AAA (zero to finals)

Question 1

What is AAA?

Answer 1

Abdominal aortic aneurysm (AAA) which refers to dilation of the abdominal aorta, with a diameter of more than 3cm.

Isn’t noticed usually until after it has ruptured.

Question 2

What is the mortality of a ruptured AAA?

Answer 2

80%

Question 3

Risk factors for AAA?

Answer 3

Men are affected significantly more often and at a younger age than women

Increased age

Smoking

Hypertension

Family history

Existing cardiovascular disease

Question 4

When is screening carried out for AAA?

Answer 4

Ultrasound scanning is usually offered to males at around 65 years of age.

Question 5

At what diameter of aorta are patients referred to a vascular team?

Answer 5

3.3cm (urgently if 5cm or above)

Question 6

Typical presentation of AAA?

Answer 6

Most patients with an AAA are asymptomatic. It may be discovered on routine screening or when it ruptures.

Other ways it can present include:

• Non-specific abdominal pain
• Pulsatile and expansile mass in the abdomen when palpated with both hands
• As an incidental finding on an abdominal x-ray, ultrasound or CT scan

Question 7

What is the typical initial investigation for AAA?

Answer 7

Ultrasound

Question 8

What is a more detailed imaging form that can be used for AAA?

Answer 8

CT angiogram

Question 9

What are the classifications of aortic aneurysm?

Answer 9

Normal: less than 3cm
Small aneurysm: 3 – 4.4cm
Medium aneurysm: 4.5 – 5.4cm
Large aneurysm: above 5.5cm

Question 10

The risk of progression of AAA can be halted by reversing some of the risk factor. What are some examples?

Answer 10

Stop smoking

Healthy diet and exercise

Optimising the management of hypertension, diabetes and hyperlipidaemia

Question 11

What are the features of a ruptured AAA?

Answer 11

Severe abdominal pain that may radiate to the back or groin

Haemodynamic instability (hypotension and tachycardia)

Pulsatile and expansile mass in the abdomen

Collapse

Loss of consciousness

Question 12

Ruptured AAA is a surgical emergency. True/false?

Answer 12

True requires immediate involvement of experienced seniors, vascular surgeons, anaesthetists and theatre teams.

Question 13

What is permissive hypotension?

Answer 13

Refers to the strategy of aiming for a lower than normal blood pressure when performing fluid resuscitation.

Question 14

What is management of haemodynamically unstable AAA patient?

Answer 14

Transferred directly to theatre. Surgical repair should not be delayed by getting imaging to confirm the diagnosis.

Question 15

What is management of haemodynamically stable AAA patient?

Answer 15

CT angiogram can be used to diagnose or exclude ruptured AAA in haemodynamically stable patients.