Week 1 – Case 1
64 years old male patient has been referred to your vascular clinic from the spine clinic. He had MRI spine for chronic back pain which showed that he has 4.8 cm infra renal AAA. Please answer the following questions.
1- Please indicate How would you approach his history?
2- How would you perform clinical examination?
3- what investigation would you request?
4- What is your treatment plan?
5- what is the risk of rupture in this patient?
6- What would be the indication for intervention in his case?
7- Could you please mention at least one level 1 evidence that has been used to indicate the threshold for intervention?
Please make your answer as short and direct as possible
1.history shuold include other Risk factors such as : ( smoking , chronic diseases , hyperlipidemia , weight,
work & lifestyle , family history)
2.Abdomila Examinatin ( lax ? < tender swelling ?..)
ful vascular examination to role out co existing peripheral aneurysms.
3.CTA
base blood tesets , lipid profile .
cardiac assessment echo
4.conservative treatment , patient will put on best medical ttt : (antiplatlets& Statins)
and controle any HTN or coexisting chronic diseases.
5.Risk of Rupture in This case is less than 2%
6.Abdominal symptoms, sudden collapse ,Hypotension.
7.
ESVS Guidelines: Level 1 evidence the threshold for considering elective abdominal aortic aneurysm repair is recommended to be equal or more 5.5cm
1. Detailed history delineating risk factors such as smoking, dyslipidemia, family history, co-morbidities
2. Abdominal exam to feel for a pulsatile mass, full Vascular exam especially femoral and distal pulsations. Feel for associated anneurysms including femoral/popliteal.
3. Orded a CTA of abdominal aorta, branches, iliacs and both lower limbs
4. After cta confirming size, i would screen with bi-annual u/s documenting max. diameter, offer intervention after it reaches 5.5 cm.
6. A max diameter more than 5.5 cm on screening, an increase of diameter more than 0.5 cm /year.. or becoming symptomatic.
1.history shuold include other Risk factors such as : ( smoking , chronic diseases , hyperlipidemia , weight)
work & lifestyle , family history.
2.Abdomila Examinatin ( lax ? < tender swelling ?..)
ful vascular examination to role out co existing peripheral aneurysms.
3.CTA (gold standard for diagnosis)
base blood tesets , lipid profile .
cardiac assessment (EKG,ECHO,..)
4.conservative treatment , patien will put on best medical ttt : (antiplatlets& Statins)
and controle any HTN or coexisting chronic diseases.
5.Risk of Rupture in This case is less than 2%
6.Abdominal symptoms, sudden collapse ,Hypotention.
7.
Answer 1
personal history including age, comorbidities (DM, HTN, hyperlipidemia, COPD and other vascular diseases), smoking history, and family history most important issue
Answer 2
local examination for the aneurysm abdominal examination pulsating swelling prominent in thin people, tender or not , pressure manifestation but most of these aneurysms are asymptomatic. general examination of the patient and vascular examination very high coincidence bet AAA and peripheral aneurysm e.g pop aneurysm
Q3: routine lab test
CBC , s. Creat , lipid profile
Aortid duplex every 6 months
Q4: conservative ttt , no medication can be taken to decrease size of aneurysm but decrease cardiovascular risk factors
Cessation of smoking
Control diabetic status
Antihyperlipidemic
Anti platelet
Doing US every 6 months
Very rare to rupture less than 2%per annum
Q5: 2.2%
Q6: if its a leaking AAA presenting by back pain or its causing pressure atrophy to the spinal column causing back pain (symptomatic AAA) or sacular aneurysm or increase during follow up more than 1 Cm per annum
Q7: According to ESVS Guidelines: Level 1 evidence : the threshold for considering elective abdominal aortic aneurysm repair is recommended to be equal or more 5.5cm
All answers in the uploaded image
1. Approach his history by : personal and occupational history, history of current illness, family history of 1st degree relatives who had same symptoms or diagnosed as AAA .
2. Clinical examination in the form of full vascular examination to exclude pop artery aneurysm.. and exclude that the aneurysm is not tender on palpation.
3. Investigations : baseline blood tests including lipid profile… And U/S
4. Treatment plan : conservative ttt by cardiovascular risk factors management with regular follow up / year by routine U/S
5. Rupture rate :less than 2 %
6. Indication for intervention: if increase in diameter > 1cm / y
7.
