostal artery, and the first lumbar artery was reconstructed with an additional graft from the left limb. The right limb of the graft was anastomosed to the celiac trunk, and the left limb was anastomosed to the left external iliac artery. After separation from cardiopulmonary bypass, femoro-femoral bypass was performed using the previous graft for perfusion, and the procedure was completed. Cardiopulmonary bypass time, spinal cord ischemic time, and operation time was 89, 28, and 303 minutes, respectively. Hemofiltration was performed during cardiopulmonary bypass. Pure red blood cells were prepared and washed out by a cell saver to reduce potassium content. They were transfused during cardiopulmonary bypass to increase the patient’s hematocrit level to greater than 30% at the time of weaning from bypass. A total 16 units of pure red blood cells and 20 units of platelet were required. Postoperative computed tomography showed complete resection of the aneurysm and good patency of the reconstructed branches (Fig 3). The patient recovered well and was discharged without complications on postoperative day 16 and is doing well after 15 months of follow-up.Fig 3Postoperative computed tomographic scan showing complete resection of the aneurysm and good patency of the reconstructed branches.View Large Image Figure ViewerDownload (PPT)CommentThoracoabdominal aneurysm (TAAA) associated with visceral arterial occlusive disease is relatively rare and can result in disastrous complications such as gangrene of the intestine or renal failure after repair. Svensson and colleagues [1Svensson L.G. Crswford E.S. Hess K.R. Coselli J.S. Safi H.J. Thoracoabdominal aortic aneurysms associated with celiac, superior mesenteric, and renal artery occlusive disease: methods and analysis of results in 271 patients.J Vasc Surg. 1992; 16: 378-389Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar] reported an excellent surgical outcome of TAAA repair for 271 of 1,509 patients (14%) with associated visceral arterial occlusive disease [2Coslli J.S. Conklin L.D. LeMaire S.A. Thoracoabdominal aortic aneurysm repair: review and update of current strategies.Ann Thorac Surg. 2002; 74: S1881-S1884Abstract Full Text Full Text PDF PubMed Scopus (171) Google Scholar]. However, TAAA associated with both visceral arterial occlusive disease and abdominal aortic occlusion is extremely rare and can present considerable obstacles to successful surgical repair.Organ protection during aneurysm repair is a difficult task in this complicated situation. Although perfusion support is the primary and most effective method for organ protection, establishing cardiopulmonary bypass was difficult in the present case owing to the presence of visceral and abdominal aortic occlusion. Kunimoto and colleagues [3Kunimoto R. Goto H. Utoh J. Kitamura N. Thoracoabdominal aortic aneurysm combined with aortic occlusion.Ann Thorac Surg. 2000; 69: 623-625Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar] established a successful distal perfusion system during TAAA repair in a patient with aortic occlusion by cannulating the femoral vein and the descending thoracic aorta, initially, after selective perfusion of the viscera. We secured the femoral artery for establishment of cardiopulmonary bypass, which was believed to be essential for performing selective active perfusion to the celiac trunk and intercostal arteries during aortic cross clamping. Thus, despite occlusion of the abdominal aorta, adequate flow (greater than 1.5 L/minute) was maintained by femoral arterial perfusion, probably due to rich collateral arterial vascularization. We believe that establishing an optimal perfusion system during these complicated cases is the most important element in the accomplishment of a successful repair.Preoperative renal dysfunction increases the operative mortality and morbidity in patients with TAAA and thoracic aortic aneurysm [4Morishita K. Kawaharada N. Fukada J. et al.Midterm results of surgical treatment of thoracic aortic disease in dialysis.Ann Thorac Surg. 2005; 80: 96-100Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar]. In patients with renal arterial occlusive lesions, concomitant revascularization, including bypass grafting, reimplantation, or endarterectomy is recommended for reduction of the risk of ischemic complications after repair [1Svensson L.G. Crswford E.S. Hess K.R. Coselli J.S. Safi H.J. Thoracoabdominal aortic aneurysms associated with celiac, superior mesenteric, and renal artery occlusive disease: methods and analysis of results in 271 patients.J Vasc Surg. 1992; 16: 378-389Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar]. However, in patients with chronic renal failure requiring hemodialysis, especially when complicated with bilateral renal arterial occlusion, as in the present case, renal reconstruction will not be beneficial. We undertook perioperative hemodialysis and intraoperative hemofiltration combined with cardiopulmonary bypass in this patient and obtained a successful result with a difficult case. Although the results of surgical repair of thoracoabdominal aneurysm (TAAA) continue to improve, associated complicated lesions, including visceral arterial occlusive disease or chronic renal failure have the potential to increase mortality and morbidity. We experienced an extremely rare case of saccular TAAA associated with high abdominal aortic occlusion, which included the superior mesenteric and bilateral renal arteries in a patient requiring hemodialysis. Femoro-femoral bypass was used for perfusion of the lower body and