Aortic Aneurysms

Question 1

Define aortic aneurysm.

Answer 1

A permanent, localised dilatation of an aortic segment to more than 1.5 times its diameter.

Question 2

Where do most aortic aneurysms present? What % of total cases does this make up?

Answer 2

Most commonly occurring in the aorta below the kidneys (infrarenal) in 85-90% of cases.

Question 3

List the risk factors for aortic aneurysms.

Answer 3

MAD HASH
Male, atherosclerosis, diabetes, hypertension, age >60, smoker, high cholesterol

Question 4

Which special populations are at significantly increased risk of aortic aneurysm?

Answer 4

Connective tissue disorders, eg. Ehlers Danlos, Marfan’s and Loeys-Dietz

Question 5

What size is a small AAA, and at what rate do they enlarge?

Answer 5

Between 3-5cm, predictably enlarging at 0.2-0.3cm per year.

Question 6

What size is a large AAA, and at what rate do they enlarge?

Answer 6

> 5cm, enlarging at 03-0.5cm per year

Question 7

What is the Law of Laplace, and how does it relate to AAA’s?

Answer 7

The larger the vessel radius, the greater the tension on the walls. Describes how larger aneurysms are at greater risk of accelerated growth and rupture.

Question 8

Outline the 4 points of pathophysiology involved in developing a AAA.

Answer 8

1. Inflammation +proteolytic connective tissue degeneration = reduced wall integrity
2. Widening of vessel at local site
3. Ongoing mechanical stress applied to weakened tissue = dilation
4. Dilation = turbulent blood flow

Question 9

Describe and define the Cullen sign.

Answer 9

Umbilical ecchymosis (bruising). Indicative of intra- or retroperitoneal haemorrhage.

Question 10

Describe and define the Grey Turner’s sign.

Answer 10

Flank ecchymosis (bruising). Indicative of intra- or retroperitoneal haemorrhage.