Positron emission tomography (PET) evaluation of abdominal aortic aneurysm (AAA)

in European Journal of Vascular and Endovascular Surgery (2002), 23(5), 431-436

Background: aneurysmal disease is associated with all inflammatory Cell infiltrate and enzymatic degradation of the vessel wall. Aim of the study: to detect increased metabolic activity in abdominal ... [more ▼]

Background: aneurysmal disease is associated with all inflammatory Cell infiltrate and enzymatic degradation of the vessel wall. Aim of the study: to detect increased metabolic activity in abdominal aortic aneurysms (AAA) by means of positron emission tomography (PET-imaging). Study design: twenty-six patients with AAA underwent PET-imaging Results: in tell patients, PET-imaging revealed increased, fluoro-deoxy-glucose (18-FDG) uptake at the level of the aneurysm. Patients with positive PET-imaging had one or more of the following elements in their clinical history: history Of recent non-aortic surgery (n = 4) a painful inflammatory aortic aneurysm (n = 2). moderate low back pain (n = 2), rapid (>5 mm in 6 months) expansion (n = 4), discovery by PET-scan of a previously undiagnosed lung cancer (n = 3) or parotid tumour (n = 1). Five patients with a positive PET scan required urgent surgery within two to 30 days. Among the 16 patients with negative PET-imaging of their aneurysm, only one had recent non-aortic surgery, none of them required urgent surgery, only two had a rapidly expanding AAA, and in only one patient, PET-imaging revealed an unknown lung cancer. Conclusion: these data suggest a possible association between increased 18-FDG uptake and AAA expansion and rupture. [less ▲]

Renal Artery Occlusion Following Blunt Abdominal Trauma

in Acta Chirurgica Belgica (2000), 100(3, May-Jun), 107-10

Le cas clinique du mois. Rupture couverte d'un anevrysme infectieux post-typhique de l'aorte abdominale sous-renale.

in Revue Médicale de Liège (1999), 54(10), 786-8

Mycotic aneurysms are uncommon but remain one of the most challenging clinical problems for the vascular surgeon. They are associated with high morbidity and mortality, and the clinical signs and symptoms ... [more ▼]

Mycotic aneurysms are uncommon but remain one of the most challenging clinical problems for the vascular surgeon. They are associated with high morbidity and mortality, and the clinical signs and symptoms are non specific. We report here the case of an abdominal aorta mycotic aneurysm due to salmonellosis treated by insertion of an arterial homograft. [less ▲]

Analysis of coding sequences for tissue inhibitor of metalloproteinases 1 (TIMP1) and 2 (TIMP2) in patients with aneurysms.

in Matrix Biology (1999), 18(2), 121-4

Aneurysms are characterized by dilation, i.e. expansion and thinning of all the arterial wall layers, which is accompanied by remodeling of the connective tissue. Genes involved in the regulation of ... [more ▼]

Aneurysms are characterized by dilation, i.e. expansion and thinning of all the arterial wall layers, which is accompanied by remodeling of the connective tissue. Genes involved in the regulation of tissue remodeling are therefore candidate genes. We analyzed TIMP1 and TIMP2 coding sequences in 12 individuals with abdominal aortic aneurysms (AAA), one individual with AAA and intracranial aneurysms (IA), four individuals with IA and two clinically unaffected individuals. We identified two nucleotide variants in both the TIMP1 and the TIMP2 coding sequences. All differences occurred in the third base positions of codons and were neutral polymorphisms. A significant difference was observed in the frequency of TIMP2 nt 573 polymorphism between 168 alleles from AAA patients and 102 control alleles. [less ▲]

Artérite et coronarite post-radiques: a propos d'un cas

in Journal de Cardiologie [= JDC] = Tijdschrift voor Cardiologie [= TVC] (1999), 11(3), 33-37

Abdominal aortic aneurysms in octogenarians.

in Acta Chirurgica Belgica (1998), 98(2), 76-84

The decision on whether to operate or not abdominal aortic aneurysms (AAA) in elderly depends on the relative risk of the operation versus the natural course of the unoperated AAA. From January 1984 to ... [more ▼]

