Aortic Aneurysm

Question 1

What is the pathogenesis of aortic aneurysm formation?

Answer 1

Medial degeneration 
Regulation of elastic/collagen in aortic wall 
Aneurysmal dilatation 
Increase in aortic wall stress 
Progressive dilatation

Question 2

What is a true aneurysm?

Answer 2

All three vessel layers are intact

Question 3

What is a false aneurysm?

Answer 3

There is a breach in the vessel wall (surrounding structures act as a vessel wall)

Question 4

What are the three main risk factors for aortic aneurysm formation?

Answer 4

Male
Smoking
Hypertension

Question 5

What is the difference between symptomatic and asymptomatic AAA?

Answer 5

Asymptomatic =
Identified on imaging for other pathology
Screening and surveillance

Symptomatic =
Pain
Trashing (clot breaks off and travels down legs, causing damage)
Collapse

Question 6

What is the presentation of a ruptured AAA?

Answer 6

Sudden onset epigastric/central pain, may radiate to the back
? tachycardia, hyper/hypotensive
Pulsatile, expansile mass +/- tenderness

Question 7

What are the investigations for an AAA, and what are their pros/cons?

Answer 7

Ultrasound =
Screening/surveillance
Diameter only

CT scan =
Gives morphology
Identifies rupture

Question 8

When do you intervene with an AAA?

Answer 8

Symptomatic

Asymptomatic
>5.5cm AP diameter
Expansion >0.5cm/6 months

Question 9

What surgical options are available for AAA?

Answer 9

EVAR - endovascular aneurysm repair

Open repair

Question 10

What is EVAR and what are the pros/cons?

Answer 10

X-ray guided to exclude AAA from inside the vessel (stenting)

Usually only of elderly who cannot have open repair
Safer in complex aneurysms

Needs more follow up
May need more interventions

Question 11

What happens in open repair and what are the pros/cons?

Answer 11

Laparotomy
Clamp aorta + iliac
Dacron graft
Tube v Bifurcated graft

Possible in most people
Effective for life

Greater mortality risk
Slower recovery