Renal Ischemia Produced by Aneurysm of Abdominal Aorta

Abstract

inclusive. They are based on the pathologic diagnosis and collected from sixteen hospitals and represent nearly all the cases of the disease in that time in this area. CONCLUSIONCertain facts can be learned from the report. Some are well known. Others are important because they represent reasons why our mortality rate has decreased from 6.8 per cent to 2.8 per cent in twelve years for the types included in the study : 1. Appendicitis is uncommon but highly fatal in the very young and the very old.2. The longer operation is delayed the higher the mortality.3. The disease is on the increase in Cleveland.4. There is a great increase in the use of spinal anesthesia. 5. The removal or nonremoval of the organ at primary operation for abscess is not of great importance as far as our mortality rate shows.6. Sulfonamides have been used in too few cases to reveal conclusive results in this series. Other workers have proved them to be of great value.As definite reasons for the great decline in mortality in this series we add the following facts:7. There is less delay in operation. This is the result of popular and professional education. 8. A gratifying decrease in drainage, especially in acute cases with perforation, is taking place. This trend should continue. 9. More private and fewer charity patients means that part of our good fortune is due to improved economic conditions. 10. The use of the McBurney type incision results in a lower mortality and we are glad to see that its use is on the increase. The experimental investigations of Goldblatt and his associates 1 on dogs in producing renal ischemia and an accompanying hypertensive vascular disease, either benign or malignant, have facilitated a better correlation of pathologic conditions observed in man in which renal ischemia has been produced by involvement of or alterations in the renal artery. The initial studies on experimental hypertension by Goldblatt and his co-workers demonstrated that constriction of the main renal artery of one kidney was followed by an elevation in blood pressure, which usually, but not always, returned to normal within four to eight weeks unless the artery to the other kidney was constricted or the other kidney removed.However, a few cases of hypertension in man have been observed and reported in which a constricting lesion of one renal artery has apparently been responsible for the coexisting hypertensive vascular disease. Hypertension has been reported in unilateral atherosclerotic narrowing 2 and embolism 3 of the main renal artery, in an aneurysm 4 of the main renal artery, in a dissecting aneurysm of the abdominal aorta with partial occlusion of the renal artery, in a tumor of one kidney 5 with compression of the renal artery and in unilateral pyelonephritis e in which the hypertension was partially or completely relieved by removal of the diseased kidney.The following case is reported because the disease process, which was a saccular aneurysm of the abdominal aorta, produced in man a condition similar to the procedure applied experim...

Renal artery stenosis due to abdominal aortic aneurysm

“…In their review they cited only one case of renal artery stenosis due to an aortic aneurysm (Hoffman, 1942). Since then there have been reports of three more such cases (Brown et al, 1960;Abrahams & Parry, 1962).…”