Vascular I Abdominal Aortic Aneurysm

SUGGESTED READINGS
VASCULAR I

Current Surgical Diagnosis & Treatment, 12th Edition, Ch. 34.

OBJECTIVES
VASCULAR I

1. Describe the common sites and relative incidence of atherosclerotic arterial aneurysm.
2. Outline the methods of diagnosis of an abdominal aortic aneurysm.
3. Differentiate between the terms “aortic dissection”, “leaking aneurysm”, and “ruptured aneurysm”.
4. Outline a management plan for a ruptured abdominal aortic aneurysm.
5. Discuss the indications and risk factors for surgery in an asymptomatic aneurysm.
6. Define and discuss the following complications of aneurysm surgery:

a. declamping shock
b. renal failure
c. ischemic colitis
d. aortoneteric fistula
e. graft infection

CASE HISTORIES
VASCULAR I

1. A 66-year old male presents to the clinic for a routine medical check-up. He has had no interval complaints over the past year. On abdominal examination he is noted to have a protuberant abdomen, but you think you can feel a prominent aortic pulsation. The remainder of his vascular examination is as follows:

2. A 75 year old female presents to the Emergency Department with new onset shortness of breath. She has a history of hypertension, GERD, and phlebitis in her lower extremities. She has had no significant surgeries. Her current medications include a beta-blocker, proton pump inhibitor and an aspirin daily.
On physical examination, she is noted to be quite dyspneic. Her blood pressure is 170/50 with a heart rate of 120. She is using accessory muscles to breath and there are bibasilar rales and JVD noted. Her abdominal exam demonstrates a flat abdomen and when you auscultate for bowel sounds you hear a harsh bruit in the abdomen.

3. A 50-year old male presents to the Emergency Department with complaints of severe chest and back pain that started early that day. He has a history of hypertension, but hasn’t been taking his medications because he can’t afford them. He was tolerating the chest/back pain, but became concerned when he began to develop right leg numbness. His blood pressure is 240/160 and he has a regular heart rate of 80. His pulse exam is as follows:

4. A 62-year old male presents to his primary care physician with complaints that the toes on his right foot are changing colors. He is a reformed smoker with a history of CAD with an MI 3 years ago, mild COPD and ED. He has had a right inguinal herniorrhaphy in the past. On physical examination he is normotensive with a heart rate of 65 bpm. He is noted to have bluish petechiae at his distal toes. There is no ulceration or gangrene. His pulse exam is as follows:

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