for selective visceral and intercostal arteries, as well as for hemodialysis, during the procedure. This enabled us to achieve successful repair of the aneurysm and concomitant revascularization of the lower extremities. A 50-year-old man was referred to our hospital for detailed examination of progressive thoracoabdominal aortic aneurysm and chronic bilateral limb ischemia. The patient had a 3-year history of hemodialysis for chronic renal failure and had pointed out abdominal aortic obstruction and proximal abdominal aortic dilatation before induction of regular hemodialysis. He had no symptoms, such as leg pain or intermittent claudication, due to leg ischemia. However, a recent computed tomographic scan showed duplicated saccular aneurysms, 35 mm and 69 mm in diameter, located on the thoracoabdominal aorta just below the diaphragm and associated with occlusion of the juxtarenal abdominal aorta (Figs 1A,1B). Although the celiac trunk was observed to branch from the anterior wall of the aneurysm, the superior mesenteric and bilateral renal arteries were not identified. Digital subtraction angiography revealed occlusion of the superior mesenteric artery and both renal arteries, and a collateral circulation connecting the celiac artery to the proximal superior mesenteric artery and the inferior mesenteric artery (Fig 2A). The bilateral iliac arteries were supplied by relatively good collateral flow, mainly from the inferior epigastric arteries (Fig 2B). Surgical resection of the aneurysm in combination with revascularization was electively conducted. After induction of anesthesia, the aneurysm and the involved visceral arteries were exposed through a thoracotomy at the eighth intercostal space and a retroperitoneal approach using a spiral skin incision. The bilateral femoral arteries were also exposed and an 8-mm prosthetic graft was sutured to the left femoral artery for establishing normothermic partial cardiopulmonary bypass in combination with femoral venous drainage after heparinization. After cross-clamping the aorta just below the relatively large intercostal arteries, the aneurysm was opened and a massive, old thrombus was removed. The celiac trunk and left first lumbar artery were perfused. Back bleeding from one intercostal artery and the right first lumbar artery was controlled using a balloon occlusion catheter. A composite graft was prepared using a “Y”-shaped prosthetic graft (18 × 9 mm in diameter) with a separate short graft sutured to the left limb. This graft was anastomosed to the aorta just below the twelfth intercostal artery, and the first lumbar artery was reconstructed with an additional graft from the left limb. The right limb of the graft was anastomosed to the celiac trunk, and the left limb was anastomosed to the left external iliac artery. After separation from cardiopulmonary bypass, femoro-femoral bypass was performed using the previous graft for perfusion, and the procedure was completed. Cardiopulmonary bypass time, spinal cord ischemic time, and operation time was 89, 28, and 303 minutes, respectively. Hemofiltration was performed during cardiopulmonary bypass. Pure red blood cells were prepared and washed out by a cell saver to reduce potassium content. They were transfused during cardiopulmonary bypass to increase the patient’s hematocrit level to greater than 30% at the time of weaning from bypass. A total 16 units of pure red blood cells and 20 units of platelet were required. Postoperative computed tomography showed complete resection of the aneurysm and good patency of the reconstructed branches (Fig 3). The patient recovered well and was discharged without complications on postoperative day 16 and is doing well after 15 months of follow-up. CommentThoracoabdominal aneurysm (TAAA) associated with visceral arterial occlusive disease is relatively rare and can result in disastrous complications such as gangrene of the intestine or renal failure after repair. Svensson and colleagues [1Svensson L.G. Crswford E.S. Hess K.R. Coselli J.S. Safi H.J. Thoracoabdominal aortic aneurysms associated with celiac, superior mesenteric, and renal artery occlusive disease: methods and analysis of results in 271 patients.J Vasc Surg. 1992; 16: 378-389Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar] reported an excellent surgical outcome of TAAA repair for 271 of 1,509 patients (14%) with associated visceral arterial occlusive disease [2Coslli J.S. Conklin L.D. LeMaire S.A. Thoracoabdominal aortic aneurysm repair: review and update of current strategies.Ann Thorac Surg. 2002; 74: S1881-S1884Abstract Full Text Full Text PDF PubMed Scopus (171) Google Scholar]. However, TAAA associated with both visceral arterial occlusive disease and abdominal aortic occlusion is extremely rare and can present considerable obstacles to successful surgical repair.Organ protection during aneurysm repair is a difficult task in this complicated situation. Although perfusion support is the primary and most effective method for organ protection, establishing cardiopulmonary bypass was difficult in the present case owing to the presence of visceral and abdominal aortic occlusion. Kunimoto and colleagues [3Kunimoto R. Goto H. Utoh J. Kitamura N. Thoracoabdominal aortic aneurysm combined with aortic occlusion.Ann Thorac Surg. 2000; 69: 623-625Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar] established a successful distal perfusion system during TAAA repair in a patient with aortic occlusion by cannulating the femoral vein and the descending thoracic aorta, initially, after selective perfusion