Aortic aneurysm Flashcards
Abdominal aortic aneurysm definition
Dilation of abdominal aorta
Diameter > 3cm
AAA risk factors
Men
Increased age
Smoking
Hypertension
Family history
Existing CVD
AAA screening
USS at 65 for all men
USS for women over 70 with risk factors
Refer to vascular team if >3 - urgent if >5.5cm
AAA presentation
Asymptomatic until rupture
Non-specific abdo pain
Pulsatile and expansile mass
Incidental finding
AAA diagnosis
USS = initial
CT angiogram
AAA classification
Small = 3-4.4cm
Medium = 4.5-5.4cm
Large = <5.5cm
AAA management
Treat reversible risk factors
Follow up scans
- yearly if small, 3 monthly if medium
Elective repair if:
- symptomatic, growing >1ccm a year, large
- insert graft via open repair (laparotomy) or endovascular aneurysm repair (EVAR) using stent
Ruptured AAA epidemiology
Risk increases with diameter
High mortality
Ruptured AAA presentation
Severe abdo pain - radiate to back or groin
Haemodynamic instability (hypotension and tachycardia)
Pulsatile and expansile mass
Collapse
LOC
Ruptured AAA management
Surgical emergency
Permissive hypotension - aim for lower than normal BP with fluid resus
Surgical repair should not be delayed by obtaining diagnosis
CT angiogram
Thoracic aortic aneurysm definition
Dilatation of thoracic aorta, esp ascending aorta
>4.5cm for ascending aorta
>3.5cm for descending aorta
But diameter varies on age, body size etc
False aneurysms
Intima and media (two innermost layers) rupture and dilatation of vessel
Blood only contained in adventitia (outer) layer
After trauma, surgery or infection
True = 3 layers intact but dilated
Aortic dissection = blood enters b/ween intima and media
Thoracic aortic aneurysm risk factors
Men
Increased age
Smoking
HTN
FH
Existing CVD
Marfan syndrome and other CT disorders
Thoracic aortic aneurysm presentation
Asymptomatic
Incidental finding
Chest/back pain
Trachea/left bronchus compression - cough, SOB, stridor
Phrenic N compression - hiccups
Oesophageal compression - dysphagia
Recurrent laryngeal N compression - hoarse voice
thoracic aortic aneurysm diagnosis
Echo
CT/MRI angiogram
Management of thoracic aortic aneurysm
Treat modifiable risk factors
Surveillance
Thoracic endovascular aortic repair (TEVAR)
Open surgery
Thoracic aortic aneurysm complications
Aortic dissection
Ruptured aneurysm
Aortic regurgitation
Ruptured thoracic aortic aneurysm sites
Bleeding into:
Oesophagus - haematemesis
Airways/lungs - haemoptysis
Pericardial cavity - cardiac tamponade
Ruptured thoracic aortic aneurysm presentation
Severe chest/back pain
Haemodynamic instability
Collapse
Death
Ruptured thoracic aortic aneurysm management
Emergency open surgery
Replacement of affected area with synthetic graft
