abdominal aortic aneurysm Flashcards
what is aneurysm
permanent dilatation of the artery to twice the normal diameter
what is a true aneurysm
arterial wall forms the wall of the aneurysm
what arteries are usually involved
- abdominal aorta
- iliac
- popliteal
- femoral arteries
- thoracic aorta
what are false aneurysm called
psuedoaneurysms
what is false aneurysms
surround tissues form the wall of the aneurysm
what can false aneurysms occur due to
femoral artery puncture
why do haematoma form
because of inadequate compression of the entry site and continued bleeding into the surrounding compressed soft tissue
where do AAA commonly occur
below the renal arteries
who gets AAA more men or women
men
what do aneurysms occur secondary to
- atherosclerosis
- infection
- trauma
- genetic
risk factors of AAA
- age
- male
- family history.
- smoking
- hypertension
- hypercholesterolaemia
does a normal <3cm require ultrasound
no
does small 3-4.4cm require ultrasound
annual ultrasound and surveillance from GP
does a medium 4.5-5.4cm require
quarterly ultrasound and cardiovascular prevention therapy
does a large >5.5cm require ultrasound
referred for assessment and elective repair
symptoms
- asymptomatic
- severe pain
what is the pain like
epigastric pain radiating to the back
what does a ruptured AAA cause
- hypotension
- tachycardia
- profound anaemia
- sudden death
what can the symptoms mimic
- renal colic
- diverticulitis
- lower abdominal pain
- testicular pain
signs
pulsatile, expansile abdominal mass is felt
- trash feet
what should be done to diagnose
ultrasound rather than CT
what should be done for treatment
insert two wide-bore cannula and cross match 8 units of packed red cells
when is an operation done
when aneurysm is:
- > 5.5cm
- expanding at a rate >1cm/year
- symptomatic
what do patients need careful control of
- hypertension
- smoking cessation
- lipid lowering medication
what is standard therapy
open surgical repair
how is an endovascular stent inserted via
femoral or iliac arteries = non surgical approach
what is an alternative to open surgical repair
laparoscopic surgery
what is prognosis
after repair can return to normal repair within few months
who most likely gets thoraco-abdominal aneurysms
patients with Marfan’s or hypertension
what do descending or arch thoraco-abdominal aneurysms occur secondary to o
atherosclerosis and are rarely due to syphilis
how are most aneurysms found
on routine CXR or cardio investigations
what can rapid expansion of aorta cause symptoms
- severe chest pain (radiating to upper back)
- stridor
- haemoptysis
- hoarseness
what is rupture associated with
- hypotension
- tachycardia
- death
what investigation are done for thoraco-abdominal aneurysms
- CT or MRI
- aortography
- transoesophageal echo
what is used for assessment of thoraco-abdominal aneurysms
CT or MRI
when is operative repair done
aneurysm >6cm
