Abdominal Aortic Aneurysm Flashcards
Define AAA
as a dilatation of the abdominal aorta greater than 3cm
AAA risk factors
smoking
hypertension
hyperlipidaemia
family history
male gender
what medical condition is a protective factor for AAA
DM
Clinical presentations of an unruptured AAA
- Asymtomatic unless is v. large
- detected at screening
AAA screening age
Male, 65 years
Clinical presentations of an AAA
large AAA
- Abdo pain
- Back / Loin pain
- Pulsatile mass
Clinical presentations of a ruptured AAA
- sudden onset abdo pain
- back / loin pain
- signs of shcok
- syncope
- hypotension
- pulsatile abdominal mass
BPH
the ‘classic triad’ of ruptured AAA
Back / loin pain
Pulsatile abdominal mass
Hypotension
Small (3cm - 4.4cm) AAA Mx
- Yearly USS
- Lifestyle advice (Smoking cessation, BP control, WL)
statin for CVD
Medium 4.4cm-5.4cm AAA Mx
- 3 monthly USS
- Lifestyle advice (Smoking cessation, BP control, WL)
statin for CVD
what size of an AAA require DVLA notification
- > 6.5cm
what is a ‘True’ aneurysm
Involves all three layers of the blood vessel wall:
Intima, Media, and Adventitia
Examples of ‘True’ aneurysm
- AAA
- Thoracic aortic aneurysm
- Berry aneurysm
what is a ‘False’ aneurysm?
Does not involve all three layers of the vessel wall.
Instead, a contained rupture occurs, where blood leaks out of the vessel but is held by surrounding tissues.
Can result from trauma, surgery, or infection.
Examples of ‘False’ aneurysm
- Post-traumatic pseudoaneurysm - From arterial injury (catherisation / vascular surgery)
- Mycotic aneurysm – Due to an infected arterial wall, often seen in bacterial endocarditis.
Surgical Intervention indications for AAA
- AAA >5.5cm
- Expanding >1cm/year
- Symtomatic AAA
Surgical Mx for AAA
- Open repair
- Endovascular Aneurysm Repair (EVAR)
suspected ruptured AAA Mx
- High flow O2 - 15L
- IV access
- Urgent bloods (FBC, UEs, clotting and X-match for min. 6 units)
- Open surgical repair stat
Ruptured AAA shock pt BP target
SBP ≤100mmHg to avoid further bleeding / clot dislodge
Permissive hypotension
Imaging for non-ruptured AAA
USS
Imaging for susp./ruptured AAA
CT angiogram
2WW vascular referral indication for AAA
AAA >5.5cm
Most common location of AAA
infrarenal aorta
Referral guidelines for AAA
- < 3cm: discharge
- > 3cm: refer to vascular surgeons within 12 weeks
- > 5.5 cm: refer to vascular surgeons via a 2WW
5,6,10,12
Define rapid expansion in terms of AAA
increase in diameter of more than 5 mm over a 6-month period or more than 10 mm over a 12-month period.
