1. 1. By Prof/ gouda ellabban SUEZ CANAL INIVERSITY/ EGYPT WWW.SMSO.NET
2. 2. It is a dilatation of the arterial wall of at least 50% increase over normal arterial diameter . WWW.SMSO.NET
3. 3. CLASSIFICATIO N Site Shape Aetiology WWW.SMSO.NET
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6. 6. 95 % Infrarenal . 3-15 cm . Fusiform . Incidence 5-7 % Mean age 70 75 Y.O M : F 5 : 1 > white people WWW.SMSO.NET
7. 7. Age. Smoking . Family history . Other aneurysm. CAD. HPN. Occlusive disease RISK FACTORS WWW.SMSO.NET
8. 8. Multifactorial < Elastin. Proteolytic enzyme . Infection . WWW.SMSO.NET
9. 9. Asymptomatic Symptomatic Compression . Complication - Rupture - Emboli / occlusion - Fistula CLINICAL MANIFISTATION WWW.SMSO.NET
10. 10. V/S . Abdominal examination . Vascular examination WWW.SMSO.NET
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12. 12. Laboratory . Radiology . WWW.SMSO.NET
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21. 21. Larger aneurysms tend to enlarge at a higher rate, as noted by Bernstein (1984). Initial Size of AAA, cm Mean Growth Rate, cm/y 3 3.9 0.39 4 4.9 0.36 5 5.9 0.43 6 6.9 0.64 WWW.SMSO.NET
22. 22. EXPANSION RUPTURE -Aneurysm diameter . - HPN. - Pulse pressure . - smoking . - thrombus -Aneurysm diameter . - Expansion rate. - Diastolic BP . - smoking / Family history - Mural inflammationWWW.SMSO.NET
23. 23. Incidence of ruptured AAA in Sweden 0.06/1000 1986 . Annual rupture based on size Max. aneurysmal Diameter cm 5 years rupture rate % < 4 2 4 4.9 3-12 5 5.9 25 6 6.9 35 > 7 75 WWW.SMSO.NET
24. 24. A Japanese series of 97 cases of (Tanabe, 1993) : Right lateral wall - 28% Pelvic arteries - 22% Posterior wall - 19% Left lateral wall - 17% Anterior wall - 10% Suprarenal - 4% WWW.SMSO.NET
25. 25. In a series of 226 AAAs in Italy, bleeding occurred into the following regions (Miani, 1984): Retroperitoneal - 85.3% Peritoneal - 7.1% IVC or iliac vein - 5.8% Enteric - 1.8% WWW.SMSO.NET
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27. 27. Pain radiating to groin . Back pain . Partial UGI obstruction . LL ischemia . GI bleeding . CHF WWW.SMSO.NET
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30. 30. Screening Medical Surgical WWW.SMSO.NET
31. 31. The Rx of AAA depends on : Size of aneurysm. Perioperative risk . The risk of rupture must be weighed against perioperative morbidity. WWW.SMSO.NET
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33. 33. AIM To reduce the expansion rate and rupture risk. e.g Smoking cessation . Control hypertension . WWW.SMSO.NET
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35. 35. INDICATIONS (1) Documented rupture or suspected rupture. (2) Rapidly expanding aneurysm. >1 cm / 12 m (3) Aneurysms > 5 cm in diameter. (4) Complicated aneurysms (5) Atypical aneurysms. (6) Symptomatic . WWW.SMSO.NET
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37. 37. Most of the perioperative morbidity , mortality and death following surgery, is related to coronary artery disease. The incidence of fatal MI following elective surgical repair 4.7 % Non fatal myocardial infarction occurs in as many as 16 % WWW.SMSO.NET
38. 38. Non cardiac symptom Mild cardiac symptom Class III or IV angina AAA repair DPT or MUGA Coronary Angio Reconst. CAD Insignificant CAD CABG AAA repair -VE +VE WWW.SMSO.NET
39. 39. PRE OP PREP : Type and crossmatch blood. Antibiotics . Foley catheter , CVP and Swan- Ganz catheterization NGT . WWW.SMSO.NET
40. 40. INTRA OP : incision . Exposure . Clamping . IMA ligation . opening the wall . Prosthetc graft WWW.SMSO.NET
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42. 42. Death 1.8-5% in elective MI - 2-5% Renal insufficiency Colonic ischemia . Spinal cord ischemia WWW.SMSO.NET
43. 43. LATE COMPLICATION Aortoenteric fistula Retrograde ejaculation. Infected graft . WWW.SMSO.NET
44. 44. Groin infection < 5% Incisional hernia - 10-20% Bowel obstruction Amputation , Blue toe syndrome Lymphocele in groin 2% WWW.SMSO.NET
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46. 46. Diameter and length of the proximal neck of the aneurysm. Tortuosity of the aorta Anatomy of the iliac arteries . WWW.SMSO.NET
47. 47. Suitable for high risk patient LA / GA Small incision . less post op complication short hospital stay . WWW.SMSO.NET
48. 48. Local hematoma or bleeding Infection Incomplete repair leakage WWW.SMSO.NET
49. 49. TYPE I Periprosthetic TYPE II Retrograde flow TYPE III Graft defect / tear TYPE IV Fabric porosity WWW.SMSO.NET
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