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Abdominal Aortic Aneurysm

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Degenerative due to atherosclerosis, most common type ... of mesenteric ischemia, HTN, renal dysfunction, horseshoe kidney, claudication ... – PowerPoint PPT presentation

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Title: Abdominal Aortic Aneurysm


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Abdominal Aortic Aneurysm
  • September 25, 2009

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Definition
  • Aneurysm irreversible dilation of an artery at
    least 1.5 times its normal caliber
  • True aneurysm vs. False aneurysm
  • Varieties
  • Degenerative due to atherosclerosis, most
    common type
  • Traumatic iatrogenic, catheter-related,
    penetrating trauma
  • Poststenotic Bernoullis principle, occurs
    distally (distal to coarctation, distal to
    cervical rib in thoracic outlet syndrome, etc.)
  • Dissecting
  • Mycotic infected
  • Anastomotic separation between graft and native
    artery

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Abdominal Aortic Aneurysm
  • Fusiform dilation of abdominal aorta gt 1.5 times
    its normal diameter
  • Incidence 5 of elderly population gt60 years old
    (6-9 times more common in males)
  • Relative risk 11.6 in patients with
    first-degree relative with known AAA
  • Risk factors Atherosclerosis, HTN, smoking, male
    gender, advanced age, connective tissue disease
  • Risk factors for rupture diastolic HTN,
    initially large size at diagnosis, COPD,
    symptomatic, recent rapid expansion

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Diagnosis
  • Exam
  • Periumbilical palpable pulsatile mass
  • Ultrasound
  • Study of choice for initial diagnosis
  • Used to follow progression of aneurysm over time
  • Abdominal or back radiographs
  • Calcifications of aneurysm wall may be seen in
    75 of patients

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Diagnosis
  • CT scan
  • Character, wall thickness, location with respect
    to renal arteries, presence of leak or rupture
  • With Contrast for visualization of surrounding
    vasculature essential for planning repair
  • MRI
  • Greater detail than CT or US regarding lumen,
    surface anatomy, neck, relationship to renal
    arteries
  • Angiogram
  • Defines vascular anatomy, assess lumen patency
    and iliac/renal involvement
  • Especially important in cases of mesenteric
    ischemia, HTN, renal dysfunction, horseshoe
    kidney, claudication

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AAA Screening
  • U.S. Preventive Services Task Force recommends
    one-time screening by ultrasonography in men age
    65 to 75 years who have ever smoked
  • No recommendation (for or against) screening in
    men age 65 to 75 who have never smoked, and an
    explicit recommendation against routine screening
    in women, based on the relatively low yield
  • Repeated screening does not appear to be needed

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Radiograph
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Ultrasound
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Ultrasound
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Ultrasound
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CT scan
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CT with contrast
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CT with contrast
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CT Three Dimensional Reconstruction
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Angiogram
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Triad of Rupture
  • Abdominal pain
  • Pulsatile abdominal mass
  • Hypotension

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X-ray
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CT scan
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