Aortic Aneurysm

Question 1

What is a true or false aneurysm

Answer 1

True - involves all layers of the arterial wall whereas false aneurysm doesn’t.

Question 2

What is an aneurysm?

Answer 2

Over 50% dilation of an artery. Can be saccular (greater risk of rupture) or fusiform

Question 3

what is the most common AAA?

Answer 3

Infrarenal AAA

Question 4

What are the risk factors for AAA?

Answer 4

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

Question 5

What are the investigations for AAA?

Answer 5

Abdominal ultrasound - Screening as most AAA are asymptomatic.

Question 6

What are the results of screening for AAA?

Answer 6

< 3cm then no action
3-4.4cm then rescan every 12 months
4.5-5.4cm then rescan every 3 months
>5,5cm then 2 week referral to vascular surgery

Question 7

What are the assessments required for a patient with a AAA?

Answer 7

• Full history and exam,
• Comorbidities
• CT ANgiogram
• CPEX to assess cardiorespiratory fitness
• Renal function

Question 8

What are the treatment options for AAA?

Answer 8

• Open repair
• Endovascular aneurysm repair (EVAR)
• Conservative

Question 9

What are the complications of open surgery for a AAA?

Answer 9

Bleeding, limb ischaemia, MI, renal failure

Question 10

Describe features of EVAR

Answer 10

• Less invasive, quicker return to full activity. Fewer complications but does require reintervention in the future

Question 11

Who should get an open repair vs EVAR?

Answer 11

Younger patients should get open repair. Older patients should get EVAR

Question 12

What is teh presentation of a ruptured AAA?

Answer 12

Sudden onset severe back/lower abdominal pain. Cardiovascular instability or collapse.
High mortality rate

Question 13

What is the management of a ruptured AAA?

Answer 13

Imaging - FAST scan
Resuscitation - but do not delay repair
Repair - Open or EVAR