Q1 personal history should include age, comorbidities (DM, HTN, hyperlipidemia, COPD and other vascular diseases), smoking history, asking about the pain (onset and character) and family history
Q2:if there is any suspicion of being a leaking AAA especially with the existed back pain i will avoid local examination for the aneurysm fearing of its rapture. I will done a general examination of the patient and vascular examination (peripheral pulses especially popliteal artery)
Q3: CBC to check the Hemoglobin level and serum creatinine to do a thin-slice contrast-enhanced arterial-phase CT angiography
Q4: if the investigation showed that the AAA is leaking, ruptured or causing pressure atrophy to the vertebral column causing the pain an urgent intervention must be done.
But if the AAA is stable and its not the cause of the back pain it will considered asymptomatic AAA for conservative treatment and follow up
Q5: 0.5-1.5%
Q6: if its a leaking AAA presenting by back pain or its causing pressure atrophy to the spinal column causing back pain (symptomatic AAA) or sacular aneurysm or increase during follow up more than 1cm
Q7: According to ESVS Guidelines: Level 1 evidence : the threshold for considering elective abdominal aortic aneurysm repair is recommended to be equal or more 5.5cm
Q1: personal history should include age, comorbidities (DM, HTN, hyperlipidemia, COPD and other vascular diseases), smoking history, asking about the pain (onset and character) and family history
Q2:if there is any suspicion of being a leaking AAA especially with the existed back pain i will avoid local examination for the aneurysm fearing of its rapture. I will done a general examination of the patient and vascular examination (peripheral pulses especially popliteal artery)
Q3: CBC to check the Hemoglobin level and serum creatinine to do a thin-slice contrast-enhanced arterial-phase CT angiography
Q4: if the investigation showed that the AAA is leaking, ruptured or causing pressure atrophy to the vertebral column causing the pain an urgent intervention must be done.
But if the AAA is stable and its not the cause of the back pain it will considered asymptomatic AAA for conservative treatment and follow up
Q5: 0.5-1.5%
Q6: if its a leaking AAA presenting by back pain or its causing pressure atrophy to the spinal column causing back pain (symptomatic AAA)
Q7: According to ESVS Guidelines: Level 1 evidence : the threshold for considering elective abdominal aortic aneurysm repair is recommended to be + or = 5.5 diameter”.
Q1: The history should include existence of all risk factors ( smoking, HTN, DM hyperlipidemia etc.). Onset, duration, character and radiation of his back pain. History of other vascular diseases symptoms (stroke, PAD etc.). History of other body systems disorders. Patient lifestyle and daily activity. Family history.
Q2: General examination of the patient to assess general patient appearance and fitness, vital signs, and systemic examination of patient (neurologic, cardiovascular, pulmonary etc.) Then, local examination of the abdomen to evaluate presence of mass, tenderness, murmurs etc. Finally, complete vascular examination of all peripheral pulses, peripheral aneurysms (e.g. popliteal AA) and other signs of limb ischemia ( color, temperature, motor and sensory function, skin changes etc.)
Q3: Blood tests ( CBC, kidney function tests, coagulation profile, liver function tests, albumin level, lipid profile, blood group…). if not contraindicated CT angiography (thin cuts 1mm) of the whole Aorta, Iliac arteries and both femoropopliteal arteries for intervention planning as well as detection of any leak or rupture. cardiopulmonary investigation ( ECG, ECHO, coronary angiography, Pulmonary function tests).
Q4: Treatment plan starts with optimization of cardiac and pulmonary functions. prepare patient for intervention in terms of discussion the condition and available options for treatment. Risks and possible complications and outcome of intervention. Stop smoking, DM control, BP control, antiplatelet, Statin and pain management.
Q5: the risk of rupture in this patient is from .5 to 1.5%
Q6: Aortic aneurysm associated with back pain is considered symptomatic aneurysm and is an indication for intervention regardless the size.
Q7: According NICE guidelines 2020; consider aneurysm repair for people with an unruptured abdominal aortic aneurysm (AAA), if it is:
Filardo G, Powell JT, Martinez MA, Ballard DJ (2015). Surgery for small asymptomatic abdominal aortic aneurysms. Cochrane Database Syst Rev. Feb;4:CD001835
participants (ADAM, CAESAR, PIVOTAL, UKSAT)
Thanks Ahmed, Really good answer regarding Q1 focusing on the back pain presentation.
could you please explain to me Q6 answer? what is the evidence to support this?
If the abdominal examination didn’t show any tenderness and MRI spine showing degenerative changes in lumber spine. Would that change your investigation and treatment plan?
Actually I proposed that it is symptomatic as the referral from spine clinic doesn’t include any comment on spine pathology.
