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Aortic Aneurysms

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Aortic Aneurysms

  1. 1.  2cm width  4 main parts  Many branches  Bifurcation: ~L4
  2. 2.  Abnormal localised dilatation of a blood vessel due to weakness of the vessel wall  Most commonly abdominal aorta  Usually asymptomatic › May have back pain  Often discovered incidentally › NHS AAA screening programme
  3. 3.  Men > women  Increased age  PMH: › Hypertension › Hypercholesterolaemia › Atherosclerosis › Marfan’s syndrome  FH: › Aortic aneurysm
  4. 4.  HISTORY › Abdominal or back pain › Family history › Risk factors  EXAMINATION › Palpation of abdomen
  5. 5.  Mortality >80%; 50% don’t reach hospital  13th commonest cause of death in UK  12,000 deaths/year in UK Source: BHF Factfile 1, 2008 AAA Diameter (cm) Annual Rupture Rate 4 - 5.4 0.5 – 1.5 % 5.5 - 5.9 5 – 15 % 6 - 6.9 10 – 20 % 7 - 7.9 20 – 40 % > 8 30 – 50 %
  6. 6.  Presentation: › Pain.  Thoracic: chest  AAA: severe back pain, often radiates to groin › Abdominal tenderness & pulsatile mass › Shock:  Cold, clammy  Tachycardia  Hypotension › Syncope › Vomiting (haemoptysis)  Emergency surgery
  7. 7.  No effective medical treatment › Can target cardiovascular risk factors  Only operate if risk of rupture greater than risk of surgery  >5.5cm  More if higher risk to surgery due to co- morbidities  Otherwise re-scan at regular intervals
  8. 8.  Longitudinal midline incision  Aorta clamped above and below aneurysm  Aneurysmal part of aorta replaced with artificial graft  4-5hrs
  9. 9.  Lower mortality, more expensive  Graft inserted through femoral artery  X-ray used to guide positioning  Stent expands to size of normal aorta above and below aneurysm  Requires ‘neck’ below renal arteries to attach stent graft  2-3hrs http://www.youtube.com/watch? v=j9aK2ECcFEY
  10. 10.  Renal failure  Emboli  MI  Graft infection
  11. 11.  Aneurysm = localised dilatation of blood vessel  1/15 men over 65, 1/35 women  Rupture has > 80% mortality  Surgical repair has ~5% mortality (varies)  Aneurysm >5.5cm  surgery  Open repair, EVAR

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