Aneurysms – presentation, investigation and therapy

Question 1

What is the difference between a true aneurysm and a false aneurysm (pseudoaneurysm)?

Answer 1

✅ True Aneurysm:

Involves all three layers of the artery (intima, media, adventitia).
Common in aorta (AAA, thoracic aneurysms), popliteal artery.
❌ False Aneurysm (Pseudoaneurysm):

Does not involve all three layers.
Occurs after trauma, surgery, or infection (e.g., after catheterization).

Question 2

What are key risk factors for AAA?

Answer 2

✅ Modifiable Risks:

Smoking (biggest risk factor!).
Hypertension.
Hyperlipidaemia.
Atherosclerosis.
❌ Non-Modifiable Risks:

Age >65.
Male sex (4:1 M:F ratio).
Family history of AAA.
Connective tissue disorders (e.g., Marfan’s, Ehlers-Danlos syndrome).
💡 Screening: In the UK, men ≥65 years offered AAA ultrasound screening.

Question 3

What are the major sequelae of aneurysms?

Answer 3

❗ Rupture → Can cause fatal haemorrhage.
❗ Thrombosis → Leads to ischemia, limb loss.
❗ Embolization → Clots break off, causing stroke or limb ischemia.
❗ Compression of nearby structures → Pain, nerve dysfunction.

Question 4

How does a ruptured AAA present?

Answer 4

✅ Classic Triad:

Severe abdominal/back pain (tearing, sudden onset).
Hypotension/Shock.
Pulsatile abdominal mass (not always palpable).
💡 Other Symptoms: Syncope, nausea, vomiting, flank bruising (Grey-Turner’s sign).

Question 5

What is the initial management of a ruptured AAA?

Answer 5

1️⃣ Call Vascular Surgery & Transfer to Theatre 🚨.
2️⃣ ABC approach – Secure IV access, fluids (but avoid over-resuscitation!).
3️⃣ Crossmatch blood (for massive transfusion protocol).
4️⃣ Urgent CT angiography (if stable; skip if unstable).
5️⃣ Surgical Repair (Open or EVAR).

Question 6

What are the pros and cons of Open Repair vs. EVAR?

Answer 6

Open Repair:
Advanatages - Long-term durability, lower reintervention rates
Disadvantages - Higher surgical risk, long recovery

EVAR:
Advantages - Less invasive, faster recovery, lower early mortality
Disadvantages - Needs lifelong follow-up, possible leaks

💡 EVAR = Preferred for high-risk patients; Open = More durable for younger patients.

Question 7

Key Advice for Patients with an AAA? (abdominal aortic aneurysm) (please also include emergency warning signs)

Answer 7

✅ Lifestyle Changes:

Stop smoking 🚭 (slows aneurysm growth!).
Control BP & cholesterol (medications if needed).
Regular exercise (low-impact to avoid sudden pressure spikes).
✅ Monitoring & Follow-Up:

Small AAA (<5.5 cm) → Ultrasound every 6-12 months.
Large AAA (>5.5 cm) → Elective repair recommended.

💡 Emergency Warning Signs: Sudden severe pain, fainting, dizziness → Seek urgent medical help!