Abdominal Aortic Aneurysm (AAA) Flashcards
What is an Abdominal Aortic Aneurysm?
Dilatation of the abdominal aorta
What is the diameter of an abdominal aortic aneurysm?
More than 3cm
How does an AAA normally present?
Asymptomatic
What ways can an AAA present?
Non-specific abdominal pain
Pulsatile and expansile mass in the abdomen when palpated with both hands
What is the initial investigation for an AAA?
Ultrasound
What can be done to give a more detailed picture of the aneurysm?
CT angiogram
What is the classification of an AAA based on?
Size
What is the normal diameter of an abdominal aorta?
Less than 3cm
What is the diameter of a small aneurysm?
3 – 4.4cm
What is the diameter of a medium AAA?
4.5 – 5.4cm
What is the diameter of a large AAA?
More than 5.5cm
How is an AAA usually discovered?
An incidental finding on an abdominal x-ray, ultrasound or CT scan
Who is invited for screening for an AAA?
All men in England are offered a screening ultrasound scan at age 65
How can the risk of progression of an AAA be reduced?
Stop smoking
Healthy diet and exercise
Optimising the management of hypertension, diabetes and hyperlipidaemia
How often are people with an aneurysm 3-4.4cm screened?
Yearly
How often are people with an aneurysm 4.5-5.4cm screened?
Every 3 months
When is it suggested that elective repair is carried out in someone with an AAA?
Symptomatic aneurysm
Diameter growing more than 1cm per year
Diameter above 5.5cm
What is elective surgical repair?
Inserting an artificial “graft” into the section of the aorta affected by the aneurysm
What are the 2 methods of elective surgical repair?
–Open repair via a laparotomy
–Endovascular aneurysm repair (EVAR) using a stent inserted via the femoral arteries
What does the risk of rupture increase with?
The diameter of the aneurysm
How does a ruptured AAA present?
Severe abdominal pain that may radiate to the back or groin
Haemodynamic instability (hypotension and tachycardia)
Pulsatile and expansile mass in the abdomen
Collapse
Loss of consciousness
How is a patient with a rupture AAA haemodynamically unstable?
Hypotension
Tachycardia
What can be used to diagnose a ruptured AAA?
CT angiogram
What type of emergency is a ruptured AAA?
Surgical emergency
What is the most common management of an AAA?
Endovascular aneurysm repair (EVAR) using a stent inserted via the femoral arteries
What are the main presenting features of a ruptured AAA?
Hypotensive and tachycardic
severe, central abdominal pain radiating to the back
pulsatile, expansile mass in the abdomen
What are the main RF for AAA?
- smoking
- hypertension
- hypercholesterolaemia
- old age
- male gender
- diabetes mellitus
- Marfan’s syndrome
What is the main complication of EVAR?
Endo-leak, where the stent fails to exclude blood from the aneurysm
What can rupture of the anneursym lead to?
Suddent death
What are the other possible complcations of an AAA?
Infection or thromboembolic phenomena–> acute ischaemia of the lower limbs
What are the other possible symptoms of AAA?
- compression of the femoral nerves, causing paraesthesia of the anterior thigh and quadriceps weakness
- embolic phenomena leading to acute lower limb ischaemia
