AAA : abdominal aorta aneurysm

 

#Define

localized enlargement of the abdominal aorta such that the diameter is greater than 3cm or more than 50% larger than normal(2~2.5cm)

 

#Cause/high risk

over 50 years old, men, family history

smoking, high blood pressure, heart or vessel disease

connective tissue disease

 

#OP indication

>5.5cm in males, >5.0cm in female

symptomatic AAA

Rapid increase in size (over 1cm per year)

 

#Signs and symptoms

usually asymptomatic, but as expand, they may become painful in the abdomen or chest, lower back, scrotum

palpable, pulsatile mass

 

**Aortic rupture

severe pain in the lower back, flank, abdomen

bleeding can lead to a hypovolemic shock

 

#Management

1) Conservative

2) Surgery

https://www.youtube.com/watch?v=PZlSEpedPn0

3) EVAR

https://www.youtube.com/watch?v=XJTp2wLZvCc

 

#Complication

-Cardio complication(MI, HF, arrythmia)

-AAA rupture

-thrombos, bleeding, infection, arterial occlusion

-wide incision (cause aorta must be clamping while operation, large enough incision for the fastest repair)

-Endoleaks (Five thypes)

 

#Endoleaks type

Type I - Perigraft leakage at proximal or distal graft attachment sites (near the renal and iliac arteries)

Type II - Retrograde flow to the aneurysm sac from branches such as the lumbar and inferior mesenteric arteries. Type II endoleaks are the most common, and least serious type of endoleak. Type II endoleaks do not require immediate treatment, as a portion will resolve spontaneously.

Type III - Leakage between overlapping parts of the stent (i.e., connection between overlapping components) or rupture through graft material.

Type IV - Leakage through the graft wall due to the quality (porosity) of the graft material. Seen in first-generation grafts, changes in graft material in modern devices have decreased the prevalence of type IV leaks.

Type V - Expansion of the aneurysm sac without an identifiable leak. Also called "endotension".

 

Type I and III leaks are considered high-pressure leaks and are more concerning than other leak types. Depending on the aortic anatomy, they may require further intervention to treat. Type 2 leaks are common and often can be left untreated unless the aneurysm sac continues to expand after EVAR