Abdominal Aortic Aneurysms

Question 1

What is an Abominal Aortic Anuerysm?

Describe most AAAs in 2 ways

Answer 1

Permanent dilation of the Aorta >x1.5 of the normal diameter (>3cm is considered abnormal)

• 90% below renal arteries
• Asymptomatic, until acute expansion/ rupture

Question 2

What is an AAA usually due to?

List 4 risk factors

Answer 2

Degeneration of the medial layer of arterial wall, composed of SM, Elastin and Collagen

• Male
• Family history
• Increasing age
• Smoking

Question 3

List 3 structures that can be compressed by an AAA and their associated symptoms

Answer 3

Stomach;
- Nausea

Bladder;
- Urinary frequency

Vertebrae;
- Back pain

Question 4

How does a ruptured AAA usually present in 5 ways?

Answer 4

• Back pain
• Ab pain
• Pulsatile abdominal mass
• Sudden cardiovascular collapse (65% die before reaching hospital)
• Transient hypotension (Syncope, Blood can accumulate in retroperitoneum compressing anuerysm)

Question 5

What are 4 methods of diagnosing AAA?

Answer 5

• Pulsatile abdominal mass on examination
• Ultrasound can detect free peritoneal blood
• CT
• Plain X-rays if Aneurysm has calcified (not routinely used)

Question 6

How is AAA treated non-surgically?

Answer 6

• Stop smoking
• BP Control
• Monitoring (Vascular surgery if >5.5cm, otherwise no treatment needed)

Question 7

How is AAA treated surgically in 2 ways?

Answer 7

Endovascular repair;

• Endograft inserted through femoral artery
• Acts as a channel between Renal and Common Iliac arteries)

Open surgical repair;

• Clamp aorta
• Open aneurysm (remove thrombus and debris)
• Suture in a synthetic segment to replace diseased segment