abdominal aortic aneurysm

Question 1

define AAA

Answer 1

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

Question 2

Epidemiology

Answer 2

6 X more common in men

Question 3

risk factors

Answer 3

Age
Male gender
Atherosclerotic disease
Family history
Smoking
Hypertension
Cocaine use
Connective tissue disorders - Ehlers downs

Question 4

pathology

Answer 4

Loss of elastic fibres from the media is the initial pathological process

Question 5

presentation

Answer 5

Unruptured AAA’s are frequently asymptomatic, the presence of symptoms often indicates rupture or impending rupture.

Question 6

signs

Answer 6

Hypotension
Tachycardia
Collapse
Pulsatile abdominal mass, in time with HR

Question 7

symptoms

Answer 7

Abdominal pain
Back/loin pain

Question 8

screening

Answer 8

< 3cm: No further follow-up required
3cm - 4.4cm: Found in just over 1%, advise yearly screening with USS, give lifestyle advice. Refer to vascular service, to be seen within 12 weeks.

4.5cm - 5.4cm: Found in around 0.5%, advise 3 monthly screening with USS, give lifestyle advice. Refer to vascular service, to be seen within 12 weeks.

> 5.4cm: Found in around 0.1%, requires urgent two-week wait referral to vascular surgery to discuss management.

Question 9

investigations

Answer 9

abdominal USS
axial imaging

Question 10

management

Answer 10

Conservative - Patients with stable AAA not requiring surgical input should be advised to follow a healthy lifestyle and diet.

Surgical - Indicated in…
Diameter > 5.4cm
Symptomatic aneurysms
Asymptomatic, > 4cm and grown by more that one cm in a year.

Endovascular Aneurysm Repair

Question 11

what level is aortic bifurcation?

Answer 11

L4