병원 환자군에서의 복부대동맥 장골동맥류의유병률 및 치료실태

최한림,이충헌,장이찬 대한혈관외과학회 2012 Vascular Specialist International Vol.28 No.4

Purpose: Abdominal aortoiliac artery aneurysm (AIAA) is a common disease in the elderly. The prevalence of AIAA was well known in western countries. However, in Korea, there are a few studies regarding the prevalence. This study was carried out to determine the prevalence of AIAA by reviewing the radiological reports of abdominal computed tomography (CT). Methods: We searched the words like “aneu” or “rysm” in radiological reports of 22,520 abdominal CT (11,974 patients) between January 1, 2005 and March 31, 2010 in patients over 50 years old. We found 121patients who had AIAA of more than 3 cm or more than 1.8 cm isolated iliac artery aneurysm. We analyzed the characteristics of these patients with aneurysm. Results: The prevalence of aneurysms was 1.01% (121 patients). The aneurysms in men were more prevalent than women (1.39% vs. 0.51%). In the octogenarian, the aneurysms were found to be most frequent (2.75%). Among the 121 aneurysms, aortic, aortoiliac, and isolated iliac artery aneurysms were 66 (54.6%), 28 (23.1%),and 27 (22.3%). In terms of aneurysmal size, greater than 6 cm, 5 to 6 cm, and less than 5 cm were 19(20%), 13 (14%), and 62 (66%), respectively. The rupture rate was 18% (6 patients) in more than 5 cm abdominal aortic aneurysm. Conclusion: The prevalence of AIAA is lower than Western countries. This is not a national-wide survey,but results are similar to the other Korean reports. Reviewing radiologic reports of abdominal CT is another way to study the prevalence of aneurysms.

대동맥-대정맥루 -치험 1예-

윤영철,조광현,권영민,한일용,전희재,이양행,황윤호 대한흉부외과학회 2005 Journal of Chest Surgery (J Chest Surg) Vol.38 No.10

Aortocaval fistula is a rare complication of abdominal aortic aneurysm, involving less than 1% of all abdominal aortic aneurysms. A 64-years old man with a long history of hypertension and abdominal aortic aneurysm had chest pain, dyspnea, epigastric discomfort and palpable abdominal pulsating mass. Physical examination revealed hypotension with a systolic blood pressure of 70 mmHg, a large pulsatile mass and a systolic abdominal bruit. Laboratory data revealed a hemoglobin values of 11.0 g/dL, blood urea nitrogen (BUN) value of 5 mg/dL, and creatine value of 2.6 mg%. Abdominal Angio CT showed a 10 cm infrarenal abdominal aortic aneurysm with dilatation of the IVC and aortocaval fistula from the aortic aneurysm, which was confirmed at emergency surgery. When the aneurysm was opened and the thrombus was removed, a 1 cm communication was identified between the aorta and IVC. This was controlled with Foley catheters ballooning, and the fistula was closed by continuous suture placed outside the aneurysm. A bifurcated aorto-iliac graft was used to restore arterial continuity. The patient was discharged home after uncomplicated postoperative course. 대동맥-대정맥 누공은 복부 대동맥류의 1% 이하에서 발생하는 희귀한 합병증 중 하나이다. 오랜 기간 동안 고혈압과 복부 대동맥류 병력을 가진 64세 남자 환자가 흉통, 호흡곤란, 상복부 불쾌감 그리고 박동성 복부 종괴를 주소로 내원하였다. 이학적 검사상 수축기 혈압이 70 mmHg로 저혈압을 보였고, 복부에서는 박동성 종괴가 촉지되었고, 지속성 기계 잡음이 청진되었다. 검사실 소견으로는 혈색소(11.0 g/dL), BUN (5 mg/dL), creatine (2.6 mg%)이었고, 복부 전산화 혈관 촬영 결과, 10 cm 크기의 신장하복부대동맥류와 복부 대동맥류와 대정맥을 연결하는 대동맥-대정맥 누공이 형성되어 확장된 대정맥 소견을 보여 응급 수술을 계획하였다. 대동맥류를 절개하고 혈전 제거 후, 1 cm 크기의 대동맥-대정맥 누공이 발견되었다. 대동맥-대정맥 누공은 도뇨관 풍선 확장술을 이용하여 지혈하였고, 대동맥류 밖에서 누공은 단순 지속 문합으로 봉합하였다. 대동맥-양측 장골동맥 이식편을 이용하여 대동맥류에 대한 수술을 마무리하였다. 환자는 수술 후 특별한 문제없이 퇴원하였다.

