Abdominal Aortic Aneurysm

Question 1

ESSENCE

Answer 1

Dilation of the abdominal aorta, diameter > 3cm

Question 2

PROGNOSIS

Mortality of ruptured AAA

Answer 2

80%

Question 3

AETIOLOGY

Risk factors

Answer 3

• Men affected more often and at younger age than woman
• Age
• Smoking
• Hypertension
• FH
• Existing CVD

Question 4

INVESTIGATION

What screening is offered

Answer 4

• All men offered US screening at 65 years
• Woman not routinly offered, but could be aged 70 with risk factors

Question 5

EPIDEMIOLOGY

Males or females more

Answer 5

Males far more than females, and at younger age

Question 6

CLINICAL FEATURES

Presentation

Answer 6

• Most are assymptomatic, and presents with rupture or routine screening
• Non-specific abdominal pain
• Pulsatile and expansile mass on abdomen when palpated
• Incidental finding on abdominal imaging

Question 7

INVESTIGATION

First investigations

Answer 7

• US - establish diagnosis
• CT angiogram - give more info to help surgery

Question 8

CLASSIFICATION

Answer 8

• Normal
  
  • <3cm
• Small
  
  • 3-4.4cm
• Medium
  
  • 4.5-5.4cm
• Large
  
  • >5.5cm

Question 9

MANAGEMENT

General principles

Answer 9

• Reduce risk of progression by treating reversible risk factors
• Regular screening
• Elective repair
• Possibly inform DVLA

Question 10

MANAGEMENT

Treating reversible risk factors

Answer 10

• Stop smoking
• Healthy diet and exercise
• Optimising management of hypertension, diabetes and hyperlipidaemia

Question 11

MANAGEMENT

Regular screening

Answer 11

• Yearly for aneurisms 3-4.4cm
• 3 monthly for aneurisms 4.5-5.4cm

Question 12

MANAGEMENT

When is elective repair recommended

Answer 12

• Symptomatic aneurism
• Diameter growing >1cm per year
• Diameter >5.5cm

Question 13

MANAGEMENT

Elective repair options

Answer 13

• Open repair via laparotomy
• Endovascular aneurism repair (EVAR)
  
  • Using stent inserted via femoral arteries

Question 14

MANAGEMENT

Rules for driving

Answer 14

• Inform DVLA if >6cm
• Stop driving if >6.5cm
• Stricter rules if driving heavy vehicles

Question 15

CLINICAL FEATURES

Presentation of ruptured AAA

Answer 15

• Severe abdominal pain that may radiate to back or groin
• Haemodynamic instability (hypotension and tachycardia)
• Pulsatile and expansile mass in abdomen
• Collapse
• Loss of consciousnsess

Question 16

MANAGEMENT

Of ruptured AAA

Answer 16

• Surgical emergency
• If haemodynamically unstable do not wait for imaging and go straight to theature, if stable can use CT angiogram to diagnose or exclude ruptured AAA
• If comorbidities may need to discuss palliative care with family