AAA Flashcards
what is an aneurysm
an abnormal dilatation of a blood vessel by more than 50% of the normal diameter
- for an AAA this is >3cm
risk factors for an AAA
smoking HTN hyperlipidaemia family hx connective tissue disorders: Marfans, Ehlors Danlos
how do AAA’s present
majority are asymptomatic and incidental findings symptoms include: - abdominal pain - back / loin pain - emboli causing limb Ischaemia
what may be felt on examination of an AAA
an expansile/ pulsatile mass
what screening is offered for AAAs
USS to men in the 65th year
presentation of a ruptured AAA
sudden onset abdo pain radiating to back
collapse
severe hypotension
gold standard for diagnosing an AAA
CT angiogram
medical management of an AAA
AAA’s less than 5.5cm can be monitored by USS
Lifesyle: smoking cessation, weight loss, exercise
Improve BP control
Statin + aspirin therapy
when should surgery be considered for an AAA
aneurysm > 5.5 cm (elective)
aneurysm expanding at >1cm a year(elective)
symptomatic patients (emergency)
surgical options for an AAA
Open repair Endovascular repair (EVAR)
Important complication of EVAR
endovascular leak
management of a ruptured AAA
ABCDE
- high flow O2
- IV access
- urgent bloods
- crossmatch 6 units
if unstable – theatre for open repair
if stable – CT angiogram to determine if suitable for EVAR
what is the concept of permissive hypotension
hypotension in ruptured AAA patients needs to be treated carefully - raising BP may dislodge a clot and precipitate further bleeding
therefore aim to keep BP <100
As long as the patient is cerebrating (alert, talking ect) then BP is adequate
how often should an aneurysm 3-4.4cm be scanned
yearly
how often should an aneurysm 4.4-5.4cm be scanned
3 monthly
