Abdominal Aortic Aneurysm (AAA)

Question 1

AAA refers to a dilation of the abdominal aorta of what?

Answer 1

More than 3cm

Question 2

What is the commonest site for an AAA?

Answer 2

Between the renal and inferior mesenteric arteries

Question 3

Name 3 risk factors for an AAA?

Answer 3

• Male
• Older age
• Smoking
• Hypertension
• Family history
• Existing cardiovascular disease

Question 4

What is the current screening available for AAA?

Answer 4

• All men in England - ultrasound scan at 65 for early detection (asymptomatic AAA)
• Women aged >70 with risk factors

Question 5

Although AAA’s are usually asymptomatic and are discovered on routine screening/when ruptured, name a way it may present as

Answer 5

• Non-specific abdominal pain
• Pulsatile and expansile mass on the abdomen when palpated

Question 6

1) How are AAA usually diagnosed?
2) What imaging technique can be used for a more detailed picture and help guide surgery to repair it?
3) What sized AAA is considered a big AAA?

Answer 6

1) Ultrasound
2) CT angiogram
3) more than 5.5cm

Question 7

1) Name 2 risk factors that can be managed to decrease the progression of an AAA?
2) How often are the follow up scans available for patients with a small AAA (3-4.4cm)?
3) How often are the follow up scans available for patients with a medium AAA (4.5-5.4cm)?

Answer 7

1) Smoking cessation, healthy diet, exercise, and optimisation of the management of hypertension, diabetes and hyperlipidaemia
2) Yearly
3) 3 monthly

Question 8

1) Elective surgical repair of AAA are offered to which 3 groups of patients?
2) What does elective surgical repair of an AAA involve?
3) What are the 2 methods possible for this, and what occurs?

Answer 8

1) Symptomatic aneurysm relief, diameter growing more than 1 cm a year, and a diameter above 5.5cm
2) Insertion of an artificial graft into the affected section of the aorta
3) Open repair via a laparotomy - surgical insertion into the abdominal cavity. Endovascular aneurysm repair - stent inserted via the femoral arteries

Question 9

Name 3 ways a ruptured AAA may present with

Answer 9

• Severe abdominal pain that may radiate to the back or groin
• Haemodynamic instability (hypotension and tachycardia)
• Pulsatile and expansile mass in the abdomen
• Collapsed patient
• Loss of consciousness

Question 10

1) The permissive hypotension strategy may be used in a ruptured AAA - what is this strategy?
2) What is the theory behind this strategy?

Answer 10

1) Aiming for a lower than normal BP when performing fluid resuscitation
2) Decreasing BP decreases blood loss