Abstract
Twenty cases (2.5%) of aortic aneurysms (AA) in 805 patients with chronic renal failure have been experienced in our institution during the past 12 years. Nine hemodialysis patients with AA were included. The average age of the 20 patients was 66.8 years, and they consisted of 14 males and six females, pain in the respective regions was the most common clinical symptom (65%). Seven cases revealed thoracic AA, 10 abdominal AA and three thoraco-abdominal AA. The pathogenesis in nine cases was arteriosclerotic, dissecting in six and unknown in six.
The 20 cases were subdivided into four groups based on hemodialysis (HD) and/or operation for AA (OP) as follows: Group I (n=9): HD (-), OP (-), Group II (n=5): HD (+), OP (-), Group III (n=2): HD (-), OP (+), Group IV (n=4): HD (+), OP (+). The average age of the respective groups increased in the order of I>IV>III>II and the average size of AA increased in the order III>IV>II>I. A woven Dacron graft replacement and aortic wrapping were used in most operated cases, and hemodialysis incorporated to V-A bypass was adopted as an additional procedure in two cases of thoracic AA. The amounts of bleeding, fluid and blood transfusion were much greater in Group IV than in Group III; however, the average duration until discharge after AA operation was shorter in Group IV. Other complications besides AA included hypertesion in 85% and cardiopulmonary lesions in 80%. Four of 20 patients are alive, whereas 16 (80%) have died. All patients in Group I died and three in Group II died due to the rupture of AA. One of two patients in Group III and one of four in Group IV are still alive after operation for AA. One of the three dead patients in Group IV died after two years.
Nine operated cases of AA in hemodialysis patients have been reported in the Japanese literature. According to our study of these cases and actual patients, aggressive operation with discrete preparation is indicated for AA in hemodialysis patients as increasing numbers of patients with this serious complication are anticipated in the near future with the expansion of the hemodialysis population.
