Abdominal aortic aneurysm Flashcards
What is an abdominal aortic aneurysm?
A dilation of the abdominal aorta with a diameter >3cm.
What is the mortality rate of a ruptured AAA?
80%
What are risk factors for abdominal aortic aneurysms?
Men Older age Smoking Hypertension Family history Existing CVD (and associated risk factors)
Describe the screening programme for AAA
Men at age 65 - ultraound
Patients with diameter >3cm are referred to a vascular team
How do patients with a AAA present?
Non- specific abdominal pain - also back and loin pain
Pulsatile mass in the abdomen
What investigations are used to diagnose a AAA?
Ultrasound - first line
CT angiogram
What is the management for a AAA?
Lifestyle changes - stop smoking, exercise, healthy diet
Control hypertension, diabetes and hyperlipiademia
Surveillance - once every year is 3-4.4cm. Or once every 3 months if 4.5-5.4cm.
Elective repair - if they meet the criteria - symptomatic, diameter > 5.5cm, diameter expands more than 1cm in a year
What surgical options are available for a AAA ?
Open repair via laparotomy
Endovascular aneurysm repair (EVAR) using a stent inserted via the femoral arteries
How does a ruptured AAA present?
Severe abdominal pain - may radiate to the back, loin or groin
Haemodynamic instability - hypotension + tachycardia
Pulsatile and expansile mass in the abdomen
Collapse / syncope
Loss of consciousness
What is permissive hypotension?
Intentionally aiming for a lower than normal blood pressure when performing fluid resus. This aims to stop excessive blood loss that may come with a higher BP.
