AAA & Aortic Disection

Question 1

What are the general characteristics of an AAA?
abdominal aortic aneurysm?
1. define
2. what causes it?
3. who is more likely to have AAA male or female?
4. what is the CLASSICAL PICTURE of AAA?
5. where does the aneurysm more likely occur?
6. what leads to rapid death in 90% of patients?

Answer 1

1. an aortic aneurysm is a weakness and subsequent dilation of the vessel wall, usually caused by genetic defect or atherosclerotic damage to the intima
2. atherosclerosis is the most common but can be congenital
3. males are 8 times more likely to have an aneurysm
4. Classic picture is an elderly male smoker with coronary artery disease, emphysema, and renal impairment
5. aneurysms may occur in the abdominal (90%) or thoracic (10%)
6. rupture (dissection) leads to rapid death in 90% of pt’s

Question 2

what are the congenital cystic medial necrosis causation factors of AAA??

Answer 2

cyctic medial necrosis = Marfan Syndrome & Ehlers-Danlos Syndrome

• -Marfan syndrome = aortic enlargement; aorta is weaker than normal and tends to stretch and bulge out of shape; aortic root is FLASK SHAPED with the MAXIMAL DILATION at the VALSALVA VALVE (close to the aortic valve); increased risk for aortic dissection
• • Ehlers Danlos Syndrome (EDS) = skin hyperextenibility, usually wide scars, and joint hyper mobility

Question 3

What are the vasculitis w/ connective tissue diseases causation factors of AAA?

Answer 3

1. Takayasu arteritis

2. Giant Cell Arteritis

Question 4

What are the chronic infection causation factors of AAA?

Answer 4

Syphilitic aortitis (syphilis)

Question 5

collectively describe the 4 causation factors to AAA?

Answer 5

1. atherosclerosis
2. cyctic medial necrosis
3. vasculitis w/ connective tissue disease
4. chronic infections
5. TRAUMA!!!!!!!!!!!!

Question 6

1. What are the clinical features of AAA if symptomatic?
2. What occlusive disease is present in 25% of pt’s?
3. THoracic aortic aneurysm symptoms?
4. What do symptoms often indicate?
5. What are the symtpoms of rupture?

Answer 6

most are asymptomatic
1. but if symptomatic = pulsating abdominal mass, sometimes accompanied by abdominal or back pain
2. renal or lower extremity occlusive dz
3. substernal back or neck pain, dyspnea, stridor, and cough; dysphagia; hoarseness; or symptoms of superior vena cava syndrome
stridor = wheezing or crowing during breathing
dysphagia = difficulty swallowing
SVCS = lung cancer/ swelling of face
4. symptoms often indicate dissection
5. rupture causes severe back, abdominal, or flank pain and hypotension and shock.

Question 7

describe the classic picture of an Iliac aneurysm

Answer 7

pulsative non-tender mass below the umbilicus (distal to the origin of the renal arteries)
hydronephrosis = swelling of the kidney with urine Because of obstruction to urinary tract. (KIDNEY STONES are a common cause)
recurrent urinary tract infections due to ureteral compression
–neurologic symptoms from compression of the sciatic or femoral nerves

Question 8

What indicated possible aneurysm rupture that requires immediate surgery?

Answer 8

Hypotension + acute abdominal pain, severe back, or flank (Posterior Side) pain and shock.

Question 9

Laboratory Studies:

1. what is the study of choice for abdominal aneurysms?
2. what is the study of choice for thoracic aneurysms?

Answer 9

1. abdominal ultrasonography ; followed by contrast-enhanced CT
2. aortography for diagnosis; CT and MRI are preferred over ultrasonography

Question 10

1. When do you treat AAA?

2. what is the alternative to surgical repair for AAA?

Answer 10

1. aneurysm repair should be performed on pt’s with large aneurysms or rapid aneurysms expansion (regardless of the size)
   - -Elective AAA Repair:
   - Peri-operative mortality rate = 2-6%
   - Studies show no benefit in surgery for aneurysms 4.0-5.5 cm in diameter
2. Percutaneous Endovascular Aneurysm Repair (EVAR)

Question 11

Risk factors for AAA:
age?
male or female?
size of aneurysm?

Answer 11

common in older patients >65
major risk factor is AGE, smoking, HTN,and family hx of AAA
AAA gradually grow in size with time w/ an average rate of 1-4 mm per year.
Low risk rupture is up to 5 cm.
1% per year 3.5 to 4.9 cm in diameter
% per year >5cm in diameter

Question 12

When do you screen for AAA?

Answer 12

routine screening for AAA w/ ultrasonography

all men between 65-75 years & men > 60 years w/ family hx of AAA in 1st degree relative