(V)- Abdominal Aortic Aneurysm Flashcards
What is an AAA?
Dilation of the abdominal aorta with a diameter over 3cm
What is the mortality rate of a ruptured AAA?
80%
What are the risk factors of developing a AAA?
Men
Age
Smoking
Hypertension
Family history
Cardiovascular disease
How are AAA screened for?
Abdominal ultrasound scan offered to all men at the age of 65
Depending on AAA size how often are they screened?
Normal
Less than 3cm, discharged unlikely to rupture in their lifetime
Small
3-4.4cm
Every 1 year
Medium
4.5-5.4cm
Every 3 months
Large
5.5cm or more
Listed for elective AAA repair
If symptomatic or grow in size rapidly, over 1cm this can also lead to surgical management
How do AAAs present?
Mainly symptomatic and discovered on rotuine screening or when it ruptures
Can present as:
- Non-specific abdominal pain
- Pulsatile and expansile mass in the abdomen when palpated
- Incidental finding on AXR, USS or CT
How are AAAs diagnosed?
Ultrasound
CT angiogram (more for guiding the surgery to repair it)
How are AAAs managed?
Treat reversible risk factors :
- Smoking
- Diet and exercise
- Optimising management of hypertension, diabetes and hyperlipidaemia
Surgery
How are AAAs repaired surgically?
Open repair via laparotomy if unstable
Endovascular aneurism repair (EVAR) if stable
Both involve putting an artificial graft onto the aorta
When must patients inform the DVLA about AAAs?
- Aneurysm over 6cm
- Stop driving if above 6.5cm
- Stricter rules for heavy vehicle drivers
How do AAA ruptures present?
- Severe abdominal pain that radiates to the back or groin
- Hypotension and tachycardia
- Pulsatile expansile mass in abdomen
- Collapse
- Loss of consciousness
A retroperitoneal AAA rupture has a slower onset of symptoms
What is permissive hypotension?
Aiming for a lower than normal blood pressure when doing fluid resuscitation
Increasing blood pressure may increase blood loss
