Aortic Aneurysm

Question 1

Where are most AAAs located?

Answer 1

95% infrarenal

Question 2

Normal infrarenal aorta diameter?

Answer 2

3cm or less
(usually 1.5ish)

Aneurysm =
>3cm infrarenal
>50% increase

Question 3

ED presentations of AAA:

Answer 3

Pain secondary to inflammation or dissection

Rupture:
- Contained: retroperitoneum
–> can be surprisingly stable
- Free: Peritoneum

Distal ischaemia
- Emboli (trash foot), dissection, compression, thrombus

Massive GI haemorrhage
- Aortoenteric fistula

Question 4

Classic triad in ruptured AAA:

Answer 4

Back/flank pain
Hypotension
Pulsatile abdominal mass

Question 5

At what diameter is a AAA first palpable?

Answer 5

5cm

(OT size!)

Question 6

Role of bedside USS in a suspected ruptured AAA?

Answer 6

Rapidly confirm presence of a AAA
–> if not already known

Cannot reliably diagnose leak or rupture
-won’t see retroperitoneal bleed at all

Question 7

Role of CT angio in suspected ruptured AAA?

Answer 7

STABLE patients, operative planning.

Location, size, extent, presence of leak/rupture, thrombus etc.

Not necessary if clinical signs of rupture, and AAA known or confirmed on bedside USS

Question 8

AAA Annual risk of rupture:

Answer 8

3-4cm - 0%
4-5cm - 1%
5-6cm - 1- 10%
6-7cm - 10- 20%
>7cm - 30%

Question 9

Mortality in ruptured AAA:

Answer 9

Most don’t get to hospital
80% who get to DEM, still die
50% who get to OT, still die

Question 10

Indication for surgical intervention for (nonruptured) AAA:

Answer 10

> 5cm female
> 5.5cm male

Or
Increasing 1cm/year
Symptomatic

Question 11

Management of ruptured AAA:

Answer 11

Usual supportive and haemostatic resus measures
Establish GOC
Permissive hypotension
–> SBP 80-90