복부대동맥류 형상 및 연령에 따른 동맥 벽 응력 특성 및 파열 위험성 평가

이충원,유지훈,허업,이치승,유동만 한국전산구조공학회 2020 한국전산구조공학회논문집 Vol.33 No.3

In this study, the wall stress and rupture risk for abdominal aortic aneurysms were calculated based on the age and geometry of the examined abdominal aortic aneurysms. The geometry of the abdominal aorta was simulated using computed tomography data from patients with abdominal aortic aneurysms. With regard to material properties, the Gasser-Ogden-Holzapfel model was applied to the analysis to simulate the anisotropic hyperelastic characteristics of the artery. In addition, each material parameter was estimated to consider the properties for age and for normal and aneurysm tissue. Moreover, the correlation between the diameter and angle of the aortic aneurysms was analyzed based on data from patients with abdominal aortic aneurysms, and series simulations were conducted. As a result, the rupture risk for the abdominal aortic aneurysms was evaluated based on the age and geometry of the aneurysm. 본 연구에서는 복부대동맥류가 발생한 환자들에서의 연령과 복부대동맥류 형상에 따른 벽 응력과 파열 위험성을 평가하였다. 복부대동맥류의 형상은 의료영상 데이터로부터 추출되어 모사되었으며, 재료 물성치 단계에서는 동맥 조직의 이방성 초탄성 성질을 모사하기 위해 Gasser-Ogden-Holzapfel 모델을 적용하였다. 또한, 모델에서 필요한 각 재료 정수들은 환자들의 연령과 정상 조직 및 동맥류 조직의 특성들을 고려하기 위하여 각기 다른 값들로 산정되었다. 게다가 복부대동맥류에서의 대동맥 직경과 목의 각도에 관한 상관관계를 분석하고, 이에 대한 시리즈 시뮬레이션 역시 수행되었다. 그 결과, 복부대동맥류 환자의 연령과 대동맥 직경, 그리고 대동맥 목의 각도에 따른 복부대동맥류의 파열 위험성이 평가되었다.

SEAL 대동맥 스텐트 그라프트를 사용한 복부대동맥류 및 장골동맥류의 혈관내 치료: 단일 병원 경험

박수영,김정호,변성수,강진모,최상태,박재형 대한영상의학회 2015 대한영상의학회지 Vol.72 No.3

Purpose: The aim of this study was to evaluate the safety and efficacy of SEAL aortic stent-graft for abdominal aortoiliac aneurysms. Materials and Methods: Between October 2007 and January 2014, 33 patients with abdominal aortoiliac aneurysms were treated with SEAL aortic stent-graft. We evaluated the technical success rate, clinical and CT follow-up periods, major complications, need for additional interventional treatment, aneurysm-related mortality and clinical success rate. Results: SEAL bifurcated aortic stent-graft was successfully placed in 32 patients (97%). Clinical and CT follow-up periods were 24 and 14 months, respectively. Endoleak developed in 13 patients (41%): spontaneous regression or decrease in 6, need for additional treatment in 4 and follow-up loss in 3. Significant stenosis of stent-graft occurred in 4 patients (12%) and was treated with stenting in 3. Migration of stent-graft was noted in 3 patients (9%) and treated with additional stent-grafting. Aneurysm-related mortality was 9% (3 of 33). The placement of SEAL stent-graft was effective in 26 patients (79%). Conclusion: The placement of SEAL aortic stent-graft was safe and effective in patients with aneurysms of abdominal aorta and iliac arteries. However, complicating endoleaks, stenosis and migration of the stent-graft developed during the follow-up. Therefore, regular CT follow-up seems to be mandatory. 목적: 복부대동맥류나 장골동맥류 환자에서 SEAL 대동맥 스텐트 그라프트 설치의 안정성과 효능을 알아보고자 하였다. 대상과 방법: 2007년 10월부터 2014년 1월까지 복부대동맥류나 장골동맥류로 SEAL 대동맥 스텐트 그라프트를 설치한33명의 환자(남:여 = 27:6, 평균나이 73세)를 대상으로 하였다. 설치의 기술적 성공률, 임상 및 CT 추적기간, 시술 후 주요합병증, 이차치료여부, 사망률, 임상적 성공률을 조사하였다. 결과: SEAL 스텐트 그라프트는 32명(32/33, 97%)에서 성공적으로 설치하였다. 임상 및 CT 추적기간은 각각 평균 24개월과 14개월이었다. 내강유출이 13명(13/32, 41%)에서 발생하였는데, 6명에서 소실되거나 감소되었고 4명에서 이차적 치료를 필요로 하였으며 3명은 추적에 실패하였다. 4명(12%)에서 스텐트 그라프트 협착이 발생하여 3명에서 추가적인 스텐트 삽입을 하였다. 3명(9%)에서 스텐트 그라프트 위치 이동이 시술 후 3년 이후에 발생하여 추가적 스텐트 그라프트 삽입을 필요로 하였다. 추적기간 중 8명이 사망하였는데 3명은 동맥류와 관련되었다. 26명(26/33, 79%)에서 임상적으로 스텐트 그라프트 삽입이 성공적이었다. 결론: 복부대동맥류나 장골동맥류 환자에서 SEAL 스텐트 그라프트 삽입술은 안전하고 효과적이었다. 하지만, 추적검사에서 내강유출, 협착, 위치 이동 등의 합병증이 발생하여 장기적 추적검사가 필요할 것으로 사료된다.

