AAA

Question 1

What is the definition of an aneurysm?

Answer 1

Dilatation of a vessel (arterial or venous) by more than 50% of its normal diameter

Question 2

What is the normal aortic diameter?

Answer 2

1.2-2cm

Question 3

What is a true aneurysm?

Answer 3

All 3 layers of the vessel wall are intact - swelling of the vessel

Question 4

What is a false aneurysm?

Answer 4

Breach in the vessel wall, involve a collection of blood in the outer layer (adventitia) which communicates with the lumen.

Question 5

What shapes can aneurysms be?

Answer 5

Fusiform - most common, aortic example

Sac like - berry aneurysm example

Question 6

What causes true aneurysms?

Answer 6

Not atherosclerosis = incidental finding
Associated with media degeneration (middle layer of the vessel wall)
Regulation of the enzymes and proteins in the aortic wall, collagen and elastin specifically.
Leading to wearing of the wall, leading to aneurysm dilatation, increased aortic wall stress, progressive dilatation, rupture

Question 7

Are AAA’s more common in male or female?

Answer 7

Male

Question 8

How may AAA’s present?

Answer 8

Asymptomatic (75%) - usually incidental finding

Symptomatic

• Pain - mimic renal colic
• trashing - Bits of thrombus (due to the turbulent blood flow over aneurysm) break off, travel down the legs, trashing distal circulation
• rupture

Question 9

What is the age of AAA screening?

Answer 9

men 65 and older

Question 10

What might the signs of a ruptured AAA be?

Answer 10

Suden onset epigastric/central pain
May radiate to the back
Patient might collapse

Question 11

When would you intervene in an aneurysm?

Answer 11

If the AAA is symptomatic
If the AAA is asymptomatic and later than 5.5cm
If the AAA is rapid growing (>1cm/yr)

Surveillance if small AAA

Question 12

Describe the use of duplex ultrasound in aneurysm?

Answer 12

allows to measure the AP

Allows to see if there is an AAA

Question 13

Describe use of CT - material phase scan?

Answer 13

Give IV contrast agent, commence when contrast is in the arterial system

Lets you see the size and shape
Lets you see relation to other vessels
Only imaging method to identify ruptured AAA

Question 14

describe open repair?

Answer 14

open the patient up
Clamp above and below aneurysm
Put in a graft

Question 15

Describe EVAR

Answer 15

Endovascular aneurysm repair
Excludes AAA from inside vessel
Insert stent
X ray guided