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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 28  |  Issue : 1  |  Page : 76-78

Open abdominal aortic aneurysm repair – Case experience in a tertiary care centre


Department of General Surgery, GMCH, Thiruvananthapuram, Kerala, India

Date of Submission11-Mar-2022
Date of Decision17-Apr-2022
Date of Acceptance04-May-2022
Date of Web Publication14-Jul-2022

Correspondence Address:
Dr. Manu Jose Chirayath
Department of General Surgery, GMCH, Thiruvananthapuram - 695 011, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ksj.ksj_7_22

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  Abstract 


Background: Abdominal aortic aneurysm (AAA) mostly affects men than women. Materials and Methods: This paper attempts to study the clinical and demographic profile of patients undergoing open surgical AAA repair. This case series is based on five successfully surgically repaired open AAA at the department of general surgery of a tertiary hospital. Results: All cases were male patients. All cases became well after the surgery. The mean hospital stay was 8.2 days. Conclusion: The study identifies the importance of vascular surgery in the successful outcome of these patients.

Keywords: Abdominal aortic aneurysm, fusiform aneurysm, open surgical repaira


How to cite this article:
Chirayath MJ, Soumya Soman M K, Ramachandran S. Open abdominal aortic aneurysm repair – Case experience in a tertiary care centre. Kerala Surg J 2022;28:76-8

How to cite this URL:
Chirayath MJ, Soumya Soman M K, Ramachandran S. Open abdominal aortic aneurysm repair – Case experience in a tertiary care centre. Kerala Surg J [serial online] 2022 [cited 2022 Sep 24];28:76-8. Available from: http://www.keralasurgj.com/text.asp?2022/28/1/76/350907




  Introduction Top


Dilatations can occur in localized segments of the arterial system. When the increase in diameter is more than 50%, it is called aneurysm, and when the increase in diameter less than 50%, it is called ectasia. All the three layers of the arterial wall are involved in true aneurysms and only single layer in false aneurysms. There are different causes for the development of aneurysm such as atheroma, trauma and bacterial infections. The risk factors for the development of aneurysm are male gender, age more than 60 years, hypertension, history of stroke, etc. Abdominal aortic aneurysm (AAA) is the most common type of large vessel aneurysm. Most of them are asymptomatic but may present in the emergency department after rupture. It can be managed by open repair or endovascular aneurysm repair (EVAR). EVAR is an effective and safe repair considering the mortality of the disease process. However, the procedure has not yet become routine. Overall combined mortality in ruptured aneurysm is around 80%–90%. This paper aims to study the clinical profile of patients undergoing open AAA repair in a tertiary care setting over a 12-month period.


  Materials and Methods Top


This was an observational study of open AAA repair cases over a period of 1 year in a tertiary care centre. The aim was to study the clinical and demographic profile of patients who underwent open AAA repair. It was a hospital-based longitudinal study conducted in the vascular surgery unit of a tertiary hospital from June 2019 to May 2020. All patients with definitive diagnosis of AAA admitted were included. Incidentally detected AAA, whose diameter was less than 4.5 cm and thoracic or suprarenal aortic aneurysm were excluded.


  Results Top


The study population was n = 5 cases of open AAA repair patients. All the five cases were in the age group of 60–70 years. The mean age of the patients was 64.25 years. All five were male patients. The presenting symptoms were back pain (3 cases), abdominal pain (4 cases) and back pain and abdominal pain (2 cases). In one case, pulsation was felt in the upper abdomen. All five were hypertensive and dyslipidaemic [Table 1]. Two of them had a history of transient ischaemic attack (TIA). One of them had Type 2 diabetes mellitus [Table 1]. Fusiform aneurysm was noted in all cases. Two of them had intramural thrombus, and atheromatous plaques were found in all cases [Table 2]. The mean hospital stay was 8.2 days.
Table 1: Comorbidities of 5 cases

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Table 2: Computed tomographic findings

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Intra-operatively, three of them showed intramural thrombus. Atherosclerotic plaques were present in all the five cases [Figure 1]. Endovascular repair was performed in all the patients [Figure 2]. Post-operatively, all of them required intensive care unit care and two needed elective ventilation [Table 3]. All the cases were able to be discharged by post-operative day 10.
Figure 1: Fusiform aneurysm with atheromatous plaque

