Abdominal Aortic Aneurysm

Question 1

What are the different classifications of aneurysm?

Answer 1

True aneurysm

• saccular= artery bulges on one side
• fusiform= whole circumference of artery dilated

False aneurysm
-tear in tunica intima and media but adventia remains intact leading to haematoma forming

Question 2

What is the difference between a false aneurysm and a dissection?

Answer 2

Dissection only involves tear in tunica intima= blood collects between intima and media layers

False involves tear in intima and media= blood forms haematoma with adventia acting as outer layer

Question 3

What is an AAA? What are the risk factors for developing one?

Answer 3

Dilation of abdominal aorta >3cm

Risk factors:

• men
• increased age
• smoking
• hypertension
• FH
• existing cardiovascular disease

Question 4

Why has the rate of AAA ruptures decreased in recent years?

Answer 4

Screening programme introduced for all men at 65 yo to try and detect asymptomatic AAA

Question 5

How might someone with AAA present?

Answer 5

Non-specific abdominal pain/tenderness
Pulsatile, expansile abdominal mass on palpation

Can be asymptomatic and found incidentally on AXR

Question 6

How can risk of progression of AAA be reduced?

Answer 6

Smoking cessation
Improve diet and exercise
Tight control of hypertension/diabetes/hyperlipidaemia

Question 7

When is elective surgery indicated for patient with AAA? What are the 2 main types of surgical treatment?

Answer 7

Symptomatic
Diameter increased by >1cm/year
Diameter >5.5cm

Open repair (laproscopic)
Endovascular aneurysm repair (EVAR) 
-stent inserted via femoral arteries guided by catheter

Question 8

What are the red flags signs and symptoms which indicate AAA rupture? What is the prognosis for these patients?

Answer 8

Severe abdo pain radiating to back 
Haemodynamically unstable 
-hypotension and tachycardia 
Collapse= hypovolaemia 
LOC 
Grey turners sign= bruising in flanks

80% mortality