Abdominal Aortic Aneurysm

Question 1

Describe the epidemiology of AAA

Answer 1

Men >65
Screening programme

Question 2

What is the most common cause of AAA?

Answer 2

Degenerative

Question 3

Describe the genetics of AAA

Answer 3

Familial clustering but no specific gene identified

Question 4

What are the risk factors for AAA?

Answer 4

Smoking
Male
Hyperlipidaemia

Question 5

What disease reduces risk of AAA?

Answer 5

Diabetes

Question 6

What is the histological process of AAA?

Answer 6

Destruction of elastin/collagen in tunica media and adventitia, smooth muscle apoptosis and thinning of media, infiltration of lymphocytes, macrophage and neovascularisation

Question 7

Name the four central mechanisms of AAA

Answer 7

Proteolysis
Inflammation
Biomechanics
Genetics

Question 8

What are the signs/symptoms of AAA?

Answer 8

Asymptomatic in 75%
Lower back pain, weight loss, increased ESR

Question 9

If a patient with AAA has symptoms what has most likely happened?

Answer 9

Rupture
Embolism

Question 10

Describe the symptoms of AAA rupture

Answer 10

Abdominal/back pain
Hypovolaemia
Pulsatile abdo mass
Groin pain
Syncope
Paralysis
Flank mass

Question 11

In AAA embolism what might develop?

Answer 11

Acute limb ischaemia/blue toe syndrome

Question 12

What is the gold standard diagnostic tool for AAA?

Answer 12

CTA

Question 13

How is AAA medically/risk factor managed?

Answer 13

Smoking cessation
Antiplatelet and statin
BP control
Metformin

Question 14

When is a repair indicated in AAA?

Answer 14

> 55mm AP outer-outer
Rapid expansion >10mm/year

Question 15

How often are AAA patients screened?

Answer 15

30-44mm annually
45-54mm 3 monthly

Question 16

Name two surgical procedures for AAA

Answer 16

OSR
EVAR

Question 17

What is the term used to describe the control of BP in patients with AAA rupture?

Answer 17

Permissive hypotension

Question 18

At what point do patients need to inform the DVLA?

Answer 18

AAA >6cm
>6.5 stop driving