Abstract: . . .  assess character, thickness of the aortic wall - visualization of the renal and iliac arteries MRI, Arteriograms also used Page 42 Treatment of an AAA Medical management for aneurysms 4cm or < Monitor and treat HTN - U/S to watch growth Safer bet for older folks, history of CVA or CAD >6cm resected unless co-morbidity precludes Mortality - elective repair - 3-5% Increased risk with CAD - CABG first? Indication for surgery: relieve pain, p/v rupture, prolong life Page 43 Cardiac Risk 5 clinical risk factors for vascular surgery - Age >70, diabetes, angina, Q-waves on the ECG, presence of ventricular ectopy With 3 or more risk factors, post-op cardiac event rate 25% 50% of AAA patients have suspected or overt CAD - reduced long term survival after surgery MI accounts for 50% of post-op and late deaths Page 44 Rupture AAA Patients present with acute abdominal pain or severe back or flank pain OR Stat! Mortality rate 15-75% depending on patient status, type of rupture, surgical team experience and delay in controlling hemorrhage Page 45 Abdominal . . .
. . .  Aorta Abdominal Aortic Aneurysms Thoracic Aortic Aneurysms Aortic Dissection Page 26 Layers of a Blood Vessel Tunica intima - innermost layer - made of endothelial cells Tunica Media - middle layer - muscle Tunica Adventitia - Outermost layer - strong and elastic Page 27 Up close and Personal Normally, all three layers of the vessel are intact and lay up against each other Provide a supportive conduit for blood flow through the body Disrupted when the integrity of the vessel is compromised Page 28 Causes of Aortic Disease & Injury 90% - history of hypertension Atherosclerotic changes in the thoracic and abdominal aorta Degenerative processes - aging Blunt trauma, deceleration injury Pregnancy Iatrogenic injury Syphilis or other infections of the arterial wall Cystic Medial Necrosis (Marfans Syndrome) Page 29 What is.. An aneurysm - a localized dilatation of the arterial wall > 1.5X its normal diameter Caused by a defect or weakening in the vessel wall Changes the vessel shape and blood flow Page 30  . . .
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