Aortic aneurysm Flashcards
What defines an abdominal aortic aneurysm (AAA)?
Focal aortic dilation greater than 3 cm in diameter.
When are patients in the population screened for AAA?
Screen all males if they have any history of smoking between the years of 65 to 75.
What are the risk factors for AAA?
Smoking (25x), advanced age and male gender (8x), hyperlipidemia and hypertension (4x), and atherosclerotic disease.
While all these factors contribute to the development of AAA, smoking is the single most important and modifiable risk factor, followed by age and male gender as the strongest non-modifiable factors.
How does ethnicity or race play into the risk for AAA?
Ethnicity and race do affect both prevalence and risk, although the effect on prevalence is more pronounced. Factors like smoking, hypertension, and healthcare access remain crucial in determining individual risk across all populations.
What is the typical clinical presentation of a stable AAA?
Usually asymptomatic, but if symptomatic, it can cause pressure or pain in the abdomen or back. Associated symptoms include a pulsatile abdominal mass or hypovolemic shock if the aneurysm ruptures.
Where do abdominal aortic aneurysms most commonly occur in the abdomen?
Below the kidneys (infrarenal)
What is a MAJOR complication of AAA?
The aneurysmatic dilatation of the vessel wall may cause disruption of the laminar blood flow and turbulence. Formation of a thrombus is a real possibility!
What is the initial diagnostic test of choice for AAA?
Abdominal ultrasound (US).
What is the imaging modality of choice following US for a stable patient with a suspected AAA?
Abdominal CTA.
What is the management approach for asymptomatic AAA?
- For diameter is ≥5.5 cm: Surgery with a endovascular aneurysm repair
- For diameter expanding >1 cm/year: Surgery with a endovascular aneurysm repair
- For an aneurysm that is expanding rapidly: Surgery with a endovascular aneurysm repair
- For symptomatic aneurysms: Elective surgical repair
- For smaller aneurysms: observation with q6-12 month ultrasounds
- For all aneurysms: risk factor modification (e.g., smoking cessation)
What would be the modality to assess for cardiac strength prior to performing a surgery for abdominal aortic aneurysm repair?
Radionuclide dipyridamole thallium
What is the classic triad of a ruptured AAA?
Abdominal pain, hypovolemic shock, and a pulsatile abdominal mass.
What is the diagnostic modality of choice for a stable patient with a suspected ruptured AAA?
Abdominal CT scan.
What diagnostic modality is used for unstable patients with suspected ruptured AAA?
Bedside ultrasound.
What is the treatment for a ruptured AAA?
Endovascular or open surgical repair.
What is a major complication of a ruptured AAA?
Aortoenteric fistula, which causes massive gastrointestinal bleeding.
