Aortic Aneurysm

Question 1

Describe features of abdominal aortic aneurysms

Answer 1

• Occurs when abdominal aorta is over 3cm in size.
• The most common site is between the renal and inferior mesenteric arteries.

Question 2

Explain the presentation of AAA

Answer 2

• Most are asymptomatic
• Can present with an abdominal mass which is pulsatile and expansile (hands will push out the way)

Question 3

Explain the screening process for AAA’s

Answer 3

If small then ultrasound is offered yearly. If medium (4.5-5.4cm) then US offered every 3 months, If greater than 5.5cm then surgery is recommended

Question 4

What are the management options for AAA’s?

Answer 4

• Open repair (for younger patients) or endovascular aneurysm repairs (EVAR) or conservative.
• Indicated if AAA is over 5.5cm or rapidly growing (>1cm per year)
• Manage CV risk factors

Question 5

What is the assessment of a patient with a AAA?

Answer 5

• Full history and exam,
• Abdominal US for screening
• CT angiogram - preop evaluation (alternatively MRA)
• Assess Cardiorespiratory fitness
• Renal function

Question 6

What are the complications of open surgery for AAA’s?

Answer 6

Bleeding, acute limb ischaemia, MIs or renal failure.
EVAR has fewer complications, they have a faster recovery however they will need re-intervention in future

Question 7

Explain the presentation of a ruptured AAA

Answer 7

• Sudden onset, severe back/lower abdo pain
• Cardiovascular instability/collapse
• Surgical emergency

Question 8

What is the management of a ruptured AAA?

Answer 8

Resuscitation and then repair with open or EVAR

Question 9

What are the risk factors for AAAs?

Answer 9

Age over 65
Male gender
Family history
Smoking
Atherosclerotic disease
Arterial hypertension
Greater height
COPD
Syphilis
Elhers danlos syndrome
Alcohol consumption