case study - norfolk and waveney aaa screening programme
TRANSCRIPT
CASE study – Norfolk and Waveney Abdominal Aortic Aneurysm
Screening Programme
Difficult Aorta Measurement
Lorna Curtis –Advanced Practitioner Ultrasound – CST Norwich
National Abdominal Aortic Aneurysm Screening Programme Scans
• The patient was scanned initially in 2013 and again in 2014 and the inner to inner AP measurement of the aorta was 3.1cm.
• The patient was scanned again in 2015 and the inner to inner AP measurement of the aorta was 3.2 but also measurement were seen at 4.8 – 4.9cm
Images from the NAAASP scan –2014 3.1cm – Recall 12 Months
Longitudinal measurement – 20143.1cm – recall 12 months
Images from NAASP scan – 20153.2cm but also 4.8 - 4.9cm
• Images QA’d by CST who recommended – Rescreen with CST present - posterior wall not well defined ? Bigger in size
• CST found the scan difficult in the community and recommended that the patient attend the Norfolk and Norwich Vascular Lab for further scan
• Report – Proximal Aorta measures 3.6cm
In the mid aorta there appears to be 2 channels of blood
? Dissection, with an AP diameter of 4.9 – 5.1cm.
The L and R Common Iliac arteries appear enlarged,
L = 3 – 3.4cm R = 3.5 - 3.7cm. Both appear to contain a large amount of thrombus
Images from the NNUH Vascular Lab
Longitudinal Aorta
Transverse Aorta
Left and Right Common Iliac Arteries
Post Ultrasound
• Patient was referred for a CT scan which confirmed that there was a dissection of the distal abdominal aorta starting below the renal arteries and extending into the Common iliac arteries bilaterally
• Not suitable for conventional EVAR (Endovascular aortic repair)
• Likely to be a chronic dissection
CT images
CT Common Iliac arteries
Coronal CT
Aortic Dissection
• A dissection is a tear in the tunica intima which causes blood to flow between the layers of the wall of the aorta
• Most commonly seen in the thoracic aorta, isolated abdominal aorta dissections are rare (2%)
• Abdominal symptoms include :-• Claudication - esp if extension into the iliacs• Bowel Ischaemia• Haematuria or acute renal failure
Treatment• Patient ceased from NAASP programme and
transferred to vascular consultant care
• CT in 6 months time –
• Monitor see if any change in calibre
• If Iliacs get above 4 cm then the surgeon will consider an – Aorto bi-iliac repair
Thank You