Abdominal aortic aneurysm

Question 2

Abdominal aortic aneurysm : Definition

Answer 2

Abdominal aortic aneurysm (AAA) is defined as a dilatation of the abdominal aorta greater than 3cm.

Question 3

Abdominal aortic aneurysm : Aietiology

Answer 3

Aetiology of abdominal aortic aneurysm is largely unknown.
1. Atherosclerosis
2. Trauma, infection,
3. Connective tissue disease (e.g. Marfan’s disease, Ehler’s Danlos, Loey Dietz
4. Inflammatory disease (e.g. Takayasu’s aortitis).

Question 4

Abdominal aortic aneurysm : Risk factors

Answer 4

• smoking
• hypertension, hyperlipidaemia,
• family history,
• male gender
• increasing age.

Question 5

Abdominal aortic aneurysm : Clinical presentation

Answer 5

asymptomatic and are simply detected on incidental finding or screening.

Symptomatic patients with an AAA can present with:
* Abdominal pain
* Back or loin pain
* Distal embolisation producing limb ischaemia

On examination : a pulsatile mass can be felt in the abdomen

Question 6

Abdominal aortic aneurysm : Screening

Answer 6

National abdominal aortic aneurysm screening programme
Abdominal US scan for all men in their 65th year

Question 7

Abdominal aortic aneurysm : Investigation

Answer 7

1. Intial Ix : USS
   If diamter >5.5cm
2. CT scan with contrast

Question 8

Abdominal aortic aneurysm : Medical management

Answer 8

Indication : AAA < 5cm
1. 3 - 4.4 cm : 1 yearly US
2. 4.5 - 5.4cm : 3 monthly US

• Smoking cessation, improve BP control
• Statin
• Asprin

Question 9

Abdominal aortic aneurysm : Surgical management

Answer 9

Indication :
* AAA > 5.5cm
* Expanding at >1cm per year
* Symptomatic

1. Open repair : midline laparotomy
2. Endovascular repair : a graft via the femoral arteries and fixing the stent across the aneurysm

Question 10

Abdominal aortic aneurysm : Rupture management

Answer 10

1. High flow O2
2. Cross match : 6U
3. BP titration : aim for < 100 systolic
   * Increase in BP may dislodge clot and percipitate further bleeding
   4.
   * Unstable - Surgery
   * Stable : CT angiogram