AAA Flashcards

1
Q

Give examples of common anatomical sites at which aneurysms occur. Why do aneurysms occur at such sites?

A

Common sites:

  • infrarenal aorta
  • popliteal
  • femoral
  • iliac

Occur at sites of bifurcation due to tumultuous blood flow

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2
Q

Explain the difference between true and false aneurysms.

A
True = involves all 3 layers of vessel wall, occurs in atherosclerosis
False = collection of blood in the tunica adventitia that communicates with the lumen, occurs in situation such as penetrating trauma
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3
Q

What are the S+S of aortic aneurysms?

A
  • central abdo pain radiating to the back
  • severe presentation = sudden collapse
  • subacute = persistent severe central abdo pain
  • patient may present with shock (hypotensive + tachycardic)
  • patient will usually have a history of CV disease
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4
Q

What are the indications for surgical intervention in aortic aneurysm disease?

A
  • if the AP diameter is >5.5cm in individuals
  • symptomatic AAA
  • if it is growing rapidly in size (>0.5cm over 6 months)
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5
Q

What are the differential diagnoses for an epigastric mass?

A
  1. Skin + soft tissue: sebaceous cysts; lipoma; sarcoma; herniae
  2. GIT: hepatomegaly; carcinoma of stomach; carcinoma of pancreas; pancreatic pseudocyst
  3. Vascular: AAA; retroperitoneal lymphadenopathy
  4. Ruptured AAA: acute abdomen; acute pancreatitis; perforation; renal colic; biliary colic; inferior MI
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6
Q

What are the risk factors for arterial aneurysms?

A
  • smoking
  • hyperlipidaemia
  • COPD
  • atherosclerosis
  • hypertension
  • central obesity
  • FHx
  • increasing age
  • male (prevalence)
  • CT disorders
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7
Q

What is the first line investigation for a suspected AAA?

A

Abdominal US (unless aneurysm is close to renal arteries - then use CTA); threshold for diameter ≥3 cm

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8
Q

What might blood tests in a patient with AAA show?

A
  • ESR/CRP: elevated
  • FBC: relative anaemia and leukocytosis (if infectious AAA)
  • Blood cultures: if infectious AAA
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9
Q

How should asymptomatic aneurysms be monitored?

A
  • 3.0-4.4 cm = abdo US every 2 years

- ≥4.5cm = abdo US every 3-6 months (the bigger it is, the more often it is monitored)

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10
Q

What are the potential complications of aneurysms?

A
  1. death (shock, MI, renal failure)
  2. rupture
  3. thrombosis
  4. embolism
  5. pressure
  6. infection
  7. fistulae
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11
Q

Describe the process of open AAA repair?

A
  • Expose AAA
  • Open AAA
  • Sew in artificial graft
  • Close AAA
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12
Q

What are the benefits and disadvantages of open AAA repair?

A

Benefits:

  • reintervention is unlikely to be necessary
  • graft is more durable

Disadvantages:

  • infection
  • significant abdominal decisions
  • 30-90 minute cross clamp of aorta
  • contraindicated in people with previous surgery
  • long hospital stay
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13
Q

What are the potential complications of open AAA repair?

A
  1. renal failure
  2. distal embolisation
  3. MI
  4. graft infection
  5. spinal cord injury
  6. impotence
  7. embolus
  8. ischaemia of the mesentery, limb or spine
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14
Q

Describe the process of endovascular aneurysm repair (EVAR).

A
  • Graft is introduced via femoral artery to the aneurysmal site and positioned in the normal diameter artery above and below the aneurysmal section
  • It is uncoiled
  • If the aneurysm is close to the aortic bifurcation then the stent must go down both iliac arteries
  • An angiogram is performed to check the stent is correctly positioned
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15
Q

What are the benefits and disadvantages of EVAR?

A

Benefits:

  • minimally invasive
  • lower mortality rate
  • shorter recovery time
  • better functional outcome than open AAA repair

Disadvantages:

  • endoleak
  • stent/graft migration
  • stent/graft relocation
  • reintervention requirement
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16
Q

What are the potential complications of EVAR?

A
  1. damage to surrounding vessels or organs by instruments
  2. endoleak
  3. renal failure
  4. groin wound infection
  5. groin haematoma
  6. spinal cord injury
  7. limb ischaemia
17
Q

Describe the S+S of a patient presenting with a leak or rupture of an AAA.

A

Symptoms:

  • sudden onset epigastric and/or back/groin pain
  • history of sudden collapse and transient hypotension
  • history of AAA

Signs:

  • cardinal signs: unexplained rapid onset of hypotension, pain and sweating
  • pulsatile abdo mass
18
Q

Describe the S+S of a patient presenting with a leak or rupture of a thoracic aortic aneurysm.

A
  • present with chest pain indistinguishable from MI
  • can have haemoptysis
  • diagnosis usually made post-mortem as rupture causes cardiac tamponade and death
19
Q

What is the acute management for an AAA?

A
  1. large bore IV access ASAP
  2. Group and save and bloods
  3. theatre ASAP
  4. secure proximal aortic control without disturbing any tamponade effect provided by extra aortic structures or haematoma
  5. resuscitation of hypovolaemic shock (fluids, high flow O2 non-rebreathing mask)
  6. repair of leak or rupture with a prosthetic graft/stent