Aortic aneurysm (AAA and TAA) 09-x (1) Flashcards
AAA. 7 risk factors?
Age >60 years
Cigarette smoking
Male sex
History of atherosclerosis or connective tissue disease
HTN
Family history of AAA
white race
AAA. whats about initial symptoms?
Patients are typically asymptomatic until the aorta rapidly expands or ruptures:
AAA. Aorta rapidly expands. Symptoms? 2
Rapid expansion:
Dull abdominal/back pain
Distal embolization
AAA. Aorta ruptures. when delayed HD instability?
If the bleeding is in retroperitoneum
AAA. Aorta ruptures. when rapid onset HD instability?
Rapid onset hemodynamic instability and shock if bleeding is in peritoneum:
AAA. Aorta ruptures. Rapid onset. 5 symptoms?
- Severe abdominal/back pain (left costovertebral angle tenderness may be present)
- Pulsatile abdominal mass at the umbilicus
- Umbilical or flank hematoma
- Shock
- Peripheral pulses are decreased
AAA. Management? 4
Smoking cessation
Elective repair for size > 5,5 cm (asymptomatic)
Urgent repair for symptomatic and HD stable patients
Emergency repair for symptomatic and HD unstable patients
AAA. management for HD stable?
Urgent repair for symptomatic and HD stable patients
AAA. management for HD unstable?
Emergency repair for symptomatic and HD unstable patients
AAA. management for asymptomatic?
Elective repair for size > 5,5 cm (asymptomatic)
AAA. what increases risk of rupture?
a. Large aneurysm diameter (>5.5 cm)
b. Aortic expansion rate >0.5 cm in 6 months or >1 cm in 1 year
c. Current ongoing smoking. It increases risk probably because of degeneration of connective tissue in the aortic wall
d. Female gender
e. Hypertension. It has a weak association with AAA (in contrast to thoracic aortic aneurysm where hypertension has the greatest overall risk for dissection)
AAA. what increases risk of rupture. size?
Large aneurysm diameter (>5.5 cm)
AAA. what increases risk of rupture. expansion rate?
Aortic expansion rate >0.5 cm in 6 months or >1 cm in 1 year
AAA. what increases risk of rupture. smoking, why?
Current ongoing smoking. It increases risk probably because of degeneration of connective tissue in the aortic wall
AAA. whats about DM?
AAA progression and development in patients with diabetes is lower than in those without diabetes.
AAA. complication?
Aortocaval fistula
AAA. complication Aortocaval fistula. heart?
Leads to venous congestion and high-output cardiac failure
AAA. complication Aortocaval fistula. kidney?
Can also lead to venous congestion of bladder, leading to hematuria that is misdiagnosed as nephrolithiasis
AAA. CT findings? 2
Pulsatile abdominal mass, prevertebral aortic calcifications
AAA. HD stable diagnosis?
CT scan
AAA. Treatment - surgical. indications for operative or endovascular repair?
- Aneurysm size >5.5 cm
- Rapid rate of aneurysm expansion i.e. more that 0,5 cm in 6months or >1 cm in year
- Presence of symptoms (abdominal, back, or flank pain; limb ischemia) regardless of aneurysm
AAA. HD unstable diagnosis? 2
Known history of aneurysm –> surgery
No prior history of aneurysm –> focused abdominal ultrasound
AAA. Treatment - surgical. what aneurysm size?
Aneurysm size >5.5 cm
AAA. Treatment - surgical. what aneurysm expansion?
Rapid rate of aneurysm expansion i.e. more that 0,5 cm in 6months or >1 cm in year
AAA. Treatment - surgical. what symptoms says we need surgery?
Presence of symptoms (abdominal, back, or flank pain; limb ischemia) regardless of aneurysm size
AAA. Screening? sex, age, risk factor?
MALES, age 65-75
If they have ANY prior history of smoking (ie, any lifetime exposure of >100 cigarettes)
AAA. Screening method?
One-time abdominal duplex ultrasound (duplex = UG + doppler (colorful)).
AAA. screening - in what other population also may be done?
Screening may also be done in patients with age 65-75 with no smoking history if they have other significant risk factors (eg, first-degree family history of AAA rupture)
AAA unstable. Algorithm. Symptoms suggesting unstable AAA?
Abdominal/flank/groin pain
Pulsatile mass
flank ecchymosis
limb ischemia
—–> ITS HD INSTABILITY
NOTE: abdominal bruit is RENAL ARTERY STENOSIS OR FIBROMUSCULAR DYSPLASIA.
AAA unstable. Algorithm.
HD stable –> whats next?
CT of abdomen
AAA unstable. Algorithm.
HD stable –> CT aneurisma detected –> whats next? if yes and no
Yes - medical optimization or repair
No - explore other diagnoses
AAA unstable. Algorithm.
HD unstable –> whats next?
evaluate if patients has KNOWN AAA.
AAA unstable. Algorithm.
HD unstable –> has known AAA –>?
Emergency repair
AAA unstable. Algorithm.
HD unstable –> does not have known AAA –>?
Obtain focused abdominal UG
AAA unstable. Algorithm.
HD unstable –> does not have known AAA –> aneurysm detected on UG –> ?
and what to do if not detected?
Emergency repair
Not detected –> explore other diagnoses
TAA. which part of aorta usually involves?
Most TAAs (60%) involve ascending aorta (between the aortic valve and the brachiocephalic artery)
A minority of aneurysms involve the descending aorta (distal to the left subclavian artery)
TAA. what is ascending aorta?
between the aortic valve and the brachiocephalic artery
TAA. what is descending aorta?
distal to the left subclavian artery
TAA. most common etiology? what risk factors?
what mechanism?
Age-related degenerative changes (more common).
Risk factors including dyslipidemia, hypertension, tobacco use, and family history.
Leads to disruption of aortic wall medial layer with loss of elasticity aortic dilation
TAA. connective tissue?
Connective tissue disease (eg, Marfan or Ehlers-Danlos syndrome)
TAA. infection?
Endarteritis of vasa vasorum due to tertiary syphilis
TAA. initial symptoms?
Mostly asymptomatic until discovery is made incidentally
TAA what pain?
Vague chest/back pain
TAA. compression? 4
Hoarseness (left recurrent laryngeal nerve or vagus nerve)
hemidiaphragmatic paralysis (phrenic nerve),
dysphagia (esophagus),
respiratory manifestations, including wheeze, cough, hemoptysis, and dyspnea (tracheobronchial obstruction).
TAA. rupture symptoms?
Rupture: severe pain, hemodynamic instability
TAA. diagnostic methods? 2
Chest X-ray: Widened mediastinum; Enlarged aortic knob; tracheal deviation
CT scan with contrast (diagnostic)
TAA differential?
Differentials:
Hilar/mediastinal lymphadenopathy. Enlarged lymph nodes appear as opacities that are discrete from the heart borders
Xray - hilar limphadenopathy on both sides + mediastinal widening.
TAA: x ray - what seen?3
Widened mediastinum; Enlarged aortic knob; tracheal deviation
TAA. instrumental diagnostic?
CT scan with contrast (diagnostic)
