Chapter 71 - Aortoiliac aneurysm - open treatment

Question 1

Open AAA first described by this person

Answer 1

Dubost 1952

Question 2

Perioperative mortality of OAAA

Answer 2

3.2%

Question 3

Pro and Con of MRA over CTA in OAAA planning

Answer 3

1) more information about surrounding inflammation 2) less information about calcification of the aortic wall 3) overestimates stenosis

Question 4

Transperitoneal vs retroperitoneal in open AAA; intraoperative concerns

Answer 4

1) right renal exposure 2) right iliac (EIA/IIA) exposure 3) visceral exposure better with retro 4) presumed benefit in LOC, resp, pulm edema, pneumonia, ileus, ICU stay (CONTROVERSIAL)

Question 5

Mobilizing left kidney in left visceral rotation requires division of this

Answer 5

Left renal lumbar vein

Question 6

To keep left kidney down in left visceral rotation need to get into this plane by dividing these

Answer 6

Linorenal and linophrenic ligament plane between gerota’s fascia and posterior surface of colonic mesentery and pancreas

Question 7

Renal protection strategies

Answer 7

Minimize ischemia time Drugs 1) fenoldopam (selective dopamine antagonist) 2) dopamine 3) lasix 4) mannitol 5) acetylcysteine Renal hypothermia: 1) hyperosmolar crystalloid (cold) 2) histidine-tryptophan-ketoglutarate (HTK) solution 3) saline w/ mannitol and methylprednisolone

Question 8

Complication rate post OAAA

Answer 8

MI 10% (beta blockers help) Pneumonia 17% Renal failure 10% (0.5% dialysis); pararenal then 15-20% (3.5% dialysis) Colonic ischemia 30% asymp; 0.2-6% symp LE ischemia Spinal cord ischemia <1% (0.2%) VTE 8% PE 1.4%

Question 9

Post-OAAA surveillance as per SVS

Answer 9

every 5 years also look for other aneurysms

Question 10

Mortality in EVAR explant conversion to open

Answer 10

0-22%

Question 11

Inflammatory aneurysm rate

Answer 11

5% of all aneurysms

Question 12

Etiology of non-infectious inflammatory aneurysm

Answer 12

1) exaggerated normal inflammation 2) chronic subacute rupture 3) variant retroperitoneal fibrosis treating aneurysm stops inflammation often

Question 13

Key in operating on inflammatory aneurysms open

Answer 13

1) enter aneurysm sac early to minimize dissections of viscerals 2) ureteric stents for protection

Question 14

Infected aneurysms rate

Answer 14

0.65-1.5% of all aneurysms

Question 15

Most common infected aneurysm organisms

Answer 15

Staph Strep Salmonella E coli

Question 16

Mortality for infected aneurysms

Answer 16

5-36%

Question 17

Results From Open Aneurysm Repair Arms of Major Randomized Endovascular Aneurysm Repair Trials

Answer 17