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
