FN: Abdominal Aortic Aneurysms

Question 1

Epi

Answer 1

5% >50yrs
Mortality: 10,000 deaths/yr
sex M>F = 3:1

Question 2

Epi

Answer 2

5% >50yrs
Mortality: 10,000 deaths/yr
sex M>F = 3:1

Question 3

Pathology

Answer 3

Dilatation of the abdominal aorta >3cm
90% infrarenl
30% involve the iliac arteries

Question 4

Presentation

Answer 4

Usually asympto: discovered incidentally
May - bacl pain or umbilical pain radiatin gto the groin
Acute limb ischaemia
Blue tow syndrome: distal embolisation
acute rupture

Question 5

Examination

Answer 5

Expansil mass just above the umbilicus
Bruits may be heard
Tenderness _ shock suggest rupture

Question 6

Investigations

Answer 6

AXR: calcification may be seen
Abdo US: screening and monitoring
CT/MRI: gold-standard
Angiography:
1. wont show true extent of aneurysm due to emdoluminal thrombus
2. Useful to delineate relationship of renal arteries

Question 7

Management conservative

Answer 7

Manage cardiovascular RF: esp BP

Question 8

Monitoring

Question 9

Surgical indications

Answer 9

Symptomatic (back pain: imminenet rupture)
Diamete >5.5cm
Rapidly expanding >1cm.yr
Causing complications: e.g. emboli

Question 10

Surgery types

Answer 10

Open or EVAR
EVAR has reduced perioperative mortality
No reduced mortality by 5yrs due to fatal endograft failures
EVAR not better than medical Rx in unfit pts.

Question 11

Screening

Answer 11

MASS trial revealed 50% reduced aneurysm-related mortality in males aged 65-74 screened with US
UK men offered one-time US screen @ 65yrs

Question 12

AAA rupture rates

Answer 12

6cm = 25%/yr

Question 13

Rupture increased risk

Answer 13

Raised BP
Smoker
Female
Strong FH

Question 14

Rupture presentation

Answer 14

Sudden onset severe abdominal pain
- Intermittent or continuous
- Radiates to back or flanks (dont dismiss as colic)
collapse - shock
Expansile abdominal mass

Question 15

Mx: a surgical emergency

Answer 15

1. High flow Oxygen
2. 2 x large bore cannulae in each ACF
   - give fluid if shocked but keep S P

Question 16

Mortality of rupture

Answer 16

50% with surgery

Question 17

Pathology

Answer 17

Dilatation of the abdominal aorta >3cm
90% infrarenl
30% involve the iliac arteries

Question 18

Presentation

Answer 18

Usually asympto: discovered incidentally
May - bacl pain or umbilical pain radiatin gto the groin
Acute limb ischaemia
Blue tow syndrome: distal embolisation
acute rupture

Question 19

Examination

Answer 19

Expansil mass just above the umbilicus
Bruits may be heard
Tenderness _ shock suggest rupture

Question 20

Investigations

Answer 20

AXR: calcification may be seen
Abdo US: screening and monitoring
CT/MRI: gold-standard
Angiography:
1. wont show true extent of aneurysm due to emdoluminal thrombus
2. Useful to delineate relationship of renal arteries

Question 21

Management conservative

Answer 21

Manage cardiovascular RF: esp BP

Question 22

Monitoring

Question 23

Surgical indications

Answer 23

Symptomatic (back pain: imminenet rupture)
Diamete >5.5cm
Rapidly expanding >1cm.yr
Causing complications: e.g. emboli

Question 24

Surgery types

Answer 24

Open or EVAR
EVAR has reduced perioperative mortality
No reduced mortality by 5yrs due to fatal endograft failures
EVAR not better than medical Rx in unfit pts.

Question 25

Screening

Answer 25

MASS trial revealed 50% reduced aneurysm-related mortality in males aged 65-74 screened with US
UK men offered one-time US screen @ 65yrs

Question 26

AAA rupture rates

Answer 26

6cm = 25%/yr

Question 27

Rupture increased risk

Answer 27

Raised BP
Smoker
Female
Strong FH

Question 28

Rupture presentation

Answer 28

Sudden onset severe abdominal pain
- Intermittent or continuous
- Radiates to back or flanks (dont dismiss as colic)
collapse - shock
Expansile abdominal mass

Question 29

Mx: a surgical emergency

Answer 29

1. High flow Oxygen
2. 2 x large bore cannulae in each ACF
   - give fluid if shocked but keep S P

Question 30

Mortality of rupture

Answer 30

50% with surgery