Medscape: A Case Study

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Figure 6. Arteriogram after successful endovascular repair of an abdominal aortic aneurysm (Radvany, Seguritan, Coombs, Gay, Cho, Weinberg, 2015). In Medscape. Retrieved from: http://emedicine.medscape.com/article/416266-overview#a6. Copyright 2015 by Medscape. Treatment Radiographic imaging is required for pre-operative and post-operative treatment plans. There are two routes that may be considered for treatment of AAA. One route includes consistent surveillance of AAA to assess any changes in size or appearance. The other option includes surgical intervention. The surgical options are endovascular repair (EVAR) or open repair. Elective surgical treatment should be considered when an aortic diameter is greater than 5.5 cm in males …show more content…
Research states as an aneurysm increases in size, it bulges out at a greater rate, thus increasing the chance of rupture. Therefore, once an AAA is diagnosed via ultrasound or computed tomography (CT) surveillance is necessary to monitor the growth. Figure 7 displays an aneurysm growth during the period of six years. The American College of Cardiology (ACC) and the American Heart Association (AHA) recommend surveillance bi-annually to three years depending on aortic diameter. According to the ACC/AHA guidelines, an aneurysm with a diameter under 3cm does not require surveillance. Although clinicians may consider consistent monitoring for at-risk patients with aortic diameter from 2.5 to 2.9cm in size. An aneurysm between 3.0 cm to 3.9 cm requires ultrasonography screening every two to three years. For an aortic dilation between 4.5 cm to 5.4cm, patients should go through ultrasonography or CT screening bi-annually up to annual visitation. Any patient with an aneurysm that is larger than 5 cm should consider surgery. Any patient with an aneurysm larger than 5.4 cm will require surgical consultation for immediate repair ( Keisler & Carter, p. 540-541, 2015) Figure 7. Abdominal Aortic Aneurysm (AAA) growth (A, B). Sagittal gray-scale images through the distal abdominal aorta show increase in the size of the aneurysm from 2.7 cm on 12/03/2007 …show more content…
Additionally MRA has been used recently to characterize endoleaks. Figure 9 illustrates and a coronal MRA image showing a type 1 endoleak (white arrow). Studies have shown that MRA has the potential to replace DSA because like DSA, MRA provides information regarding direction and movement of contrast that may be visible from endoleaks (Francois, et al., 2012). Another modality that is effective in post-EVAR follow-up imaging in regards to endoleak detection is color duplex ultrasound. Studies have shown color duplex ultrasound is viable in post-EVAR follow-up imaging due to its accuracy in determining endoleak flow direction, as well as its lower cost, noninvasiveness, and no radiation dose benefits. Lastly plain radiograph imaging can be helpful when combined with CT for assessing structural changes in the stent-grafts. Plain radiographs can be useful when evaluating for kinking or stent-graft migration, and this is performed at a lower radiation dose and cost comparted to CT. Anteroposterior and lateral radiograph images are done to assess stent-graft migration and separation, while oblique views are done to assess wire fractures (Francois, et al.,
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