Abdomina Aortic Aneurysm (AAA) Flashcards
1
Q
What is AAA?
A
- abnormal dilatation of the abdominal aorta with a diameter greater than 3 cm
2
Q
What are the RF for AAA?
A
- Age
- Male gender
- Atherosclerotic disease
- Family history
- Smoking
- Hypertension
- Diabetes
- Connective tissue disorders (Marfan’s disease, Ehler’s Danlos, Loey Dietz)
3
Q
What are the clinical features of AAA?
A
- Asymptomatic (majority of times)
- Symptomatic if ruptures of impending rupture
- Abdominal pain
- Back/loin pain
- Hypotension
- Tachycardia
- Collapse
- Pulsatile abdominal mass
4
Q
Who is the AAA screening programme for?
A
- USS for men aged 65 and over
- women over 70 with any one of;
- COPD, vascular disease, family history, hyperlipidaemia, hypertension, smoker/ex-smoker
5
Q
Describe the AAA screening program
A
- < 3cm: No further follow-up required
-
3cm - 4.4cm:
- advise yearly screening with USS
- give lifestyle advice.
- Refer to vascular service within 12 weeks.
-
4.5cm - 5.4cm:
- advise 3 monthly screening with USS,
- give lifestyle advice
- Refer to vascular service within 12 weeks.
-
> 5.4cm:
- urgent two-week wait referral to vascular surgery
6
Q
What Ix would you order for AAA?
A
Bedside
- Observations/Monitoring
- ECG
- Urine dip
Bloods
- FBC
- UE
- LFT
- Clotting screen
- ABG/VBG
- Group and Save / Crossmatch
Imaging
- Abdo USS - trace free fluid is considered normal finding (first line)
- thin-slice contrast-enhanced arterial-phase CT angiography
7
Q
A
8
Q
How would you mx
A
9
Q
What is the AAA screening programme called?
A
national abdominal aortic aneurysm screening programme (NAAASP)
10
Q
What is the differential diagnosis for AAA?
A
- renal colic
- diverticulitis
- inflammatory bowel disease
- irritable bowel syndrome
- GI haemorrhage
- ovarian rupture
- splenic rupture
11
Q
How would you mx AAA in an eletive setting?
A
Conservative
- Smoking cessation
- Improve blood pressure control
- statin and aspirin therapy
- Weight loss and increased exercise
Surgery
- open surgical repair
- Endovascular Aneurysm Repair (EVAR)
12
Q
What are the indications for elective surgery?
A
- Diameter > 5.4cm
- Symptomatic aneurysms
- Asymptomatic, > 4cm and grown by more than one cm in a year.
13
Q
What is a cx of EVAR?
A
- Endovascular leak
14
Q
What are the cx of AAA?
A
- ruptured AAA
- retroperitoneal leak
- embolisation
- aortoduodenal fistula
15
Q
What increases risk of ruptured AAA?
A
- inc. diameter of aneurysm
- smoking
- hypertension
- female gender
16
Q
What is the classic triad of AAA?
A
- flank or back pain
- hypotension
- pulsatile abdominal mass
17
Q
How would you mx ruptured AAA?
A
Initial
- High flow O2
- IV access - 2 large bore cannula
- urgent bloods + crossmatch 6U
- keep the BP≤100mmHg - prevent clot dislodge
- refer to vascular unit
if Ruptured infrarenal AAA
- EVAR
if Standard EVAR unsuitable
- Open surgical repair
18
Q
Where do most triple As rupture?
A
- posteriorly into retroperitoneal space
- *presents with classic triad of
- Flank pain, hypotension, abdominal mass
