AAA Flashcards
Definition?
Permanent pathological dilatation of the aorta and is 1.5x the expected AP diameter of that segment. Or >3cm
Difference bt true and false aneurysm?
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.
Strong risk factors?
- Smoking
- Family history
- Age
- Male-prevalence
- Female-rupture
- CT disorders-Marfans, ED,
Weak risk factors?
• Hypertension
• Hyperlipidaemia
• Atherosclerosis
COPD
Differentials? (9)
• Diverticulitis • Ureteric Colic • IBS • Inflammatory bowel disease • Appendicitis • Ovarian torsion • GI haemorrhage • Splanchnic artery aneurysms or occlusion Renal stones
Epidemiology?
0ver 60’s, male 6:1 , white
Aetiology?
- AS
- Smoking
- Marfan’s-impaired elastin
- Ehlers -Danos-collagen disruption
- Infection
- Degeneration and inflammation of bv wall by MMP’s
clinical presentation
- 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
Pathophysiology?
Atherosclerosis, MMPs, and IgG all result in the destruction of elastin and collagen in the walls, making it weaker and prone to dilatation.
The more it expands, the more it is likely to…?
Rupture
1st line investigation
Abdo and back exam, vital signs, ABCDE in rupture
2nd line investigation
US
3rd line investigation
CT
4th line investigation
CRP/ESR,FBC, MRI
Management for small? (3cm to 4.4cm across)
US are recommended every year to check if it’s getting bigger; and healthy lifestyle changes to help stop it growing
Management for medium? (4.5cm to 5.4cm)
US are recommended every 3 months to check if it’s getting bigger; and healthy lifestyle changes
Management for large? (5.5cm or more)
surgery to stop it getting bigger or bursting is usually recommended
Management for rupture?
Standard resuscitation measures CT Urgent surgical repair perioperative antibiotics surveillance imaging
Options for surgery?
open or EVAR
Process of Open surgery?
Midline laparotomy, clamp aorta and transect it to insert graft.
Complications of open surgery?
organ ischaemia, coagulopathies, MI, stroke, resp distress, gut ischaemia, AKI, distal limb ischaemia, infection, fistulas, impaired sexual function and incisional hernias
Process of EVAR?
Endovascular stent inserted through femoral/ileac arteries and guided via US guidance
Complications of EVAR?
Wire trauma/access problems Endoleak bt wall of graft and vessel Graft migration Graft kinking/occlusion US survey every 6 months
5 yr survival?
60-75%
Which risks are assessed?
Risk of rupture vs risk of surgical intervention
how many people die before hospital?
75%
how many die in hospital?
40%