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Surgery - Vascular Surgery > AAA > Flashcards

Flashcards in AAA Deck (13)
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1
Q

What is the definition of an

  • aneurysm
  • abdominal aortic aneurrysm
A

- Aneurysm: abnormal dilatation of a blood vessel more than 50% its normal diameter

- AAA: dilatation of the AA greater than 3cm, every 8mm increase there is 34% more chance of death

2
Q
A
3
Q

What are some risk factors for an AAA?

A
  • Smoking
  • HTN
  • Hyperlipidaemia
  • FHx
  • Male
  • Increasing age
  • DM is negative risk factor
4
Q

What are the clinical features of an AAA?

A

Asymptomatic: detected on screening or incidental finding

Symptomatic: see image

5
Q

What is the AAA screening programme in the UK?

A

Abdominal US offered to men aged 65 once

If AAA detected either direct referral for surgery or 3-5 years surveillance before reaching threshold for elective repaire

6
Q

What are the differentials with the pain produced in AAA?

A

- Renal colic (due to back pain and no other symptoms)

  • IBD/IBS
  • GI haemorraghe
  • Appendicitis
  • Ovarian rupture
  • Splenic infarctions
7
Q

How do you investigate a suspected AAA (not ruptured)?

A

- US

  • Once US has confirmed then CT scan with contrast with a threshold diameter of 5.5cm
8
Q

How are unruptured AAA’s managed?

A

Medical (<5.5cm asymptomatic)

- Monitor with Duplex USS (3-4.4cm yearly, 4.5-5.4 every 3 months)

  • Smoking cessation to stop expansion and rupture
  • Improve blood pressure control

- Aspirin and Statin therapy

Surgical (>5.5cm, symptomatic or expanding >1cm a year)

  • If >6.5cm tell DVLA
  • If unfit patient can wait until 6cm
  • See image for options
9
Q

What would be preferred for an AAA repair, endovascular stenting or open repair?

A
  • Both have similar outcomes
  • Endovascular repair has better short term outcomes (30 day mortality and decreased hospital stay) but higher rate of reintervention and aneurysm leaking
  • Young patient open repair preferred
10
Q

What are the complications of an AAA?

A

- Rupture

  • Retroperitoneal leak
  • Embolisation
  • Aortoduodenal fistula
11
Q

How do AAA ruptures present?

A
  • Abdominal and back pain
  • Syncope
  • Vomiting
  • Haemodynamicall compromised
  • Pulsatile tender mass in abdomen

TRIAD OF RUPTURED AAA: flank or back pain, hypotension, pulsatile abdominal mass

12
Q

How is any suspected AAA rupture managed?

A

Immediate: high flow O2, IV access with 2 large bore cannulas, urgent boods (FBC, U+Es, Clotting), crossmatch for minimum 6 units

Shock treatment: try to keep BP<100 as raising BP could dislodge any clot and cause further bleeding

Transfer to local vascular unit: if unstable immediate theatre for open surgical repair, if stable CT angiogram to determine if suitable for endovascular repair

13
Q

Where are the common locations for aneurysms in the body?

A

AAA most commonly infrarenal