Of course if the pain is related to degenerative changes in lumber spine with negative clinical examination I would change my management plan starting by US scan instead of CTA to confirm measurement ( inner to inner AP diameter). And treatment to be conservative as mentioned before and surveillance by US scan every 3-6 months according to ESVS guidelines
Regards
Based on European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines
Q3 :
Regarding to investigation of this case:
We should start with base line lab test, mainly lipid profile.
Radiologically, patient should undergo abdominal us to confirm AP diameter.
If US confirm the same measure, CT aortogram is not needed as aneurysm diameter not reach threshold for elective repair.
Q5
As the aneurysm diameter < 5.5 cm, risk of rupture is very low ranging between 0.3 and 0.8% per year.
Lederle FA, Wilson SE, Johnson GR, Reinke DB, Littooy FN, Acher CW, et al. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med 2002;346: 1437-44.
Powell JT, Brown LC, Forbes JF, Fowkes FG, Greenhalgh RM, Ruckley CV, et al. Final 12-year follow-up of surgery versus surveillance in the UK Small Aneurysm Trial. Br J Surg 2007;94: 702-8.
Cao P, De Rango P, Verzini F, Parlani G, Romano L, Cieri E. Comparison of surveillance versus aortic endografting for small aneurysm repair (CAESAR): results from a randomised trial. Eur J Vasc Endovasc Surg 2011;41:13-25.
Ouriel K, Clair DG, Kent KC, Zarins CK. Endovascular repair compared with surveillance for patients with small abdominal aortic aneurysms. J Vasc Surg 2010;51:1081-7.
..
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Thank you so much for this answer Ahmed.
This is the star answer for Q3. well done.
Well done on Q3 answer, well spotted
1- asking of history of chronic diseases as cardiac, renal, liver problems , cigarette smoking, family history.
2- exam vital signs , distal pulses, searching for popliteal or femoral aneurysm, abdominal exam , assessment of general condition
3- CT angio thoracic, abdominal aorta, L.Ls arteries 1 mm cut, echo, chest x ray, abd. U/S , full labs.
4- conservative and follow up U/S / 6 m
5- 9.5%
6- if increasing more than 0.5 cm/ 6 months or > 1 cm/ 1 y or if there is mural thrombus with distal embolism or complicated by leakage or rupture
7- Ultrasonography is recommended for aneurysm surveillance; every three years for aneurysms 3-3.9 cm in diameter, annually for aneurysms 4.0-4.9 cm, and every 3-6 month for aneurysms ≥ 5.0 cm.
ESVS Level IB
5- rupture risk 0.5- 1%
Thanks Mohamed,
Could you review your answer for Q4 based on the answer you gave for Q7.
I agree with you regarding the conservative treatment, However, what is the indication for CTA ?
To confirm accurate size of aneurysm and to search for another thoracic aortic aneurysm of popliteal aneurysm
Thanks Mohamed,
Can you please provide evidence for this practice or guideline recommendation that support your answer?
Are other causes of back pain excluded to consider this as symptomatic aneurysm? I would consult spine surgeon before suggesting any treatment plan
Thanks Ahmed,
This is correct, chronic back pain is mostly due to spinal pathology. His MRI showed degenerative spine disease. His aneurysm is asymptomatic.
How would you procced with management?
Then for
1.medical treatment (antiplatlet,statin)
2. Control risk factors especially smoking and hypertension
3. Follow up ct after 6 monthes if there is increase 0.5 cm then for intervention
Good structured approach
Answer Q6:
The NICE guidelines 2020 suggest intervention for:
1- Symptomatic AAA.
2- Asymptomatic AAA > 4.0 cm with rapid growth (>1 cm/year on US).
3- Asymptomatic AAA ≥ 5.5 cm (US, inner-to-inner diameter).
https://www.nice.org.uk/guidance/ng156
Thanks Saeed, very clear answer.
Q6: According to the European Society of Vascular Surgery, the management of AAA depends on the size of the aneurysm.
F.L. Moll, J.T. Powell, et al, Management of Abdominal Aortic Aneurysms Clinical Practice Guidelines of the European Society for Vascular Surgery, European Journal of Vascular and Endovascular Surgery, Volume 41, Supplement 1,2011, S1-S58, ISSN 1078-5884,https://doi.org/10.1016/j.ejvs.2010.09.011.
