Aortic aneurysm

Question 1

What is an aneurysm? Define true + false. Which is worse?

Answer 1

• aneurysm = dilation of an artery of at least 1.5x the expected normal diameter
• 2 x = defs and aneurysm
• true = involves all vessel wall layers (intima, media, adventitia)
• false (pseudo) = disruption of the aortic wall of the anastomotic site between vessel and graft
  
  • containment of blood by a fibrous capsule made of surrounding tissue
  • false = likely to rupture even with a small diameter

Question 2

When do aortic aneurysms usually present?

Answer 2

• old man
• typically 50-70 years old

Question 3

Classic triad of ruptured AAA

Answer 3

1. Hypotension/collapse
2. Back/abdominal pain
3. Palpable, pulsatile abdominal mass (caution in patients with raised BMI)

Question 4

Complications of AAA?

Answer 4

aneurysms can:

• rupture
• thrombose
• embolize
• erode
• fistulize

Question 5

Symptoms in AAA

Answer 5

• common presentatio is due to acute expansion or rupture
  
  • syncope
  • pain (chest/abdo/flank/back)
  • hypotension
  • palpable pulsatile mass above umbilicis
  • airway/oesophageal obstruction
    
    • hoarseness
    • hemoptysis
    • hematemesis
  • distal pulses may be intact
• 75% are asymptomatic and are discovered incidentally
• uncommon:
  
  • ureteric obstruction + hydronephrosis
  • GI bleed (aortoduodenal fistula)
  • distal embolization

Question 6

Investigations for AA?

Answer 6

• FBC, UEC, PTT, INR, type + cross
• mostly diagnosed by CT, contrast CT outlining diameter + size, MRI can also be done, not usually used
• abdominal USS
• peripheral artery doppler/duplex to rule out aneurysms elsewhere (popliteal)

Question 7

Indications for treatment of AA?

Answer 7

• symptomatic
• complicated
• growing size (5-6cm)
• patients undergoing concomitant surgery
  
  • cases have to be individualised = if you have a connective tissue disorder maybe don’t wait til it is 5-6cm

Question 8

Treatment for AA?

Answer 8

• Conservative
  
  • if asymptomatic or do not meet threshold for repair
  • CVD risk reduction:
    
    • smoking cessation
    • control HTN, DM, lipids
    • regular exercise
    • watch + wait, USS surveillance
• Surgical
  
  • if ruputured, symptomatic, or >5.5cm
  • open repair
  • endovascular aneurysm repair (EVAR)

Question 9

Common aetiology of AA?

Answer 9

• atherosclerosis most common aetiology
• connective tissue disorder in young
  
  • Marfan’s, Eiler Danlos

RISK FACTORS

• smoking
• HTN
• PVD
• CAD
• CVD
• age >70
• family hx
• connective tissue disorder
  
  • Marfan, Ehlers-Danlos

Question 10

Common sites of AA?

Answer 10

• Abdominal Aorta Alone: 65%
• Thoracic Aorta Alone: 19%
• Abdominal + Iliac: 13%
• Thoraco-Abdominal: 2%
• Isolated Iliac: 1%
• Popliteal: 2.5%
• Visceral (splenic, SMA, renal, celiac): 2%