Aneurysm Disease

Question 1

What are the risk factors for an abdominal aortic aneurysm?

Answer 1

Male sex
Age (usually greatest over 65 years old)
Family history
Smoking
Hypertension

Question 2

What is the aetiology for aneurysm disease?

Answer 2

Degenerative I.e. atherosclerosis
Infection I.e. mycotic aneurysm
Connective tissue disorder I.e. Marian’s syndrome

Question 3

What is the presentation of an AAA?

Answer 3

Asymptomatic
Symptomatic;
Due to impeding rupture = back pain and tender abdominal aorta
Due to rupture = abdominal/back/ flank pain, pulsating tender AA, haemodynam,ic compromise and hypoperfusion (SHOCK)
Also unusual presentations

Question 4

What are some abnormal presentations of an AAA?

Answer 4

Distal embolisation
Aortocaval fisula (AAA erodes into inferior vena cava)
Aortoenteric fistula (connection between aorta and intestines/stomach/peso-Hague’s
Uterus occlusion
Duodenal obstruction

Question 5

What are the criteria for screening?

Answer 5

Men aged 65
If they have AAA 3 - 4.4 cm = annual screening
If they have AAA 4.5 - 5.5 cm = 3 monthly screening
If they have AAA >5.5 cm = treatment

Question 6

How is treatment for AAA surgery considered?

Answer 6

Treatment is considered if the AAA is >5.5 cm
Fitness for surgery - if they aren’t fit then conservative treatment is given
Is it suitable for open repair or EVAR ?

Question 7

How is fitness to practice determined?

Answer 7

Full history and examination is carried out
Tests such as 
Bloods
ECG
ECHO
Pulmonary function tests
Cardiopulmonary exercise stress test
Myocardial perfusion tests

Question 8

Describe the pathology of Abdominal aortic aneurysms.

Answer 8

AAA are dilatation of all they layers of the aorta leading to a 50% increase in diameter
They most commonly occur just below the superior mesenteric artery and therefore the inferior mesenteric artery is usually the only one which is affected

Question 9

By how much do AAA’s grow per year?

Answer 9

2cm per year approx.

Question 10

What are the complications of open repair?

Answer 10

General; Wound infection, Bleeding, Pain and a Scar
Technical; 
damage to bladder, ureter, veins and nerves
Incisional hernia
Distal emboli
Renal failure
Colonic ischaemia 
Graft infection

Question 11

What are the complications of endovascular repair?

Answer 11

General; wound infection, scar, bleeding/ haematoma, pain, contrast - reaction / kidney injury, radiation
Technical;
Endoleak
Femoral artery dissection/ pseudoaneurysm,
Rupture,
Distal emboli/ colonic ischaemia,
Damage to femoral vein/ nerve

Question 12

What are the patient factor complications from EVAR and open repair?

Answer 12

Stroke
MI
DVT / PE
Death

Question 13

why are abdominal aneurysms more common than thoracic aneurysms?

Answer 13

Due to the bifurcation of the abdominal aorta into the common iliac arteries.
Aneurysms are more likely to form at a bifurcation as this is where there is more turbulent blood flow.
Turbulent blood flow increases risk of aneurysm development.