Abdominal Aortic Aneurysm Flashcards
What is an abdominal aortic aneurysm (AAA)?
It is a condition in which there weakening of the aortic wall, creating a bulge in the aorta
What is the pathological consequence of an abdominal aortic aneurysm?
The aneurysms can rupture, causing life threatening bleeding
What are the two classifications of abdominal aortic aneurysms?
True Abdominal Aortic Aneurysm
False Abdominal Aortic Aneurysm
What is a true abdominal aortic aneurysm?
It involve weakness and dilatation of all three layers of the aortic wall
What is a false abdominal aortic aneurysm?
It involve weakness and dilatation of a single layer of the aortic wall
Which aortic wall layer is involved in false abdominal aortic aneurysms?
Adventitia layer
What are the eight risk factors associated with abdominal aortic aneurysms?
Male Gender
Older Age > 65 Years Old
White Race
Family History
Hypertension
Syphilis
Connective Tissue Diseases
Smoking
Which two connective tissue diseases are associated with abdominal aortic aneurysms?
Ehlers Danos Type One
Marfan’s Syndrome
How do unruptured abdominal aortic aneurysms tend to present?
Asymptomatically
What are the three clinical features of unruptured abdominal aortic aneurysms?
Abdominal Pulsatile Mass
Central Abdominal Pain
Back Pain
What are the five clinical features of ruptured abdominal aortic aneurysms?
Sudden Collapse
Abdominal Pulsatile Mass
Severe Central Abdominal Pain
Severe Back Pain
Shock
What are the two features of shock?
Hypotension
Tachycardia
What two investigations are used to diagnose abdominal aortic aneurysms?
Ultrasound Scan
CT Angiogram
What is the first line investigation used to diagnose abdominal aortic aneurysms?
Ultrasound scan
What is the feature of abdominal aortic aneurysms on ultrasound scan?
Dilated aorta diameter > 3cm
What is the normal diameter of the aorta in females?
1.5cm
What is the normal diameter of the aorta in males?
1.7cm
What is the gold standard investigation used to diagnose abdominal aortic aneurysms?
CT angiogram
What is the feature of abdominal aortic aneurysms on CT angiogram scan?
Dilated aorta diameter > 3cm
Why are CT angiogram scans considered the gold standard investigation used to diagnose abdominal aortic aneurysms?
This imaging scan provides a more accurate measurement in comparison to an ultrasound scan
What is the most appropriate investigation to conduct in individuals with a suspected ruptured aortic aneurysm, who are haemodynamically unstable?
None
Instead these patients should be taken to theatre immediately
What is the most appropriate investigation to conduct in individuals with a suspected ruptured aortic aneurysm, who are haemodynamically stable?
CT scans
They can be conducted in where there is diagnostic doubt. It also enables assessment of endovascular repair suitability
What is the aim of the abdominal aortic aneurysm screening programme?
It aims to detect aneurysms in the asymptomatic phase, prior to rupture
Which patient group is offered abdominal aortic aneurysm screening?
Males > 65 years old
What does the abdominal aortic aneurysm screening programme involve?
One time ultrasound scan
What does an aorta diameter < 3cm indicate?
It indicates that there is no aneurysm present
How do we manage individuals with an aorta diameter < 3cm?
The patient requires no further treatment or monitoring, and will not be invited for screening again
What does an aorta diameter 3cm - 4.4cm indicate?
It indicates that there is a small aneurysm present
How do we manage individuals with an aorta diameter 3cm - 4.4cm?
The patient requires no treatment due to a low risk of rupture occurrence
Instead, these individuals are invited annually for another screening scan
They are also advised on conservative measures that can prevent enlargement of the aorta – such as smoking cessation, healthy eating and regular exercise
What does an aorta diameter 4.5cm - 5.4cm indicate?
It indicates that there is a medium sized aneurysm present
How do we manage individuals with an aorta diameter 4.5cm - 5.4cm?
The patient requires no treatment due to a low risk of rupture occurrence
Instead, these individuals are invited every three months for another screening scan
They are also advised on conservative measures that can prevent enlargement of the aorta – such as smoking cessation, healthy eating and regular exercise
What does an aorta diameter > 5.5cm indicate?
It indicates that there is a large aneurysm present
How do we manage individuals with an aorta diameter > 5.5cm?
A 2 week referral to vascular surgery for surgical intervention
What are the two other circumstances in which individuals should receive a 2 week referral to vascular surgery for surgical intervention?
Symptomatic
Rapidly enlarging aorta diameter > 1cm/year
What are the two surgical management options for abdominal aortic aneurysms?
Endovascular Surgery
Open Repair Surgery
What is the first line surgical management option for abdominal aortic aneurysms?
Endovascular surgery
What is abdominal aortic aneurysm endovascular surgery?
It involves the insertion of a catheter through the femoral artery, which is then guided into aorta
A graft on the end of the catheter is placed at the site of the aneurysm, which strengthens the weakened section of the aorta in order to prevent rupture
What is a common complication of endovascular surgery?
Endovascular leak
What is an endovascular leak?
It occurs when the stent fails to exclude blood from the aneurysm
What is the second line surgical management option for abdominal aortic aneurysms?
Open repair surgery
How do endovascular leak complications present?
Asymptomatically on routine follow up
What is abdominal aortic aneurysm open repair surgery?
It involves open abdominal surgery to remove the damaged aorta section and replace it with a graft
This strengthens the weakened section of the aorta in order to prevent rupture
How do we manage ruptured abdominal aortic aneurysms?
An immediate vascular review is required to enable emergency surgical repair
In terms of blood products, what is recommended to manage ruptured abdominal aortic aneurysms?
A crossmatch of 6 units of blood
