abdominal aortic anuerysm

Question 1

what is the defintion of an AAA?

Answer 1

dilation of the aorta over 3 cm

Question 2

what are the risk factors?

Answer 2

1. smoking
2. hypertension
3. hyperlipidaemia
4. family history

Question 3

what is a negative risk factor?

Answer 3

diabetes mellitus

Question 4

what are clinical features of AAA?

Answer 4

1. mainly asymptomatic
2. symptomatic patients with AAA
   - abdominal pain
   - back or loin pain
   - distal embolisation

Question 5

what is seen on examination?

Answer 5

pulsatile mass in the abdomen

Question 6

screening programmed

Answer 6

all men must have an abdominal ultrasound at 65

Question 7

first line Ix?

Answer 7

1. abdominal ultrasound scan

2. 2nd line - follow up with a CT scan

Question 8

monitoring ultrasounds

Answer 8

1. 3.0 - 4.4 cm = yearly US scan

2. 4.5 to 5.4 = 3 monthly

Question 9

when must surgery be indicated?

Answer 9

1. > 5.5 cm
2. AAA expanding at more than 1 cm a year
3. symptomatic AAA

Question 10

Medical mx

Answer 10

1. smoking cessation
2. improve blood pressure control
3. commence statin and asprin therapy
4. weightloss

Question 11

surgical mx options

Answer 11

1. Open repair - tansverse incision / clamping of aorta / replacing segment of aorta with prosthetic graft
2. endovascular repair - stenting of the aneurysm

Question 12

which surgical intervention is preferred?

Answer 12

1. EVAR - better short term prognosis e.g. shorter hospital stay etc but higher rate of reintervention needed
2. Open repair - better for younger and fitter patients

Question 13

symptoms of ruptured AAA

Answer 13

1. abdo/back pain
2. hypotension
3. pulsatile abdominal mass

Question 14

management of AAA

Answer 14

1. IV oxygen, bloods and cross match
2. treat shock - aim BP < 100 as increase in BP will increase bleeding
3. if unstable - open repair
4. if stable - CT and EVAR