Abdominal Aortic Aneurysm Flashcards
What is the indication for yearly ultrasound?
3-4.4cm
How are aneurysms less than 3cm managed?
Discharged with safety-netting advice
How are aneurysms 4.5 to 5.4 cm managed?
Repeat ultrasound every 3 months
How are large aneurysms managed?
Surgical intervention
What is the imaging modality of choice for AAA?
CT angiography
What is the alternative to CTA for patients who cannot tolerate contrast?
MRA but takes more time
When is elective repair considered?
Symptomatic
AAA grown more than 1cm in a year AND larger than 4cm
AAA is 5.5cm or larger
What ae the surgical options for triple A?
Open surgical repair
Endovascular entrusts repair
What surgical option is ideal for men under 70?
Open surgical repair
However, it can be contraindicated by anaesthetic risks, medical comorbidities or anatomic difficulties (i.e. horseshoe kidney, stoma, numerous previous surgeries resulting in significant adhesions)
How does endovascular aneurysm repr occur?
A stent graft is inserted through the femoral arteries into the aorta, where it channels blood flow into the iliac arteries. The surrounding aneurysm then becomes thrombosed around the graft.
What is the comparison of EVAR and open surgical repair?
EVAR has higher morbidity and mortality, but less peroperative deaths.
What are the risks with open repair?
Spinal cord ischaemia
Anastomotic pseudoaneurysm
Graft infection
Death (mortality during elective repair is reported to be 5% of men and 7% of women
What are the risks with EVAR?
Endoleak
Defined as the presence of blood flow within the aneurysm sac but outside the EVAR graft
Contrast-enhanced CT angiography, or contrast-enhanced ultrasound if CT is contraindicated, is used to assess for endoleak.
They can be repaired using open, endovascular or percutaneous intervention for endoleak
Post-implantation syndrome
What is the initial management for abdominal aortic aneurysm?
Fluid resuscitation
Followed by CT angiogram unless contrast injury than MRA
Finally surgical repair
What is the cause of dissection flap on arterial duplex?
Indicates arterial dissection
What is the action in symptomatic popilateal artery aneurysm?
Surgical repair or endovascular intervention
What is the management for asymptomatic popiliteal aneurysm?
Observation and monitoring for SMALL
IF large, then active surgical intervention
