Abdominal Aortic Aneurysm

Question 1

What is an aneurysm?

Answer 1

Permanent abnormal dilatation of all 3 layers of arterial wall

More than 50% of normal diameter

Question 2

What are the layers of the artery wall?

Answer 2

Tunica intima

• inner layer
• elastic membrane
• smooth endothelium

Tunica media

• middle layer
• smooth muscle

Tunica adventitia

• outer layer
• connective tissue
• collagen + elastic fibres

Question 3

What is an abdominal aortic aneurysm?

Answer 3

Dilatation of the abdominal aorta over 3cm

Question 4

Risk factors of AAA

Answer 4

Atherosclerosis 
Genetics
Trauma 
Smoking 
Male 
Connective tissue disorder

Question 5

Clinical features of AAA

Answer 5

Most are asymptomatic

Abdominal pain
Back pain

O/E:

• pulsatile mass = normal
• expansile mass = concerning

Question 6

Screening for AAA

Answer 6

Men 65+

60 + connective tissue disorder

60+ family history

Question 7

Medical management for AAA

Answer 7

3. 0 -4,4cm = yearly ultrasound
4. 5 - 5.5cm = 6 monthly ultrasound

Smoking cessation
Weight loss
Statin + aspirin
Blood pressure control

Question 8

Surgical management for AAA

Answer 8

Open repair
- laparotomy

EVAR
- graft via femoral arteries

Question 9

Clinical features of AAA rupture

Answer 9

Abdominal pain
Back pain
Syncope

Haemodynamically compromised
Pulsatile abdominal mass

Question 10

Management of ruptured AAA

Answer 10

High flow O2
IV access (large bore cannula x2)
Urgent bloods 
- FBC
- U&Es 
- clotting 
- crossmatch 

Treat for shock

Question 11

When is surgery considered for an AAA?

Answer 11

Considered

• AAA > 5.5cm
• AAA expanding > 1cm a year
• symptomatic AAA