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Figure 2: Aneurysm repair with Dacron graft

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Table 3: Post-operative events

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  Discussion Top


AAA is defined as an aortic diameter more than 1.5 times the normal diameter at the level of renal arteries more than 3 cm. Environmental and genetic risk factors are associated with the development of AAA.[1]

Risk factors include smoking, hypertension, age >60 years, male gender and family history. Majority are detected incidentally on imaging studies.[2] Symptoms include back pain, abdominal pain and symptoms of thromboembolisation. Sometimes, it presents as a life-threatening emergency as ruptured AAA. Ruptured AAA has a 30-day mortality of 70%.[3] Men are more affected than women.[4] All the cases studied were males more than 60 years. Four of them had abdominal pain and had back pain as a presenting complaint.

There is evidence pointing towards the inverse relationship between diabetes and AAA.[5] On the other hand, hypertension has a direct association with development and expansion of AAA.[6] Men with a history of TIA or stroke are found to have a double prevalence of AAA.[7] In our study, all the cases were hypertensive and two had a history of cerebrovascular accident. Only one patient had diabetes mellitus.

Significant reduction in AAA-related mortality has been found to be associated with screening men more than 65 years in studies conducted in developed countries,[8] but cost-effective screening is not possible in our country at present.

Symptomatic aneurysms, larger aneurysms (>4.5 cm) and faster expanding aneurysms necessitate intervention. As endovascular repair has evolved much in the current era, more patients prefer stent grafting than conventional open repair.[9] More patients can undergo this less invasive intervention reducing the operative mortality.


  Conclusion Top


Our case series highlights the importance of vascular surgery and lifesaving intervention. Routine screening ultrasonogram takes a pivotal role in the early diagnosis of AAA. All individuals above 65 years of age even without comorbidities should undergo a routine screening ultrasound. Timing of surgery also plays a lead role in outcome of these patients. The outcome of surgery in centres with a vascular surgeon is very good in case of an open surgical repair. The experience at our institution has been positive and encourages open surgical repair for patients with less morbidity and mortality.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Toghill BJ, Saratzis A, Bown MJ. Abdominal aortic aneurysm – An independent disease to atherosclerosis? Cardiovasc Pathol 2017;27:71-5.  Back to cited text no. 1
    
2.
Ullery BW, Hallett RL, Fleischmann D. Epidemiology and contemporary management of abdominal aortic aneurysms. Abdom Radiol (NY) 2018;43:1032-43.  Back to cited text no. 2
    
3.
Tchana-Sato V, Sakalihasan N, Defraigne JO. Ruptured abdominal aortic aneurysm. Rev Med Liege 2018;73:296-9.  Back to cited text no. 3
    
4.
Clancy K, Wong J, Spicher A. Abdominal aortic aneurysm: A case report and literature review. Perm J. 2019;23:18.218. doi: 10.7812/TPP/18.218.  Back to cited text no. 4
    
5.
Raffort J, Lareyre F, Clément M, Hassen-Khodja R, Chinetti G, Mallat Z. Diabetes and aortic aneurysm: Current state of the art. Cardiovasc Res 2018;114:1702-13.  Back to cited text no. 5
    
6.
Takagi H, Umemoto T; ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. Association of hypertension with abdominal aortic aneurysm expansion. Ann Vasc Surg 2017;39:74-89.  Back to cited text no. 6
    
7.
Gratama JW, van Leeuwen RB. Abdominal aortic aneurysm: High prevalence in men over 59 years of age with TIA or stroke, a perspective. Abdom Imaging 2010;35:95-8.  Back to cited text no. 7
    
8.
Ali MU, Fitzpatrick-Lewis D, Miller J, Warren R, Kenny M, Sherifali D, et al. Screening for abdominal aortic aneurysm in asymptomatic adults. J Vasc Surg 2016;64:1855-68.  Back to cited text no. 8
    
9.
Calero A, Illig KA. Overview of aortic aneurysm management in the endovascular era. Semin Vasc Surg 2016;29:3-17.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
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