Online CME

This CME offering has expired.

Welcome to ETMC's online CME presentation. We are pleased to provide this opportunity for online learning. Please read the materials below in order to earn credit.

Presenter:
S. Edwin Duncan, MD, FACS is certified by the American Board of Surgery
with Special Qualification in Vascular Surgery, Recertified 1995.

He is a graduate of Texas A&M University and earned his medical degree from the University of Texas SouthWestern Medical School. He completed his residency at University of Texas medical School, San Antonio. His vascular surgery fellowship was compelted at Vanderbilt and St. Thomas Hospital, Nashville. He served as ship's surgeon on the USS Forrestal, U.S. Navy 6th Fleet. Dr. Duncan has authored numerous articles and presentations on abdominal aortic aneurysms.

Target Audience:
This program will be beneficial to primary care physicians including family medicine physicians, internists and healthcare professionals involved in the treatment of individuals who may be at risk for abdominal aortic aneurysms.

Learning Objectives
Upon completion of this activity the participant should be able to:

1. Identify the patient population at risk for abdominal aneurysm
2. Discuss screening and diagnostic tools to discover abdominal aneurysms.
3. Increase knowledge on the latest treatment modalities for the repair of abdominal aneurysms.

Participating
Participants must read the learning objectives and study the the material provided and complete the evaluation and post test using the printed .pdf files provided.

• Post Test

Please mail or fax completed materials to:

ETMC CME Department
721 Clinic Drive
Tyler, TX 75701
Fax: (903)531-8532 (ATTN: CME Department)

Accreditation:
East Texas Medical Center is accredited by TMA to sponsor continuing medical education for physicians.East Texas Medical Center designates this educational activity for a maximum of ONE Category 1 credit toward the AMA Physician?s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

Release Date
March 1, 2007

Expiration
Feb. 29, 2008

Disclosures:
There is no commercial support do disclose.

Introduction
Each year, approximately 200,000 new cases of abdominal aortic aneurysm are diagnosed. An abdominal aortic aneurysm is an area of swelling or ballooning of the large blood vessel called the abdominal aorta coming from the heart to the rest of the body.

Introduction
An aneurysm is a weakened part of that blood vessel which expands over time like a balloon. As the aneurysm size increases and stretches and the blood vessel wall increases, it becomes a thinner blood vessel wall and weakens to the point that the vessel bursts or ruptures leading to a life threatening and surgical emergency. Aneurysms usually cause no symptoms. Typically, they are found when other tests are being done for unrelated problems, or are detected on a physical exam by the examining physician.

Aneurysms can develop because of the potential of heredity, in that aneurysm history tends to run in families with that disease. Also, factors such as cigarette smoking, high blood pressure, and high cholesterol can add to the potential for having aneurysms.

What are the causes to weaken the blood vessel wall?
As mentioned, a buildup of fat or other material in the blood vessel can form plaque or a hard substance along the aorta which weakens it. Also, cigarette smoking influences the potential for abdominal aneurysms by the inflammation brought about by the nicotine on the interior of the blood vessel wall. Additionally, untreated high blood pressure over a long period of time causes the internal stress or pressure on the blood vessel wall to enlarge the weakened area of the blood vessel.

How are aneurysms evaluated?
The history and physical by the family physician may detect an aneurysm based upon the family history of an aneurysm or by feeling the area of the aneurysm enlargement during an abdominal examination. Further testing can be done by sonogram or ultrasound which would allow the detection of the aneurysm in the abdomen. An abdominal CT scan or MRI could also demonstrate the abdominal aneurysm and a common identification is by an arteriogram where contrast material is placed in the blood vessel showing x-ray image of blood flow through the aorta and the branches of the aorta identifying the ballooning of the blood vessel.

Decisions regarding treatment for aneurysm is based upon the testing, as ordered by the physician. When the aneurysm is small, only periodic checkup examinations to monitor the aneurysm size with a sonogram is recommended. However, a rapidly growing aneurysm or one that is larger than 5.5 cm requires aneurysm repair.

Two procedural options are available for the treatment of abdominal aneurysms:

• open surgical repair
• endovascular repair.

Open surgical repair
The open surgical repair has been the traditional choice to treat abdominal aneurysms in the past. During this type of operation, the surgeon makes an incision in the abdomen and repairs the aorta by replacing the diseased section and aneurysm with a synthetic graft made out of Dacron that is sewn into place with suture material.

This procedure requires stopping the blood flow through the aorta while the graft is being put into place. Open surgical repair is typically performed under general anesthesia and takes about 3-4 hours to complete. The patient usually stays overnight in the intensive care unit and another 5-7 days in the hospital. Depending upon how quickly the body heals, full recovery time may take as long as three months.

Although open surgical repair is a proven medical procedure, not all patients can tolerate this major operation, based upon their attending risk factors of hyper1ension heart disease, diabetes, and lung difficulties

Endovascular repair
A newer innovation for treatment of abdominal aneurysm is by endovascular repair. Endovascular repair is a relatively new procedure for the treatment of abdominal aortic aneurysms. It is less invasive than open or conventional surgery and involves excluding or sealing off the aneurysm by placing an endovascular graft inside of the diseased aorta, making a new path for the blood to flow.

The endovascular graft remains inside the aorta permanently through the use of metal prongs or anchors, as well as a tight fit of the endovascular graft against the aortic blood vessel wall. Endovascular repair may be performed under general or spinal" anesthesia while the patient remains conscious but sedated, and usually takes 1 ~3 hours to complete. Patients may have a hospital stay of only a few days and can usually return to normal activity within six weeks after the procedure.

East Texas Medical Center has been in the forefront of endovascular aneurysm repair for the past five years with more than 100 cases of endovascular grafts being placed by the surgeons of East Texas Vascular Associates.

Because of the less invasive nature of endovascular aneurysm repair, individuals with severe cardiac and pulmonary problems, who would be prohibited from having open standard conventional aneurysm repair, are able to be candidates for the endovascular technique.

Clinical follow-up
Clinical follow-up for endovascular repair is necessary with periodic CT scans of the abdomen and pelvis. These routine exams are performed to determine that the endovascular graft remains in the appropriate position without any migration, rotation, or any degree of blood leakage around the graft. These follow-up examinations are scheduled with the performing surgeon on a routine interval basis.

The results for the outcomes of endovascular graft, now at five years, are now known to equal the long term good results of open repair, without the potential complications of the large open operation. Consequently, if the anatomical considerations found at the workup allow the endovascular repair to be done, it is the preferred method of aneurysm repair at this point.

Post Test