The decision of surgery in based on patient’s physical and functional condition. The procedure is contraindicated in patients who are considered to be at high risk. These include patients with unstable angina, serum creatinine >3 mg/dl, compromised pulmonary function (low oxygen saturation) and ejection fraction <25%. Thus, the contraindications of the procedure are severe COPD, severe cardiac disease, active infection, etc.
Tests: There are many different diagnostic tests which are used for the diagnosis of AAA. Plain radiograph shows a characteristic eggshell appearance of calcification of abdominal aorta. This can detect aneurysm in 70% of the patients but is still an unreliable method as this does not detect the exact size of the aneurysm and a negative result does not rule out the possibility of an aneurysm.
Diagnostic tests are usually done to determine the size of the aneurysm. Abdominal ultrasound is the most commonly used modality for diagnosis and determination of size of the aneurysm. The advantages are that it is non invasive, safe, cost effective and can detect the structural changes and size of the aneurysm accurately and in all dimensions. But it cannot clearly visualize other arteries and abnormalities present and is therefore not a good preoperative tool.
CT scan is a good diagnostic modality as it can accurately locate both the ends of the aneurysm and identify abnormalities in all the vessels. It can also identify surrounding abdominal structures. It can also clearly distinguish between true and false lumen and can be used in the diagnosis of aortic dissection. The use of I.V. contrast helps in the investigation of aortic lumen, presence of hematoma and mural thrombus. Nowadays, CT angiography has replaced traditional angiography techniques in the diagnosis of AAA.
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