Aortic aneurysm

Question 1

What is an abdominal aortic aneurysm?

Answer 1

Dilation of the abdominal aorta, with a diameter of more than 3cm

Question 2

Where does a AAA most commonly form?

Answer 2

Below the level of the renal arteries - called an infra-renal anerysm

Question 3

What are the risk factors for AAA?

Answer 3

Increasing age
Male gender
Smoking
Hypertension
Connective tissues disorders - Elhers Danlos and Marfan syndrome
Family history

Question 4

Who is offered screening for AAA?

Answer 4

All men in England are offered a screening ultrasound at age 65 to detect asymptomatic AAA

Question 5

What is the presentation of AAA?

Answer 5

Most cases are asymptomatic
Symptoms can include:
- Flank, back or abdominal pain
- Pulsating abdominal sensation

Question 6

What is the initial investigation for diagnosis of a AAA?

Answer 6

Abdominal ultrasound

Question 7

What other investigations may be considered in diagnosis of AAA?

Answer 7

FBC - leaking AAA can cause anaemia
U&Es
CRP/ESR
Group and save and crossmatch
CT angiogram - more detailed anatomical information

Question 8

How often should identified AAA be rescanned?

Answer 8

3-4.4cm - rescan every 12 months
4.5-5.4cm - rescan every 3 months
>5.5cm - refer within 2 weeks to vascular surgery

Question 9

What are the indications for elective repair of aneurysm?

Answer 9

Symptomatic aneurysm
Diameter growing more than 1cm per year
Diameter above 5.5cm

Question 10

What are the surgical management options for AAA?

Answer 10

Open repair via laparotomy
Endovascular aneurysm repair (EVAR) via femoral arteries

Question 11

What is the presentation of a ruptured AAA?

Answer 11

Severe abdominal pain
Pain radiating to the back
Haemodynamic instability
Pulsatile and expansile abdominal mass
Collapse
Loss of consciousness

Question 12

Where is a thoracic aortic aneurysm most commonly found?

Answer 12

Ascending aorta

Question 13

What is the presentation of a thoracic aortic aneurysm?

Answer 13

Chest or back pain
Cough
SOB - tracheal compression
Stridor
Hiccups - phrenic nerve compression
Dysphagia - oesophageal compression
Hoarse voice - recurrent laryngeal nerve compression

Question 14

What are the imaging options for a thoracic aortic aneurysm?

Answer 14

CT angiogram
MRI angiogram
Echo

Question 15

What are the complications of a thoracic aortic aneurysm?

Answer 15

Aortic dissection
Ruptured aneurysm
Aortic regurgitation