Abdominal Aortic Aneurysm

Case: You are in a hospital setting and working as an HMO where you have to discuss with the son of a man who had
undergone a recent laparatomy for abdominal aortic aneurysm. He is currently in the ICU and is now on assisted ventilation.
Specialist decides to extubate him tomorrow. Patient gave consent before surgery to discuss the condition and progress with
family members.

Task
a. Discuss current situation
b. Answer sons questions

- What is wrong with my father? Why is he admitted to ICU? Can you explain how come he has no illness and he
underwent a major operation suddenly? Am I going to have this condition? What are my chances?

Case 2: An elderly man came to visit you again after youve organized an urgent abdominal ultrasound. The ultrasound was
organized at the first visit after you detected a pulsatile mass on his abdomen. He came back after the usd confirmed an
aneurysm on the abdominal aorta below the renal arteries with a size >5cm. He came to check the situation and he is planning to
go on a wagon caravan trip next week.

Task
a. Explain the diagnosis
b. Advise further management
c. Explain consequences and answer his questions

Questions:
- Is it a serious condition? Can I go for my trip then go to the operation afterwards? What is the risk and percent of death
if surgery is done and not done at all? What happens if it ruptures? How successful is the elective surgery?

Case 1
- I know you are here to discuss your fathers condition and he gave his permission to discuss it. First of all your father
was diagnosed with a not uncommon condition called AAA which is an abnormal dilation of the main blood vessel in
our body which comes from the heart and crosses the chest, abdomen, and supplies almost every part of the body with
blood, known as aorta. Your father has this dilatation at the level of his tummy and he developed this dilatation due to
weakness in the wall of this vessel which happens due to a degenerative process happening in all layers of the aortic
wall.
- The lining of the aorta is the endothelial layer and this is damaged by various triggers: smoking, hypertension, fats
leading to damage or injury of the wall which in turn leads to certain enzymes (chemicals) causing weakness and
dilatation of the wall causing aneurysm. (DRAW).
- Let me assure you that your father currently is in the ICU which is the place for patients who had major operation and
its routine where there is need to give 1:1 monitoring and advanced support for breathing, fluid and heart functions as
major operations can affect these systems. Your father had an elective surgery to correct this lesion by repair. Having
said that, the outcome of this operation is mostly good with 95% success and less risk. If left untreated or patient did
not proceed with the operation, they carry a risk of rupture by about 25% with increased mortality to 80-90%.
- The specialist has decided to remove the assisted ventilation/breathing tube and reassess or observe him for 1-2 days
and if he is stable, he will be put in the ward and once fully stable, he will be sent home and given painkillers and blood
thinner to prevent DVT (clotting of veins of the body), which is a common complication.
- He will be referred for rehabilitation to rehabilitate him back to normal. Is everything clear?
- Offer/organize specialist review if patient is concerned.
- AAA is a common condition in older males especially with a family history and it would be reasonable for you to have
regular examination and investigation from 50 onwards and work on reducing risk factors for developing the condition:
smoking, high blood pressure, diabetes mellitus, hyperlipidemia.
- Operations: open repair with endoluminal stenting and graft repair.

Case 2
- Are you alone today? Do you need somebody to be with us? I am afraid that I have bad news. The ultrasound which
was done showed that you have a not uncommon condition for your age but it is a serious condition.
- I am concerned because of the size. When it is more than 5cm, you are at risk of rupture of aneurysm. Do you have
any back pain or tummy pain at the moment? Even if you dont have any serious symptoms, I would like to refer you
ASAP for an elective surgery done by the vascular surgeon at the hospital the sooner the better as this condition is
serious. And I am sorry to say that you will have to reschedule your caravan. If it is done electively, success rate is
95%. If operation is delayed, the risk of rupture is 25%, but if ruptured, 80-90% of cases lead to death. It is a better
outcome if an elective operation is done ASAP.