Abdominal Aorta Aneurysm Case Study - SDMS

Abdominal Aorta Aneurysm Case Study

Patient History

? 71-year-old male ? Previous smoker

Model

? Asymptomatic

? Bounding mass in abdomen upon physical exam

Lung Cancer Screening

? Ages 55-88 ? Prior smokers

? Quit within the last 15 years ? No signs and symptoms of lung cancer

Chest CT

? Ascending Aorta measured 4.1 cm ? Possible aortic aneurysm ? Coronary artery calcifications seen

Ascending Aorta Aneurysm on CT

Diagnosis and Management

? Patient is taken for Ultrasound AAA scan ? Ultrasound findings lead to abdominal CT ? Distal abdominal aorta measured >7 cm on

Ultrasound and CT

Size 2-3 cm 3-3.9 cm 4-4.9 cm > 5.0 cm

Management Normal

Repeat US every 3 years Annual Ultrasounds Surgical Repair

(Avishay & Reimon, 2020)

Ultrasound

CT

CT or Ultrasound?

Advantages

Disadvantages

Reproducible

Risk of carcinogenesis

Can identify pathology Risk of renal damage in obese patients

Rapid acquisition of images

Allergic reactions to imaging contrast

Can distinguish

Higher Cost

between endoleak types

Advantages

Disadvantages

Non-invasive

Sonographer dependent

Relatively inexpensive Smaller/deep vessels may be hard to visualize

More readily available Near field obstructions to ultrasound beam

No exposure contrast or Unable to differentiate

radiation

between endoleak types

Measurement of Left CIA, on CT and Ultrasound. ? CT measured the Left CIA at 40 mm ? First measurement (blue line) with ultrasound measured the

Left CIA at 2.01 cm ? Second measurement (red line) with ultrasound correlates

closer with the CT measurement at 4.01 cm

Intervention

? Endovascular repair (EVAR) of aortic + bilateral CIA aneurysms

? Immediately post intervention: ? No sign of endoleaks ? Right PTA/DPA pulses palpable ? Left ATA/PTA pulses palpable

Transverse view of the main body of an endograft (inner ring) and the aneurysm sac (outer ring)

Indirect arterial study showing normal pressures and waveforms were gathered

References

1. Avishay, D. & Reimon, J. (2020). Abdominal Aortic Repair. Stats Pearl Publishing. Treasure Island.

2. Basnyat, P. S., Aiono, S., Warsi, A. A., Magee, T. R., Galland, R. B.,& Leis, M.H. (2003). Natural history of the ectatic aorta. Retrieved from

3. Devaraj, S., & Dodds, S. R. (2008, September). Ultrasound surveillance of ectatic abdominal aortas. Retrieved from

4. Franca, G.J., BaronRcinei,fLe.rAe.nV.c, Oelsiveira, A. D., Vidal, E. A.,

Miyamotto, M., Toregeani, J.F., ... Timi, J. R. R. (2013). Evaluation with Doppler vascular ultrasound in posteperative endovascular treatment of abdominal aortic aneurysm: a prospective comparative study with angiotomography. Journal Vascular Brasileiro. 12(2), 102109. doi: 10.1590/s1677-54492013000200003

5. N.A. (2017, April 15). Duplex Assessment of Aortic Endografts. Retrieved from

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