Abdominal Aortic Aneursym

Question 1

Abdominal aortic aneurysm (AAA) is defined as an abnormal dilatation of the abdominal aorta with a diameter greater than ..cm.

Answer 1

Abdominal aortic aneurysm (AAA) is defined as an abnormal dilatation of the abdominal aorta with a diameter greater than 3 cm.

Question 2

AAA - it is a relatively common aortic pathology that results in significant amounts of morbidity and mortality. Between 1-2% of men undergoing NHS screening (over the age of 65) will be found to have a AAA. The vast majority are … (i.e below the origin of the …).

Answer 2

It is a relatively common aortic pathology that results in significant amounts of morbidity and mortality. Between 1-2% of men undergoing NHS screening (over the age of 65) will be found to have a AAA. The vast majority are infrarenal (i.e below the origin of the renal arteries).

Question 3

AAA may be considered a … condition of the aorta though its aetiology is not fully understood.

Answer 3

AAA may be considered a degenerative condition of the aorta though its aetiology is not fully understood.

Question 4

A number of risk factors have been shown to be associated with AAA: (7)

Answer 4

Age
Male gender
Atherosclerotic disease
Family history
Smoking
Hypertension
Connective tissue disorders

Question 5

AAA’s are frequently …

Answer 5

AAA’s are frequently asymptomatic, the presence of symptoms often indicates rupture or impending rupture.

Question 6

Unruptured AAA’s tend to be asymptomatic. Local mass effect may result in … pain or … obstruction. AAA may be found incidentally on imaging or clinical examination. It may also present due to complications such as distal embolisation.

Answer 6

Unruptured AAA’s tend to be asymptomatic. Local mass effect may result in back pain or ureteric obstruction. AAA may be found incidentally on imaging or clinical examination. It may also present due to complications such as distal embolisation.

Question 7

Symptoms of unruptured AAA?

Answer 7

Abdominal pain

Back/loin pain

Question 8

Signs of AAA

Answer 8

Hypotension
Tachycardia
Collapse
Pulsatile abdominal mass

Question 9

The NHS has introduced screening for AAA for men aged … and over in England. It consists of an abdominal USS.

Answer 9

The NHS has introduced screening for AAA for men aged 65 and over in England. It consists of an abdominal USS.

Question 10

The NHS has introduced screening for AAA for men aged 65 and over in England. It consists of an … …

Answer 10

The NHS has introduced screening for AAA for men aged 65 and over in England. It consists of an abdominal USS.

Question 11

Why is abdominal USS used to screen men over 65 for AAA?

Answer 11

USS is a relatively cheap, non-invasive test with a high sensitivity for detecting AAA. Further management is dependent on the USS findings:

< 3cm: No further follow-up required
3cm - 4.4cm: Found in just over 1%, advise yearly screening with USS, give lifestyle advice. Refer to vascular service, to be seen within 12 weeks.
4.5cm - 5.4cm: Found in around 0.5%, advise 3 monthly screening with USS, give lifestyle advice. Refer to vascular service, to be seen within 12 weeks.
> 5.4cm: Found in around 0.1%, requires urgent two-week wait referral to vascular surgery to discuss management.

Question 12

USS is a relatively cheap, non-invasive test with a high sensitivity for detecting AAA. Further management is dependent on the USS findings:

Answer 12

< 3cm: No further follow-up required
3cm - 4.4cm: Found in just over 1%, advise yearly screening with USS, give lifestyle advice. Refer to vascular service, to be seen within 12 weeks.
4.5cm - 5.4cm: Found in around 0.5%, advise 3 monthly screening with USS, give lifestyle advice. Refer to vascular service, to be seen within 12 weeks.
> 5.4cm: Found in around 0.1%, requires urgent two-week wait referral to vascular surgery to discuss management.

Question 13

Further management