AAA Flashcards
What is an abdominal aortic aneurysm
Dilation of the abdominal aorta
Diameter >3cm
Risk factors of AAA
- smoking: most common
- men
- increasing age
- hypertension
- family history
- existing cardiovascular disease
Screening of AAA
Ultrasound offered to all men >65
Offer to women >70 with existing CVD, COPD, family history, hypertension Ro smoking
If aorta diameter >3cm refer to vascular
Presentation of AAA
- Mostly asymptomatic
- most found when ruptured or on routine screening
- non specific abdominal pain
- pulsatile + expansive mass in abdomen
Diagnosis of AAA
USS (first line)
CT angiogram
Classification of AAA
- normal: <3cm
- small aneurysm: 3-4.4cm
- medium aneurysm: 4.5-5.4cm
- large aneurysm: >5.5cm (urgent referral needed)
Surveillance of AAA
Yearly for small aneurysm 3-4.4cm
3 monthly for medium aneurysm 4.5-5.4cm
Who does NICE recommend elective repair of AAA in?
- symptomatic aneurysm
- diameter growing >1cm per year
- diameter >5.5.cm
Outline elective surgery of AAA
- inserting artificial graft into section of aorta affected by aneurysm by:
- open repair via laparotomy
- endovascular aneurysm repair - stent inserted via femoral artery
When do patients with a AAA need to do regarding driving?
- inform DVLA if >6cm
- stop driving if >6.5cm
- stricter rules for heavy vehicle drivers
Presentation of ruptured AAA
- severe abdominal pain that can radiate to back or groin
- Haemodynamic instability
- pulsatile + expansile mass in abdomen
- collapse
- LOC
Mortality % of ruptured AAA
80%
Management of ruptured AAA
- surgical emergency
- permissive hypotension
- open repair via laparotomy
- endovascular aneurysm repair
- surgical repair should not be delayed by getting diagnostic imaging
What is permissive hypotension?
Aiming for BP lower than normal to try and reduce blood loss
Medical management of small AAA
- smoking cessation
- improve blood pressure control
- start statin + aspirin therapy
- weight loss + increase exercise
Aetiology of thoracic aortic aneurysms
- degradation of tunica media
- artery loses structural integrity + dilates
- main causes: connective tissue diseases e.g. Marfan’s + Ehlers-Danlos + bicuspid aortic valve
What is an aneurysm?
A persistent abnormal dilatation of n artery to 1.5x its normal diameter
Presentation of of thoracic aortic aneurysms
- mostly asymptomatic
- chest pain
- ascending aorta - anterior chest pain
- aortic arch - neck pain
- descending aorta - posterior thoracic pain
- hoarse voice
Why can a thoracic aortic aneurysm cause a hoarse voice?
Damage to left recurrent laryngeal nerve
Risk factors of of thoracic aortic aneurysms
- family history
- hypertension
- atherosclerosis
- smoking
- high BMI
- male
- increasing age
What is the preferred imaging of AAA vs TAA
AAA: USS
TAA: CT angiogram
Management of TAA
- smoking cessation
- statins + anti platelet therapy
- optimise BP
Preferred imaging of AAA:
- surveillance
- before elective surgery
- if ruptured
- surveillance: abdominal USS
- before elective surgery: CT angiography
- if ruptured: CT angiography
Post surgery complications of AAA repair
- endovascular repair: endo leak
- graft: graft thrombosis