복부대동맥류내의 정상유동에 대한 수치해석

신상철,이건휘,모정하 원광대학교 공업기술개발연구소 2000 工業技術開發硏究誌 Vol.20 No.-

Aneurysm is a vascular disease which is characterized by the local dilatation of arterial wall, and the ruphure of aortic aneurysm causes high mortality rate. The structural changes of arterial wall and the stress acting on the artery wall affect the formation and rupture of aneurysm. Wall shear stress is one of the important hemodynamic factors which change the arterial wall structure and cause lesions on the artery wall. We calculate the wall shear deformation rates for the steady flow in the models of the abdominal aortic aneurysm using FLUENT-program. Wall shear rates data using flUENT-program is compared with experiment data. Laminar flow medel takes more a good data than that of Spalart-Allmaras model for the wall shear rates. The important point is a sudden decrease of wall shear rates at the end of secondary flow, but experiment shows a slow increase. The result of FlUENT-program estimate a sudden change of velocity at the end of secondary flow that is faster than that of other secondary flow. Since temporal and spatial variation of wall shear rates are significant and the local maximum of wall shear rates occurs near the distal sites of the maximum aneurysmal dilatation, we expect the distal sites of aneurysm are more prone to aneurysmal ruphne.

Fenestrated Stent Graft Repair of Abdominal Aortic Aneurysm: Hemodynamic Analysis of the Effect of Fenestrated Stents on the Renal Arteries

Zhonghua Sun,Thanapong Chaichana 대한영상의학회 2010 Korean Journal of Radiology Vol.11 No.1

Objective: We wanted to investigate the hemodynamic effect of fenestrated stents on the renal arteries with using a fluid structure interaction method. Materials and Methods: Two representative patients who each had abdominal aortic aneurysm that was treated with fenestrated stent grafts were selected for the study. 3D realistic aorta models for the main artery branches and aneurysm were generated based on the multislice CT scans from two patients with different aortic geometries. The simulated fenestrated stents were designed and modelled based on the 3D intraluminal appearance, and these were placed inside the renal artery with an intra-aortic protrusion of 5.0-7.0 mm to reflect the actual patients’treatment. The stent wire thickness was simulated with a diameter of 0.4 mm and hemodynamic analysis was performed at different cardiac cycles. Results: Our results showed that the effect of the fenestrated stent wires on the renal blood flow was minimal because the flow velocity was not significantly affected when compared to that calculated at pre-stent graft implantation, and this was despite the presence of recirculation patterns at the proximal part of the renal arteries. The wall pressure was found to be significantly decreased after fenestration, yet no significant change of the wall shear stress was noticed at post-fenestration, although the wall shear stress was shown to decrease slightly at the proximal aneurysm necks. Conclusion: Our analysis demonstrates that the hemodynamic effect of fenestrated renal stents on the renal arteries is insignificant. Further studies are needed to investigate the effect of different lengths of stent protrusion with variable stent thicknesses on the renal blood flow, and this is valuable for understanding the long-term outcomes of fenestrated repair. Objective: We wanted to investigate the hemodynamic effect of fenestrated stents on the renal arteries with using a fluid structure interaction method. Materials and Methods: Two representative patients who each had abdominal aortic aneurysm that was treated with fenestrated stent grafts were selected for the study. 3D realistic aorta models for the main artery branches and aneurysm were generated based on the multislice CT scans from two patients with different aortic geometries. The simulated fenestrated stents were designed and modelled based on the 3D intraluminal appearance, and these were placed inside the renal artery with an intra-aortic protrusion of 5.0-7.0 mm to reflect the actual patients’treatment. The stent wire thickness was simulated with a diameter of 0.4 mm and hemodynamic analysis was performed at different cardiac cycles. Results: Our results showed that the effect of the fenestrated stent wires on the renal blood flow was minimal because the flow velocity was not significantly affected when compared to that calculated at pre-stent graft implantation, and this was despite the presence of recirculation patterns at the proximal part of the renal arteries. The wall pressure was found to be significantly decreased after fenestration, yet no significant change of the wall shear stress was noticed at post-fenestration, although the wall shear stress was shown to decrease slightly at the proximal aneurysm necks. Conclusion: Our analysis demonstrates that the hemodynamic effect of fenestrated renal stents on the renal arteries is insignificant. Further studies are needed to investigate the effect of different lengths of stent protrusion with variable stent thicknesses on the renal blood flow, and this is valuable for understanding the long-term outcomes of fenestrated repair.