Q5: According to the European Society of Vascular Surgery, the risk of rupture = is 1 %
F.L. Moll, J.T. Powell, et al, Management of Abdominal Aortic Aneurysms Clinical Practice Guidelines of the European Society for Vascular Surgery, European Journal of Vascular and Endovascular Surgery, Volume 41, Supplement 1,2011, S1-S58, ISSN 1078-5884,https://doi.org/10.1016/j.ejvs.2010.09.011.
Thanks Eslam, Could you please comment on Q3 and Q4?
Q3) investigation:
labs: CBC, Coagulation profile, lipid profile, ECG, ECHO, lung function test, Renal function test, liver function test, Albumin level.
imaging: Abdomino-pelvic ultrasound then according to the size of aneurysm, survillence plan will be done.
Good answer
Q1: I would ask about any medical problems like DM, HTN, cardiac condition, Neurological, lung, renal and hepatic history.
Also, ask about age and +ve family history.
Habits (Smoking and Alcohol).
Q2: I would do full vascular examination and to search for other arterial aneurysms especially popliteal artery aneurysm.
Also, I will perform abdominal examination (pulsatile mass and tenderness to exclude sings of ruptured AAA).
Q3: I would order:
* Whole aorta CTA (1mm cuts): the most important for treatment planning (according to ESVS guideline).
* Other investigation and pre-operative labs: CBC, Coagulation profile, lipid profile, ECG, ECHO, lung function test, Renal function test, Hepatic function test, Albumin level.
Q4: According to ESVS Guidelines
* Live style modification (stop smoking, exercise, healthy dite).
* BP control, stations, antiplatelet drugs.
* This patient has symptomatic AAA that need definitive TTT (open repair or EVAR).
Q5: According to the UK Small Aneurysm Trail: the risk of rupture in this patient is from .5 to 1.5% (Rutherford’s 9th edition).
Q6: According to ESVS Guidelines, this patient is indicated for definitive TTT as he has symptomatic AAA whatever the size of the aneurysm.
Patient has back pain due to pressure of AAA on the spine.
Q7: According to ESVS Guidelines: Level 1 evidence of threshold for intervention in AAA patient: “In men, the threshold for considering elective abdominal aortic aneurysm repair is recommended to be ‡5.5 diameter”.
Rutherford’s 9th edition
symptomatic AAA (ESVS Guidelines)
Recommendation 22 in ESVS guidelines 2024 changed from class l level A to class all level C
Thanks Mena,
How did you come to the conclusion that he has symptomatic AAA?
Q1.
i would ask about positive family history, any known medical problems, DM, hypertension, cerebrovascular disease, cardiovascular disease, COPD, bowel or urinary problems, lower limb swelling
nature and duration of pain
also ask about life style and activity
Q2.
after BP measurements, its important to perform full peripheral vascular examination to exclude peripheral arterial aneurysm as popliteal aneurysm.
examine peripheral arterial pulsation
abdominal examination and determine if the aneurysm is painful on palpation or not
exclude any signs for ruptured AAA
Q3.
CT angiography whole aorta and lower limbs
laboratory investigations ( lipid profile, kidney and liver functions)
cardiopulmonary exercise testing if possible.
Q4.
case of a symptomatic aortic aneurysm considered for full rapid assessment to prove the symptoms followed by delayed urgent repair under optimal conditions. with strict control of blood pressure
ESVS guidelines
NICE guidelines 1.5.1
Q5. risk of rupture is about 2% in asymptomatic patients although symptomatic patients have higher risk
Q6. intolerable pain even on pain killers, increase in size more than 1 cm in one year or risk of rupture .
Q7.Filardo G, Powell JT, Martinez MA, Ballard DJ (2015). Surgery for small asymptomatic abdominal aortic aneurysms. Cochrane Database Syst Rev. Feb;4:CD001835
Thanks Ahmed,
What is the chances that chronic back pain is due to AAA? This is an asymptomatic AAA.
How would that change your investigation and treatment plan?
AAA may cause back pain according to site of the aneurysm and if there is pressure on the spine or not.
if the back pain is chronic and due to spine pathology then my decision will chance to medical treatment
first i think that abdominal ultrasound by trusted and experienced physician will be required
medical treatment is the choice
(aspirin and clopidopril )
cardiovascular risk reduction
stop smoking
control of blood pressure
with follow up every year as the aneurysm diameter is below 5 cm (4.8)
Q5
Less than 2%
Thanks Abdullah,
Could you please comment on other questions as well?
