Aneurysms - Presentation, Investigation and Treatment

Question 1

Describe the difference between a true aneurysm and a false aneurysm

Answer 1

TRUE
- weakness and dilation of wall
- involves all 3 layers

FALSE
- rupture of wall of aorta with the haematoma either contained by the thin adventitial layer or by the surrounding soft tissue

Question 2

List risk factors associated with abdominal aortic aneurysm formation and progression

Answer 2

• Males
• Increasing age
• Positive family history
• Connective tissue disorders
• Smoking
• Hypertension

Question 3

Describe common sequalae of aneurysms

Answer 3

1. Rupture
   - risk related to size
   - high morbidity/mortality
2. Occlusion –> ischaemia
   - Risk of limb loss
3. Distal embolization (trash)

Question 4

Describe the clinical presentation of ruptured abdominal aortic aneurysm

Answer 4

• Hypotension
• Abdominal/back pain
• Collapsing
• Pulse near lower abdomen

Question 5

What are the main advantages of open repair and endovascular repair (EVAR) for abdominal aortic aneurysms

Answer 5

OPEN
- Good long-term outcomes
- No long-term surveillance

EVAR
- Lower up-front morbidity and mortality

Question 6

What are the main disadvantages of open repair and endovascular repair (EVAR) for abdominal aortic aneurysms

Answer 6

OPEN
- Higher up-front morbidity and mortality

EVAR
- Higher re-intervention rates –> long term surveillance
- Not all aneurysms anatomically suitable

Question 7

Outline key advice to provide to patients with an abdominal aortic aneurysm

Question 8

Describe the initial management of ruptured abdominal aortic aneurysm

Answer 8

• CT angiogram (if possible)
• Activate major haemorrhage protocol
• Analgesia
• Make calls to:
  ~ vascular consultant
  ~ On call anaesthetist
  ~ ICU
  ~ Emergency theatre co-ordinator
  ~ Patient’s family if not present