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Aortic aneurysm- Abdominal aneurysm, management, prognosis, complications

ABDOMINAL ANEURYSM

CLINICAL FEATURES

The symptoms of rupture include

  • Pain in the abdomen or back — severe, sudden, persistent, or constant. The pain may radiate to the groin, buttocks, or legs.
  • Clammy skin
  • Nausea and vomiting
  • Tachycardia
  • Shock

INVESTIGATIONS

  • Abdominal examination also will include an evaluation of pulses in lower extremity.
  • A lump (mass) in the abdomen
  • Pulsating sensation in the abdomen
  • Stiff or rigid abdomen
  • CT scan of the abdomen
  • Ultrasound of the abdomen

 

MANAGEMENT

If any internal bleeding from an aortic aneurysm, open abdominal aortic aneurysm repair indicated.

If the aneurysm is small and there are no symptoms

  • Checking the size of the aneurysm with ultrasound tests every 6 months, to see if the aneurysm is getting bigger.

Surgery is usually recommended for patients who have aneurysms bigger than 2 inches (5.5 cm) across and aneurysms that are growing quickly.

The goal is to perform surgery before complications or symptoms develop.

There are two approaches to surgery

  • Traditional (open) repair : A large cut is made in abdomen. The abnormal vessel is replaced with a graft made of man-made material, such as Dacron.
  • Endovascular stent grafting: This procedure can be done without making a large cut in abdomen, If patient have certain other medical problems, this may be a safer approach. Endovascular repair is rarely done for a leaking or bleeding aneurysm

PROGNOSIS

The long-term prognosis for patients with thoracic aortic aneurysm is determined by other medical problems such as heart disease and diabetes, which may have caused or contributed to the condition.

The outcome is usually good if an experienced surgeon repairs the aneurysm before it ruptures. However, less than 80% of patients survive a ruptured abdominal aneurysm

COMPLICATIONS

Serious complications after thoracic aortic surgery can include:

  • Bleeding
  • Graft infection
  • Heart attack
  • Irregular heartbeat
  • Kidney damage
  • Paralysis
  • Stroke

Death soon after the operation occurs in 5 – 10% of patients.

Complications after aneurysm stenting include damage to the leg, which may require another operation.

When an abdominal aortic aneurysm ruptures, it is a true medical emergency. Aortic dissection occurs when the innermost lining of the artery tears and blood leaks into the wall of the artery. This most commonly occurs in the aorta within the chest.

Complications include

  • Arterial embolism
  • Heart attack
  • Hypovolemic shock
  • Kidney failure
  • Stroke

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