of the viscera. We secured the femoral artery for establishment of cardiopulmonary bypass, which was believed to be essential for performing selective active perfusion to the celiac trunk and intercostal arteries during aortic cross clamping. Thus, despite occlusion of the abdominal aorta, adequate flow (greater than 1.5 L/minute) was maintained by femoral arterial perfusion, probably due to rich collateral arterial vascularization. We believe that establishing an optimal perfusion system during these complicated cases is the most important element in the accomplishment of a successful repair.Preoperative renal dysfunction increases the operative mortality and morbidity in patients with TAAA and thoracic aortic aneurysm [4Morishita K. Kawaharada N. Fukada J. et al.Midterm results of surgical treatment of thoracic aortic disease in dialysis.Ann Thorac Surg. 2005; 80: 96-100Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar]. In patients with renal arterial occlusive lesions, concomitant revascularization, including bypass grafting, reimplantation, or endarterectomy is recommended for reduction of the risk of ischemic complications after repair [1Svensson L.G. Crswford E.S. Hess K.R. Coselli J.S. Safi H.J. Thoracoabdominal aortic aneurysms associated with celiac, superior mesenteric, and renal artery occlusive disease: methods and analysis of results in 271 patients.J Vasc Surg. 1992; 16: 378-389Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar]. However, in patients with chronic renal failure requiring hemodialysis, especially when complicated with bilateral renal arterial occlusion, as in the present case, renal reconstruction will not be beneficial. We undertook perioperative hemodialysis and intraoperative hemofiltration combined with cardiopulmonary bypass in this patient and obtained a successful result with a difficult case. Thoracoabdominal aneurysm (TAAA) associated with visceral arterial occlusive disease is relatively rare and can result in disastrous complications such as gangrene of the intestine or renal failure after repair. Svensson and colleagues [1Svensson L.G. Crswford E.S. Hess K.R. Coselli J.S. Safi H.J. Thoracoabdominal aortic aneurysms associated with celiac, superior mesenteric, and renal artery occlusive disease: methods and analysis of results in 271 patients.J Vasc Surg. 1992; 16: 378-389Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar] reported an excellent surgical outcome of TAAA repair for 271 of 1,509 patients (14%) with associated visceral arterial occlusive disease [2Coslli J.S. Conklin L.D. LeMaire S.A. Thoracoabdominal aortic aneurysm repair: review and update of current strategies.Ann Thorac Surg. 2002; 74: S1881-S1884Abstract Full Text Full Text PDF PubMed Scopus (171) Google Scholar]. However, TAAA associated with both visceral arterial occlusive disease and abdominal aortic occlusion is extremely rare and can present considerable obstacles to successful surgical repair. Organ protection during aneurysm repair is a difficult task in this complicated situation. Although perfusion support is the primary and most effective method for organ protection, establishing cardiopulmonary bypass was difficult in the present case owing to the presence of visceral and abdominal aortic occlusion. Kunimoto and colleagues [3Kunimoto R. Goto H. Utoh J. Kitamura N. Thoracoabdominal aortic aneurysm combined with aortic occlusion.Ann Thorac Surg. 2000; 69: 623-625Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar] established a successful distal perfusion system during TAAA repair in a patient with aortic occlusion by cannulating the femoral vein and the descending thoracic aorta, initially, after selective perfusion of the viscera. We secured the femoral artery for establishment of cardiopulmonary bypass, which was believed to be essential for performing selective active perfusion to the celiac trunk and intercostal arteries during aortic cross clamping. Thus, despite occlusion of the abdominal aorta, adequate flow (greater than 1.5 L/minute) was maintained by femoral arterial perfusion, probably due to rich collateral arterial vascularization. We believe that establishing an optimal perfusion system during these complicated cases is the most important element in the accomplishment of a successful repair. Preoperative renal dysfunction increases the operative mortality and morbidity in patients with TAAA and thoracic aortic aneurysm [4Morishita K. Kawaharada N. Fukada J. et al.Midterm results of surgical treatment of thoracic aortic disease in dialysis.Ann Thorac Surg. 2005; 80: 96-100Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar]. In patients with renal arterial occlusive lesions, concomitant revascularization, including bypass grafting, reimplantation, or endarterectomy is recommended for reduction of the risk of ischemic complications after repair [1Svensson L.G. Crswford E.S. Hess K.R. Coselli J.S. Safi H.J. Thoracoabdominal aortic aneurysms associated with celiac, superior mesenteric, and renal artery occlusive disease: methods and analysis of results in 271 patients.J Vasc Surg. 1992; 16: 378-389Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar]. However, in patients with chronic renal failure requiring hemodialysis, especially when complicated with bilateral renal arterial occlusion, as in the present case, renal reconstruction will not be beneficial. We undertook perioperative hemodialysis and intraoperative hemofiltration combined with cardiopulmonary bypass in this patient and obtained a successful result with a difficult case." @default.
