AAA

Question 1

What is the definition of an

• aneurysm
• abdominal aortic aneurrysm

Answer 1

- 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

Question 3

What are some risk factors for an AAA?

Answer 3

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

Question 4

What are the clinical features of an AAA?

Answer 4

Asymptomatic: detected on screening or incidental finding

Symptomatic: see image

Question 5

What is the AAA screening programme in the UK?

Answer 5

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

Question 6

What are the differentials with the pain produced in AAA?

Answer 6

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

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

Question 7

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

Answer 7

- US

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

Question 8

How are unruptured AAA’s managed?

Answer 8

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

Question 9

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

Answer 9

• 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

Question 10

What are the complications of an AAA?

Answer 10

- Rupture

• Retroperitoneal leak
• Embolisation
• Aortoduodenal fistula

Question 11

How do AAA ruptures present?

Answer 11

• 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

Question 12

How is any suspected AAA rupture managed?

Answer 12

Immediate: high flow O_2, 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

Question 13

Where are the common locations for aneurysms in the body?

Answer 13

AAA most commonly infrarenal