Aortic aneurysm

Question 1

Abdominal aortic aneurysm definition

Answer 1

Dilation of abdominal aorta
Diameter > 3cm

Question 2

AAA risk factors

Answer 2

Men
Increased age
Smoking
Hypertension
Family history
Existing CVD

Question 3

AAA screening

Answer 3

USS at 65 for all men
USS for women over 70 with risk factors
Refer to vascular team if >3 - urgent if >5.5cm

Question 4

AAA presentation

Answer 4

Asymptomatic until rupture
Non-specific abdo pain
Pulsatile and expansile mass
Incidental finding

Question 5

AAA diagnosis

Answer 5

USS = initial
CT angiogram

Question 6

AAA classification

Answer 6

Small = 3-4.4cm
Medium = 4.5-5.4cm
Large = <5.5cm

Question 7

AAA management

Answer 7

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

Question 8

Ruptured AAA epidemiology

Answer 8

Risk increases with diameter
High mortality

Question 9

Ruptured AAA presentation

Answer 9

Severe abdo pain - radiate to back or groin
Haemodynamic instability (hypotension and tachycardia)
Pulsatile and expansile mass
Collapse
LOC

Question 10

Ruptured AAA management

Answer 10

Surgical emergency
Permissive hypotension - aim for lower than normal BP with fluid resus
Surgical repair should not be delayed by obtaining diagnosis
CT angiogram

Question 11

Thoracic aortic aneurysm definition

Answer 11

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

Question 12

False aneurysms

Answer 12

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

Question 13

Thoracic aortic aneurysm risk factors

Answer 13

Men
Increased age
Smoking
HTN
FH
Existing CVD
Marfan syndrome and other CT disorders

Question 14

Thoracic aortic aneurysm presentation

Answer 14

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

Question 15

thoracic aortic aneurysm diagnosis

Answer 15

Echo
CT/MRI angiogram

Question 16

Management of thoracic aortic aneurysm

Answer 16

Treat modifiable risk factors
Surveillance
Thoracic endovascular aortic repair (TEVAR)
Open surgery

Question 17

Thoracic aortic aneurysm complications

Answer 17

Aortic dissection
Ruptured aneurysm
Aortic regurgitation

Question 18

Ruptured thoracic aortic aneurysm sites

Answer 18

Bleeding into:
Oesophagus - haematemesis
Airways/lungs - haemoptysis
Pericardial cavity - cardiac tamponade

Question 19

Ruptured thoracic aortic aneurysm presentation

Answer 19

Severe chest/back pain
Haemodynamic instability
Collapse
Death

Question 20

Ruptured thoracic aortic aneurysm management

Answer 20

Emergency open surgery
Replacement of affected area with synthetic graft