Internal Medicine

0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45

Abdominal Aortic Aneurysm (AAA) Abscesses and Fistulas 5

➣Can occur after either open or endovascular repair. Symptoms:

persistent fever or aorto-enteric fistula (upper GI bleeding).

Diagnosis: CT scan. Treatment: graft excision and extra-anatomic

bypass. Mortality: 50%.

Prognosis

■Ruptured AAA

➣Most die en route to hospital or on arrival

➣50% of those undergoing surgery survive

➣Preoperative predictors of poor survival:

age > 80

preoperative hypotension

elevated creatinine preop or postop renal failure

■Elective Repair

➣Perioperative mortality approximates 5%

■Endovascular Repair

➣Requires life-long follow-up for late complications

Late onset endoleak:

Graft migration or disruption

➣Late complications

Graft infection (1%)

Secondary aorto-enteric fistula

Abscesses and Fistulas..................................

EMMET B. KEEFFE, MD

history & physical

Risk Factors

■Recent abdominal surgery

■Penetrating or blunt abdominal trauma

■Perforation of appendix or colonic diverticulum

■Perforation associated w/ intraabdominal malignancy

■Crohn disease

■Chronic diseases, eg, cirrhosis, renal failure

■Drugs, eg, corticosteroids, chemotherapy

■Prior radiotherapy

History

■High spiking fevers w/ chills

■Abdominal pain