Aortic Aneurysm

Question 1

How many layer to the aorta?

Answer 1

3 layers
Tunica Intima
Tunica Media
Tunica Adventitia

Question 2

Where does the aorta bifurcate?

Answer 2

L4

Just above the umbilicus

Question 3

Cause?

Answer 3

• Degenerative
• Connective Tissue Disease (Marfan’s)
• Infection

Question 4

Risk factors?

Answer 4

• Male
• Smoker
• Family History
• over 65 yrs
• hypertension

Question 5

How might a patient present?

Answer 5

Asymptomatic- found on Scan
Symptomatic- impending rupture or rupture
Unusual

Question 6

Describe the screening program?

Answer 6

Males aged 65 yrs older 
ultrasounds
small AAA- yearly US
medium AAA (4.5-5.5) - 3 monthly US
Large AAA (>5.5) - vascular unit

Question 7

What are the signs if impending rupture?

Answer 7

Increasing back pain and tender AAA

Question 8

Signs of Rupture

Answer 8

Abdominal and back pain
Painful Pulsitile Mass
Fainting
Hypoperfusion- cold, confused, low urine

Question 9

Unusual presentations

Answer 9

• distal embolization
• Duodenal occlusion
• ureteric occlusion
• aorto-caval fistula
• aorto-enteric fistula

Question 10

Management of Asymptomatic

Answer 10

> 5.5= surgery
Conservative- patient is not fit
Endovascular repair- low risk of rupture, done under GA
Open Repair- major surgery

Question 11

Investigations

Answer 11

Patient status- Bloods, Echo, ECG, PFT, EET

AAA status- CT/MRI

Question 12

Management of Symptomatic

Answer 12

1. Emergency Open Repair- straight to theatre (CT), keep awake as long as possible
2. Emergency EVAR- done under local A

Question 13

What is compartment syndrome?

Answer 13

Build up of blood in a muscle compartment due to bleeding- muscle dies, releases creatine and causes kidney failure.