1. Abdominal Aortic Aneurysm Case Study By Lisa Erwert

2. Patient History 70 year old male Smoker High blood pressure CABG Cholecystectomy Inguinal Hernia Repair Abdominal Aortic Aneurysm (AAA)

3. About AAAs What is AAA? Are AAAs deadly? Why are AAAs known as the silent killer? Where are they located? Who’s at risk? www.vascularsociety.org.uk

4. Anatomy of Abdominal Cavity www.vascularsociety.org.uk

5. Anatomy on CT

6. Recent History 10/28/05 Ultrasound 8/28/06 CT of abdomen and pelvis 11/16/06 Endovascular Stent Graft placement 12/15/06 Follow-up CT of abdomen/pelvis

7. Incidental Finding on Ultrasound AAA measuring 5.8 x 5.8 cm Proximal aorta - 2.4 x 2.3 cm Mid-abdominal - 2.3 x 2.4 cm R & L common iliac arteries - 1.2 cm

8. Confirmation CT 8/28/06 Abdomen/Pelvis CT Non-contrast 5mm axial images 100 cc of Ultravist 2 mm axial images in arterial

9. CT Findings Cysts in left kidney

10. Additional Findings Normal renal arteries L & R renal veins AAA measuring 6.7 x 6.7cm L common iliac measuring 2.6 x 2.7 cm R common iliac measuring 2.0 x 2.4 cm

11. CTs of AAA

12. CT Angiograms (CTAs)

13. Endovascular Stent Graft (Endograft) Procedure 11/16/06 Prep Incision Placement of vascular sheath and pigtail Performed aortogram

14. Stent Graft Components Constructed of ePTFE Nitinol Support structure Pencil size in diameter Internally relines aorta Inserted by catheter 80-90% success rate Quicker recovery rate www.angioplasty-vir.com

15. Endograft Procedure cont. Right sheath exchange Deployment of stent graft Left sheath exchange Deployment of Contralateral stent graft Angioplasty Removal of catheters and wires

16. Post-deployment of graft Successful placement of graft Visible endoleak

17. Follow-up CT 12/15/06 Abdomen / Pelvis 5mm axial / non-contrast 100cc Ultravist 2mm delayed images

18. CT Unchanged AAA Unchanged common iliac arteris No evidence of endoleak

19. Post CTAs

20. Patient Prognosis Constant Observation Possible further operations in future

21. References Abdominal Aortic Aneurysm. Retrieved January 4, 2007, http://www.med.umich.edu/. http://www.med.umich.edu/ Endovascular Stent Graft for Abdominal Aortic Aneurysms. Retrieved January 22, 2007,from http://www.vascularweb.org /Endovascular_Stent_Graft.html Mosquera, Damien BSc MB ChB FRCS FRACS MD; © 2002 D Mosquera Ltd, www.vascular.co.nz.www.vascular.co.nz Netter, Frank H., Hansen, John T. (2001). Atlas of Human Anatomy. Nowygrod R, Egorova N, Greco G et al. Trends, complications, and mortality in peripheral vascular surgery. J Vasc Surg 2006; 43: 205-216.