AAA Flashcards
what is considered abdominal aortic anneyursim?
> 3cm
why does AAA occur?
3 layers to the blood vessle
- tunica intima
- tunica media
- tunica advanticia
degredations of the tunica media and advanticia driven by atherosclerosis, smoking and hypertension leads to dilatation of the abdominal aorta
what are the risk factors?
- smoking
- male
- atherosclerosis
- vasculitis
- advancing age
what is a true aneurysm and what are the different types?
- they involve all layers of the abdominal aorta
- can be fusiform or sacular
what is a pseudoaneurysm?
blood is contained in a single layer of the blood vessel
there have a higher rate of rupture
ussually caused by trauma than normal risk factors
what is the most common site of a AAA?
infrarenal- below the level of the renal artery
what types of symptoms will someone with AA have?
- most commonly they will be asymptomatic
- abdominal, flank or back pain
- pulsating abdominal sensation
- syncope
anyone with symptoms of AAA needs surgery
what might you see on examination of someone with a AAA?
- pulsatile abdominal mass
- tachycardia and hypotension
- grey turners sign (flank bruising)
what is the initial imaging of choice when suspecting AAA?
bedside USS
what is the most important test for preoperative planning?
CT angiogram -> MRI if pregnant or allergic to contrast
dont do a CT if the aorta has ruptured as they may not survive to CT scanner.
endovascular repair needs CT but open repair does not
what are the bloods you would do when suspecting an AAA?
- FBC: anaemia, but dont be falsely reassured by a normal HB as it takes a while to come down
- UandE: baseline renal function prior to CT angiogram and also may have a prerenal AKI
CRP/ESR: raised in an inflamatory AAA
group and save and corssmatch
also do VBG
what is the treatment for ruptured infrarenal AAA?
Endovascular repair if…
- female
- male >70
open surgical repair…
- if otherwise i.e. male <70
what is the permissive hypotension approach?
if suspecting tripple A make sure BP is at a lower than normal range by employing a special method of giving fluids and blood products
<100 systolic
if BP is going up can cause dislodging of clot and further problems
how does the AAA screening programme work?
offered to all men >65 as a one off
< 3cm discharge from screening
3-4.4. anual surveillance
4.5-5.4. 3 monthly surveillence
>5.5 refer to vascular surgeon within 2 weeks
what is the management of unruptured AAA?
URGENT REPAIR:
- if symptomtatic
ELECTIVE REPAIR:
asymptomatic and >5.5
>4cm and grown >1cm in last year
NICE favours open repair,, but consider endovascular repair if have significant comorbidities
