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
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. 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. 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
26. WWW.SMSO.NET
27. Pain radiating to groin . Back pain . Partial UGI
obstruction . LL ischemia . GI bleeding . CHF WWW.SMSO.NET
28. WWW.SMSO.NET
29. WWW.SMSO.NET
30. Screening Medical Surgical WWW.SMSO.NET
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
32. WWW.SMSO.NET
33. AIM To reduce the expansion rate and rupture risk. e.g
Smoking cessation . Control hypertension . WWW.SMSO.NET
34. WWW.SMSO.NET
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
36. WWW.SMSO.NET
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. 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. PRE OP PREP : Type and crossmatch blood. Antibiotics .
Foley catheter , CVP and Swan- Ganz catheterization NGT .
WWW.SMSO.NET
40. INTRA OP : incision . Exposure . Clamping . IMA ligation .
opening the wall . Prosthetc graft WWW.SMSO.NET
41. WWW.SMSO.NET
42. Death 1.8-5% in elective MI - 2-5% Renal insufficiency
Colonic ischemia . Spinal cord ischemia WWW.SMSO.NET