Abdominal Aortic Aneurysm: Management

by Kevin Pei, MD

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    00:01 Welcome back.

    00:02 Thanks for joining me on this discussion of abdominal aortic aneurysms in the section of vascular surgery.

    00:09 This is a particularly important topic.

    00:11 So, I hope you pay close attention.

    00:15 There are lots of risk factors for abdominal aortic aneurysms.

    00:18 We’ll call it AAA going forward.

    00:21 Smoking, remember the other vascular lectures? Smoking is a bad player in all vascular diseases.

    00:27 Certainly, there's a male preponderance.

    00:31 And as we get older, most of our abdominal aortic diameters actually enlarge a little bit, but not necessarily aneurysmic.

    00:40 High blood pressure and non-laminar flow.

    00:43 There is some suggestion of a family history and perhaps there's a genetic component, although we’re not exactly sure why.

    00:51 And history of any other peripheral aneurysms.

    00:55 This is true of all patients with aneurysms.

    00:58 As we say, once you have one aneurysm, you might have an aneurysm elsewhere, so you should have a high index of suspicion to look for other sites.

    01:08 And like many of the peripheral vascular diseases, history or the actual presence of coronary artery disease and other atherosclerotic sclerotic disease also, of course, puts you at risk for AAA.

    01:23 Here's a quick review of the normal anatomy.

    01:26 Take a look at the picture in the center of the screen.

    01:29 The red is actually the aorta.

    01:31 Remember, the aorta is to the left of the inferior vena cava.

    01:35 It's, of course, a little closer to the midline of your abdomen than the IVC.

    01:40 Also, clearly shown here are the superior and inferior mesenteric takeoffs.

    01:46 You also note very clearly the common bifurcation.

    01:50 Now, what’s the definition of an aortic aneurysm? In the infrarenal position, any aortic diameter greater than 3 cm.

    02:00 You might be a little surprised, 3 cm is not that large, and yet that aorta is responsible to be a conduit for supplying blood all over your body.

    02:11 This is considered a progressive dilation.

    02:14 Didn't happen overnight.

    02:16 And by the time it either becomes symptomatic or something that we’ve picked up, it's probably been many years in the making.

    02:23 Here in the diagram, you notice an aneurysmic sac.

    02:27 When you look at it compared to the normal anatomy to the left side, it’s clearly an aneurysm or a bulbous bulging of the vascular wall.

    02:37 As I previously described, we think of abdominal aortic aneurysms as multifactorial.

    02:44 There’s likely a genetic component because it does seem to run in some families.

    02:49 And there are pro-inflammatory mediators, hyperlipidemia, atherosclerotic plaques.

    02:56 And there are also biomechanical stressors on the arterial wall.

    03:01 These factors are particularly exacerbated by high blood pressure.

    About the Lecture

    The lecture Abdominal Aortic Aneurysm: Management by Kevin Pei, MD is from the course Special Surgery.

    Included Quiz Questions

    1. 5.5cm diameter of AAA.
    2. 6.5cm diameter of AAA.
    3. 4.5cm diameter of AAA.
    4. 4cm diameter of AAA.
    5. 6cm diameter of AAA.
    1. Men aged 45 with smoking history of >50 cigarettes per year, with no family history of AAA.
    2. Men aged 60-75 with smoking history of >100 cigarettes per year, with no family history of AAA.
    3. Men aged >70 with recent MI.
    4. Men aged 55-75 with a family history of AAA.
    5. Women aged 55-75 with smoking history of >100 cigarettes per year anda family history of AAA.

    Author of lecture Abdominal Aortic Aneurysm: Management

     Kevin Pei, MD

    Kevin Pei, MD

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