Case Report
this pathologic condition and its clinical implications , as well as shed the light on the importance of cadaveric dissection in medical education .
AAA is defined as an increase in the diameter of a localized segment of the aorta to at least 1.5 times the normal diameter of 2 cm , or an aortic diameter of greater than 3 cm ( Weintraub et al ., 2009 ). The long latency period in the natural history of AAA made it necessary for the United States preventive service task force ( USPSTF ) to suggest routine screening recommendations ( USPSTF 2019 ). Especially that an effective approach to the management of AAA lies in the importance of early diagnosis , close monitoring and follow up , as well as prompt treatment . Open , or more recently endovascular surgical repair ( when the anatomic specifications allow ) is recommended when the risk of AAA rupture surpasses the risk of surgical repair . Had our cadaver been involved in a AAA screening program , he would have probably been referred for elective surgical repair , and might have altered the sequence of events .
Surgically options for AAA evolved over the years with the same goal : minimizing the disease morbidity and mortality . Open surgical repair has been traditionally used to treat AAA . During this procedure , the surgeon dissects the abdominal aorta along its course , cross-clamp the aorta and the iliac vessels for the shortest time possible ( Schanzer et al ., 2012 ). A more recent treatment alternative is catheter-based endovascular aortic aneurysm repair ( EVAR ): it was first adopted in 1987 and proved to be an efficient and less risky alternative ( England et al ., 2013 ). EVAR entails the endovascular placement of a covered , selfexpanding stent that lands proximal and distal to the AAA itself . Thereby , it constitutes the aortic lumen and diverts the blood flow away from the aneurysm cavity ( Schanzer et al ., 2012 ). EVAR has recently surpassed open surgical repair as the modality of choice for managing AAA aneurysms : recent review of the National Inpatient Sample database showed that 55 % of ruptured and 85 % of intact AAA are currently repaired using EVAR ( Schanzer et al ., 2012 ). treatment , and present a post-mortem illustration of the anatomical parameters surgeons take into consideration when AAA repair is indicated . We would like to demonstrate the undervalued opportunities of post mortem autopsy , which can narrow the discrepancies between the reported and actual cause of death as was the case in this cadaver , leading to pursuit of further studies to improve existing applied medical knowledge .
Case Report
We describe this cadaveric finding in terms of surgical parameters , as evidence for the utility of post-mortem dissection in medical education and surgical training .
The cadaver studied was that of a man in his early 80s , who was known to be a hypertensive , heavy smoker , with a body mass index ( BMI ) of 25.37 ; and whose primary reported cause of death was “ sudden cardiac death ”.
Following Grant ’ s Dissector manual of human anatomy , we reflected the anterior abdominal wall and removed the gastrointestinal tract exposing the posterior abdominal wall ( Detton et al ., 2016 ).
The anatomical parameters of this abdominal aortic aneurysm were measured according to the Reporting Standards for Endovascular Aortic Aneurysm Repair , published in 2002 by the Ad Hoc Committee for Standardized Reporting Practices in Vascular Surgery of The Society for Vascular Surgery / American Association for Vascular Surgery ( Chaiof et al ., 2002 ). Table 1 shows the details of this grading system .
We took advantage of this unexpected encounter to teach medical students about a common , dangerous , yet manageable disease , in order to shed light on this pathology and its anatomical basis . Throughout this paper , we review the screening guidelines , indications for elective