WDBD?

Or more commonly said, "what does baine do?".

Well, today I am trying to re-instruct my staff in reguards to Abdominal Aortic Endografts.  Pretty easy right?  Yes, in theory.

Basically short hand is this, an Abdominal Aortic Endograft (I'll just say endograft) is a non-surgical device very similar to a Stent that is used in place of direct surgical repair of abdominal aortic aneurysm.   A aneurysmal dilatation of the abdominal aorta is by definition  a localized dilatation of the abdominal aorta, that exceeds the normal diameter by more than 50%.  A normal adult aorta measured around 2cm (20mm) in diamter.   So basically if the rest of your abdominal aorta is 2cm and then you get a area or portion that is let us say, around 3cm, then we consider that a aneurysmal dilatation.  Intervention is recommended when the dilatation is over 5cm, this has been determined to be the size in which the walls of the vessel are in imminate danger of failure and rupture can and most likely will occur, which more often than not results in death.

Now, when you have a anuerysm of character that needs to be repaired, the normal routine is open surgical intervention where the aneurysm is removed and that portion of the aorta and any associated vessels are replaces with a synthetic material, usually PTFE(polytetrafluoroethylene) or GoreTex/Teflon, the same stuff they make the water proof coats out of.  This isn't the only material but its the one we use most often. 

This surgery is all fine and good, but what do you do when someone has a bad aneurysm, but they are not healthy enough to under go open surgery?  Well, someone verys mart and very skilled came up with the Endograft.

Basically, through a series of catheters that are inserted into the femoral arteries, a guidewire is threaded up to the point of the aneurysm.  Then they deploy very....very carefully the endograft.  Its like a giant Stent, they open it up, anchor it to a area above the aneurysm, then insure that it seals off the vessel adequately and then they deploy portions down below the aneurysm into normal size distal vessels.    Basically once its deployed what it should do is redirect the arterial flow through the graft and close off the aneurysmal body(sac) from blood flow, this excluded portion of vessel then if all goes well thrombosis (clots off) and gradually starts to shrink on its own over the years. 

VIOLA!, Emergency averted.

But thats not where everything ends.  At regularly spaced intervals, the patient needs follow up visits to make sure everything is going well, usually at three month spacings with both a CTA(Computer Tomography Angiogram...fancy CAT scan) and a Vascular Ultrasound (where we come in).  This is a fairly new exam for us, I have been doing them for over 2 years, but my staff is pretty much noobs with not much experience.  So I have to try to get them up to speed on these thigns in a manner that is both timely and efficient.

There is alot of stuff you have to be very careful about when scanning these things and there are alot of little things you have to pay attention to that I have to make sure they are all proficient in.

And to think, I can barely spell huh?