AAA Flashcards
Arterial aneurysm?
An artery with a dilatation >50% of it’s original diameter.
True aneurysms
are abnormal dilatations that involve all layers of arterial wall.
Pseudoaneurysms
involve collection of blood in the outer layer only (adventitia) after trauma.
Screening test?
what size are you then put under surveillance?
what size are you considered for surgery?
all men in their 65th birthday are offered a ultrasound; if they have a abdominal aortic aneurysm of:
- 3cm: surveillance
- > 5.5cm: considered for surgery.
typcial AAA patient?
o Male >65yrs
o Western world
RF for rupture?
Smoking
Hypertension
Family history
Causes of AAA
DM
Atheroma
CTD - Marfan’s syndrome
Symptoms of unruptured AAA?
Asymptomatic
May cause abdo/back pain
Often picked up incidentally on abdo exam
Symptoms of ruptured AAA?
intermittent/continuous pain radiating to back or groins expansile abdo mass not pulsatile haemorrhagic shock acute ischaemia in legs
get the trauma triad in ruptured AAA - what is it?
hypothermia
acidosis
coagulopathy
complications of AAA?
Infection bleeding ischaemic limb major cardio-pulmonary event (MI, PE) Retrograde ejaculation Death
Tx for Ruptured AAA
what do you do first and foremost?
what do you do whilst you wait?
how do you treat shock?
do you do imaging?
what Abx do you give prophylactically pre-surgery?
o Summon vascular surgeon and anaesthetist
o ECG,
o Blood for amylase, Hb, crossmatch, catheterise bladder
o Treat shock with O Rh-ve blood (if not crossmatched) but keep systolic <100mmHg to avoid rupturing a contained leak.
o Straight to theatre (no x-rays – timewaste but CT may be helpful in stable patient with uncertain diagnosis).
Ao Give prophylactic Abx – co-amoxiclav 625mg IV).
Tx for unruptured AAA
what % of aneurysms need repair?
Elective open vascular repair surgery:
who is it reserved for?
what is the advantage?
what is EVAR?
advantages?
disadvantages?
o 75% of aneurysms under monitoring will need repair.
o Elective open vascular repair surgery: Reserve for aneurysms >5.5cm or expanding at >1cm/yr. No chance of recurrence.
o Stenting (EVAR) – Avoid open surgery by inserting a endovascular stent via a femoral artery. Faster recovery reduced chance of wound infection but higher graft complications.
what is group and save?
find out blood GROUP and SAVE abit of blood to potentially crossmatch
crossmatch?
find out blood group and take small sample to see if it reacts with other blood donations and see which one is most suitable for urgent transfusion
A 78-year-old gentleman presents to the emergency department with a 3 hour history of lower back pain. It is achey in nature and a 6/10 on the pain scale. On examination he has some tenderness on his abdomen and loin area. His blood pressure is 100/70 mmHg despite 500ml fluid bolus and his heart rate is 110/min. What’s the most likely diagnosis?
AAA
A 77-year-old man with a background of diabetes, hypertension, hypercholesterolaemia and previous myocardial infarction (MI) sees his GP about intermittent abdominal pain that he has been having for two months. It is dull in nature and radiates to his lower back. On examination, he has a pulsatile expansile mass in the central abdomen. He has had a previous US abdomen 6 months ago which showed an abdominal aortic diameter of 5.1cm. His GP repeats the US abdomen and refers to vascular clinic. The vascular surgeon sees the patient with the US report:
US abdomen:
No focal pancreatic, liver or gall-bladder disease. Trace free fluid. Abdominal aorta has diameter of 5.4cm. No biliary duct dilation. Kidneys look normal-sized and mildly echogenic.
What factor in the history most suggests that this patient needs surgery?
Abdominal pain
A 27-year-old man is involved in a road traffic accident. He is seen in the emergency department with chest pain. Clinical examination is essentially unremarkable and he is discharged. He subsequently is found dead at home. What is the most likely underlying injury?
Traumatic aortic disruption
Aortic injuries that do not die at the scene may have a contained haematoma.
