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Abdominal Aortic Aneurysm. September 25, 2009. 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

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abdominal aortic aneurysm

Abdominal Aortic Aneurysm

September 25, 2009

definition
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 – Bernoulli’s 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
abdominal aortic aneurysm5
Abdominal Aortic Aneurysm
  • Fusiform dilation of abdominal aorta > 1.5 times its normal diameter
  • Incidence: 5% of elderly population >60 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
diagnosis
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
diagnosis7
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
aaa screening
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
triad of rupture
Triad of Rupture
  • Abdominal pain
  • Pulsatile abdominal mass
  • Hypotension