Giant Abdominal Aortic Aneurysms Greater Than 10 CM: A Case Report And Review Of Literature
Joshua Ng, MSE, Tuong Nguyen, MD, Dawn Salvatore, MD, FACS, Paul DiMuzio, MD, FACS, Babak Abai, MD, FACS, Babak Abai, MD, FACS
Thomas Jefferson University Hospital, Philadelphia, PA, USA
DEMOGRAPHICS: A 68 year old man with a past medical history of alcohol use disorder and 70 pack year smoking history, was transferred from an outside hospital for management of an incidentally discovered giant abdominal aortic aneurysm (AAA).
HISTORY: He was brought to the outside hospital after being found down while at home. On presentation, the patient was hemodynamically stable. On review of systems, he reported an enlarging abdominal mass for several years without any associated abdominal or back pain. Physical exam revealed a firm, pulsatile abdominal mass and right inguinal hernia. Femoral pulses were detected with doppler bilaterally. CT with IV contrast demonstrated a massive, fusiform aneurysm of the abdominal aorta measuring 18cm in transverse diameter beginning at the level of the SMA and extending to the iliac bifurcation. No retroperitoneal fluid was observed to suggest aneurysm rupture. Additionally, the right iliac artery was identified to be partially occluded. PLAN: The patient was brought to the operating room after 2 days, following cardiology and pulmonary clearance. Open AAA para-renal repair was completed with a rifampin-soaked, bifurcated, 24mm diameter Dacron graft. Endarterectomy of the right common iliac was also performed. The patient recovered well post-operatively and was discharged five days following surgery. He was seen in the office ten days after discharge and was doing well without any complications. He had no complications at 1 month followup.
DISCUSSION: A literature review of 40 patients with AAAs measuring >10cm was conducted. The demographics were similar to known risk factors of increasing age, male gender, smoking, and hypertension. 30 percent of the patients presented with rupture. Open technique was the preferred intervention with only 4 endovascular repairs attempted.
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