Aortic Aneurysm Flashcards
AAA
Dilation of the abdominal aorta >3cm.
Pathophysiology
Failure of elastic proteins within the extracellular matrix causing dilation of all layers of the arterial wall.
Loss of the intima with loss of elastic fibres in the media - due to increased proteolytic activity and lymphocytic infiltration.
RF Aortic Aneurysm
Increased age male smoker with HTN and Fhx
Ehlers Danlos
Marfans
Presentation
Non specific abdominal pain
Pulsatile and expansile mass in abdomen
Incidental finding on x-ray, US or CT
Ix
USS
CT angiogram - detailed picture for guidance for surgery
Screening for AAA
Ultrasound age 65.
Routine USS can be considered in women over 70 with rf.
Outcome of screening
Aorta diameter >3cm referred to vascular team or urgent within 2 weeks if >5.5cm.
When to rescreen AAA
Screen yearly for pt with small aneurysm
3 monthly for medium aneurysm.
When to repair aneurysm
Repair for symptomatic, growing more than 1 cm per year or large aneurysm.
Size of Aneurysm
Normal = <3cm
Small = 3-4.4cm
Medium 4.5-5.4cm
Larger = >5.5cm
Treatment aneurysm
Elective surgical repair by inserting artificial graft either via Open repair laparotomy or Endovascular aneurysm repair (EVAR)
Secondary prevention of AAA
Stop smoking
Healthy diet and exercise
Optimising management of HTN, DM, and hyperlipidaemia
Driving and AAA
Inform DVLA if aneurysm >6 cm.
Stop driving if above 6.5cm
Heavy vehicle drivers have more restrictions.
Symptoms ruptured aneurysm
Severe abdo pain radiating to back or groin
Haemodynamic instability
Pulsatile and expansile mass in abdomen
Collapse or LOC
Treatment ruptured aneurysm
Surgical emergency - permissive hypotension.
Do not wait for CT angiogram or confirmation in those suspected and hemodynamically unstable.
