Aortic Aneurysm (Vascular) Flashcards
Vascular surgery core condition (C)
What is a true aneurysm?
An abnormal dilation or a bulging in the wall of a blood vessel, where all the layers of the wall are bulging out. They are either a fusiform aneurysm or saccular/berry.
What is a pseudoaneurysm?
This is a false aneurysm. It occurs when the blood vessel wall gets punctured and blood leaks out and pools, resembling a true aneurysm.
Types of aortic aneurysms?
Abdominal aortic aneurysms or thoracic aortic aneurysm.
What is an abdominal aortic aneurysm?
Potentially lethal, characterised by an enlargement of the abdominal aorta exceeding a diameter of 3cm. In the absence of repair, a ruptured AAA is generally fatal.
What are the major risk factors/causes of aortic aneurysm?
Smoking is a strong RF, Male, Hypertension, hypercholesterolaemia, Hx of peripheral arterial disease or MI, increased age, FHx, COPD
Rare but important causes are: syphilis, connective tissue diseases such as Marfan’s syndrome and Ehlers danlos type 1
What are the differentials for aortic aneurysms?
Renal colic, pancreatitis, peptic ulcer disease, diverticulitis
Describe the epidemiology of abdominal aortic aneurysms (age, sex, countries)
Mainly affects older people (above 65), mainly males, geographic and ethnic variation as we see higher prevalence in western countries
What is involved in the aetiology of AAA?
Complex, multifactorial - genetics, env and lifestyle - they cause a weakening in the wall. e.g. atherosclerosis, inflammatory damage. These factors result in loss of elastic fibres in the media so the mechanical forces of BP causes the wall to bulge but doesn’t recoil back.
What are the symptoms and signs of abdominal aortic aneurysm before rupture?
AAA is usually asymptomatic and most people find out during AAA screening. However, if gets bigger then - abdominal pain (tummy/back), during palpating exam is pulsatile+expansile mass, pulsing feeling in tummy. It may be found as an incidental finding on an abd x ray, US, or CT scan.
Who gets screened for triple A?
Screening for AAA is offered to men ithe year they turn 65 - this is so we can spot early as it can usually be treated then. Not routinely offered to women, men under 65, ppl already been treated for AAA.
What scan is used for AAA screening, and the 4 outcomes?
Abdominal ultrasound scan.
What happens if screening shows an aneurysm (mention sizes)?
Less than 3 is normal, 3-4.4cm is small and rescan every 12 months, 4.5-5.4 is medium and every 3 months, more than 5.5 is large aneurysm and refer within 2 weeks to vascular surgery for surgical intervention
How is CT angiogram relevant to AAA diagnosis and investigation?
CT angiogram gives a more detailed picture of the aneurysm (e.g. shows calacification in wall), and helps guide elective surgery to repair the aneurysm.
What is the management of AAA (unruptured) and when is it done?
Two elective surgical repair options: Open repair via a laparotomy or Endovascular aneurysm repair (EVAR) using a stent inserted via the femoral arteries. Both involve inserting an artificial “graft” into the area of the aorta. Indications are AAA size >5.5cm or rapid expansion (increasing >1cm per year). Aneurysms less than 5cm are v unlikely to rupture.
What is the emergency presentation of AAA? Signs/symptoms
This is when the AAA ruptures (high mortality). Severe abdominal pain radiating to the back,
signs of shock/haemodynamic instability (hypotension and tachycardia), Pulsatile, expansile mass in the abdomen, Collapse, Loss of consciousness