Q1 full history include risk factors DM HTN IHD hyperlidemia Smoking
Drug hx surgical hx familly history
Q2 clinical examination started dg generall examination BP HR RR temp peripgeral pulsation neurolgical problem
Then abd examination pulsatile swelling tenderness skin changes and bruit
Q3. Full labs ECG ECHO Abd U/S CTA
Q4 life style modification controll of risk factors follow up by US every 6 months
Q6 if he become sympotmatic
If size increased more than 10mm/ year or 5mm/ 6 monnths
Or if >55mm
Dear Abdullah,
what is the indication for ECHO and both US and CT?
Case 1
1-Case of symptomatic AAA with 4.8cm diameter pain mostly due to pressure on the spine.
With ESVS recommendation
Symptomatic non-ruptured abdominal aortic aneurysms should be considered for deferred urgent repair ideally under elective repair conditions .
2-clinical examination
family history HTN smoking DM
*General
cardiovascular
Neurological , chest ,funcutional capacity,pallor .
*Perform abdominal examination for pain tenderness exclude suspecious of ruptured AAA
* perform prephiral vascular examination to exclude other Aneurysms or ischemia.
3- laboratory invetigation
Ex*Cbc/ kidney function
CTA on whole aorta and both LL
4-According ct and risk assement
the management of these cases should involve a brief period of rapid assessment and followed by delayed urgent repair under optimum conditions.Careful monitoring with strict BP management waiting repair is important.
https://research.tue.nl/en/publications/symptomatic-abdominal-aortic-aneurysm-repair-to-wait-or-not-to-wa
Thanks Muhamed,
MRI showed degenerative spine pathology causing his pain.
It is in fact not common for AAA to cause chronic back pain. This is a case on asymptomatic AAA.
on these basis, would you consider any changes your investigations and treatment plan?
Thanks dr ahmed
Will change plan for conservative follow up by US annually for aneurysms 4.0-4.9 cm (ESVS) l .
Advice patient to stop smoking life style modification and prescribe statin antiplatelets . (ESVS)lla.
According to pain i would refer to spine surgery again with my recommendation.
Answer Q4:
Treatment Plan for Abdominal Aortic Aneurysm (case size 4.8cm):
Surveillance:
-Yearly abdominal ultrasounds with adjustments based on growth rate.
Lifestyle Optimization:
1- Smoking cessation (highest priority).
2- Aggressive blood pressure management targeting a goal of systolic BP < 130mmHg or 140mmHg.
3- Lipid profile normalization aiming for LDL cholesterol reduction by 50% and reaching below 70 mg/dL using high-intensity statin therapy (if appropriate).
4- Tailored diet and exercise program..
Medication (consult cardiologist):
1-May consider medications to optimize blood pressure control (e.g., beta-blockers).
2-May consider lipid-lowering medications (statins, ezetimibe for LDL).
3- Antiplatelet therapy
Patient Education:
-Provided with comprehensive information about AAA and its symptoms and complications.
Shared Decision-Making:
1-Surgical/endovascular repair typically considered for aneurysms ≥ 5.5cm.
2-Individualized discussion for intervention timing based on 4.8cm size.
Follow-Up:
– Regular appointments for monitoring health, treatment adherence, and imaging results.
*Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Back M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol 2022;29:5e115
*The attached tables ESVS 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms
Thanks Saeed, could you please expand on these two points in our answer
Surveillance:
-Yearly abdominal ultrasounds with adjustments based on growth rate.
-Individualized discussion for intervention timing based on 4.8cm size
or let me ask you direct questions,
on what basis you choose to do his US on yearly basis?
are you planning to consider treatment based on this size 4.8 if patients wants operation?
Point 1
Guidelines ESVS 2024 considered for imaging surveillance using ultrasound annually for aneurysms 40 – 49 mm.
Point 2
I meant if the patient becomes symptomatic on size 4.8cm.
Thanks Saeed,
regarding point one. I mean you need baseline US scan to confirm the actual size of the AAA MRI is no specific regarding AAA diameter size. There is a chance when you do US the AAA size turn to be 5.2 then the frequency of the scans will change.
Thank you Mr Shalan
in terms of Q1,
Through the given history, I am thinking about symptomatic non ruptured AAA.
so, I will complete taking history from the patient; risk factors and family history.
putting in mind a deferred urgent repair after completing examination, investigation, and counselling
EVS Recommendation 65 IIa B
Q2,
I will do full vascular examination including, abdominal pulsations, femoral, pop, and pedal pulses.
16,6% of patient with a primary aneurysm has an additional aneurysm and increased to 25% if the patient has POP AA.
