Aortic Aneurysms

Question 1

Where are abdominal aortic aneurysms most commonly found?

Answer 1

Between renal and inferior mesenteric arteries

Question 2

Features of abdominal aortic aneurysm?

Answer 2

Expansile, pulsatile mass
Abdominal bruits
If symptomatic: abdominal or back pain, testicular pain if testile blood supply impacted by rupture

Question 3

Risk factors for an AAA?

Answer 3

Male
65 or over
Hypertension
Hypercholesterolaemia
Family history of AAA
Peripheral arterial disease
Previous MI
COPD
Marfan’s

Question 4

How does screening work for AAA?

Answer 4

Offered to all men at age 65
Involves Ultrasound scan to assess for AAA
If AAA detected, and it’s 3-4.4.cm → do repeat US every year
If AAA 4.5-5.4cm → repeat US every 3 months
If AAA above 5.5cm → consideration for surgery

If AAA detected on US, offer CT angiography for preoperative evaluation
Blood tests for pre-operative process

Question 5

Advice for AAA to patients?

Answer 5

Surveillance depending on size, Stop smoking, Hypertension management

Question 6

Surgical management options of AAA and the indications for each?

Answer 6

Open repair → better for men < 70yo, as decreased mortality afterwards

Endovascular aneurysm repair → better for >70yo, shorter hospital stays, lower perioperative deaths, but higher mortality rate afterwards