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Castle Connolly Graduate Board Review Series

Castle Connolly Graduate Board Review Series

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Published by CCGMP
Castle Connolly Graduate Medical Publishing (CCGMP) www.ccgmp.com. Here is a free sample chapter from the "Educational Review Manual in Surgery."

Our 14 online board reviews are FREE for ALL doctors.

Visit our Facebook Page: www.facebook.com/ccgmp
Castle Connolly Graduate Medical Publishing (CCGMP) www.ccgmp.com. Here is a free sample chapter from the "Educational Review Manual in Surgery."

Our 14 online board reviews are FREE for ALL doctors.

Visit our Facebook Page: www.facebook.com/ccgmp

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Published by: CCGMP on Oct 05, 2009
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01/28/2015

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Educational Review Manualin General Surgery
8thEdition2009Editor-in-Chief
Samuel E. Wilson, MD
Professor, Department of Surgery and Associate DeanUniversity of California, Irvine School of Medicine
CASTLE CONNOLLY GRADUATE BOARD REVIEW SERIES
 
CHAPTER16:ABDOMINAL AORTIC ANEURYSMS
465
Chapter16:AbdominalAorticAneurysms
Contents
1. AtheroscleroticAneurysms2. RupturedAbdominalAorticAneurysms3. InflammatoryAorticAneurysms4. TraumaticAorticAneurysms5. ThoracoabdominalAorticAneurysms6. PoplitealAneurysms7. EndovascularAorticAneurysmRepair8. PharmacotherapyofAorticAneurysm9. References10. Questions
SamuelE.Wilson,MD
 
466
EDUCATIONALREVIEW MANUALINGENERALSURGERY
1.AtheroscleroticAneurysms
Definition
Ananeurysmisalocalizeddilationofabloodvessel,usuallyanartery,togreaterthan150%ofitsnormaldiameter.Arterialaneurysmsarefoundthroughoutthevasculartree.Aorticaneurysmsaretypicallyacquired,trueaneurysms,affectingall3layersofthearterialwall(intima,mediaandadventitia).Traumaticaneurysmsaremostoftenfalse.Abdominalaorticaneurysms(AAA)aretypicallyfusiform,butabout10%orlessaresaccular.
History
TheFrenchsurgeonDubostaccomplishedthefirstsuccessfulrepairofanabdominalaorticaneurysmin1951,replacingtheaneurysmwithahomograft.Sur-gicalpioneers,particularlyDeBakey,notonlymadeAAArepairasaferoperation,butdevelopedthemod-erntechnicalmethodsforopenrepair.Replacementof theaortawithahomograftwasformedtobeassoci-atedwithlatecomplications,whichledtothedevel-opmentofprostheticgraftmaterial.Voorheesiscred-itedwiththefirstuseofsyntheticgraftmaterial.Since1957,Dacron
®
(DupontCompany,Inc.)hasbeentheprimarymaterialusedforsyntheticaorticgrafts.Beginningintheearly1990s,endovascularaneurysmrepair(EVAR)dramaticallyreducedthemorbidityandmortality,sothattodaythemajorityofpatientswithabdominalaneurysmshaveanendovascularpro-cedure.Improvementsintechnique,devices,graftmaterialandintensivecaremanagementhavemadeaneurysmrepairavailabletonearlyallreasonablyfitpatients.
Epidemiology
Abdominalaorticaneurysmsmostfrequentlyaffecttheelderly,andruptureofAAAsisthe10leadingcauseofdeathinoldermen.Theincidenceofabdomi-nalaorticaneurysmsofallsizeshasincreasedoverthepast5decades.Inmen,theincidenceincreasesrapidlyafterage55;inwomen,afterage70.
45
TheincidenceofAAAinalargescreeningstudyisshowninTable1.
Table1PrevalenceofAbdominalAorticAneurysms4cmorLargerDetectedbyScreeningMen
NeverSmoked Prevalenceof PrevalenceofAge(yrs) (No.) AAA(
%)
Smokers(No.) AAA(
%)
50-54 1152 0 4359 0.355-59 1481 0 5819 0.960-64 2985 0.2 11,119 1.565-69 4198 0.2 14,129 1.970-74 4679 0.5 13,008 2.575-79 254 0.8 5669 2.7
FromLederleFA,JohnsonGR,WilsonSE,etal.
AnnIntMed.
1997;126:441-449.

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