Abdominal Aortic Aneurysms

Question 1

What defines a AAA?

Answer 1

• >50% dilation of the abdominal aorta (generally about 3cm is pathological)

Question 2

Outline the pathogenesis of AAA

Answer 2

• Altered tissue MMPs and atherosclerotic disease play a role in weakening of the arterial wall
• Collagen and elastin obliteration with smooth muscle loss

Question 3

What are the common risk factors for AAA?

Answer 3

• Smoking
• FHx
• Increasing age
• Male sex
• Connective tissue disorders (Marfan’s)
• Trauma

Question 4

What are the signs and symptoms likely to be found in a patient with a AAA? How would you investigate it?

Answer 4

• Abdominal, back or groin pain (rupture)
• Hypotension (rupture)
• Palpable, expansile, pulsatile abdominal mass
• Often asymptomatic
• Abdominal ultrasound

Question 5

How are AAAs managed?

Answer 5

• Small, asymptomatic - monitoring
• Large, asymptomatic/symptomatic, not-ruptured - stenting, preoperative CV risk reduction (beta-blockers, statins)
• Ruptured - airway maintenance, maintenance of BP at 50-70 mmHg, surgical repair