Aortic aneursym

Question 1

What is a AAA?

Answer 1

Abdominal Aortic Aneurysm (AAA) is a dilated abdominal aorta (increased circumference)

Question 2

What is a ruptured AAA?

Answer 2

Ruptured AAA is when the aneurysm “pops” and starts bleeping into the abdominal cavity

Question 3

How do AAAs present?

Answer 3

• Often asymptomatic
• Symptoms of peripheral vascular disease
• Non-specific abdominal pain
• Palpable expansile pulsation in abdomen when palpated with both hands
• Found incidentally on abdominal Xray
• Diagnosis by ultrasound or angiography (CT or MRI)

Question 4

How are AAAs managed?

Answer 4

•Treat reversible risk factors
•Monitoring size
•Treating peripheral arterial disease
•Surgical (usually considered >5.5cm) 
◦Endovascular stenting
◦Laparoscopic repair
◦Open surgical repair

Question 5

What size is a AAA for surgery to be considered?

Answer 5

> 5.5cm

Question 6

What increases risk of AAA rupture?

Answer 6

Diameter of AAA

roughly 5% for 5cm aneurysm, 40% for 8 cm aneurysm

Question 7

How does a ruptured AAA present?

Answer 7

• Known AAA or pulsatile mass in abdomen
• Severe abdominal pain (non- specific, possibly radiating to the back or loin)
• Haemodynamic instability (hypotension, tachycardia)

Question 8

How to manage ruptured AAA?

Answer 8

Patients with suspected AAA that are haemodynamically unstable should be transferred directly to theatre from A&E resus. As the mortality is so high, transfer to theatre for surgical repair should not be delayed by getting imaging.

Diagnosis of the rupture can be confirmed or excluded by immediate CT abdomen in patients that are haemodynamically stable.