Abdominal Aortic Aneurysm (AAA)

Question 1

Describe the pathogenesis of an Abdominal Aortic Aneurysm

Answer 1

• degeneration of tunica media in the arterial wall
  => lack of elastin/collagen in aortic wall
  => Aneurysmal dilatation

Question 2

What increases a person’s risk of an AAA?

Answer 2

Male 
FHx
Age 
Smoking 
PVD 
Cardiac disease 
Cerebrovascular disease
Hypertension 
Hypercholesterolaemia 
diabetes

Question 3

Most AAAs are asymptomatic. TRUE/FALSE?

Answer 3

TRUE

~75%

Question 4

If patients are symptomatic as a result of an AAA, how do they present?

Answer 4

• many will not make it to hospital
• Pain
• May have tachycardia/hypotension
• Pulsatile, expansile mass +/- tender
• patients can present in collapse

Question 5

What investigations can be used to visualise an AAA?

Answer 5

• US

- CT

Question 6

What are US scans used for?

Answer 6

• Screening / Surveillance
• Measuring AP Diameter
• Check for Involvement of iliac arteries

Question 7

WHat is a CT scan used for ?

Answer 7

IV contrast injected to see:

• Aneurysm morphology
• Shape, size, iliac involvement

Also allows for management planning

Question 8

What are the two different types of aneurysm repair?

Answer 8

Elective repair - prophylactic procedure

Emergency repair - therapeutic procedure

Question 9

WHat procedure is used to repair an AAA?

Answer 9

Endovascular Aneurysm repair (EVAR)

• excludes AAA from inside vessel
• sets up two new blood channels that avoid dilatation
• Inserted via peripheral artery
• X-ray guided

Question 10

HOw can AAAs be treated in an open operation?

Answer 10

• Laparotomy
• Clamp aorta + iliacs
• Dacron Graft
• Tube vs Bifurcated graft

Question 11

How would you choose between no intervention, EVAR and an open procedure to treat an AAA?

Answer 11

What is the patient’s life expectancy?
What level of procedure risk?
What does the patient want?