Assessment of pulmonary function is of paramount importance in AAA patients. Because surgical intervention requires an abdominal incision, preoperative assessment of the patient’s pulmonary status allows postoperative care to be appropriately tailored to the patient’s condition.
Assessment of cardiac status is mandatory in all patients with vascular disease. If one vascular bed is involved with an atherosclerotic process, others may be involved as well. Electrocardiographic findings provide a baseline assessment of cardiac rhythm and old disease processes. A stress test can be performed to uncover unsuspected cardiac ischemia. Significant coronary disease may have to be addressed before the AAA can be repaired.
On histologic examination, AAAs contain a chronic inflammatory infiltrate and neovascularity of varying degrees. Inflammatory AAAs may contain germinal centers.
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Radiograph shows calcification of abdominal aorta. Left wall is clearly depicted and appears aneurysmal; however, right wall overlies spine.
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On radiography, lateral view clearly shows calcification of both walls of abdominal aortic aneurysm, allowing diagnosis to be made with certainty.
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CT demonstrates abdominal aortic aneurysm (AAA). Aneurysm was noted during workup for back pain, and CT was ordered after AAA was identified on radiography. No evidence of rupture is seen.
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Arteriography demonstrates infrarenal abdominal aortic aneurysm. This arteriogram was obtained in preparation for endovascular repair of aneurysm.
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Lateral arteriogram demonstrates infrarenal abdominal aortic aneurysm. Demonstration of superior mesenteric artery, inferior mesenteric artery, and celiac artery on lateral arteriogram is important for complete evaluation of extent of aneurysm.
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Arteriogram after successful endovascular repair of abdominal aortic aneurysm.
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Ultrasonogram from patient with abdominal aortic aneurysm (AAA). This aneurysm was best visualized on transverse or axial image. Patient underwent conventional AAA repair.
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MRI of 77-year-old man with leg pain believed to be secondary to degenerative disk disease. During evaluation, abdominal aortic aneurysm was discovered.
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Age is risk factor for development of aneurysm.
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Inflammation, thinning of media, and marked loss of elastin.
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Pulsatile abdominal mass.
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Aneurysm with retroperitoneal fibrosis and adhesion of duodenum.
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Aortic endoprosthesis (Cook aortic and aortobi-iliac endograft).
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Endoaneurysmorrhaphy
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Endovascular grafts.
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Atheroemboli from small abdominal aortic aneurysms produce livedo reticularis of feet (ie, blue toe syndrome).
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Enhanced spiral CT scans with multiplanar reconstruction and CT angiogram.
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Angiography is used to diagnose renal area. In this instance, endoleak represented continued pressurization of sac.
