AAA

Question 1

Definition?

Answer 1

Permanent pathological dilatation of the aorta and is 1.5x the expected AP diameter of that segment. Or >3cm

Question 2

Difference bt true and false aneurysm?

Answer 2

They may occur as either true or false aneurysm. With the former all 3 layers of the arterial wall are involved, in the latter only a single layer of fibrous tissue forms the aneurysm wall and causes tract bt layers.

Question 3

Strong risk factors?

Answer 3

• Smoking
• Family history
• Age
• Male-prevalence
• Female-rupture
• CT disorders-Marfans, ED,

Question 4

Weak risk factors?

Answer 4

• Hypertension
• Hyperlipidaemia
• Atherosclerosis
COPD

Question 5

Differentials? (9)

Answer 5

• Diverticulitis
• Ureteric Colic
• IBS
• Inflammatory bowel disease
• Appendicitis
• Ovarian torsion
• GI haemorrhage
• Splanchnic artery aneurysms or occlusion
Renal stones

Question 6

Epidemiology?

Answer 6

0ver 60’s, male 6:1 , white

Question 7

Aetiology?

Answer 7

• AS
• Smoking
• Marfan’s-impaired elastin
• Ehlers -Danos-collagen disruption
• Infection
• Degeneration and inflammation of bv wall by MMP’s

Question 8

clinical presentation

Answer 8

• Asymptomatic
• Severe left flank- abdo, chest, lower back, groin
• Pulsating mass with heart beat at or above level of umbilicus and expansile
• Bruit on auscultation
• Hypotension
• Peripheral thrombosis
• Low ankle brachial index
• Shock-high hr, resp high, urine output low, low bp

Question 9

Pathophysiology?

Answer 9

Atherosclerosis, MMPs, and IgG all result in the destruction of elastin and collagen in the walls, making it weaker and prone to dilatation.

Question 10

The more it expands, the more it is likely to…?

Answer 10

Rupture

Question 11

1st line investigation

Answer 11

Abdo and back exam, vital signs, ABCDE in rupture

Question 12

2nd line investigation

Answer 12

US

Question 13

3rd line investigation

Answer 13

CT

Question 14

4th line investigation

Answer 14

CRP/ESR,FBC, MRI

Question 15

Management for small? (3cm to 4.4cm across)

Answer 15

US are recommended every year to check if it’s getting bigger; and healthy lifestyle changes to help stop it growing

Question 16

Management for medium? (4.5cm to 5.4cm)

Answer 16

US are recommended every 3 months to check if it’s getting bigger; and healthy lifestyle changes

Question 17

Management for large? (5.5cm or more)

Answer 17

surgery to stop it getting bigger or bursting is usually recommended

Question 18

Management for rupture?

Answer 18

Standard resuscitation measures
CT
Urgent surgical repair
perioperative antibiotics
surveillance imaging

Question 19

Options for surgery?

Answer 19

open or EVAR

Question 20

Process of Open surgery?

Answer 20

Midline laparotomy, clamp aorta and transect it to insert graft.

Question 21

Complications of open surgery?

Answer 21

organ ischaemia, coagulopathies, MI, stroke, resp distress, gut ischaemia, AKI, distal limb ischaemia, infection, fistulas, impaired sexual function and incisional hernias

Question 22

Process of EVAR?

Answer 22

Endovascular stent inserted through femoral/ileac arteries and guided via US guidance

Question 23

Complications of EVAR?

Answer 23

Wire trauma/access problems
Endoleak bt wall of graft and vessel
Graft migration
Graft kinking/occlusion
US survey every 6 months

Question 24

5 yr survival?

Answer 24

60-75%

Question 25

Which risks are assessed?

Answer 25

Risk of rupture vs risk of surgical intervention

Question 26

how many people die before hospital?

Answer 26

75%

Question 27

how many die in hospital?

Answer 27

40%