AAA

Question 1

What are the risk factors for having an AAA?

Answer 1

• european descent
• men
• age (over 66 (women screening offered >70)
• COPD
• family history
• other Cardiovascular disease
• Hyperlipidemia
• HTN
• Smoking

Question 2

What is an AAA?

Answer 2

abnormal, persistent, localized dilatation of the aorta

• >3cm diameter –> aneurism

Question 3

How can you classify AAAs?

Answer 3

Classified by size

• >3cm diameter –> aneurism
  
  • Small >4cm
  • medium (4.0–5.5cm)
  • large (>5.0cm)
  • and very large (>6.0cm)

Question 4

What does rapid expansion of the AAA indicate?

Answer 4

Rapid expansion of an AAA

• >5mm in 6 Months
• >10mm in 12 Month
  
  • risk of rupture (when using same radiographig instrument of measure)

Question 5

What is the epidemiology of an AAA?

Answer 5

In Ultrasound screening

• 4-8% of elderly population (occult)
• Large aneurism 0.4-0.6% of screened population

Question 6

Explain the aetiology of an AAA

Answer 6

Thought to be multifactoral

• wall degenerative change
• inflammation
• force of blood
• • Mostly: Atherosclerotic changes

Question 7

What is the most common place for AAA to appear?

Answer 7

95% are infrarenal

(below renal arteries)

Question 8

How does a patient with an intact AAA present?

Answer 8

Normally Asyptomatic

(detected in screening + with other investigations)

But might cause

• Lower back pain
• Pulsatile abdominal mass at or above the level of the umbilicus
• Bruit on auscultation
• Peripheral thrombosis and distal atheroembolic phenomena (e.g., blue toe syndrome and livedo reticularis)
• Decreased ankle brachial index

Question 9

What is livedo reticularis?

Answer 9

A reddish-blue discoloration of the skin in a reticular (net-like) pattern

Question 10

What is a Decreased ankle brachial index?

Answer 10

Indiex that indicated arterial vascular health

• Mearsure BP at arm and ankle
• Devide BP ankle / BP arm
• Normally should be >1
• if <1 –> pAVK

Question 11

What is a presentation of a ruptured AAA?

Answer 11

• Hypovolemic shock (especially in free ruptures)
• Sudden onset of severe, tearing back or abdominal pain with radiation to the flank, buttocks, legs, or groin
• Painful pulsatile mass
• Grey Turner sign and/or Cullen sign (if there is an extensive retroperitoneal hematoma)
• Nausea, vomiting
• Syncope
• Hematuria

Question 12

What are risk factors for rupture of an AAA?

Answer 12

• rapidly expanding diameter
• more common in women
• lagere diamteter
• smoking

Question 13

How do you diagnose a AAA?

Answer 13

US

• anterior-posterior diameter of abdominal aorta more than >1.5 x normal diameter (>3cm)