Systematic Review of the Co-Prevalence of Arterial Aneurysms Within the Vasculature, 2021, European Journal of vascular and endovascular surgery
Thanks Peter, His back pain is due to spine pathology. His AAA is asymptomatic, How would you procced?
I will go for US surveillance every 12 months
1- I would ask for any Medical history Diabetic, HTN, Cardiac History.
I would ask for any positive family history for AAA.
I would ask for any special Habits Smoking or Alcohol.
2- I would examine the abdomen for any tenderness, Look for any other aneurysms “popliteal aneurysm”, examine for peripheral pulsation.
3- I would recommend CTA for proper measurement of the Aneurysm and proper planning.
4- Conservative Management I would refer him to stop smoking service if he is smoker and strict control of hypertension “NICE Guidance 1.2.1 & 1.2.2”
5- the risk of rupture is 0.5% to 5% Aggarwal S, Qamar A, Sharma V, Sharma A. Abdominal aortic aneurysm: A comprehensive review. Exp Clin Cardiol. 2011 Spring;16(1):11-5. PMID: 21523201; PMCID: PMC3076160.
6- if became symptomatic
if has grown by more than 1 cm in diameter in 1 year. “NICE Guidance 1.5.1”
7-Filardo G, Powell JT, Martinez MA, Ballard DJ (2015). Surgery for small asymptomatic abdominal aortic aneurysms. Cochrane Database Syst Rev. Feb;4:CD001835
Thanks Mina for your answers.
What is the indication for CTA? You didn’t mention any blood test in your answer. would you like to perform any blood test?
The Nice guidance state that AAA 4.5-5.4 should be diagnosed and followed up by ultrasonography every 3 months and CTA is preferred only if intervention is required.
Routine blood test should be done including CBC to detect any susptible anemia, kidney function test to decide the possiblity of dye administration, liver function and lipid profile to exclude hyperlipidemia and to start proper anti-hyplipidemic.
Answer question 1
Taking a detailed medical history and risk factors such as (smoking, hypertension, hyperlipidemia,COPD and cardiovascular diseases) and inquiring about the main complaint behind the patient’s request for medical attention, including any symptoms associated with abdominal aortic aneurysm such as (abdominal or back pain, or flank discomfort, lower limb oedema, changes in bowel habits, or urinary symptoms and a pulsating abdominal mass).
Family History: Assess the patient’s family history, especially regarding any first-degree relatives with a history of aneurysm or death due to ruptured AAA
Medication History: Review the patient’s current medications, including any antihypertensive or lipid-lowering agents and antiplatelet.
Social History: Explore the patient’s social history, including smoking, alcohol consumption and cocaine use.
Previous Imaging or Procedures:
Determine if the patient has undergone any previous imaging studies or surgical procedures related to any peripheral aneurysms ( popliteal, femoral and iliac) also about any abdominal surgical procedures (hostile abdomen).
The attached table (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms
Thank you Saeed for your comment. This is satisfactory review of history. a question for you, What would be your next course of action with this patient?
The next course of action with this patient will be
-Physical Examination:
General appearance and observation any signs of discomfort.
-Vital signs: Measure BP, HR, Temp, and oxygen saturation.
-Abdominal examination:
-Inspection: for any visible pulsations or masses in the abdomen.
-Palpation of the abdomen for any pulsatile masses and assess for tenderness
-Auscultation: Listen any bruits over the aorta.
-Peripheral pulsations: Femoral, Popliteal (popliteal aneurysm??) and distal.
Hi Saeed,
Have you ever done auscultation in clinic for AAA assessment?
Dear Drs,
Thank you so much for your comments and questions? Please keep posting your questions. However, The live meeting next Sunday will be dedicated to answer your questions.
Now, Please start answering Case 1 questions
Thanks Dr. Ahmed for the enlightening lecture..
May i ask about the ethical considerations involved in deciding the appropriate timing and type of intervention for aortic abdominal aneurysms, particularly in cases where the patient’s age, comorbidities, and preferences may influence the decision-making process
Thanks for this illustrative lecture .
My question is if the patient has arteritis and AAA more than 5.5 , what is way of management.
Thanks
Thank you Dr. Ahmed for this informative and comprehensive aortic approach introduction. Are the peoperative analysis tools important before undergoing an endovascular procedure too?
Thanks sir for this great lecture
May i ask if patient has aortic and popliteal artery aneurysm
Which one should i manage first and upon what criteria should i build my decision?
Thank you Mr. Ahmed for this informative lecture. I’ve a question please:
Does it make any difference in AAA patient management if he has a positive family history?
Regards.