AAA Flashcards
Abdominal Aortic Aneurysm is a — of the abdominal – (> 3cm) formed by – of the — secondary to — of the aortic wall, that may extend — or — along the artery
— preponderance – 4:1
3000 death per year in UK
10th cause of death in men
5% of smoker have AAA
25% of patients with AAA have coexisting — or – aneurysms
dilatation
aorta
widening
lumen
weakness
proximally or distally
male
femoral or popliteal
risk factors:
High risk associated with;
- —
- —
- —
- — disease
- FHx
- anrusym classification:
1- — / —
2- —
3- aetiology —
-Inflammatory
-Infective
-Traumatic
-Post dissection
smoking
hyperlipdiemia
hypertension
peripheral vascular
true/false
anatomical
degenerative
clinical presentation:
— - 75%
Incidental finding:
Routine examination
US/Pfa for other reason
Patient notices pulsatile mass
Symptomatic:
Distal Embolisation (blue toe syndrome)
Leak (abdominal/back /flank pain)
Rupture(hypovolaemic shock, sudden epigastric/back pain)
Fistulation – “Rare”(aorto-caval/aorto-enteric)
asymptomatic
assessment clinical examination:
Clinical Examination
Inspect for abdominal — at eye level
Feel for pulsatile/expansile mass in — planes
Listen for –
Examine — and — arteries
- management - operative:
Indications for Surgery:
Rupture
Symptomatic - back/flank/abdominal pain, embolisation
Rapid increase in size >1.0 cm/year
Asymptomatic ≥ 5.5 cm – exact lower limit controversial
Aorto-caval/Aorto-enteric fistula
pulsation
2
bruits
femoral and politeal
1- surgical consideration:
2- assessment :
CT Angiography
Size, site and extension
Tortuosity:
Involvement of – arteries
Evidence of –
Risk of rupture vs
Operative mortality vs
Individual life expectancy
renal
leak
1- mangement - endovasuclar:
Advantages over Surgery:
Suitable for — age groups
Suitable in significant co-morbid illnesses
Avoids the major 3 insults of surgery:
Laparotomy
Aortic Cross-Clamping
Ischaemia-Reperfusion
older
management by EVAR ( Endovascular Aneurysm Repair ) or open repair
open repair:
1. —
Midline
TV
Retroperitoneal
2- —
3- — dissection
4- cross clamping
Proximal / Distal —
Evacuation of –
Ligation of Lumbars / IMA
5- aortic —
incision
exposure
proximal dissection
control
haemotomma
reconstruction
EVAR complication:
Operative Mortality <1 %
Access
Endoleaks / Graft Migration / Erosion - Reintervention
Limb Occlusion
Pelvic Ischaemia
Open repair complications:
Operative Mortality 5-10%
1– — :
Cardiac / Resp
Bleeding
Colonic / Limb Ischaemia
2- — :
Hernia
Sexual dysfunction
Graft infection
Aorto-Enteric Fistula
earlu
late
summary:
Risks: Smoking, HTN, IHD, FHx
Aetiology: True, Infrarenal, Degenerative
Dx: US, CTA
Operate: 5.5cm / Symptomatic
EVAR
