Endovascular Surgery using Stent Grafts
Endovascular Surgery using Stent Grafts is being performed for thoracic and abdominal aortic aneurysms. This is a combination approach, which allows for a minimally invasive alternative to open surgical reconstruction.
Abdominal Aortic Aneurysm (AAA)
General Information
- Aortic aneurysm is a leading cause of death in the US (#9 for men and #13 for all Americans)
- Defined as a focal dilation of >50% of normal expected diameter (>3 cm for most people)
- Risk factors include: smoking, male gender, age > 60, hypertension and family history
- Often there are no symptoms, but may present with abdominal pain or pulsating mass
- Approximately 5% of men > age 65 have abdominal aortic aneurysms
Diagnostic Tests To Consider
- Ultrasound - best noninvasive test for screening and serial measurement of aneurysms
- CT scan with IV contrast (request protocol for AAA evaluation) or MRI/MRA may be indicated if ultrasound is technically limited, or if the aneurysm extends above the renal arteries
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Indications for Abdominal Aorta Ultrasound:
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Diagnostic Evaluation for an Abdominal Aortic Aneurysm
- Palpable/pulsatile abdominal mass
- Unexplained lower back pain, flank pain, or abdominal pain
- Follow-up of a previously demonstrated abdominal aortic aneurysm
- Follow-up of patients with an abdominal aortic and/or iliac stent graft
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Screening Evaluation for an Abdominal Aortic Aneurysm
- Patients > age 50 with a first-degree relative with AAA
- Males age 65-75 who are current or previous smokers
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Diagnostic Evaluation for an Abdominal Aortic Aneurysm
Management of Patients With AAA
- Smoking cessation and blood pressure control (< 130/85) may reduce risk of AAA growth
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Size of AAA: (Aneurysm diameter is the most important factor associated with rupture risk)
- Diameter 3.0-4.5 cm: Abdominal ultrasound every 6 months to 1 year
- Diameter > 4.5 cm: Refer to vascular specialist for further management