The decision on whether to operate or not abdominal aortic aneurysms (AAA) in elderly depends on the relative risk of the operation versus the natural course of the unoperated AAA. From January 1984 to December 996, 138 patients, aged 80 years and older, were referred to our department for an aneurysm of 40 mm or more (transverse diameter) of the infrarenal abdominal aorta (95 asymptomatic, 15 painful, and 28 ruptured AAA). For 58 patients with asymptomatic AAA, operation was denied at referral because of transverse diameter less than 50 mm (n = 21), patient refusal (n = 10) or unacceptable operative risk or poor general condition (n = 27). Thirty-four of these observed AAA were ultimately operated after a mean delay of 41 months because of aneurysm enlargement (n = 15), aneurysm tenderness (n = 6) or rupture (n = 13). Overall, 52 patients had immediate (n = 37) or delayed (n = 15) elective repair of their AAA, with an in-hospital mortality of 5.7%. Urgent operation was done for 21 patients with a painful AAA. Six patients died at hospital (28% mortality rate). Emergent surgery was applied to 41 patients with ruptured AAA (including 13 AAA who ruptured during surveillance). The operative mortality in this subgroup attained 68%. Follow-up for the 77 survivors and the 24 non-operative patients averaged 43 months. The 5-year survival (operative mortality included) is 47% for electively operated patients, 30% for urgently and 20% for emergently operated patients. For comparison, the 5-year survival of an age and sex matched Belgian population is 63%. For the 24 medically followed AAA, the 5-year survival was 33%. In six cases, the cause of death was rupture of the AAA. Of the 58 patients for whom operation was initially not considered, 19 (33%) presented AAA rupture (13 operated in emergency and 6 who never came to surgery). The operative outcome of AAA repair in octogenarians is less favourable than in the younger age group (3.6% mortality after elective repair, 44% after operation for AAA rupture, according to our institution data). The authors conclude that AAA surgery should not be denied to octogenarians on the basis of advanced age alone. They recommend a straightforward surgery for otherwise healthy octogenarians with AAA of 50 mm diameter, surveillance up to 60 mm for high-risk patients and no surgery for unfit, bedridden or demented patients. [less ▲]

Advantages of Inferior Vena Caval Flow Preservation in Combined Transplantation of the Liver and Heart

in Transplant International (1997), 10(2), 150-1

Only a few cases of combined liver and heart transplantation have been reported in the literature, and no standard surgical procedure has yet been established. We report the successful transplantation of ... [more ▼]

Only a few cases of combined liver and heart transplantation have been reported in the literature, and no standard surgical procedure has yet been established. We report the successful transplantation of both liver and heart in a 28-year-old patient suffering from homozygous beta-thalassemia. We used Belghiti's technique of inferior vena caval flow preservation for liver transplantation, which avoids inferior vena cava occlusion by a side-to-side caval anastomosis. Applied to combined liver and heart transplantation, preservation of caval flow during liver transplantation may allow early discontinuation of cardiopulmonary bypass and, thus, minimize the general consequences of prolonged bypass. [less ▲]

Uretero-arterial fistula: two observations.

in Acta Chirurgica Belgica (1997), 97(3), 133-6

Two cases of life-threatening haematuria, secondary to an uretero-arterial fistula, are reported. Both cases present predisposing causative factors. One patient had a combination of previous aorto ... [more ▼]

Two cases of life-threatening haematuria, secondary to an uretero-arterial fistula, are reported. Both cases present predisposing causative factors. One patient had a combination of previous aorto-bifemoral bypass grafting, an iliac artery aneurysm (retrogradely perfused), and an indwelling ureteral stent for ureteral compression. The other patient had previous aortoiliac surgery and obstructive uropathy with chronic urinary tract infection. Preoperative diagnosis of uretero-arterial fistula was made in only one patient. He was successfully operated (exclusion of the iliac aneurysm). In the other patient, nephrectomy was attempted to control reno-ureteral bleeding of unknown origin. Fatal recidive of brisk haematuria occurred some days later. Factors contributing to the development of uretero-arterial fistula, their diagnosis and optimal treatment are discussed. [less ▲]

Spinal ischaemia after surgery for abdominal infrarenal aortic aneurysm. Diagnosis with nuclear magnetic resonance.

in Acta Chirurgica Belgica (1997), 97(5), 250-6

A 76-year-old man underwent surgery for an infrarenal aortic aneurysm reaching 6 cm in maximal transverse diameter. The aorta was crossclamped below the level of the renal arteries. A tube graft was ... [more ▼]

A 76-year-old man underwent surgery for an infrarenal aortic aneurysm reaching 6 cm in maximal transverse diameter. The aorta was crossclamped below the level of the renal arteries. A tube graft was interposed and tend between the infrarenal aorta and the aortic bifurcation. Due to leakage on the suture line two consecutive episodes of crossclamping for a total duration of 40 min. were required. No hypotension was noted during or after the procedure. After operation, the patient complained of difficulties to move both legs and neurologic examination demonstrated paraparesis, with mild sensory deficit. Faecal and urinary incontinences were also noted and urodynamic testing demonstrated sphincterovesical palsy. Nuclear magnetic resonance imaging detected an ischaemic zone in the spinal cord at the level of T11. Faecal incontinence and motor deficit partially resolved but no bladder function recovery was observed. Spinal ischaemia is a rare complication after abdominal aortic surgery. Several risk factors have been suggested which include level and duration of the aortic crossclamping, possible interruption of the spinal cord blood supply via the greater medullary artery (the so-called artery of Adamkiewicz), presence of intra- or postoperative episodes of hypotension, atheromatous embolization, underlying occlusive arteriosclerosis of spinal arteries, and respect or not of the hypogastric circulation. In our case, the duration of the crossclamping and interruption of the blood flow in lumbar arteries probably supplying the distal spinal cord were likely contributive factors. [less ▲]

Transplantation combinée du foie et du coeur chez un patient souffrant de thalassémie majeure

in Revue Médicale de Liège (1997), 52(8), 532-4