Case Modules + Flashcards
What are indications for surgery in an abdominal aortic aneurysm?
Greater than 5.5cm (even if asymptomatic)
Growth rate
Shape
What test done before AAA surgery and why?
Nuclear stress test
MI is major complication of AAA repair
Might do cath before AAA surgery if heart is problematic
Why should kidney function be evaluated pre-operatively with an AAA?
Contrast is used in AAA repair surgery which may harm the kidneys. If BUN or creatinine is elevated, radiologist may take special steps to protect the kidneys.
What tests might you do before surgery in general?
CXR, CBC, PT, PTT, platelets, EKG, electrolytes & urinanalysis
Most common form of aneurysm?
Male 50+
Infra-renal (95%)
Abdominal aortic
From atherosclerotic disease
5 Big Risk Factors for AAA?
Male > 50 Smoking (5x greater risk!) Family history of aneurysm Hypertension Hypercholesterolemia (also other vascular disease)
What is risk of rupture of AAA that is 5.5cm+ ?
5-10% risk of rupture every year of life
The larger the AAA the greater the risk of rupture
Simplest way to see an aneurysm?
Plain abdominal Xray (see calcification of aortic wall) Seen well on lateral film too Also Ultrasound (not good for measuring distance from renal or iliac)
How measure diameter of aneurysm?
Not angiography
Plain Xray (but decrease by 20% due to overshoot)
Ultrasound is accurate to +/- 5mm
CT scan is best for diameter
What is angiography good for in AAA?
Great at locating renal arteries and diameter of aorta below the renal arteries.
What two modalities will give you the most info about AAA?
CT w/ contrast
Magnetic Resonance Angiogram (this contrast is NOT nephrotoxic)
What imaging best for AAA?
CT imaging allows the determination of both the size of the aneurysm and its relation to other intra-abdominal arteries as well as the length of proximal and distal landing zones that are necessary for evaluation of the possibility for an endovascular stent-graft.
A 54 year old man is diagnosed with a right popliteal artery aneurysm measuring 3.5 centimeters. What are the chances he has a coexisting abdominal aortic aneurysm?
50%
A 52 year old man with a 6 centimeter aneurysm has elected to undergo repair with an endovascular stent-graft. What are the downsides to this repair?
This requires an aneurysm with permissive anatomy, having an adequate length and diameter of proximal landing zone (neck) below the renal arteries as well as a distal landing zone in the iliac arteries.
Postoperatively, however, patients are required to follow up regularly with surveillance imaging including CT scans initially to ensure no endoleaks (flow of blood outside of the stent-graft) have occurred. This may occur in up to 20% of patients.
Heartburn, chest pain after eating, regurgitation
GERD or Esophageal Motility Disorders
- can differentiate via esophageal manometry (pressure)
