1. Management of AAA Andrew Stanley, MD 2006

2. History HPI 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. 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 PMH Hysterectomy Hysterectomy HTN HTN Meds Meds HCTZ HCTZ Cozaar Cozaar ASA ASA Shx-Never smoker/Retired accountant/clerical-type worker. Living independently with local family Shx-Never smoker/Retired accountant/clerical-type worker. Living independently with local family Fhx-no known AAA hx Fhx-no known AAA hx

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

6. U/S shows growth from 4.0-5.5 cm in 6 months.

7. What to do? What to do? Back in 6 months Back in 6 months Send for cardiolite/repair if possible in next 1-2 months Send for cardiolite/repair if possible in next 1-2 months CT to R/O leak. CT to R/O leak.

11. What To Do/When To Do It CT-5.5 cm AAA with 4.5cm right common iliac AAA. No leak. Options include CT-5.5 cm AAA with 4.5cm right common iliac AAA. No leak. Options include Fix in next 24 hours. Fix in next 24 hours. Schedule follow up visit to discuss repair following cardiolite or ECHOcardiogram. Schedule follow up visit to discuss repair following cardiolite or ECHOcardiogram.

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

13. Had AAA repair with uneventful hospital course

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

15. 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. 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.