Abdominal aortic aneurysm Flashcards
Define an aneurysm
Focal dilatation of an artery >1.5x normal
Define arteriomegaly
Diffuse arterial enlargement >50% above normal
Define ectasia
Focal dilatation of an artery <1.5x normal
Name the morphological types of aneurysms
Saccular
Fusiform
Give the aetiology of abdominal aortic aneurysms
Degenerative Infectious Inflammation Connective tissue disorders Post-stenotic Post-dissection Pseudo
Name risk factors for abdominal aortic aneurysm
Male Smoker Caucasian Family history Hypertension Hypercholesterolemia
Describe the pathogenesis of abdominal aortic aneurysm
Proteolytic degradation of aortic wall CT Inflammation Immune response Biochemical wall stress Molecular genetics
Name clinical features of abdominal aortic aneurysm
Compressive
- early satiety
- nausea
- vomiting
- obstructive uropathy
- recurrent UTIs
- back pain
Rupture
- acute abdominal pain
- hemodynamic instability
- pulsatile abdominal mass
Embolic
- blue toe syndrome
- acute threatened limb
Fistulation
Name investigations in suspected AAA
U/S
CTA
MRA
When should AAA screening begin?
> 65yo
Discuss the management of AAA
Non-operative
- best medical therapy
- U/S 3 monthly if 4.5 - 5.5cm, 6 monthly if 3-4.5cm
Elective repair when risk of rupture
- open
- EVAR
Name the criteria for elective repair of AAA
- male >5.5cm female >5cm
- expansion >1cm/y
- factors assoc w/ increased expansion (smoking, chronic obstructive airway disease)
How do you perform a preoperative assessment before elective AAA repair?
Cardiac risk factors - MI - angina - HF - arrhythmia - valvular disease Age >70yo Renal dysfunction
Which open approach to AAA repair is preferred?
Transperitoneal
Name indications for retroperitoneal AAA repair
Hostile abdomen Inflammatory aneurysm Suprarenal aneurysm Horseshoe kidney Renal ectopy
Name complications of open AAA repair
Early
- CVS
- hemorrhage
- renal failure
- limb ischemia
- colonic ischemia
- VTE
Late
- graft sepsis
- pseudoaneurysm
- aorto-enteric fistula
Name requirements for EVAR
Aneurysm - straight neck >10mm - 60 degree angulation >15mm - <3cm diameter Iliac vessels - >7mm Wide enough aortic bifurcation diameter
Name complications of EVAR
Iatrogenic vessel injury
Contrast nephropathy
Graft sepsis
Graft limb thrombosis
Discuss the classification of EVAR endoleak
1 - proximal/distal seal zone leak 2 - retrograde perfusion of aneurysm sac 3 - component separation/graft material failure 4 - graft porosity 5- endotension
Which EVAR endoleak types are dangerous?
Type 1
Type 3
Discuss post-EVAR surveillance
CTA and duplex U/S
Before discharge, 1 month, 6 month, 1 year, yearly
Name the Hardman criteria
Age>70 Cr >190 Hb<9 ECG evidence of ischemia LOC
