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