Abdominal Aortic Aneurysms

Question 1

What is an aneurysm?

Answer 1

Permanent localised dilatation of an artery of more than 50% of the normal diameter of the artery.

Question 2

What is ectasia?

Answer 2

Localised area of enlargement in the artery but less than 1.5 x.

Question 3

What is arteriomegaly?

Answer 3

Generalised enlargement of arterial tree.

Question 4

What are the types of aneurysm?

Answer 4

True and false.

Question 5

What is a true aneurysm?

Answer 5

Pathological degeneration involving all or part of the vessel wall.

Question 6

What is a false aneurysm?

Answer 6

Leakage of blood out of an artery into a cavity surrounded by connective tissue that’s expansile and pulsatile.

Question 7

What is an example of congenital aneurysms?

Answer 7

Berry aneurysms on the circle of Willis.

Question 8

What are the causes of degenerative aneurysm formation?

Answer 8

Smoking, hypertension causing degeneration of the vessel wall.

Question 9

What are the risk factors of aneurysms?

Answer 9

Male, familial history, Caucasian, connective tissue disease (Marfans, Ehlers-Danlos).

Question 10

What are the common sites of aneurysms?

Answer 10

Aorta, popliteal artery, common femoral arteries, intra-abdominal splanchnic arteries, subclavian arteries, carotid arteries.

Question 11

What is the most common site for arterial aneurysms?

Answer 11

Infra-renal AAA.

Question 12

How many people have infra-renal AAAs?

Answer 12

5% of elderly males.

Question 13

What is the pathophysiology of aneurysms?

Answer 13

Loss of elastin and smooth muscle from medial wall, systemic dilating disease, possible genetic component.

Question 14

What is the natural history of AAAs?

Answer 14

Aneurysms expand by about 10% per year. Rupture made more likely if HTN and smoking.

Question 15

What is the presentation of AAAs?

Answer 15

Asymptomatic mostly. Distal embolisation sometimes. Abdominal pain, general malaise, weight loss - inflammatory aneurysm. Rupture -> abdo pain, pulsatile mass, hypovolaemia.

Question 16

What are the indications for AAAs repair?

Answer 16

Operative risk < risk of rupture. Symptomatic, rapidly expanding or ruptured. <5.5cm and asymptomatic should be monitored.

Question 17

What are the features of pre-operative assessment for AAA repair?

Answer 17

Medical assessment, risk assessment and modification, radiological assessment of AAA.

Question 18

What are the methods of AAA repair?

Answer 18

Conventional open repair, endovascular repair.

Question 19

What are the complications of open AAA surgery?

Answer 19

Haemorrhage, cardiac events, respiratory complications, renal failure, embolisation/thrombosis of distal arterial tree, colonic ischaemia, death 5-10%.

Question 20

What is endovascular AAA repair?

Answer 20

Radiographically guided intraluminal placement of stent-graft.

Question 21

What are the positives of endovascular AAA repair vs open repair?

Answer 21

Avoids laparotomy, intraperitoneal manipulation, reduces aortic occlusion time, small incisions, less painful, shorter hospital stay.

Question 22

What are the complications of endovascular AAA repair?

Answer 22

Graft migration, fracture of supporting wires, endoleak, endotension.

Question 23

What have the benefits of AAA screening been?

Answer 23

Reduces deaths by 42%.

Question 24

What is the AAA screening programme?

Answer 24

US screening of men aged 65 in community.
If normal - no further scans or treatment.
If 3cm-4.4cm - scan every year to check size.
If 4.5cm-5.4cm - scan every 3 months to check size and RF modification.
If 5.5cm+ - referred to surgeon within 2 weeks and have surgery.