1. Abdominal Aortic Aneurysm Bryan Imayanagita UCI T-RAP 2/2/11

2. Background Aka: AAA Aka: AAA Aneurysm: swelling/dilation Aneurysm: swelling/dilation Most common in men over 60. smoking increases risk Most common in men over 60. smoking increases risk Rupture most dangerous complication Rupture most dangerous complication

3. Pathophysiology Degredation of tuncia media Degredation of tuncia media Metalloproteinases destroy elastin making aortic wall more susceptible to change in BP Metalloproteinases destroy elastin making aortic wall more susceptible to change in BP Abdominal aorta contains less elastin compared with the thoractic aorta; higher chance in abdomen for aneurysm Abdominal aorta contains less elastin compared with the thoractic aorta; higher chance in abdomen for aneurysm Age causes decline in elastin Age causes decline in elastin 90% infrarenally 90% infrarenally

5. Causes Smoking Smoking Atherosclerosis Atherosclerosis Heredity Heredity Hypertension Hypertension High cholesterol High cholesterol Trauma Trauma

7. Symptoms Often asymptomatic Often asymptomatic Can manifest as back, abdomen, groin pain Can manifest as back, abdomen, groin pain Palpable abdominal mass upon examination Palpable abdominal mass upon examination

8. Diagnosis Physical examination Physical examination CT/Ultrasound CT/Ultrasound MRI and Angiography used less often MRI and Angiography used less often

10. Treatment Conservative: Conservative: Surgery more risky Surgery more risky Lifestyle changes: cholesterol meds, stop smoking, etc. Lifestyle changes: cholesterol meds, stop smoking, etc. Surgical: Surgical: Endovascular stent insertion Endovascular stent insertion Open surgery Open surgery

11. Stent Insertion

12. Open Repair

13. Prognosis s/p mortality 40% for ruptured AAA s/p mortality 40% for ruptured AAA Pre-rupture surgery: 1-6% Pre-rupture surgery: 1-6%

14. Sources http://my.clevelandclinic.org/disorders/aneurys ms/hic_abdominal_aortic_aneurysm.aspx http://my.clevelandclinic.org/disorders/aneurys ms/hic_abdominal_aortic_aneurysm.aspx http://my.clevelandclinic.org/disorders/aneurys ms/hic_abdominal_aortic_aneurysm.aspx http://my.clevelandclinic.org/disorders/aneurys ms/hic_abdominal_aortic_aneurysm.aspx http://emedicine.medscape.com/article/463354 -overview http://emedicine.medscape.com/article/463354 -overview http://emedicine.medscape.com/article/463354 -overview http://emedicine.medscape.com/article/463354 -overview http://www.mayoclinic.org/aortic-aneurysm/ http://www.mayoclinic.org/aortic-aneurysm/ http://www.mayoclinic.org/aortic-aneurysm/ http://www.nlm.nih.gov/medlineplus/ency/arti cle/000162.htm http://www.nlm.nih.gov/medlineplus/ency/arti cle/000162.htm