Coexistence of expanding abdominal aortic aneurysm and aggravated intervertebral disc extrusion -a case report-

김난설,Sung Hyun Kang,박선영 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.65 No.4

Abdominal aortic aneurysm is included in the differential diagnosis of lower back pain. Although rare, this important disease can cause potentially lethal complications. In this case, expanding abdominal aortic aneurysm coexisted with intervertebral disc extrusion. The diagnosis of abdominal aortic aneurysm was delayed, putting the patient at risk of aneurysmal rupture. In the management of patients with degenerative spinal diseases, we should not overlook the possibility of comorbidities such as an abdominal aortic aneurysm. We also suggest the importance of interpreting images more carefully, especially for elderly male patients.

복부 대동맥류의 혈관내 치료: 122명에 대한 단일 기관 연구

이윤영,송장현,김용태,김수현,임남열,장남규,김재규,이호균,최수진나,정상영 대한영상의학회 2013 대한영상의학회지 Vol.68 No.2

목적: 단일 기관에서 시술한 복부 대동맥류의 혈관내 치료(endovascular aneurysm repair; 이하 EVAR)의 결과를 분석하고자 하였다. 대상과 방법: 복부 대동맥류로 EVAR를 시행받은 122명의 결과를 후향적으로 분석하였다. 성별, 나이, 대동맥류의 형태, 부적절한 동맥류 목, 시술 전과 후의 대동맥류 크기변화, 기술적 성공, 임상적 성공, 그리고 시술 후 합병증과 이차시술 여부에 대해 분석하였다. 결과: 남자 111명, 여자 11명이었다. 복부 대동맥류는 방추형(n = 108), 주머니모양(n = 3), 파열된(n = 11) 형태였으며 64명에서 부적절한 동맥류 목에 해당되었다. 시술 전 대동맥류의 평균 크기는 52.4 mm였으며 시술 후 110명(90.2%)에서 크기가 감소하거나 변화가 없었고, 8명(6.6%)에서 크기가 증가하였다. 모든 환자(100%)에서 기술적 성공을, 105명(86.1%)에서 임상적인 성공을 보였다. 혈관누출은 51명(41.8%)에서 관찰되었다. 15명(12.3%)에서 부가적인 시술이 필요하였으며 제1, 2형 혈관누출에 의한 경우가 각각 4명 그리고 스텐트-그라프트의 혈전성 폐색으로 인한 경우가 7명이었다. 결론: 복부 대동맥류의 치료에 있어서 EVAR는 기술적, 임상적 성공률이 높으며 합병증이 적은 안전하고 유용한 치료법이다. Purpose: To analyze a single center experience of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. Materials and Methods: Results of 122 patients who underwent EVAR were analyzed, retrospectively. Sex, age, aneurysmal morphology, hostile neck anatomy, preprocedural and postprocedural sac-diameter, technical and clinical success, postprocedural complication and need of additional procedure were analyzed. Results: A total of 111 male and 11 female patients were included. Morphology of the aneurysms was as follows: fusiform (n = 108), saccular (n = 3) and ruptured type (n = 11). Sixty-four patients had hostile neck anatomy. The preprocedural mean sac-diameter was 52.4 mm. Postprocedural sac-diameter was decreased or stable in 110 patients (90.2%) and increased in 8 patients (6.6%). Technical success rate was 100% and clinical success rate was 86.1%. Fifty-one patients showed endoleak (41.8%) and 15 patients (12.3%) underwent secondary intervention due to type I endoleak (n = 4), type II endoleak (n = 4) and stent-graft thrombosis (n = 7). Conclusion: EVAR is a safe and effective therapy for abdominal aortic aneurysm, and it has high technical success and clinical success rate, and low complication rate.