• W1987814981 created "2016-06-24" @default.
• W1987814981 creator A5006328463 @default.
• W1987814981 creator A5040191987 @default.
• W1987814981 creator A5044789901 @default.
• W1987814981 creator A5045685821 @default.
• W1987814981 creator A5074508673 @default.
• W1987814981 date "2007-06-01" @default.
• W1987814981 modified "2023-09-23" @default.
• W1987814981 title "Thoracoabdominal Aortic Aneurysm Associated With Abdominal Aortic and Visceral Arterial Occlusion in a Hemodialysis Patient" @default.
• W1987814981 cites W1983711523 @default.
• W1987814981 cites W2007289618 @default.
• W1987814981 cites W2102179793 @default.
• W1987814981 cites W2135651510 @default.
• W1987814981 doi "https://doi.org/10.1016/j.athoracsur.2006.11.087" @default.
• W1987814981 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/17532434" @default.
• W1987814981 hasPublicationYear "2007" @default.
• W1987814981 type Work @default.
• W1987814981 sameAs 1987814981 @default.
• W1987814981 citedByCount "2" @default.
• W1987814981 countsByYear W19878149812019 @default.
• W1987814981 crossrefType "journal-article" @default.
• W1987814981 hasAuthorship W1987814981A5006328463 @default.
• W1987814981 hasAuthorship W1987814981A5040191987 @default.
• W1987814981 hasAuthorship W1987814981A5044789901 @default.
• W1987814981 hasAuthorship W1987814981A5045685821 @default.
• W1987814981 hasAuthorship W1987814981A5074508673 @default.
• W1987814981 hasBestOaLocation W19878149811 @default.
• W1987814981 hasConcept C126322002 @default.
• W1987814981 hasConcept C141071460 @default.
• W1987814981 hasConcept C164705383 @default.
• W1987814981 hasConcept C2776098176 @default.
• W1987814981 hasConcept C2776268601 @default.
• W1987814981 hasConcept C2777323849 @default.
• W1987814981 hasConcept C2778063415 @default.
• W1987814981 hasConcept C2779980429 @default.
• W1987814981 hasConcept C2779993416 @default.
• W1987814981 hasConcept C71924100 @default.
• W1987814981 hasConceptScore W1987814981C126322002 @default.
• W1987814981 hasConceptScore W1987814981C141071460 @default.
• W1987814981 hasConceptScore W1987814981C164705383 @default.
• W1987814981 hasConceptScore W1987814981C2776098176 @default.
• W1987814981 hasConceptScore W1987814981C2776268601 @default.
• W1987814981 hasConceptScore W1987814981C2777323849 @default.
• W1987814981 hasConceptScore W1987814981C2778063415 @default.
• W1987814981 hasConceptScore W1987814981C2779980429 @default.
• W1987814981 hasConceptScore W1987814981C2779993416 @default.
• W1987814981 hasConceptScore W1987814981C71924100 @default.
• W1987814981 hasIssue "6" @default.
• W1987814981 hasLocation W19878149811 @default.
• W1987814981 hasLocation W19878149812 @default.
• W1987814981 hasOpenAccess W1987814981 @default.
• W1987814981 hasPrimaryLocation W19878149811 @default.
• W1987814981 hasRelatedWork W1993364384 @default.
• W1987814981 hasRelatedWork W2047899902 @default.
• W1987814981 hasRelatedWork W2337053829 @default.
• W1987814981 hasRelatedWork W2400775450 @default.
• W1987814981 hasRelatedWork W2463544427 @default.
• W1987814981 hasRelatedWork W2464397047 @default.
• W1987814981 hasRelatedWork W2985603752 @default.
• W1987814981 hasRelatedWork W2995246356 @default.
• W1987814981 hasRelatedWork W4200418891 @default.
• W1987814981 hasRelatedWork W4285103908 @default.
• W1987814981 hasVolume "83" @default.
• W1987814981 isParatext "false" @default.
• W1987814981 isRetracted "false" @default.
• W1987814981 magId "1987814981" @default.
• W1987814981 workType "article" @default.