Abdominal Aortic Aneurysms

Question 1

What is a AAA?

Answer 1

A dilation of the abdominal aorta to > 3cm

Question 2

What size is classified as a small AAA?

Answer 2

3-4.4cm

Question 3

What size is classified as a medium AAA?

Answer 3

4.5-5.4cm

Question 4

What is classified as large AAA?

Answer 4

>5.5cm

Question 5

What are the risk factors for AAA?

Answer 5

• Smoking
• Hypertension
• Hyperlipidaemia
• Male
• Family History

Question 6

How do most AAA’s present?

Answer 6

Most are actually asymptomatic and are detected by screening

Question 7

In what demographic are AAA’s screened for?

Answer 7

Men >65 yrs

Question 8

How do symptomatic AAA’s present?

Answer 8

• Abdominal/back pain
• Rarely have pulsatile mass
• Can cause a distal embolism leading to limb ischaemia

Question 9

How do ruptured AAA’s present?

Answer 9

Classic triad of:

• Abdominal/back pain
• Pulsatile mass
• Hypotension

Question 10

How should AAA’s be investigated?

Answer 10

• USS
• Follow up with CT angiogram

Question 11

What are some differential diagnoses of a typical AAA presentation?

Answer 11

• Renal colic (as back pain alone is most common)
• Pancreatitis
• Peritonitis, appendicitis, IBD (other causes of abdo pain)

Question 12

What are some complications of AAA?

Answer 12

• Rupture
• Retroperitoneal leak
• Embolism to distal limb
• Fistulae

Question 13

What increases the risk of AAA rupture?

Answer 13

Size of the aneurysm

Question 14

Rupture into which abdominal cavity has a better prognosis?

Answer 14

Rupture into retroperitoneum

Question 15

How should a AAA <5.5cm be managed?

Answer 15

• Managaement of risk factors
• Imaging via ultrasound

Question 16

How often should a small (3-4.4cm) AAA be viewed with ultrasound?

Answer 16

Every year

Question 17

How often should a medium (4.5-5.4cm) AAA be imaged with ultrasound?

Answer 17

Every 3 months

Question 18

How can risk factors for AAA be managed?

Answer 18

• Lose weight
• Quit smoking
• Alter diet
• Increase exercise

Question 19

If a AAA is >5.5cm how should it be managed?

Answer 19

Surgically

Question 20

What are the options for surgical management of AAA?

Answer 20

• Open graft
• Endovascular repair

Question 21

What is the advantage of an open graft?

Answer 21

Reduced long-term chance of rupture

Question 22

What are the advantages of endovascular repair?

Answer 22

• Lower mortality in the short-term (e.g. death intra- or pos-op)
• Shorter hospitalisation

Question 23

How should a ruptured AAA be managed?

Answer 23

• Oxygen
• Fluids and O- blood
• Urgent blood tests (clotting, FBC, U+E’s and cross-match)
• Transfer to vascular immediately