Patient with abdominal aortic aneurysm – diagnostics, follow-up and treatment in the ambulance of general practitioner

Česká verzia

Authors: L. Kubíček; R. Staffa
Authors place of work: Přednosta: prof. MUDr. Robert Staffa, Ph. D. ; Centrum cévních onemocnění ; Fakultní nemocnice u sv. Anny v Brně a Lékařská fakulta Masarykovy univerzity ; II. chirurgická klinika
Published in the journal: Prakt. Lék. 2015; 95(6): 283-287
Category: Of different specialties

Summary

Introduction:
Incidence of patients with abdominal aortic aneurysm is continually rising and in the case of its rupture the mortality rate remains still very high. General practitioner is the first who can diagnose aneurysm’s presence by clinical examination of a risk population, primarily elder male smokers with hypertension. The goal of this paper is to summarize up to date knowledge of AAA both from available literature and from the experience of centre for vascular surgery and create a brief recommendations for general practitioners.

Patients:
During the years 2010–2015 we performed 144 elective interventions for asymptomatic AAA (117 open repairs and 27 endovascular procedures) and 80 urgent open repairs for ruptured AAA.

Results:
The mortality rate in our patients with AAA rupture was 48.8%, however the mortality after an elective intervention was 4.3% only. There was a clear predominance of males both in the set of ruptured AAA (80.0%) and elective interventions (83.3%). The most important risk factor either for aneurysm development or its rupture is hypertension, which was presented in the vast majority of patients. Interesting outcome is the distribution of rupture count into a particular months; the biggest concentration of aneurysm ruptures was presented in the period from april to july.

Discussion:
Due to absence of national ultrasound screening program in the Czech Republic, the ambulance of general practitioner is the first place, where a part of asymptomatic AAA can be detected by a quick physical examination of the risk patients (male older than 65 years, smoker, hypertension) and consequent ultrasound examination. Crucial for a patient with AAA is strict hypertension treatment, because hypertension is the main risk factor for aneurysm rupture. General practitioner should frequently monitor patient´s blood pressure and eventually correct patient´s anti-hypertensive medication. After a successful intervention the general practitioner is usually the first who can detect potential complications, therefore these should be kept in mind and general practitioner should closely cooperate with a centre for vascular surgery. Mutual cooperation is the key to detection of higher number of asymptomatic AAA and successful treatment.

Keywords:
abdominal aortic aneurysm – rupture – dispensarization – risk factors

Zdroje

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