abdominal aortic aneurysm Flashcards
definition of abdominal aortic aneurysm
permanent, pathological dilation of aorta >1.5x expected
(3cm or more)
RF for aortic aneurysm
smoking
FHx
age (older)
male higher prevalence
female higher rupture rate
congenital/connective tissue disorders
signs and sx of aortic aneurysm
unruptured are usually detected on screening
palpable, pulsatile abdo mass
abdo/flank/back pain
hypotension
LOC
pallor
abdo distension
fever
Ix for abdo aortic aneurysm
aortic USS - but normal size aorta with hypotension doesnt rule out rupture
cross match
clotting screen
ESR/CRP
FBC
blood cultures
CTA
MRA
PET-CT
screening for AAA
routine >65yo male USS
* less than 3cm = discharged
* 3-4.4cm = annual surveillance
* 4.5-5.4 = 3mo surveillance
* >5.5cm = refer to vascular surgery
mx for ruptured AAA
urgent surgery
resus
abx
analgesia
VTE prophylaxis
benefits of endovascular aneurysm repair (EVAR)
recommended in most pts
* lower periop mortality
* less time in hospital
open might be better for men less than 70yo
mx for sx unruptured AAA
urgent surgery
patient discussions for AAA
smoking cessation
bp and cholesterol control
complications of AAA
- abdo compartment syndrome
- ileus, BO, ischemic colitis
- AKI
- post-implantation syndrome of EVAR - fever, back pain, malaise
- amputation due to limb ischemia
- spinal cord ischemia
- impaired sexual function
- anastomotic pseudoaneursym
- aortic neck dilation
- graft infection
- ureteric obstruction
- functional gastric outlet obstruction
- graft limb occlusion
- endoleak
- distal embolisation
- abdo wall hernia
px of AAA
poor
rupture = v high mortality
repair when risk of surgery is less than aneurysm
link between low skeletal mass and morbidity
post op monitoring after EVAR
CTA and plain XR 30 days after repair
surveillance imaging 5yr intervals - frequency depend on risk
if endo-leak suspected use contrast CTA
abx prophylaxis with: bronchoscopy, gastrointestinal or genitourinary endoscopy, and any dental procedure that may lead to bleeding
