Aortic Aneurysm Flashcards
What is an aortic aneurysm?
full-thickness dilation of a segment of blood vessel (more than 50% normal diameter and weakness in blood vessel wall)
What is the most common type of aortic aneurysm?
AAA
What is an AAA?
a localised enlargement of the abdominal aorta where the diameter is >3cm or >50% larger than normal diameter
What are RF for aortic aneurysms?
- Large diameter
- Rapid expansion
- Current smoking
- Recent MI
- History of sepsis
- Male
- Connective tissue disorder
- Old age
- Inflammatory disorder
- Hypertension
What is an unruptured AAA?
> 3cm across
What is patho of AAA?
Cause is degeneration of elastic lamella and smooth muscle loss and genetics
What should be done if 5.5cm or expanding more than 1cm a year or symptomatic aneurysms?
elective surgery and stenting EVAR
What are symptoms of a proximal AAA?
upper abdominal pain or back pain
What are symptoms of a distal AAA?
lower abdominal or pelvic pain
What are the symptoms of an unruptured aneurysm?
- indolent onset of pain + vague and nonspecific
2. pain in back, abdomen or groin
What are symptoms of a ruptrued aneurysm?
sudden onset severe pain
What is the classic triad for an aortic aneurysm?
- Acute pain
- Pulsatile abdominal mass
- Hypotension
What are signs of haemodynamic compensation?
- Tachycardia
- Peripheral cyanosis
- Mottling
What are vague symptoms in aortic aneurysm?
- Pain in back, flank, pelvis or hip (lower back and abdomen)
- Nausea and vomiting
- Syncope
What are causes of an aortic aneurysm?
- Trauma
- Atheroma
- Infection
- Connective tissue disorder
- Inflammatory
What are the common sites for an aortic aneurysm?
- Aorta
- Iliac
- Femoral
- Poplitieal arteries
What are the signs for all AAA?
- Pulsatile, laterally expansile mass on palpation
- Abdominal bruit
- Grey-Turners sign (ruptured)
What happens if rupture into peritoneal cavity?
sudden cardiovascular collapse and death
What happens if rupture into retroperitoneal space?
may stabilize temporarily, massive haemorrhaging and then shock and death
What is the diagnosis for AA?
- dilation with transverse diameter exceeding 3cm
- Incidental finding + one time screening
What imaging is done for AAA?
- ECG
- Abdominal US
- CT angiogram
- Magnetic resonance angiogram
What would abdominal US show?
Gold standard: can detect presence of AAA but not if ruptured yet
What would CT angiogram show?
can detect whether AAA has ruptured
What would magnetic resonance angiogram show?
detect whether AAA has rupture: if patient has contrast allergy or renal impairment
What bloods are done in AA?
- Amylase
- Hb
- Crossmatch
- FBC
- Clotting screen
- U+Es
- LFTs
What is the management for AAA?
- IV access, keep systolic over 100
- Prophylactic antibiotics
- Surgery for clamping aorta above leak and inserting dacron graft
Is there screening for AAA?
All males over 65 screened in UK for AAA
What is the prognosis for AAA?
Ruptured AAA: morality in treated is 41% and untreated around 100%
What are true anurysms?
-saccular
-fusiform
(goes into intima)
Where do most AAA occur?
90% below renal arteries
