Abdominal Aortic Aneurysm (AAA)

Question 1

Presentation of AAA

Answer 1

• Often asymptomatic
• Symptoms of PVD
• Non-specific abdominal pain
• Palpable expansile pulsation in abdomen when palpated with both hands
• Found incidentally on AXR
• Diagnosis by US or CT/MRI angiography

Question 2

Management of AAA

Answer 2

• Treat reversible risk factors
• Monitor size
  
  • Every 3 months if the AAA is 4.5–5.4 cm
  • Every 2 years if the AAA is 3.0–4.4 cm
• Treat PAD
• When to repair?
  
  • Symptomatic
  • Asymptomatic and 5.5 cm or larger
  • Asymptomatic, larger than 4.0 cm and has grown by more than 1 cm in 1 year
• Surgical
  
  • Endovascular stenting
  • Laparoscopic repair
  • Open surgical repair

Question 3

Rupture of AAA

Answer 3

• Risk increases with diameter
• Presentation
  
  • Known AAA or pulsatile mass in abdomen
  • Severe abdominal pain (non-specific, radiating to back or loin)
  • Haemodynamically unstable
• Diagnosis by CT abdomen in haemodynamically stable
• If ruptured AAA and unstable transfer directly to theatre for surgical repair