scholarly journals Mathematical modeling of an optimal mini-access for reconstruction of arteries of the aortofemoral segment

2012 ◽  
Vol 93 (4) ◽  
pp. 611-616
Author(s):  
A V Maksimov ◽  
S D Mayanskaya ◽  
M V Plotnikov ◽  
E A Gaysina
Keyword(s):  
Mathematical Modeling ◽  
Aortic Aneurysm ◽  
Occlusive Disease ◽  
Optimal Size ◽  
Infrarenal Aorta ◽  
Aneurysmal Dilatation ◽  
Iliac Arteries ◽  
Abdominal Aortic ◽  
The Common ◽  
Mini Laparotomy

Aim. To determine the optimal size and location of the mini-laparotomic access for the reconstruction of arteries of the aortofemoral segment. Methods. The method of mathematical modeling was used. The parameters of the mini-access were calculated depending on the sex of the patient, as well as for a variety of clinical situations (operations for occlusive disease, for abdominal aortic aneurysm, including the propagation of the aneurysmal dilatation to the iliac arteries). Topography of the aorta and iliac arteries was determined on the basis of computer tomograms of 155 patients (61 of them with an aneurysm of the infrarenal aorta). Results. It was established that for the purpose of creation of an adequate access an incision of 6.8-7.0 cm in length at the level of the umbilicus and above is sufficient during surgery for occlusive disease. No significant gender differences were found. During aortic aneurysm the required length of the mini-laparotomic access is significantly increased up to 7.6 cm (p=0.003), and in cases of propagation of the aneurysmal dilatation on to the common iliac arteries - up to 8.5 cm (p=0.001). In the latter case its location also changes: approximately half of the length of the access incision is located below the umbilicus. Conclusion. Mathematical modeling of the optimal mini-access makes it possible to optimize the use of mini-laparotomy in various clinical situations.

scholarly journals Carotid surgical cut-down technique for neuroendovascular therapy

2018 ◽  
Vol 25 (3) ◽  
pp. 348-352
Author(s):  
Issei Takano ◽  
Yoshiyuki Matsumoto ◽  
Yoshiko Fujii ◽  
Yuki Inoue ◽  
Yoshiki Sugiura ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Carotid Artery ◽  
Thoracic Aortic Aneurysm ◽  
Case Series ◽  
Aortic Arch Anomaly ◽  
Anticoagulation Agents ◽  
Abdominal Aortic ◽  
Major Vessel ◽  
The Common ◽  
Intracranial Circulation

Background Neuroendovascular therapy is typically performed via the femoral artery, but there are rare cases in which a tortuous upstream angioarchitecture makes it difficult to access the intracranial circulation via this route. Methods In this case series, we describe six cases treated by surgical cut-down in the neck, with puncture of the carotid artery. Antiplatelet and anticoagulation agents were used in all cases. The indications for the technique were postsurgical thoracic aortic aneurysm (two cases), postsurgical abdominal aortic aneurysm (one case), major vessel tortuosity of the common carotid artery (two cases) and aortic arch anomaly (one case). Results The surgical cut-down technique permitted successful neuroendovascular therapy. Although one patient had a small cervical haematoma, he was treated without surgical evacuation. Conclusion Overall, our findings indicate that the surgical cut-down technique is safe and useful for patients in whom the femoral approach is unsuitable.

Abstract 15228: Role of Sympathetic Innervation in the Pathogenesis of Abdominal Aortic Aneurysm

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Bin JIANG ◽  
Yugang Liu ◽  
Guillermo A Ameer
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Sympathetic Innervation ◽  
Nerve Fibers ◽  
Elastic Fibers ◽  
Surgical Removal ◽  
Infrarenal Aorta ◽  
Abdominal Aortic ◽  
Nerve Bundles

