Aneurysm Flashcards
What is an Abdominal Aortic Aneurysm (AAA)?
Dilation in the abdominal aorta where the abdominal aorta diameter > 3cm
Normal diameter: 1.5cm female, 1.7cm male
What are the key pathophysiological changes in AAA?
- Loss of intima and elastic fibres of the media
- Proteolytic activity and lymphocytic infiltration
- Dilation of all 3 layers of the arterial wall
What are the risk factors for developing an AAA?
- Age
- Smoking
- Hypertension
- Syphilis
- Connective tissue disorders: Ehlers Danlos (T1), Marfan’s Syndrome
What is the screening methods used for AAA?
- 1 SINGLE abdominal ultrasound for all MALES 65+
- Further management depending on result.
If the aorta diameter in inital screening reusult is < 3cm what are the next stesp?
Normal = no further action
If the aorta diameter in inital screening reusult is 3cm-4.4cm what are the next stesp?
Small Anyrusm = Rescan every 12 months
If the aorta diameter in inital screening reusult is 4.5-5.4cm what are the next stesp?
Medium Anyrusm = Rescan every 3 months
If the aorta diameter in inital screening reusult is >5.5cm what are the next stesp?
Large Aneurysm = refer wihtin 2 weeks to vascular surgery for intervention
What are common symptoms of AAA?
- Often asymptomatic
- Abdominal/back/flank pain
- Pulsating feeling
- Pain radiating to the legs
What management is recommended for AAA with low rupture risk?
- Asymptomatic, aortic diameter < 5.5cm
- Abdominal US surveillance
- Optimise CVD risk factors (HTN/stop smoking)
What management is recommended for AAA with high rupture risk?
- Symptomatic >5.5cm or enlarging (>1cm/year)
- Refer to vascular surgery for probable intervention
What are the surgical options for AAA?
- Elective endovascular repair (EVAR)
- Open repair
What is the mortality rate of a ruptured AAA?
80%
What are the typical presentations of a ruptured AAA?
- Sudden collapse
- Severe pain (loin to groin pain with central tenderness)
- Shock symptoms (low BP, high HR, sweating)
What SIGN might indicate a ruptured AAA?
- Pulsatile + expansile mass in the abdomen
What is the emergency management protocol for a ruptured AAA?
- Immediate vascular review
- Haemodynamically unstable: no CT, clinical diagnosis, straight to theatre
- Haemodynamically stable: CT angiogram to assess suitability for EVAR, then surgery
- Frail patients: consider palliative approach
Fill in the blank: The abdominal aorta diameter is considered aneurysmal if it is greater than _______.
3cm
True or False: Most patients with AAA are symptomatic.
False
