AAA

Question 1

AAA?

Answer 1

Abdominal Aortic Aneurysm

Permanent pathological dilation of aorta> 1.5x the expected diameter

Question 2

Trigger for annual AAA check ups

Answer 2

3 cms infrarenal aorta
grow 4-5mm

Screening 65y Male , 70 Female
yearly if 3.55 -4.4cms
6 moths 4.5 -5.4

surgery offered at 5.5cm

Question 3

Risk factors for AAA

Answer 3

55Y.0 MALE, smoking, posive primary relative family history, COPD,Marfan’s syndrome, Ehrlers-Danlos syndrome

Question 4

Aetiology

Answer 4

Atherosclerosis accompanies
Metalloproteins - enhanced enzyme activity breaking down structural matrix protein
Biomechanical wall stress - collagen degradation, decreased elasticity

Question 5

AAA potential regions

Answer 5

Retroperitoneal - initial and may be temporarily contained

Intraperitoneal - may be primary or secondary to retroperitoneal, increases mortality rate

Question 6

Retroperitoneal

Answer 6

Behind the peritoneum
Kidneys
Adrenal glands
Pancreas
A.Aorta
IVC
Ascending and descending colon

Question 7

Intraperitoneal

Answer 7

Esophagus, Stomach, S.intestines, appendix, transverse and sigmoid colon

Question 8

Clinical features

Answer 8

Male
over 65y.o
Back/abdo pain may radiate to flanks or down to the groin
Hypotension - syncope, dizziness
Tachycardia
Postural drop
Pallor
Peritonism
Neurological signs - spinal cord ischaemia t10-T12

Question 9

Observation signs

Answer 9

Expansile, pulsatile mass in epigastrium
Difficult depending on body habitus
Lack of lower limb arterial pulses

Question 10

Clinical investigations

Answer 10

Refer to Vascular surgeons
If known AAA and suspected rupture - immediate surgery
If suspected with hypotension and known history - do not delay surgery

If unknown but suspected - CT RA, US
CRP and ESR - if infective AAA suspected
ECG- rule out MI

Question 11

DDx AAA

Answer 11

Perforated viscus
Intra abdominal sepsis
Renal colic
Musculoskeletal back pain
MI

Question 12

Treatment

Answer 12

Surgery - eVAR endovascular AAA repair

or open repair

Question 13

Management of suspected leaking AAA

Answer 13

Urgent CT angio and vascular referral for urgent surgical repair.

Supportive management – analgesia, blood transfusion, control BP – aim sys ~90

Question 14

Limb Viability

Answer 14

A viable limb looks normal, is neurovascularly intact and has pulses present on Doppler.

A threatened limb may have reduced sensation but normal motor function. It may feel cool with non-fixed mottling and pulses may not be audible with Doppler.

An irreversibly ischaemic limb has sensation and motor loss, with or without tissue loss (gangrene). Fixed mottling is present and no pulses are audible on Doppler. Likely to need amputation.