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Abdominal Aorta Aneursym
Abdominal Aorta Aneursym
Abdominal Aorta Aneursym
Part one of Review Handbook on Vascular Surgery. This is meant for revision and should not be
used as initial study. Prepared by Dr Dale Maharaj FRCS FICS FICA
Definition
Aneurysm: a focal dilatation of a blood vessel 1.5 to 2 times the diameter of the
native vessel. (The normal diameter of the infrarenal aorta is about 2 cm. This vessel is
generally considered aneurysmal above 3 cm
Incidence
AAA is most commonly diagnosed in the 7th decade of life
Men outnumber women by 4 to 1
Prevalence estimated at 2-5 percent in men over age of 60
Incidence is approximately 30-60 per 1000 of population and increasing
1 in 5 patients with PAOD
Etiology
Arteritis
Inflammatory
Decreased Risks
DVT
Diabetes Mellitus
Black race
Female gender
Clinical Presentation
Abdominal pain
Back/lumbar pain
Beating in abdomen
Pulsatile & EXPANSILE mass
Other aneurysms eg popliteal, femoral
MRI
Aortography: will underestimate size of aneurysm
Blood work up: Hb, Renal Function, Blood Glucose levels, Vasculopath
Full vessel work up
(80%)
on size
Surgery
1. Operative approach
o Transperitoneal approach (laparotomy)
o Retroperitoneal approach
2. Control the proximal & distal aorta/iliacs
3. Inlay prosthetic graft
4. Cover graft with aortic wall
Endovascular aortic grafting
Hemorrhage
Ischemic colitis
Prolonged ileus
Ureteral injuries
Paraplegia
MI
Stroke
Pelvic/Buttock ischemia
Screening
Late Complications
Graft infection- common in 1st year
Anastomotic aneurysm- 1-3%
Aortoenteric fistula
Graft limb occlusion
Retroperit
oneal approach