Aortic Aneurysm (Vascular) Flashcards
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 for aortic aneurysm?
Smoking is a strong RF, Hypertension, increased age, male, family history of aneurysm
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
What is the management of ruptured AAA?
A surgical emergency - pts with a suspected ruptured AAA require an immediate vascular review by MDT with a view to emergency surgical repair.
How should haemodynamically unstable vs stable patients be managed if suspecting AAA?
Haemodynamically unstable patients with a suspected AAA should be transferred directly to theatre. Surgical repair should not be delayed by getting imaging to confirm the diagnosis.
In haemodynamically stable patients, CT angiogram can be used to diagnose or exclude ruptured AAA.
Management of frail pts with co morbidities suspecting AAA?
In patients with co-morbidities that make the prognosis with surgery very poor, a discussion needs to be had with senior doctors, the patient and their family about palliative care.