Treatment Outcomes of Patients With Ruptured Abdominal Aortic Aneurysms

Kim Hyangkyoung,Kwon Tae-Won,Cho Yong-Pil,Gwon Jun Gyo,Han Youngjin,Lee Sang Ah,Kim Ye-Jee,Kim Seonok 대한의학회 2023 Journal of Korean medical science Vol.38 No.39

Background: Ruptured abdominal aortic aneurysm (rAAA) is a serious complication of abdominal aortic aneurysm associated with high operative mortality and morbidity rates. The present study evaluated the perioperative and long-term outcomes of Korean patients with rAAA based on national health insurance claims data. Methods: The National Health Insurance Service (NHIS) database was searched retrospectively to identify patients with rAAA who underwent endovascular aneurysm repair (EVAR) and open surgical repair (OSR) from 2009 to 2018. Perioperative (≤ 30 days), early postoperative (≤ 3 month), and long-term (> 3 month) survival, reinterventions, and complications were assessed. Results: The search identified 1,034 patients with rAAA, including 594 who underwent EVAR and 440 who underwent OSR. When the study period was divided into two, the total numbers of patients with rAAA, patients who underwent EVAR, and octogenarians were higher during the second half. The perioperative mortality rate was 29.8% in the EVAR and 35.0% in the OSR group (P = 0.028). Hartmann’s procedure for bowel infarction was performed more frequently in the OSR than in the EVAR group (adjusted odds ratio, 6.28; 95% confidence interval [CI], 2.33–21.84; P = 0.001), but other complication rates did not differ significantly. All-cause mortality during the entire observation period did not differ significantly in the EVAR and OSR groups (adjusted hazard ratio, 1.17; 95% CI, 0.98–1.41; P = 0.087). Abdominal aortic aneurysm-related reintervention rate was significantly lower in the OSR group (adjusted hazard ratio, 0.31; 95% CI, 0.14–0.70; P = 0.005). Conclusion: Although EVAR showed somewhat superior perioperative outcomes for rAAA, the long-term outcomes of EVAR after excluding initial 3 months were significantly worse than OSR. When anatomically feasible for both treatments, the perioperative mortality risk and reasonable prospects of long-term survival should be considered in rAAA.

Anesthetic, Sedation, and Analgesic Technique for Successful Local Anesthetic EndoSuture Aneurysm Repair

Martin Hennessy,Keith Kelso Hussey 대한혈관외과학회 2023 Vascular Specialist International Vol.39 No.1

Purpose: We aimed to describe our technique for and experience with elective endovascular aneurysm repair using EndoAnchors under local anesthesia. Materials and Methods: We included seven patients with abdominal aortic aneurysms who underwent endovascular aneurysm repair using EndoAnchors with a standard regimen consisting of local anesthesia, intravenous sedation, and analgesia. The procedural and follow-up details were retrospectively reviewed. Results: Six out of seven infrarenal abdominal aortic aneurysms were successfully treated with endovascular aneurysm repair using primary EndoAnchors under local anesthesia. One patient was converted to general anesthesia due to acute aneurysm thrombosis independent of EndoAnchor deployment during the procedure. Remifentanyl infusions of up to 3.2 mg/min, morphine doses up to 6 mg (median, 0.5 mg), and midazolam doses of up to 4 mg (mean, 1.4 mg) were used. The mean theater time was 83 minutes (range, 60–130 minutes). Two patients were discharged on day 0, and the mean hospital stay was one day. All patients were alive between 484 and 1,128 days post-procedure, with no aneurysm-specific reintervention. Conclusion: The combination of local anesthesia, intravenous sedation, and analgesia is a viable strategy for timely and effective endovascular aneurysm repair using EndoAnchors. This technique may allow endovascular repair of more ruptured aneurysms using EndoAnchors with potential survival benefits.