Management of AAA Andrew Stanley, MD 2006

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Management of AAAAndrew Stanley, MD2006
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History

• HPI
• 73 yo woman presenting to vascular clinic for
  routine follow up for AAA. Last measured (6
  months prior) AAA size was 4.0cm. In clinic pt
  reports some recent back pain in last 2 weeks.
  Other than that pt is jogger and exercises
  avidly.
• PMH
• Hysterectomy
• HTN
• Meds
• HCTZ
• Cozaar
• ASA
• Shx-Never smoker/Retired accountant/clerical-type
  worker. Living independently with local family
• Fhx-no known AAA hx

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Physical

• P.E BP Rt-180/70 Lt (same)
• Neck-No carotid bruits
• Lungs-Clear
• Heart-Regular
• Abd-Tender RLQ with pulsatile mass
• Normal pulse exam.

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U/S shows growth from 4.0-5.5 cm in 6 months.
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• What to do?
• Back in 6 months
• Send for cardiolite/repair if possible in next
  1-2 months
• CT to R/O leak.

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What To Do/When To Do It

• CT-5.5 cm AAA with 4.5cm right common iliac AAA.
  No leak. Options include
• Fix in next 24 hours.
• Schedule follow up visit to discuss repair
  following cardiolite or ECHOcardiogram.

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GROWTH

• What is rapid rate of growth (for AAA)?
• What is average rate of growth (for AAA)?
• What is size at which iliac aneurysms are
  considered for repair?

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Had AAA repair with uneventful hospital course
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Follow-Up/Counseling Issues

• In clinic post-op---significant issues are
• Other possible locations for aneurysmal
  degeneration
• Familial counseling (AAA risk)
• Kids
• Sisters
• Brothers
• Any follow up imaging needed following open AAA
  repair in a 73yo woman?

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Summary

• Abdominal pain in presence of significant AAA
  (especially one that has demonstrated recent
  substantial growth) should be considered sign of
  impending rupture. In this setting it is uncommon
  to find good reason to rationalize any preop risk
  stratifying testing (cardiolite/PFT/labs) prior
  to repair. Urgent repair is the rule.