Abdominal Aortic Aneurysm (AAA)

Question 1

What is an Abdominal Aortic Aneurysm?

Answer 1

Dilatation of the abdominal aorta

Question 2

What is the diameter of an abdominal aortic aneurysm?

Answer 2

More than 3cm

Question 3

How does an AAA normally present?

Answer 3

Asymptomatic

Question 4

What ways can an AAA present?

Answer 4

Non-specific abdominal pain

Pulsatile and expansile mass in the abdomen when palpated with both hands

Question 5

What is the initial investigation for an AAA?

Answer 5

Ultrasound

Question 6

What can be done to give a more detailed picture of the aneurysm?

Answer 6

CT angiogram

Question 7

What is the classification of an AAA based on?

Answer 7

Size

Question 8

What is the normal diameter of an abdominal aorta?

Answer 8

Less than 3cm

Question 9

What is the diameter of a small aneurysm?

Answer 9

3 – 4.4cm

Question 10

What is the diameter of a medium AAA?

Answer 10

4.5 – 5.4cm

Question 11

What is the diameter of a large AAA?

Answer 11

More than 5.5cm

Question 12

How is an AAA usually discovered?

Answer 12

An incidental finding on an abdominal x-ray, ultrasound or CT scan

Question 13

Who is invited for screening for an AAA?

Answer 13

All men in England are offered a screening ultrasound scan at age 65

Question 14

How can the risk of progression of an AAA be reduced?

Answer 14

Stop smoking
Healthy diet and exercise
Optimising the management of hypertension, diabetes and hyperlipidaemia

Question 15

How often are people with an aneurysm 3-4.4cm screened?

Answer 15

Yearly

Question 16

How often are people with an aneurysm 4.5-5.4cm screened?

Answer 16

Every 3 months

Question 17

When is it suggested that elective repair is carried out in someone with an AAA?

Answer 17

Symptomatic aneurysm
Diameter growing more than 1cm per year
Diameter above 5.5cm

Question 18

What is elective surgical repair?

Answer 18

Inserting an artificial “graft” into the section of the aorta affected by the aneurysm

Question 19

What are the 2 methods of elective surgical repair?

Answer 19

–Open repair via a laparotomy

–Endovascular aneurysm repair (EVAR) using a stent inserted via the femoral arteries

Question 20

What does the risk of rupture increase with?

Answer 20

The diameter of the aneurysm

Question 21

How does a ruptured AAA present?

Answer 21

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

Question 22

How is a patient with a rupture AAA haemodynamically unstable?

Answer 22

Hypotension

Tachycardia

Question 23

What can be used to diagnose a ruptured AAA?

Answer 23

CT angiogram

Question 24

What type of emergency is a ruptured AAA?

Answer 24

Surgical emergency

Question 25

What is the most common management of an AAA?

Answer 25

Endovascular aneurysm repair (EVAR) using a stent inserted via the femoral arteries

Question 26

What are the main presenting features of a ruptured AAA?

Answer 26

Hypotensive and tachycardic
severe, central abdominal pain radiating to the back
pulsatile, expansile mass in the abdomen

Question 27

What are the main RF for AAA?

Answer 27

• smoking
• hypertension
• hypercholesterolaemia
• old age
• male gender
• diabetes mellitus
• Marfan’s syndrome

Question 28

What is the main complication of EVAR?

Answer 28

Endo-leak, where the stent fails to exclude blood from the aneurysm

Question 29

What can rupture of the anneursym lead to?

Answer 29

Suddent death

Question 30

What are the other possible complcations of an AAA?

Answer 30

Infection or thromboembolic phenomena–> acute ischaemia of the lower limbs

Question 31

What are the other possible symptoms of AAA?

Answer 31

• compression of the femoral nerves, causing paraesthesia of the anterior thigh and quadriceps weakness
• embolic phenomena leading to acute lower limb ischaemia