Aortic Aneurysm

Question 1

Define AAA

Answer 1

Focal dilation of the abdominal aorta to >1.5x its normal diameter or >3cm

Question 2

Describe the pathophysiology of AAA

Answer 2

. Primary event is loss of the intima with loss of fibres from the media- Associated with and potentiated by increased proteolytic activity and lymphocytic infiltration
. Aneurysms typically represent dilation of all layers of the arterial wall

Question 3

What do intima and media

Answer 3

Intima- inner layer of blood vessel’s wall (direct contact with blood)
Media- middle layer of blood vessel’ wall (structural support and elasticity

Question 4

Where do majority of aortic aneurysms occur

Answer 4

Below the renal arteries (infrarenal)

Question 5

What groups does it affect the most

Answer 5

M>F
60-70 years old

Question 6

What is the screening population

Answer 6

Males >65 years- single USS at 65

Question 7

What is the most important risk factor for aortic aneurysm

Answer 7

Smoking

Question 8

What are the other risk factors

Answer 8

FH
Increased age
Male
Connective tissue disorder (marfan syndrome)
Atherosclerosis
Hypercholesterolemia

Question 9

What are the clinical feature of aortic aneurysms

Answer 9

Usually asymptomatic- discovered incidentally on USS or CT

Question 10

What is the clinical features if it ruptures

Answer 10

Severe central abdominal pain radiating to the back
Pulsatile and expansile abdominal mass
Shock- hypotension tachycardia

Question 11

What are the main 2 investigations of aortic aneurysms

Answer 11

Aortic ultrasound
CT angiogram to visualise ruptured aaa

Question 12

For aortic ultrasound- what should you not do while waiting for results?

Answer 12

Do not delay diagnosis and management of a ruptured aaa whilst waiting because imaging doesn’t tell you if the aaa is ruptured

Question 13

What type of patients would you do CT angiogram on

Answer 13

Only in haemodynamically stable patients

Question 15

Who is ultrasound screening offered to

Answer 15

All men >65 in the uk to determine the diameter of their abdominal aorta

Question 16

What is the management plan

Answer 16

Regular surveillance (ultrasound)

Question 17

How often should a patient have a rescan if a small aneurysm is found (3-4.4cm)

Answer 17

Every year

Question 18

How often should a patient have a rescan if a medium aneurysm is found (4.5-5.4cm)

Answer 18

Every 3 months

Question 19

List conditions for surgical management of an aortic aneurysm

Answer 19

Ruptured (or symptomatic)
5.5cm or more
Rapidly enlarging ( 1cm / year)

Question 20

What are the management options after surgery

Answer 20

Refer within 2 weeks to vascular surgery for repair (unless rupture, then emergency surgery)
. Open repair
. EVAR (endovascular aneurysm repair)

Question 21

What a dive do we give to patients with >6.5 cm?

Answer 21

Don’t drive until repaired

Question 22

Complication of endovascular aneurysm repair

Answer 22

• Endo-leak if the stent fails to exclude blood from the aneurysm
• Presents without symptoms on routine follow-up

Question 23

Prognosis of ruptured AAA

Answer 23

Patients will not survive to reach theatre