T12 - Aneurismas da Aorta Abdominal

Question 1

Importância da AAA?

Answer 1

Prevalence in Portugal 2.4%
Silent disease
Mortality rate >70%
Screening by a simple method

Question 2

Abdominal Aortic Aneurysm?

Answer 2

Abdominal Aortic Diameter of 3.0 cm in either anteroposterior or transverse planes
AAA can also be defined when the maximum diameter is >50% greater than the suprarenal diameter

Question 3

Classificaçao de AAA?

Answer 3

Sacular

Fusiform

Question 4

Etiologia de AAA?

Answer 4

Congénitas
Doenças do tecido conjuntivo
Degenerativas
Infeção
Arterites inflamatórias
Pós-disseção
Pós-estenóticos
Pseudoaneurismas
Outras causas

Question 5

Location of AAA?

Answer 5

Suprarenal
Pararenal
Justarenal
Infrarenal

Question 6

Risk Factors for AAA?

Answer 6

• Smoking History
• AAA Family History
• Age
• Coronary disease
• High cholesterol levels
• Chronic Pulmonary Disease
• Height

Diabetes, etnicidade negra e mulheres parecem ter risco reduzido

Question 7

Clinical Presentation of AAA?

Answer 7

• Assintomáticos
• Abdominal pulsatility
• Duodenal compression
• Ureteral compression
• Venous compression
• Nervous compression
• Thrombosis (bilateral acute limb ischemia)
• Distal embolization
• RUPTURE (abdominal or dorsal pain, hypotension, shock)

Question 8

Diagnosis of AAA?

Answer 8

Ultrasonography (first-line diagnosis and surveillance)

Angio-TC (therapeutic decision making and treatment planing)

Question 9

AAA Surveillance?

Answer 9

Recommended every 3 years for aneurysms 3.0-3.9 cm in diameter; annually for 4.0-4.9 cm; every 3-6 months for aneurysms >5.0cm

Question 10

Threshold for elective repair of AAA?

Answer 10

In men >5.5cm
In women >5.0cm
Rapid AAA growth is observed (>1 cm/year), fast track referral to a vascular surgeon with additional imaging should be considered

Question 11

Resources and availability?

Answer 11

Centres can offer both endovascular and open aortic surgery at all times
The waiting time for vascular surgical care is recommended to be kept to a minimum, with an eight-week pathway as a reasonable upper limit from referral to elective treatment

Question 12

Surgical techniques - Elective repair?

Answer 12

• Suitable anatomy and reasonable life expectancy, endovascular abdominal aortic aneurysm repair should be considered as the preferred treatment modality
• Long life expectancy, open abdominal aortic aneurysm repair should be considered as the preferred treatment modality
• Limited life expectancy, elective abdominal aortic aneurysm repair is not recommended

Question 13

Surgical techniques - Rupture repair?

Answer 13

• Patients with ruptured abdominal aortic aneurysm and suitable anatomy, endovascular repair is recommended as a first option
• Local anesthesia should be considered as the anesthetic modality of choice for endovascular repair of unruptured abdominal aortic aneurysm whenever tolerated by the patient

Question 14

EndoVascular Aneurysm Repair (EVAR)?

Answer 14

• Percutaneous access
• No need for ICU stay
• Performed under Local Anesthesia
• One Day Surgery