JAYATHEESWARAN. VIJAYAKUMAR JAYATHEESWARAN. VIJAYAKUMAR GROUPGROUP 8888

I.M.SECHENOV FIRST MOSCOW STATE MEDICAL I.M.SECHENOV FIRST MOSCOW STATE MEDICAL UNIVERSITYUNIVERSITY

• DEFINITION: FOCAL DILATION 1.5X GREATER THAN DEFINITION: FOCAL DILATION 1.5X GREATER THAN THE NORMAL DIAMETER OF THE ARTERY (>3 CM)THE NORMAL DIAMETER OF THE ARTERY (>3 CM)

• TRUE ANEURYSM (ALL 3 LAYERS) VS. TRUE ANEURYSM (ALL 3 LAYERS) VS. PSEUDOANEURYSMPSEUDOANEURYSM

• INFRARENAL ABDOMINAL AORTA MOST COMMON INFRARENAL ABDOMINAL AORTA MOST COMMON LOCATIONLOCATION

• CAN INVOLVE SUPRARENAL AORTA, ILIAC CAN INVOLVE SUPRARENAL AORTA, ILIAC ARTERIES ARTERIES

• AORTIC DISSECTION IS DIFFERENT DISEASEAORTIC DISSECTION IS DIFFERENT DISEASE

• SMOKINGSMOKING

• HYPERTENSIONHYPERTENSION

• FAMILY HISTORYFAMILY HISTORY

• PROGRESSIVE ENLARGEMENT LEADING TO RUPTURE, PROGRESSIVE ENLARGEMENT LEADING TO RUPTURE, EXSANGUINATION AND DEATHEXSANGUINATION AND DEATH

• TENTH LEADING CAUSE OF DEATH AMONG MEN >65 YEARS TENTH LEADING CAUSE OF DEATH AMONG MEN >65 YEARS OLDOLD

• ACTUAL DEATH RATE LIKELY EXCEEDS 15,000 REPORTED ACTUAL DEATH RATE LIKELY EXCEEDS 15,000 REPORTED DEATHS ANNUALLY, BECAUSE SUDDEN DEATH IS OFTEN DEATHS ANNUALLY, BECAUSE SUDDEN DEATH IS OFTEN MISTAKENLY ATTRIBUTED TO MIMISTAKENLY ATTRIBUTED TO MI

• RUPTURE IS THE GRAVEST AND MOST RUPTURE IS THE GRAVEST AND MOST COMMON COMPLICATIONCOMMON COMPLICATION

• OTHER COMPLICATIONS INCLUDE:OTHER COMPLICATIONS INCLUDE:• PERIPHERAL EMBOLIZATIONPERIPHERAL EMBOLIZATION• AORTIC THROMBOSISAORTIC THROMBOSIS• FISTULA FORMATIONFISTULA FORMATION

• AORTO-DUODENALAORTO-DUODENAL• AORTO-CAVALAORTO-CAVAL

• LOCAL COMPRESSION/MASS EFFECTLOCAL COMPRESSION/MASS EFFECT• HYDRONEPHROSISHYDRONEPHROSIS

AAA Diameter Annual Rupture Rate

4.0 – 5.4 cm 0.5 – 1.0%

5.5 – 6.4 cm 10%

6.5 – 6.9 cm 19%

7.0 – 7.9 cm 32%

> 8.0 cm 50%

• RUPTURED AAA 90% MORTALITYRUPTURED AAA 90% MORTALITY• ELECTIVE REPAIR <5% MORTALITYELECTIVE REPAIR <5% MORTALITY• EARLY DIAGNOSIS AND ELECTIVE EARLY DIAGNOSIS AND ELECTIVE

REPAIR CAN REDUCE MORTALITY REPAIR CAN REDUCE MORTALITY FROM AAAFROM AAA

• SCREENING HIGH RISK POPULATIONS SCREENING HIGH RISK POPULATIONS IS COST EFFECTIVE AND REDUCES IS COST EFFECTIVE AND REDUCES AAA-RELATED MORTALITYAAA-RELATED MORTALITY

Downloaded from: Vascular Surgery 6/e (on 17 October 2005 08:13 PM)© 2005 Elsevier

Downloaded from: Vascular Surgery 6/e (on 17 October 2005 11:17 PM)© 2005 Elsevier

Angio = luminogram

thrombus lumen

• LESS INVASIVE PROCEDURELESS INVASIVE PROCEDURE• AAA EXCLUDED FROM CIRCULATION WITH INTRALUMINAL STENT-AAA EXCLUDED FROM CIRCULATION WITH INTRALUMINAL STENT-

GRAFTGRAFT• ENDO HAS LOWER PERIOP MORBIDITY AND MORTALITY RATES BUT ENDO HAS LOWER PERIOP MORBIDITY AND MORTALITY RATES BUT

MAY BE LESS DURABLE AND REQUIRES MORE FREQUENT FOLLOW-MAY BE LESS DURABLE AND REQUIRES MORE FREQUENT FOLLOW-UP THAN OPEN REPAIRUP THAN OPEN REPAIR

• TYPICALLY RESERVED FOR ELDERLY OR HIGH RISK PATIENTTYPICALLY RESERVED FOR ELDERLY OR HIGH RISK PATIENT

Bilateral groin incisions

Endoluminal graft insertion

gas

Perigraft fluid

duodenum graft