Real-Life Challenge: Abdominal Aortic Aneurysms
A 75-year-old female diabetic has been diagnosed with two small abdominal aortic aneurysms. She also has a history of elevated blood pressure, 150/90. Lisinopril has been prescribed to maintain an acceptable level. The physician suggested that the course of treatment could be watchful waiting. A surgeon had been consulted and after reviewing lab values and a CT scan of the abdomen and abdominal aorta, suggested not pursuing a surgical course at the time of the tests. The patient was scheduled to be followed up every 3 months. The first 3-month exam revealed no significant change. The second 3-month exam showed that the aneurysm had started to increase in size. The course of watchful waiting was to continue. The patient was instructed to monitor her blood pressure (BP) closely and not to lift anything weighing more than 10 pounds. Additionally, she was advised not to stretch or reach out. The surgeon preferred to schedule a procedure to install a stent into the abdominal aorta. The patient had begun to experience severe muscle spasms in the muscles of the lower legs. She also was unsure about the proposed procedure and asked what would happen if she did not have the procedure.
1. What might be the cause of the aneurysms?
2. Why is controlling the blood pressure important?
3. Why would the surgeon want to adopt a wait and see attitude at first?
4. What is the significance of the cramping in the legs?
5. Why would the patient be instructed not to lift or stretch?
6. What would be the outcome if the aneurysm began to leak?
7. What would be the chances of survival if the aneurysm ruptured?