Abdominal Aortic Aneurysm(AAA)LECT7

ALI B ALHAILIY

Abdominal aortic aneurysm

• is a localized dilatation (ballooning) of the abdominal aorta exceeding the normal diameter by more than 50 percent

• Abdominal aortic aneurysms occur most commonly in individuals between 65 and 75 years old and are more common among men and smokers.

• They tend to cause no symptoms, although occasionally they cause pain in the abdomen and back .

Anatomy

AAA

Risk Factors

1. Tobacco smoking: Greater than 90% of people who develop an AAA have smoked at some point in their life.

2. Alcohol and Hypertension3. Genetic influences: The influence of genetic

factors is highly probable 4. Atherosclerosis 5. Other causes: Other causes of the development

of AAA include: infection, trauma

DIAGNOSIS

1. An abdominal aortic aneurysm is usually diagnosed by physical exam, ultrasound, or CT. Plain abdominal radiographs may show the outline of an aneurysm when its walls are calcified.

2. CT scan has a nearly 100% sensitivity for aneurysm

Treatment (surgery) A. Open repair

• A. Open repair is indicated in young patients as an elective procedure, or in growing or large, symptomatic or ruptured aneurysms. It was the main surgical intervention used from the 1950s until other procedures developed.

• For most operations, the surgeon tries to use as small an incision as reasonably possible, but that is not the case for open AAA surgery because there is an overriding concern. The aorta must be clamped off during the repair, and that denies blood to the entire abdomen and both legs; this can cause a whole range of complications

• Recovery after open AAA surgery takes significant time. The minimums are a few days in intensive care, a week total time in hospital and a few months before full recovery.

B. Endovascular aneurysm repair

• Endovascular repair first became practical in the 1990s and although it is now an established alternative to open repair, its role is yet to be clearly defined. It is generally indicated in older, high-risk patients or patients unfit for open repair

Endovascular aneurysm repair procedure• 1.The procedure is carried out in a sterile environment under

x-ray fluoroscopic guidance. It is usually carried out by an interventional radiologist orvascular surgeon

• 2.Access to the patient's femoral arteries can be through small incisions at the top of each leg ("the groins"),.

• 3.Diagnostic angiography images or 'runs' are captured of the aorta to determine the location of the patient's renal arteries, so the stent graft can be deployed without blocking these.

• 4.. The "main" body of the endograft is placed first, followed by the "limbs" which join the main body and extend to the iliac arteries, effectively bypassing the aneurysm sac from blood flow.

• 5.The endograft, once in place, acts as an artificial lumen for blood to flow through, and not into the surrounding aneurysm sac. This reduces the pressure in the aneurysm.[3]

• 6.Multiplanar reformatted image of a TAAA (sagital view)

Endovascular aneurysm repair

SAGITTAL CT SCAN OF AA

Aneurism

NormalAA

With contrast

Without contrast