case conference on abdominal aortic anurysm

8/10/2019 Case Conference on Abdominal Aortic Anurysm

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Case Conference on a

67-year-old male sent

to ER due tochest tightnessand

back soreness


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Who is this patient?

67y/o, male, married

Working in a storehouse

Smoke1 pack per day for 10+ years

Drink a cup of wine at dinner for 10+ years

With past history of hypertension


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What happened before coming to

ER at on 103 11 17?

Felt dizzyand pain spreading from both

soles upwardswhen taking a bath

Then lied down on the bed, feeling lower

back soreness, backache, and chest

tightness

Was sent to ER by his wife and son right

away


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His vital signs when arriving at

ER

Blood Pressure: 86/63 mmHg

Heart Rate: 76/min

Respiration Rate: 16/min

Body Temperature: 35.5 C

GCS: 15


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Physical Examination at ER

Perfusion: warm without cyanosis

Chest

symmetric expansion

Breathing sound: bilateral clear

Heart rhythm: regular

Abdomen

flat, soft, normal bowel sound


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The diagnostic tools used at ER and

their results

EKG: Normal


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their results

Blood Test


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their results

Blood Test


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their results

Blood Test


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their results

Blood Test


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their results

Echo: AAA, no ascites, left renal blurred

shadow

highly suspected AAA rupturewith

retroperitoneum hematoma


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their results

CT:


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The treatments given at ER

Sodium chloride 0.9% 500mL/Bot (1BT )

Meperidine(Pethidine) 50mg/mL/Amp

Blood transfusion

Packed RBC 4 unit

Meperidine(Pethidine) 50mg/mL/Amp


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His vital signs during time at ER

SBP

DBP

HR

RR

BT

SPO2

GCS

22:38 86 63 76 16 35.5 15

22:43 100 51 75 11 99 15

22:51 114 75 73 18 98 15

23:15 94 57 71 18 36.3 100 15

23:25 107 72 75 22 36.1 100 15

23:31

99

63

73

22

35.6

100

15


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Diagnosis

1.AAA rupturewith hypovolemic shock

2.Thoracic aorta PAU(Penetratingatherosclerotic ulcer) impending rupture

3.HTN


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Operative Methods

TEVAR: thoracic endovascular aortic repair

(Medtronic 34-34-100)

EVAR:

(28-16-170, 16-16-124 and 16-16-82)


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Post-OP Vital Signs

Blood Pressure: 96/74 mmHg

Heart Rate: 79/min

Respiration Rate: 16/min

Body Temperature: 37 C


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Risk Factors of AAA

Age > 60

Smoking

Male

While people

Connective tissue abnormality (Marfanssyndrom)

Family history of AAA

Atherosclerosis (HTN, DM, Lipids)


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Screening for AAA

Screening test: abdominal ultrasound

Recommended for

Men age 65 to 75

Men age >60 with family history of AAA


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Risk of AAA rupture

Annual risk of rupture based on the size of AAA

Less than 4.0 cm = less than 0.5%

Between 4.0 to 4.9 cm = 0.5~5%

Between 5.0 to 5.9 cm = 3~15%

Between 6.0 to 6.9 cm = 10~20%

Between 7.0 to 7.9 cm = 20~40%

Greater than 8.0 cm = 30~50%


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Risk of AAA rupture

Risk of rupture of AAA 5.0cm is greater in

women than men (18% vs. 12%)

High risk of rupture for AAA expanding more than

0.5 cm over 6 months


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When to repair?

AAA 4.0 cm No

Asymptomatic AAA 5.5 cm Yes

Between 4.0 and 5.5 cm

Asymptomatic but expanding > 0.5 cm within 6

months

Yes

Presence of other aneurysms Yes

Symptomatic AAA Yes


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Screening for AAA

Screening test: abdominal ultrasound

Recommended for

Men age 65 to 75

Men age >60 with family history of AAA


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Reference

UpToDate

Sabiston Textbook of Surgery, 19thed. Elsevier, 2012.

case conference on abdominal aortic anurysm

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