AAA dr bernardo

8/2/2019 AAA dr bernardo

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Over 15,000 people in the U.S. died last year from rupturedabdominal aortic aneurysms (AAA).

AAAs are the tenth leading cause of death in men over 50.

An estimated 1 million men and women worldwide are living with

undiagnosed AAAs.

Could yourpatient have an undiagnosed AAA?

THE SITUATION


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Aneurysma permanent localized dilation ofan artery, enlarging the artery to twice itsnormal diameter

AneurysmsThoracic aortic aneurysm

Abdominal aortic aneurysm

Aortic dissection

Aneurysms of CentralArteries


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Characteristics of ArterialAneurysms


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Pain related to AAA is usually steady with agnawing quality, is unaffected by movement,and may last for hours or days.

Pain is in the abdomen, flank, or back.

Abdominal mass is pulsatile.

Rupture is the most frequent complication andis life threatening.

Assessment of AbdominalAortic Aneurysm (AAA)


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Assess for back pain and manifestation ofcompression of the aneurysm on adjacentstructures.

Assess for shortness of breath, hoarseness,and difficulty swallowing.

Occasionally a mass may be visible above

the suprasternal notch.

Sudden excruciating back or chest pain issymptomatic of thoracic rupture.

Assessment of ThoracicAortic Aneurysm


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X-ray eggshell appearanceCTAortic arteriographyUltrasonography

Diagnostic Assessment


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Monitor the growth of the aneurysm.

Maintain BP at a normal level to decrease therisk of rupture.

NonsurgicalManagement


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Preoperative care

Operative procedure

Postoperative care: Monitor vital signs Assess for complications Assess for signs of graft occlusion or rupture

Abdominal AorticAneurysm Resection


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Preoperative care

Operative procedure

Postoperative care assessments: Vital signs Complications Sensation and motion in extremities

Respiratory distress Cardiac dysrhythmias

Thoracic AorticAneurysm Repair


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May be caused by a sudden tear in the aorticintima, opening the way for blood to enter theaortic wall

Pain described as tearing, ripping, andstabbing

Aortic Dissection


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Emergency care goals include: Elimination of pain Reduction of blood pressure

Decrease in the velocity of left ventricular ejection

Nonsurgical treatment

Surgical treatment

Aortic Dissection(Contd)


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Diameter of the aorta 1.5 timesgreater than normal.

Most are infrarenal, and a significantnumber extend down into one orboth iliac arteries.

AAA ESSENTIALS

Definition


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Approximately 200,000 are diagnosed in the U.S. each year.

15,000 Americans died of this condition in 2007.

75% produce no symptoms.

75% are detected incidentally usually duringimaging scans.

Mortality rate: When AAAs rupture, only 18% of patients survive.

AAA ESSENTIALS

Scope of the Challenge


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Men over 60

Men are four times more likely to develop AAAs, but20%do occur in women.

Smokers

Current smokers are seven times more likely todevelop AAA

than non-smokers.

Former smokers are three times more likely. Family History

20% of AAA patients have a relative with thecondition.

WHO IS MOST AT RISK?

Primary Risk Factors


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Obesity

High blood pressure

High cholesterol

Atherosclerosis

Cardiovascular disease

WHO IS MOST AT RISK?

Secondary risk factors:


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Pain or tenderness in the lower back, abdomen or side

Throbbing in the abdomen Indications of rupture may include:

Lightheadedness

Sweating

Clammy skin

Nausea

SYMPTOMS

Although there are frequently no symptoms, AAA symptomsmay include:


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Physical examination of abdomen

Abdominal tenderness may indicate an AAA Bruit over the aorta Palpable mass

Not effective in obese patients and/or those with anAAAunder 2 cm in diameter

Usual: abdominal ultrasound >80% accurate As required: MRI, CT or other imaging systems Angiography rarely indicates

DIAGNOSIS


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AAAs under 5 cm in diameter: usually monitored with serialultrasound examinations

AAAs 5 cm and larger: usually repaired with open surgeryor endovascular repair

No proven lifestyle changes can decrease the size of AAAs.

TREATMENT OPTIONS


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Both endovascular and open surgeries are used to repair AAAs. Approximately 40,000 repairs are performed each year in the

U.S.

REPAIR OPTIONS


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Requires two small incisions in the groin area. An endovascular graft is inserted through the femoral artery

via a catheter and deployed inside the lumen, relining the aorta.

Average hospital stay: 2-3 days

Average recovery time: 1-2 weeks

REPAIR OPTIONS

Endovascular Surgery


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Requires large abdominal or flank incision Retroperitoneal dissection and exclusion of the aneurysm by

clampingthe aorta

Removal of the affected aorta and replacement with surgicalgraft

Average hospital stay: 1 week

Average recovery time: 1-3 months

REPAIR OPTIONS

Open Surgery


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Remember those most at risk:

Men over 60

Smokers

Those with a family history of AAA Screen as early as possible and refer to a specialist, as

appropriate.

WHAT YOU CAN DO

Be aware AAAs are most often silent killers and are increasing innumber.

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