Chapter 10 Suspect Abdominal Aortic aneurysm (DMS120)

repair of abdominal aortic aneurysms is indicated when the aneurysm becomes greater than

5.5 cm in diameter or grows more than 0.6 to 0.8 cm per year.

despite reduction in overall complications endoleak is a frequent occurrence after a stent graft deployment. The overall endoleak rate ranges from

7 to 47%. the complication can be due to device failure. During placement. Changes over time. Our failure to control blood flow within the aneurysm sac.

the DeBakey classification of aneurysms differentiates between dissections that involve the entire aorta. which is type 1 or dissections that involve only the ascending aorta which is Type 2.

and dissections that involve only the descending aorta which is type 3.

abdominal aortic aneurysms usually affect older patients. Ruptured AAA are the leading cause of death in the United States.

and infrarenal aorta 3 cm in diameter or larger is considered aneurysmal. AAAs develop as the Tunica Media which is composed of smooth muscle. collagen. and elastin Thins.

major risk factors for aortic aneurysms are age 65 years or older. Male. And smoking at least a hundred cigarettes in a lifetime. no recommendations were made for men 65 to 75 years of age who have never smoked.

and it recommended against screaming women. man with a strong family history of AAA should be counseled about the risks and benefits of screening as they approach 65 years old.

elderly woman. Severe back pain. 40 year history of high blood pressure and smoking. Pause Town midline abdominal Mass. During exam becomes hypotensive and goes into cardiac arrest. Abdomen begins to swell. Diagnosis?

aortic rupture. Beata is dilated and thrombus is seen in aneurysm. Hypotensive State and fluid in abdomen suggest rupture.

the risk of rupture sharply increases with aneurysm more than 6 cm in diameter. High blood pressure. And current smoking. Increases the growth rate of aneurysms and resultant rupture.

classic presentation of ruptured AAA includes the Triad of hypotension. Abdominal or back pain. And a pulsatile abdominal Mass. Pain radiates to the back groin or scrotum.

if the patient history includes hypertension. Aortic aneurysm. Or Marfan syndrome.

dissection should be strongly considered. Clinical exams may also reveal absent pulses in the legs.

aneurysms are characterized with the Stanford or DeBakey classification. The Stanford classification differentiates between dissection is that involved the ascending aorta which is type A and dissections that

do not involve the ascending aorta. Which are called type B.

aortic aneurysms maybe fusiform or uniform dilation. Or secular. Asymmetric sac-like dilation in appearance. Or the aorta may have

gradual widening. Referred to as aortic ectasia. Thrombus within the dilation may be noted. most commonly appears as low-level echoes.

aortic dissection occurs with the rupture of the intima of the aorta. Which separates from the media with a column of blood between the two layers. Causes of aortic dissection include

hypertension. Marfan syndrome. And less frequently pregnancy and chest pain. may also result from the degenerate if changes that occur with artherosclerotic disease.

the latest advances in treatment for aortic aneurysms is the placement of endoluminal graft. The graphs are inserted into the aorta rather than exposing the aneurysm surgically.

no incision is required making recovery time considerably shorter than open resection. configured as a metallic self-expanding framework covered with various non porous materials.

symptoms for aortic rupture

pulsatile abdominal Mass. Hypotension. Abdominal pain. Radiating pain. Sonographically you will see an aortic aneurysm. Hemoperitoneum. periaortic hematoma.

symptoms for aortic aneurysm

pulsatile abdominal Mass. Sonographically you will see an aortic A&P diameter of greater than or equal to 3 cm. Uniform or asymmetric dilation with or without thrombus.

patients with ruptured AAA may present in shock and be unable to communicate. They need immediate intervention to prevent death. postoperative mortality after ruptured AAA

repair is still more than 40% in patients who survived the operation.

symptoms for aortic dissection

severe chest pain. Neck or throat pain. Abdominal or back pain. Syncope. paresis. Dyspnea. Sonographically you will see a linear flap in aorta. Flow may or may not be demonstrated on both sides of flap.

what is the most common method for Imaging dissections of the ascending aorta

tee. Or transesophageal echocardiography. transabdominal ultrasound is used for Imaging dissections of the descending aorta. CT and MRI may be useful in the ascending aorta. and the descending aorta.

dissection of the ascending aorta has a much higher mortality rate than dissection of the descending aorta.

the clinical presentation of dissection is usually acute onset of severe chest pain. may have neck or throat pain. Pain in the abdomen or lower back. Syncope. Paresis and dyspnea.

an endo week occurs when blood is allowed to flow into the aneurysm sac. I know leaks are classified as one of four types. Type one and attachment site leak. Cause when the device is improperly sealed at the proximal or distal end point.

type 2. Retrograde flow through collateral branches like the lumbar or i.m.a. Type 3 flow into the aneurysm secondary to inadequate seal between components of the device or a tear in the fabric or graph. type 4 flow through the fabric of the graft secondary to graft poricy.

symptoms for endoleak

varies with type of leak. Sonographically you will see that blood flows into aneurysm Sac. Classified as one of four types.

the recommended surveillance is no further testing for patients with abdominal aortic aneurysm Less Than 3 cm and annual testing for aneurysms measuring 3 to 4 cm.

when in aortic aneurysm reaches 4 to 4.5 centimeters screening is done every 6 months. If it is greater than 4.5 cm they should get surgery.

dissection of the descending aorta may be diagnosed with identification of the intimal flap in the aorta. Doppler can be used to document flow in the true lumen.

whether the dissection is acute or chronic. Flow may or may not be shown in the false Lumen. Located between the Tunica intima and the Tunica Media.