Abdominal Aortic Aneurysm

Question 1

Define an aortic aneurysm?

Answer 1

Dilatation of ALL the aortic layers to 150% of its original diameter (In an AAA that’s > 3cm)

Question 2

What commonly causes an AAA?

Answer 2

Degenerative Disease or Connective Tissue Disorders (Marfans)
Sometimes Infection (e.g. Mycotic Aneurysm)

Question 3

What are the risk factors for an AAA?

Answer 3

Old Age - Male - Smoking - Hypertension - FH

Question 4

How are asymptomatic AAAs found?

Answer 4

By screening programs or random unrelated imaging

Question 5

What screening programs are in place for AAA?

Answer 5

In England every man gets an abdominal ultrasound at 65 yrs to detect AAA and other things

Question 6

What are the symptoms of a symptomatic AAA?

Answer 6

Impending Rupture: Increasing Back pain & Tenderness in abdomen
Ruptured: Abdo/back/flank pain - Painful pulsatile mass - Haemodynamic Instability (unstable BP, can be single episode or progressive in nature) - Hypoperfusion of the lower limbs.

Question 7

Some AAAs present abnormally, what are the features of one?

Answer 7

Distal Embolisation
Aortocaval fistula
Aortoenteric fistula
Ureteric Occlusion
Duodenal occlusion

Question 8

What investigation would be used to assess the AAA & plan surgery?

Answer 8

CTA

MRA

Question 9

At what size do we offer repair?

Answer 9

5.5cm

Question 10

What are the types of repair we can give?

Answer 10

Endovascular (EVAR):

• Local Anaesthetic
• Small groin puncture, pass up through iliac arteries
• Place stent through aneurysm sac

Open (OR):

• General Anaesthetic
• Open abdomen & aneurysm sac
• Remove sac contents and sew in plastic tube in place of dilated section of aorta

Question 11

How can AAA repair ‘fail’?

Answer 11

An endoleak where blood is still reaching the aneurysm sac from somewhere. This is usually very minor and can be monitored for years before it needs intervention