Introduction: The objective of this study is to understand the role of neurological factors, specifically those from the perivascular sympathetic nervous system (SNS), on the initiation and development of Abdominal Aortic Aneurysm (AAA). Hypothesis: We hypothesize that the formation of AAA is associated with the loss of perivascular SNS-induced vasoconstriction specific to the aneurysm region. Methods: We developed a rat Abdominal Aortic Denervation (AAD) model, where the infrarenal aorta of Spauge Dawley rats was denervated with surgical removal of nerve fibers and chemical denervation with 10% phenol ( Figure. A ). A sham control group was included where the infrarenal aorta was treated with PBS. The arteries were harvested at 1 month after the surgeries for histological assessment. Results: The denervated aortas exhibited significant thinning of the aortic wall including the media and the adventitia, compared to the sham controls ( Figure. B ). Moreover, degradation of elastin, demonstrated by the fragmentation of elastic fibers and the decreased number of lamellar units, was also observed in the dennervated aortas in comparison to the sham controls. While the control aortas were well innervated with perivascular nerve bundles adjacent to the adventitia, no nerves were found surrounding the denervated aortas, suggesting successful denervation. Conclusions: We generated an AAD model that could be used for mechanistic understanding and therapeutic development of AAA. The preliminary data suggest a direct link between the lack of aortic sympathetic innervation and AAA formation. Long-term studies are currently underway to further characterize changes in the aortic walls after sympathetic denervation. Figure. (A) Illustration of the denervated region on the rat infrarenal aorta. ( B ) Histological staining of control and denervated rat abdominal aortas at 1 month after surgery. Yellow stars: para-aortic nerve bundles. Scale bar = 200 μm.

Investigating the Effect of Intraluminal Thrombus in Abdominal Aortic Aneurysm by Computational and Experimental Methods

2009 ◽  
Author(s):  
Florentina Ene ◽  
Carine Gachon ◽  
Patrick Delassus ◽  
Liam Morris
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
High Risk ◽  
Aortic Aneurysm ◽  
Abdominal Aorta ◽  
Experimental Methods ◽  
Infrarenal Aorta ◽  
Intraluminal Thrombus ◽  
Abdominal Aortic ◽  
Risk Of Rupture

Abdominal aortic aneurysm (AAA) represents an abnormal dilatation and weakening of the abdominal aorta with high risk of rupture. Most aneurysms of the infrarenal aorta possess an asymmetrical fusiform morphology.

Morphometry and Classification in Abdominal Aortic Aneurysms: Patient Selection for Endovascular and Open Surgery

1997 ◽  
Vol 4 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Hardy Schumacher ◽  
Hans H. Eckstein ◽  
Friedrich Kallinowski ◽  
Jens Rainer Allenberg
Keyword(s):  
Patient Selection ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Type I ◽  
Infrarenal Aorta ◽  
Iliac Arteries ◽  
Proximal Neck ◽  
Aorta Aneurysm ◽  
Abdominal Aortic ◽  
Selection For

Purpose: To evaluate the anatomic morphology of abdominal aortic aneurysms (AAAs) and compose a classification system to facilitate patient selection for endovascular graft (EVG) repair. Methods: Data on 242 consecutive AAA patients evaluated on a nonemergent basis in a 3.5-year period to July 1996 were prospectively entered into a registry. Patients were examined using sequential intravenous spiral computed tomographic angiography and intraarterial digital subtraction angiography. The data collected and analyzed included: diameters of the supra- and infrarenal aorta, aneurysm, aortoiliac bifurcation, and iliac arteries; lengths of the proximal neck, distal cuff, and aneurysm; degrees of iliac artery tortuosity; and occlusion of the visceral, renal, or iliac arteries. Results: The 242 aneurysms could be easily grouped into three distinctive categories related to the extent of the aneurysmal disease. Type I AAAs (11.2%) had nondilated, thrombus-free infrarenal (15 mm) necks and distal (10 mm) cuffs appropriate for EVG anchoring. In type II and its subgroups (72.3%), a sufficient proximal neck was present, but the aneurysm extended into the iliac arteries; 56% of these were eligible for a bifurcated endograft. In type III (16.5%), a sufficient proximal neck was missing, independent of distal involvement. In all, 51.7% were good EVG candidates based on AAA morphology. Taking into consideration relevant concomitant vascular diseases, proximal iliac kinking, and iliac, renal, or visceral occlusive disease, only 30.2% of the population were potential candidates for an efficient and secure EVG repair using the devices currently available. Conclusions: In contrast to classical open repair, detailed preoperative measurements are recommended for EVG planning. The use of liberal EVG indications may lead to a higher incidence of complications, whereas restrictive morphology-based selection criteria may offer excellent results.

