FN: Abdominal Aortic Aneurysms Flashcards Preview

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Flashcards in FN: Abdominal Aortic Aneurysms Deck (30):
1

Epi

5% >50yrs
Mortality: 10,000 deaths/yr
sex M>F = 3:1

2

Epi

5% >50yrs
Mortality: 10,000 deaths/yr
sex M>F = 3:1

3

Pathology

Dilatation of the abdominal aorta >3cm
90% infrarenl
30% involve the iliac arteries

4

Presentation

Usually asympto: discovered incidentally
May - bacl pain or umbilical pain radiatin gto the groin
Acute limb ischaemia
Blue tow syndrome: distal embolisation
acute rupture

5

Examination

Expansil mass just above the umbilicus
Bruits may be heard
Tenderness _ shock suggest rupture

6

Investigations

AXR: calcification may be seen
Abdo US: screening and monitoring
CT/MRI: gold-standard
Angiography:
1. wont show true extent of aneurysm due to emdoluminal thrombus
2. Useful to delineate relationship of renal arteries

7

Management conservative

Manage cardiovascular RF: esp BP

8

Monitoring

9

Surgical indications

Symptomatic (back pain: imminenet rupture)
Diamete >5.5cm
Rapidly expanding >1cm.yr
Causing complications: e.g. emboli

10

Surgery types

Open or EVAR
EVAR has reduced perioperative mortality
No reduced mortality by 5yrs due to fatal endograft failures
EVAR not better than medical Rx in unfit pts.

11

Screening

MASS trial revealed 50% reduced aneurysm-related mortality in males aged 65-74 screened with US
UK men offered one-time US screen @ 65yrs

12

AAA rupture rates

6cm = 25%/yr

13

Rupture increased risk

Raised BP
Smoker
Female
Strong FH

14

Rupture presentation

Sudden onset severe abdominal pain
- Intermittent or continuous
- Radiates to back or flanks (dont dismiss as colic)
collapse - shock
Expansile abdominal mass

15

Mx: a surgical emergency

1. High flow Oxygen
2. 2 x large bore cannulae in each ACF
-give fluid if shocked but keep S P

16

Mortality of rupture

50% with surgery

17

Pathology

Dilatation of the abdominal aorta >3cm
90% infrarenl
30% involve the iliac arteries

18

Presentation

Usually asympto: discovered incidentally
May - bacl pain or umbilical pain radiatin gto the groin
Acute limb ischaemia
Blue tow syndrome: distal embolisation
acute rupture

19

Examination

Expansil mass just above the umbilicus
Bruits may be heard
Tenderness _ shock suggest rupture

20

Investigations

AXR: calcification may be seen
Abdo US: screening and monitoring
CT/MRI: gold-standard
Angiography:
1. wont show true extent of aneurysm due to emdoluminal thrombus
2. Useful to delineate relationship of renal arteries

21

Management conservative

Manage cardiovascular RF: esp BP

22

Monitoring

23

Surgical indications

Symptomatic (back pain: imminenet rupture)
Diamete >5.5cm
Rapidly expanding >1cm.yr
Causing complications: e.g. emboli

24

Surgery types

Open or EVAR
EVAR has reduced perioperative mortality
No reduced mortality by 5yrs due to fatal endograft failures
EVAR not better than medical Rx in unfit pts.

25

Screening

MASS trial revealed 50% reduced aneurysm-related mortality in males aged 65-74 screened with US
UK men offered one-time US screen @ 65yrs

26

AAA rupture rates

6cm = 25%/yr

27

Rupture increased risk

Raised BP
Smoker
Female
Strong FH

28

Rupture presentation

Sudden onset severe abdominal pain
- Intermittent or continuous
- Radiates to back or flanks (dont dismiss as colic)
collapse - shock
Expansile abdominal mass

29

Mx: a surgical emergency

1. High flow Oxygen
2. 2 x large bore cannulae in each ACF
-give fluid if shocked but keep S P

30

Mortality of rupture

50% with surgery

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