Abdominal Aortic Aneurysm Flashcards
What is an abdominal aortic aneurysm? (AAA)
abnormal dilatation of the abdominal aorta greater than 3cm
What is the increase risk of cardiac death each time an AAA grows by 8mm?
1.34x
What are the risk factors for an AAA?
Athersclerosis, connective tissue diseases like Marfans, Ehlers Danlos, inflammatory diseases, smoking, hypertension, hyperlipidaemia, family history, male, increasing age, diabetes is a negative risk for AAA
What are the symptoms of an AAA?
Asymptomatic, but can have abdominal pain, back or loin pain, distal embolisation producing limb ischaemia, aorticenteric fistula
What will be found on an examination of an AAA?
Pulsatile, expansile mass, and also signs of retroperitoneal haemorrhage may be present
What are the signs of a ruptured AAA?
Abdominal back or loin pain, and shock and syncope
What year are AAA screened for?
65 years- goes a 50% reduction in aneurysm related mortality, will have 3-5years in surveillance before repair
What are the differential diagnosis of an AAA?
Renal colic, diverticulitis, IBD, IBS, GI haemorrhage, appendicitis, ovarian torsion, ovarian rupture, splenic infarct
What investigations would you do for an AAA?
Ultrasound scans and then a CT with contrast is warranted when at threshold diameter of 5.5cm
At what size of AAA is medical management given and what is it?
Any AAA less than 5.5cm can be monitored by Duplex USS as surgery before this gives no survival benefit, if 3-4.4 then yearly ultrasound, if 4.5-5.4 then every 3months, should stop smoking, improve blood pressure, start statin and aspirin and lose weight
What size AAA should surgery be considered?
above 5.5cm, if expanding by more than 1cm a year or symptomatic
What are the surgical options for an AAA?
Open repair (midline laparotomy or long transverse incision) or endovascular repair
What is an important complication of endovascular repairs?
endovascular leak
What is an endovascular leak?
Where an incomplete seal forms around the aneurysm resulting in blood leaking around the graft
What are the symptoms of an endoleak?
Usually asymptomatic so will need regular ultrasounds
What can occur due to an endoleak?
the aneurysm can expand and rupture
What are the complications of AAA?
rupture
Retroperitoneal leak. embolisation, aortoduodenal fistula
What increases the risk of AAA rupture?
the diameter increase, smoking, hypertension, female
What are the symptoms of an AAA rupture?
abdominal pain, back pain, syncope, vomiting, haemodynamically compromised, pulsatile abdominal mass and tenderness
What is the classic triad of a ruptured AAA?
Flank or back pain, hypotension, pulsatile abdominal mass
What has a better prognosis an AAA that ruptures anteriorly into the peritoneal cavity or posteriorly into the retroperitoneal space?
If rupture posteriorly into the retroperitoneal space has a better prognosis
What is the management of a ruptured AAA?
immediate high flow O2, IV access (2x large bore cannulae), urgent bloods taken and crossmatch, treat shock but keep BP <100mmHg as raising BP will dislodge any clot and precipitate bleeding, theatre for open repair or a CT angiogram to check if can do an endovascular repair
What has better outcomes Endovascular repair or open repair for an AAA?
no improvement at 30 or 1 year difference, but at 3 years EVAR is better due to short hospital stays, return to own homes and lower cost