The Nellix™ EndoVascular sealing system in patients with abdominal aortic aneurysms in conjunction with iliac artery occlusive disease

Vascular ◽  
2016 ◽  
Vol 25 (2) ◽  
pp. 190-195 ◽  
Author(s):  
Steven MM van Sterkenburg ◽  
Leo H van den Ham ◽  
Luuk Smeets ◽  
Jan-Willem Lardenoije ◽  
Michel MPJ Reijnen
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Iliac Artery ◽  
Occlusive Disease ◽  
Aortic Aneurysms ◽  
Covered Stents ◽  
Single Center ◽  
Technical Success ◽  
Abdominal Aortic

Introduction Concomitant abdominal aortic aneurysm formation and aortoiliac occlusive disease is a challenging combination, often requiring open reconstructive surgery. In this study, we have assessed a single center experience of the Nellix EndoVascular Aneurysm Sealing System in the treatment of an abdominal aortic aneurysm in conjunction with iliac artery occlusive disease. Methods Retrospectively case files of patients treated with Nellix EndoVascular Aneurysm Sealing System in a single center were reviewed. The primary endpoints of the study were the technical success of Nellix EndoVascular Aneurysm Sealing System in patients with coincidental iliac artery occlusive disease and the successful exclusion of the aneurysm during follow-up. Results Of the 96 patients that were treated with Nellix EndoVascular Aneurysm Sealing System, five were identified that had an abdominal aortic aneurysm in conjunction with iliac artery occlusive disease. Treated patients had either unilateral (n = 4) or bilateral (n = 1) common iliac artery occlusive disease varying from 70% stenosis to complete occlusions. The lesion length varied from 5 to 50 mm and in two cases it involved an occluded bare metal stent. The indication for surgery was the abdominal aortic aneurysm in all patients, including three also suffering from claudication. In all patients the iliac artery occlusive disease was pretreated with balloon-expandable covered stents. Technical success was achieved in all five patients. After a median follow-up of nine months all stents were patent with no signs of endoleak and stable aneurysm diameters. All patients were free of intermittent claudication or ischemic wounds. Conclusion Nellix EndoVascular Aneurysm Sealing System seems feasible and safe in patients with a combination of abdominal aortic aneurysm and iliac artery occlusive disease.

scholarly journals Anterior Rectal Resection in a Patient with Aortoiliac Occlusive Disease and Coexisting Collateral Pathways: Management and Pitfalls

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Floryn Cherbanyk ◽  
Jean-Loup Gassend ◽  
Olivier Martinet ◽  
Snezana Andrejevic-Blant ◽  
Henri-Marcel Hoogewoud
Keyword(s):  
Multidisciplinary Approach ◽  
Occlusive Disease ◽  
Uneventful Recovery ◽  
Aortoiliac Occlusive Disease ◽  
Rectosigmoid Junction ◽  
Iliac Arteries ◽  
Anterior Rectal Resection ◽  
Collateral Network ◽  
Collateral Pathways ◽  
The Common

Chronic aortoiliac occlusive disease most often affects the common iliac arteries and distal aorta but can progress all the way to the renal arteries, occluding the inferior mesenteric artery. A compensatory collateral network typically develops to preserve lower body perfusion. Inadvertent compression or ligation of such collaterals during surgery can have catastrophic consequences. In this article, we present the case of a 63-year-old patient with aortoiliac occlusive disease, requiring surgery for an adenocarcinoma of the rectosigmoid junction. A CT angiography was performed in order to map out the collateral pathways that had developed and Doppler ultrasound was used to mark their positions. The surgical procedure was adapted to his specific anatomy. A successful anterior resection was performed, and the patient made an uneventful recovery. In cases of aortoiliac obliteration, the existence of collaterals must be kept in mind and investigated with a multidisciplinary approach before any surgery is considered.

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