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SURGERY

Vascular

QuestionAnswer
Cause of AAA due to vessel wall weakness secondary to loss of collagen/elastin, may be from atherosclerosis
Most common location for AAA typically infrarenal
How are most AAA diagnosed? most asymptomatic & discovered on routine PE
Sx's of AAA Sx may include vague epigastric discomfort or back/abd pain
How would symptomatic AAA pt present? pt may present w. rupture (abd pain, pulsatile abd mass, hypotension)
What is a good way to clinically follow a AAA? U/S (easiest, least $), CT (accurate, expensive)
In a AAA, what do you use an A-gram for? looking for signs of lumen patency & iliac/renal involvement,
If pt has sx's of a AAA rupture, what imaging study do you do before going to the OR? None. Go directly to OR.
What kind of imaging do you do to see calcification in the wall of an aneurysm? KUB
AAA associated with which other types of aneurysms? thoracic aorta (4%), femoral (3%), popliteal (2%)
AAA also associated with which conditions? CAD, HTN, occlusive arterial dz
Indications for surgical AAA repair rupture, size (> 4-5cm), size increase (> 0.5cm/6mos), Sx from aneurysm
What is the surgical tx for AAA? IMA ligation, removal of thrombus through anterior wall, tube or bifurcation graft placed, wrap graft in native Ao
Risks of surgery for AAA MI & arrhythmias, atheroembolism, declamping, hypotension, acute renal failure, ureteral injury, hemorrhage, aortoenteric fistula, infxn, chylous ascites, colonic ischemia, stroke
Risks of not tx AAA 5 year survival rate of about 50% if < 6cm, 6% if > 6cm; rupture (75% mortality)
Benefits of AAA surgery Surgical repair doubles survival time for pts; elective operative mortality is 1-2%; emergent operative mortality is about 50% (w. 50% dying before getting to the hospital)
Created by: christinapham