Abdominal Aortic Aneurysm

Question 1

Define AAA

Answer 1

Permanent pathological dilation of the aorta with a diameter >1.5x the expected AP diameter of that segment, given the patient’s sex and body size

Question 2

Aetiology of AAA

Answer 2

Atherosclerotic disease

Congenital: bicuspid aortic valves and Marfan’s

Infectious: aortic wall infection by Staph and salmonella

Inflammation

Question 3

Risk Factor

Answer 3

Smoking 
Family history 
Increased age 
Male sex 
Congenital/connective tissue disorders

Question 4

Epidemiology of AAA

Answer 4

Highest prevalence in white male smokers

M&raquo_space; F (4-6x)

Question 5

Symptoms of AAAa

Answer 5

Usually symptomatic

Epigastric pain that radiates to the back (May also be back or groin), intermittent/continuous

Question 6

Signs of AAA

Answer 6

Palpable pulsatile expansile abdominal mass (thin patients, AAA>5cm)
Hypotension
Retroperitoneal bleed - Grey Turner’s or Cullen’s

Question 7

Investigations for AAA

Answer 7

Abdominal USS: >1.5x the expected

Bloods: ESR/CRP elevated, leucocytosis and anaemia, cultures +ve if infectious cause

CT/MRI: dilation >1.5x expected AP diameter

Question 8

What is the standard follow up for untruptured AAA

Answer 8

USS to assess diameter 
<3 - normal 
<4.4 - yearly scan 
4.5-5.5 - every 3 months 
>5.5, - 2 week referral for surgery

Question 9

What is the screening for AAA

Answer 9

Single screen for all men at 65