腹主动脉瘤.ppt

AbdominalAorticAneurysmIntroductionAbdominalaorticaneurysms(AAAs)representadegenerativeprocessoftheabdominalaortaatherosclerosiselderlymen(peakincidenceaged70years).smoking,%,(Approximately25%)smokingcoronaryarterydiseasehypertension(1-15%)previousaneurysmrepairorperipheralaneurysm(popliteal25-50%orfemoral,)ClinicalmanifestationsAsymptomatic:anasymptomaticpulsatileabdominalmass(seefigure)pressionsymptom:duodenum,urinarytract,CBDClinicalmanifestationsFistulae:Aortoduodenal,lusion:lowerextremities(thebluetoesyndrome,seefigure),mesentericartery,renalarteryClinicalmanifestationsRupture:intraperitoneal,postperitonealtheriskfactorofrupture10-20%focaloutpouchingsorblebsTransienthypotensionTemporarylossofconsciousness>6-7cmindiameterPhysicalexaminationandradiologicstudies38%ofAAAcasesweredetectedbasedonphysicalexaminationfindings,while62%(seefig)icresonanceangiography(MRA)Angiography(seefig)EchocardiographyIndicationsandcontraindicationsIngeneral,AAAsgraduallyenlarge(-)andeventuallyruptureandpotentiallimbloss.<4cm,followuptherapywithUSevery6months;>4cm,electiverepair;6-7cm,thresholdforrepairThecontraindications:COPD,,VesaliusdescribedthefirstAAA,medicalmanagementfailed;In1923,Matas,essfulaorticligation;Inthesametime,inducethrombosisbyinsertingintraluminalwires;In1948,cellophanewrappingaroundtheaneurysminordertoinducefibrosisandlimitexpansion(AlbertEinsteinin1949);