Aortic Aneurysm Flashcards
What does AAA stand for?
- Abdominal aortic aneurysm
When is a swelling of the aorta categorised as an AAA?
- When maximal external diameter exceeds 3cm OR- When there is a 50% increase in vessel diameter above the norm
What does a fusiform aneurysm mean?
- Spindle shaped (symmetrical)
What does a saccular aneurysm mean?
- Pouch shaped (asymmetrical)
What percentage of AAA’s are infra-renal?
- 95%
What are true aneurysms?
- Aneurysms that consist of all 3 tunica layers bulging
What are false aneurysms?
- When the blood is contained by the thin adventitia layer OR- Contained by surrounding soft tissue in a haemotoma
What conditions can cause AAA’s earlier in life?
- Marfans - Ehlers danlos syndrome
What is an asymptomatic AAA?
- When it is discovered on examination and has no other symptoms
What is an emergency AAA?
- Impending/actual rupture - High mortality
What is an unusual presenting AAA?
- Aortic occlusion- Distal embolism- Uretic occlusion - Aortocaval fistula - Aortoenteric fistula - Duodenal obstruction All traced back to the AAA
Besides occasional asymptomatic ones, what are the common symptoms of an established AAA?
- Dyspnoea - Dysphagia - Hoarseness - Sharp chest pain radiating to back between shoulder blades- Dissection
What are the signs of an AAA?
- Low BP - Heart failure
What are the symptoms of an emergency AAA?
- Sudden onset of severe central/lumbar pain - Dull back ache later - Hypoveolaemic shock
What is hypovolaemic shock?
-Blood/fluid loss leading to organ failure
Who is most susceptible to an AAA?
- Elderly - Male - Smoker w/ wo/ COPD- HBP - Peripheral vascular disease - Ischaemic HD
What new symptom in those over 60 should be assumed as result of AAA?
- New onset renal colic pain
What genetic aspects are important in calculating patient risk of AAA?
- 1st degree male relatives with it
What non-genetic causes are linked to AAA development?
- Weakening of vessel wall - Hypertension
What congenital issues can lead to AAA?
- Bicuspid aortic valve - Marfan’s syndrome - Coarctation
What can a biscupid aortic valve cause?
- Stenosis or regurgitation - Is associated with coarctation and then aneurysm
What are the 3 developmental coarctations that can cause shunt if not closed?
- Ductus arteriosus - Foramen ovale - Ductus venosus
How does the ductus arteriosus cause coarctation of the aorta?
- When it closes the smooth muscles contracts on the aorta resulting in coarctation
What are the signs of coarctation of the aorta?
- Cold legs - Poor leg pulses - Radiofemoral delay - Heart failure - Failure to thrive - Hypertension
On presentation and suspected AAA what are the pre operative investigations?
- Routine bloods - ECG - Echocardiogram- Cardiac perfusion scan - CXR - Pulmonary function tests - CT of abdomen
What is the management and treatment of a ruptured AAA?
- First diagnosis - CXR - Ultrasound CT scan if CXR obscured - Coagulation screen - FBC - U’s and E’s- Explorative
What are U’s and E’s?
- Urea and electrolytes
Following a rupture, what risk factor treatment should be implemented?
- Aspirin/clopidogrel - Statin - Anti-hypertensives- Smoking cessation
