Abdominal Aortic Aneurysm Case Study

By Lisa Erwert

Patient History

 70 year old male  Smoker  High blood pressure  CABG  Cholecystectomy  Inguinal Hernia Repair  Abdominal Aortic Aneurysm (AAA)

About AAAs

 What is AAA?

 Are AAAs deadly?

 Why are AAAs known as the silent killer?

 Where are they located?

 Who’s at risk?

www.vascularsociety.org.uk

Anatomy of Abdominal Cavity www.vascularsociety.org.uk

Anatomy on CT

Recent History

 10/28/05 Ultrasound  8/28/06 CT of abdomen and pelvis  11/16/06 Endovascular Stent Graft placement  12/15/06 Follow-up CT of abdomen/pelvis

Incidental Finding on Ultrasound

 AAA measuring 5.8 x 5.8 cm  Proximal aorta - 2.4 x 2.3 cm  Mid-abdominal - 2.3 x 2.4 cm  R & L common iliac arteries - 1.2 cm

Confirmation CT

 8/28/06  Abdomen/Pelvis CT  Non-contrast  5mm axial images  100 cc of Ultravist  2 mm axial images in arterial

CT Findings

 Cysts in left kidney

Additional Findings

 Normal renal arteries  L & R renal veins  AAA measuring 6.7 x 6.7cm

 L common iliac measuring 2.6 x 2.7 cm  R common iliac measuring 2.0 x 2.4 cm

CTs of AAA

CT Angiograms (CTAs)

Endovascular Stent Graft (Endograft) Procedure

 11/16/06  Prep  Incision  Placement of vascular sheath and pigtail  Performed aortogram

Stent Graft Components

 Constructed of ePTFE  Nitinol Support structure  Pencil size in diameter  Internally relines aorta  Inserted by catheter  80-90% success rate  Quicker recovery rate

www.angioplasty-vir.com

Endograft Procedure cont.

 Right sheath exchange  Deployment of stent graft  Left sheath exchange  Deployment of Contralateral stent graft  Angioplasty  Removal of catheters and wires

Post-deployment of graft

 Successful placement of graft  Visible endoleak

Follow-up CT

 12/15/06  Abdomen / Pelvis  5mm axial / non-contrast  100cc Ultravist  2mm delayed images

CT

 Unchanged AAA  Unchanged common iliac arteris  No evidence of endoleak

Post CTAs

Patient Prognosis

 Constant Observation  Possible further operations in future

References



Abdominal Aortic Aneurysm

. Retrieved January 4, 2007, http://www.med.umich.edu/.



Endovascular Stent Graft for Abdominal Aortic Aneurysms

. Retrieved January 22, 2007, from http://www.vascularweb.org /Endovascular_Stent_Graft.html

 Mosquera, Damien BSc MB ChB FRCS FRACS MD ; © 2002 D Mosquera Ltd, www.vascular.co.nz.

 Netter, Frank H., Hansen, John T. (2001).

Atlas of Human Anatomy

.  Nowygrod R, Egorova N, Greco G et al. Trends, complications, and mortality in peripheral vascular surgery. J Vasc Surg 2006; 43: 205-216.