Abdominal aortic aneurysm (Complete)

Question 1

What is the normal abdominal aortic diametre in males and females over 50?

Answer 1

Females: 1.5 cm

Males: 1.7cm

Question 2

How large must the abdominal aoritc diametre be to diagnose AAA?

Answer 2

> 3cm

Question 3

Where does abdominal aorta aneurysm formation typically occur?

Answer 3

Between the renal arteries and inferior mesenteric artery

Question 4

What is a typical presentation of AAA?

Answer 4

Typically assymptomatic

May feel a expansile and pulsatile abdominal mass

May in rarer cases present with:

Non-specific abdominal pain

Signs of AAA rupture

Question 5

What are the main risk factors for AAA?

Answer 5

Age

Male

Hypertension

Smoking

Syphillis

Ehler’s danlos syndrome

Marfans syndrome

Question 6

As AAA is mainly assymptomatic, what measures have been implemented to aid in quicker diagnosis?

Answer 6

Preventative screening (Abdominal US)

Question 7

What groups of patients are offered screening for AAA?

Answer 7

Males over 65

Question 8

How frequent is abdominal US monitoring in patients with small and medium sized AAA?

Answer 8

Small (3-4.4cm): Offered yearly repeat US

Medium (4.5-5.4cm): Offered 3 monthly US

Question 9

What abdominal aortic diamtre ranges are used to classify aneurysms as small, medium and large?

Answer 9

Small AAA: 3cm-4.4cm

Medium AAA: 4.5cm-5.4cm

Large AAA: _>_5.5 cm

Question 10

When should surgery be offered for patients with AAA?

Answer 10

Patients with large AAA (_>_5cm)

Patients with rapidly increasing AAA

Question 11

What additional investigation should be performed in patients with planned elective surgery for AAA?

Answer 11

CT angiogram

Question 12

What is the management plan for patients diagnosed with AAA?

Answer 12

Manage risk factors:

Smoking cessation

Healthy diet + exercise

Management of hypertension, diabetes and/or hyperlipidaemia if present.

Follow-up scans:

Small: 1 yearly US
Medium: 3 monthly US

Surgery:

Elective repair (e.g. open repair laparotomy or EVAR)
Symptomatic
If >1cm growth per year
AAA > 5.5 cm

Question 13

What are indications for elective surgery of AAA?

Answer 13

Patient is symptomatic

Patient has >1cm per year growth

Patient has a large AAA >5.5cm

Question 14

What are the surgical options for patients with AAA?

Answer 14

Open repair laparotomy

Endovascular aneurysm repair [EVAR] (via femoral artery)

Question 15

Which patients with AAA should be advised to inform the DVLA?

Answer 15

Patients with AAA >6cm

Question 16

Which patients with AAA should not be allowed to drive?

Answer 16

AAA >6.5 cm

N.B. Stricter rules for heavy veichle drivers like lorries/busses

Question 17

What is the mortality rate of a ruptured abdominal aneurysm?

Answer 17

80%

Question 18

What are the signs/symptoms of a ruptured AAA

Answer 18

Severe abdominal pain with radiation to back or groin.

Signs of haemodynamic instability (Hypotension + tacchycardia)

Pulsatile expansile mass in abdomen

Collapse and loss of consciousness

Question 19

What is the management plan for patient with ruptured anaeurysm?

Answer 19

FAST [Focused assessment with sonography for trauma] in haemodynamically unstable patient if no delay

Immediate surgery if haemodynamically unstable (Multidisciplinary surgical team and seniors)

CTA and then surgery if patient is haemodynamically stable

Aim for lower than normal blood pressure (Idea is that giving fluids may actually increase blood loss)

Discussion with palliative team (As prognosis is poor)