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.