abdominal aneurysms Flashcards
what is an aneurysm
dilation and essentially refers to an abnormal bulge in a blood vessel
what is an AAA
Abdominal Aortic Aneurysm is a permanent localized dilation of the abdominal aorta
what diameter does the abdominal aorta need to be to be classified as a aneurysm
> 3cm
diagnosis of any aneurysm size wise
one and a half the size of the normal vessel
general pathophysiology of an AAA
any inflammatory process that will decrease the elasticity of the vessel wall which decreases tensile strength causing the vessel the expand
what main factor can weaken the arterial wall and why
•Atherosclerotic plaque build up making it harder for oxygen and nutrients to reach all layers of the arterial wall
oWithout oxygen and nutrients these artery’s develop ischemia and become weaker making them prone to aneurysms
diagnosis of an AAA
asymptomatic generally but USS is highly sensitive
main risk factors for an AAA (5)
GASD >60 man smoking hypertension diabetes
other risk factors for AAA
- genetic predisposition
- any condition that makes you prone to atherosclerosis
layers of the blood vessel
tunica intima
elastic layer
tunia media
tunica adventitia
two types of aneurysm and subtypes
true- all layers of the vessel expand together
- fasiform- whole circumference of vessel effected
- saccular- only a portion of circumference dilated
False- only tunica intima and media dilate
-mainly iatrogenic in nature
mortality risk rate in emergency vs elective AAA repair
emergency- 80%
elective- 2-7%
management of a AAA <4cm
recall annually for USS
management of a AAA 4-5cm
recall USS every 6 months
management of a AAA >5cm
intervention needed
when do you treat an AAA
more than 5cm
rupture or symptomatic
growing more than 1cm a year
symptoms of AAA rupture
abdominal pain radiating to the back
pulsatile mass
chest pain
hypotension
disadvantages to an open AAA repair
- significant incision in abdomen
- long recovery
- high post op mortality risk
- contraindicated in many patients
followup for open AAA
ultrasound every year
who isnt suitable for an open repair
high anesthesia risk
co-morbities
-previous abdo surgery
EVAR indication
anyone over 70
anatomy suitable for repair
patients with co-morbidities
EVAR contraindication
curvy artery
EVAR cons
complications and reinterventions are common
EVAR followup
6 month CT/X-ray then anually
pros of EVAR
minimally invasive
faster recovery
good for younger patients
reduced risk of death
