An abdominal aortic aneurysm (AAA) is a focal dilation of the abdominal aorta greater than 1.5 times its normal diameter. AAAs are classified as either true or false aneurysms. Risk factors include smoking, hypertension, and family history. Rupture of an AAA leads to exsanguination and death and is among the top 10 causes of death in men over 65 years old. Treatment options include open surgical repair or endovascular aneurysm repair (EVAR) with a stent graft, with EVAR being less invasive but requiring more follow-up. Early diagnosis and elective repair can significantly reduce mortality from AAAs.

1. JAYATHEESWARAN. VIJAYAKUMARJAYATHEESWARAN. VIJAYAKUMAR
GROUPGROUP 8888
I.M.SECHENOV FIRST MOSCOW STATE MEDICALI.M.SECHENOV FIRST MOSCOW STATE MEDICAL
UNIVERSITYUNIVERSITY

2. • DEFINITION: FOCAL DILATION 1.5X GREATERDEFINITION: FOCAL DILATION 1.5X GREATER
THAN THE NORMAL DIAMETER OF THE ARTERYTHAN THE NORMAL DIAMETER OF THE ARTERY
(>3 CM)(>3 CM)
• TRUE ANEURYSM (ALL 3 LAYERS) VS.TRUE ANEURYSM (ALL 3 LAYERS) VS.
PSEUDOANEURYSMPSEUDOANEURYSM
• INFRARENAL ABDOMINAL AORTA MOSTINFRARENAL ABDOMINAL AORTA MOST
COMMON LOCATIONCOMMON LOCATION
• CAN INVOLVE SUPRARENAL AORTA, ILIACCAN INVOLVE SUPRARENAL AORTA, ILIAC
ARTERIESARTERIES

6. • SMOKINGSMOKING
• HYPERTENSIONHYPERTENSION
• FAMILY HISTORYFAMILY HISTORY

8. • PROGRESSIVE ENLARGEMENT LEADING TO RUPTURE,PROGRESSIVE ENLARGEMENT LEADING TO RUPTURE,
EXSANGUINATION AND DEATHEXSANGUINATION AND DEATH
• TENTH LEADING CAUSE OF DEATH AMONG MEN >65 YEARS OLDTENTH LEADING CAUSE OF DEATH AMONG MEN >65 YEARS OLD
• ACTUAL DEATH RATE LIKELY EXCEEDS 15,000 REPORTED DEATHSACTUAL DEATH RATE LIKELY EXCEEDS 15,000 REPORTED DEATHS
ANNUALLY, BECAUSE SUDDEN DEATH IS OFTEN MISTAKENLYANNUALLY, BECAUSE SUDDEN DEATH IS OFTEN MISTAKENLY
ATTRIBUTED TO MIATTRIBUTED TO MI

9. • RUPTURE IS THE GRAVEST AND MOSTRUPTURE 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

10. 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%

11. • RUPTURED AAA 90% MORTALITYRUPTURED AAA 90% MORTALITY
• ELECTIVE REPAIR <5% MORTALITYELECTIVE REPAIR <5% MORTALITY
• EARLY DIAGNOSIS AND ELECTIVEEARLY DIAGNOSIS AND ELECTIVE
REPAIR CAN REDUCE MORTALITYREPAIR CAN REDUCE MORTALITY
FROM AAAFROM AAA
• SCREENING HIGH RISKSCREENING HIGH RISK
POPULATIONS IS COST EFFECTIVEPOPULATIONS IS COST EFFECTIVE
AND REDUCES AAA-RELATEDAND REDUCES AAA-RELATED
MORTALITYMORTALITY

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

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

26. Angio = luminogram
thrombus lumen

38. • 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 MAYENDO HAS LOWER PERIOP MORBIDITY AND MORTALITY RATES BUT MAY
BE LESS DURABLE AND REQUIRES MORE FREQUENT FOLLOW-UP THANBE LESS DURABLE AND REQUIRES MORE FREQUENT FOLLOW-UP THAN
OPEN REPAIROPEN REPAIR
• TYPICALLY RESERVED FOR ELDERLY OR HIGH RISK PATIENTTYPICALLY RESERVED FOR ELDERLY OR HIGH RISK PATIENT

41. Bilateral groin incisions

42. Endoluminal graft insertion

49. gas
Perigraft fluid

51. duodenum graft