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Aor,c Aneurysm
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2006 Medtronic, Inc. All rights reserved. This presentation is for international use only, products not available for sale in the USA. UC200702115EE.
SILENT KILLER
Deni&on
An aneurysm is a permanent and irreversible dilata&on of a blood vessel by at
least 50% of the normal expected diameter.
The larger the AAA, the higher its growth rate and greater the risk of rupture. The
risk of rupture is also greater for women.
Pathophysiology of a AAA
Pathological changes cause the
aorta wall to:
Become thinner
Bulge
Tear
Rupture
Pathophysiology of a AAA aneurysm growth
AAA growth:
Expansion tends to be highly
variable
AAA growth accelerates with
the diameter of the AAA
Aneurysm growth is inuenced
by risk factors
What are the sta&s&cs on AAA in Asia?
7
Risk Factors
Atherosclero&c disease : stroke, coronary artery disease, peripheral artery disease
Male sex.
Increasing age.
Hypertension.
Hyperlipidaemia.
Unruptured AAA
NO SYMPTOMS
AAA may be an incidental nding on clinical examina&on, or on
scans - ultrasound, CT or MRI. It may some&mes be visible on a
plain X-ray lm.
AAA repair.
Examina&on
Elec,ve repair
Overall mortality in the UK is 2.4% for elec&ve AAA repair. There is an inverse rela&onship
between opera&ve mortality and the number of cases performed in individual hospitals, with
many specialist centres repor&ng mortality rates well below 52%.
The mortality rate of aneurysm repair depends on the pa&ent's tness for surgery and the
morphology of the aneurysm.
Pa&ents with severe cardiorespiratory or renal disease may have high peri-opera&ve
mortality rates, and for them the threshold for elec&ve repair may be set at a larger
aneurysm diameter.
Without surgery
The annual survival rate is only 20% for aneurysms
larger than 5 cm.
Ruptured AAA
Risk of rupture increases with aneurysm size and
aneurysms over 6 cm have a 25% annual risk of
rupture.
The outcome is poor, with approximately 80% overall
mortality from ruptured AAA.
Most pa&ents die before reaching hospital. Surgical
repair of ruptured AAA has a mortality of around 50%.
Why is early diagnosis of AAA so important?
19
Pa&ent Screening
High Risk Pa,ents
Risk Factors People over age 60
Male gender, 5 &mes > females
Family history of AAA
History of or currently smoking
Atherosclerosis
High blood pressure
High cholesterol
COPD
Prior CABG
Ultrasound
20
Screening
Screening by ultrasound is feasible to allow
early diagnosis. The idea is to oer a single
scan to men aged 65.
If nega&ve, this eec&vely rules out AAA for life.
Mr M, 70 y.o Aorta aneurysm, EVAR
Mr H, 60 y.o, internal iliac aneurysm, covered stent
Mr H, 60 y.o Aor&c aneurysm, right iliac
aneurysm, EVAR
Mr J, 76 y.o Aor&c aneurysm, EVAR
Mr M, 72 y.o Right Common Mr M, 73 y.o Abdominal
Iliac Aneurysm Aortic Aneurysm with frog
leg common iliac
Thank you!
Questions?