infra renal abdominal aortic aneurysm.pptx

infra renal abdominal aortic aneurysm

1. ABDOMINAL AORTIC ANEYRSUM infra-renal

2. An A lbert E instein died from a ruptured abdominal aortic aneurysm

3. OBJECTIVE DEFINE AAA CLASSIFY AAA DISCUSS PATHOPHYSIOLOGY OF AAA ENLIST RISK FACTORS FOR AAA INDICATION FOR INTEREVNTION ESTABLISH INVESTIGATION & DIAGNOSIS RECOMMEND TREATMENT OPTIONS

4. Abdominal aortic aneurysm AAA is permanent, localized dilatation of aortic diameter greater than 3 cm Aortic diameter > 50 % of the involved segment than a normal adjacent segment of aorta

5. E pidemiology MALE to female ratio is 8;1 12 th leading case of death It is a silent killer because there are often no symptoms that an aneurysm is developing in the abdominal aorta

6. Pathophysiology of AAA Pathological changes in the aortic wall ; Inflammatory process Causing breakdown of elastin & collagen Decrease tensile strength Leading to expansion

7. Risk factors Main risk factors Male Smoking history Hypertension Family history Increasing age Atherosclerosis vasculitis

8. Types of AAA Morphological classification True aneurysm Fusiform aneurysm S accular aneurysm Pseudo aneurysm

9. Why is early diagnosis of AAA so important ? The operative mortality of treating ruptured aneurysm is 80 % For elective AAA cases , the operative mortality rate is drastically reduced , approximately only 2-7% of cases result in death AAA ruptures can be avoided by identifying the population at risk and conducting simple and inexpensive ultrasound examinations

10. If untreated ,the AAA may rupture Risk of rupture for untreated aneurysm within 5 yrs 5-5.9 cm -----25% 6-7cm----------35% > 7% -----------75% When the aneurysm diameter reaches 5 cm, the risk of rupture is generally considered to be higher than the operative risk

11. Why do you have a major role in preventing AAA ruptures ?? You are the first to see the patient No national or international AAA screening program is in place today except in the USA A simple ultrasound examination easily detects aneurysm

12. How can you diagnose AAA Clinical F eatures; Majority are asymptomatic Symptomatic can present with spectrum P hysical E xamination; With palpation ,pulsating mass in the middle of a patient abdomen However ,you may miss up to 80 % of AAA,if the diagnosis is limited to physical examination ONLY

13. How can you diagnose AAA Ultrasound scan has proven to be reliable and cost effective way to diagnose a AAA It is extremely sensitive test for all AAA sizes It is painless and non invasive It is cost effective

14. Investigation for confirmation Ct aortogram

15. Indication for intervention Symptomatic patient regardless of size Male size > 5.5 cm ,female size >5 cm Saccular aneurysm Expansion of 1 cm/ yr Leaking or ruptured aneurysm

16. Treatment option Endovascular stent grafting Open surgery

17. Take home message Ultrasound is the best tool for screening of AAA. 90 % AAA are found infrarenal aneurysum Male to female ratio 8;1 Male > 5.5 cm & in female >5cm needs intervention

18. THANKS