Aortic aneurysms

Question 1

Where does the aorta leave the heart?

Answer 1

Left ventricle

Question 2

Is the aorta an artery or vein?

Answer 2

Artery

Question 3

What is an aneurysm?

Answer 3

Permanent localised dilation of an artery wall

Question 4

What can happen as a result of an aneurysm?

Answer 4

Can be asymptomatic

Affect blood pressure

They can cause the vessel to rupture

Form a fistula

Source of emboli

Question 5

Where do aortic aneurysms usually occur?

Answer 5

In the abdomen

Question 6

What is an AAA?

Answer 6

Abdominal aortic aneurysm

Question 7

What are the risk factors of AAA?

Answer 7

Male gender

Age

Smoking

Atherosclerosis

Hypertension

Family history

Connective tissue disease

Question 8

How does smoking increase the risk of AAA?

Answer 8

Contains toxins that damage the aorta wall and cause it to stretch

Question 9

How does atherosclerosis increase the risk of AAA?

Answer 9

Atherosclerotic plaques narrow the arteries

They stretch to counter this, stretching = aneurysm

Question 10

Is there a screening programme for AAA?

Who? How?

Answer 10

Men, when they turn 65

An ultrasound scan to look at the aorta

Question 11

What are the symptoms of an AAA?

Answer 11

Asymptomatic

Pressure on other structures can cause pain in the epigastric or back region

Unruptured AAAs usually found incidentally

If it ruptures there will be severe epigastric pain and hypovolaemic shock

Question 12

What is the prognosis of a ruptured AAA?

Answer 12

Very poor

If it is a large one often they don’t make it to hospital or they don’t survive reparative surgery

Question 13

What is the treatment of an AAA?

Answer 13

Unruptured: monitoring, modify lifestyle, surgery

Ruptured: emergency surgery, treat hypovolaemic shock
Do ECG, crossmatch blood, prepare for surgery

Question 14

What surgery can be done to correct an AAA?

Answer 14

Replacement of aneurysm part of aorta with a prosthetic graft

OR

Endovascular repair with insertion of aortic stent

Question 15

What is a dissecting aortic aneurysm?

Answer 15

When a tear in the tunica intima of the aorta causes blood to flow between the layers of the wall of the aorta, forcing the layers apart

Question 16

How would a patient with a dissecting aortic aneurysm present?

Answer 16

Abrupt onset of severe, tearing, central chest pain which radiates through to the back

Other symptoms that result from decreased blood supply to other organs:

• neurological signs
• absent or uneven pulses or BP in arms

Question 17

Investigation of a dissecting aortic aneurysm.

Answer 17

CXR: shows a widened mediastinum

CT, trans ECHO, MRI can confirm diagnosis

Question 18

Management of a dissecting aortic aneurysm.

Answer 18

Emergency surgery

Crossmatch blood
Admit to ITU
Try to bring BP down