Abdominal Aortic Aneurysms
Type A
A type of Thoracic aortic dissection Affect the ascending aorta
Type B
A type of Thoracic aortic dissection Does not affect the ascending aorta
Endovascular stent grafting
Advantages: Minimally invasive Reduced risk of death Faster recovery Improved functional outcomes
4.5 - 5.5cm
An AAA between these diameters warrants a 3 -monthly hospital surveillance (ultrasound)
3.0-4.4cm
An AAA between these sizes warrants an ultrasound scan yearly as surveillance
Renal arteries
Below these arteries is where an AAA is most likely to occur
Thoracic aortic dissection
Blood splits aortic media Branches of aorta occlude
False aneurysm
Collection of blood in the outer layer (adventitia) which communicates with the lumen after trauma
Aneurysms
Common sites: Aorta - infrarenal Iliac bifurcation Femoral Popliteal
Open surgery
Contraindications for AAA: High anasthaesia risk Significant comorbidities Previous abdominal surgery
Pseudoanuerysm
Defined as a collection of blood in the adventitia which communicates with the lumen eg. after trauma
Aneurysm
Defined as an abnormal dilatation involving all the layers of the arterial wall
Abdominal aorta aneurysm
Diagnosis: Clinical exam Ultrasound Spiral CT MRI
Endovascular stent grafting
Drawbacks: Endoleaks Stent graft migration Modular dislocation
AAA
Indications for surgery: >5.5cm Rapidly growing (>1cm/year) Symptomatic - back pain, infection Embolization
Abdominal aorta aneurysm
Indications for surgery: Dilatation greater than 5.5cm Expanding quickly (more than 1cm a year) Embolisation Symptomatic
AAA
Investigations: Bloods - CRP/ESR ECG Ultrasound CT
Unruptured AAA
More than 3cm dilatation of the abdominal aorta Caused by degeneration of the elastic lamina and smooth muscle Often asymptomatic
Abdominal aorta aneurysm
Permanent localised dilatation of the abdominal aorta
Abdominal aorta aneurysm
Risk factors: Age Male Atherosclerosis Marfan's syndrome Infection
Ruptured AAA
Risk factors: High blood pressure Smoking Female Family history
AAA
Screening: Single USS for men >65
Thoracic aortic dissection
Signs: Unequal BP and pulses in arms Acute limb ischaemia Hemiplegia/paraplegia Anuria
Ruptured AAA
Symptoms: Intermittent or continuous abdominal pain Radiates to back, iliac fossa or groin Expansile mass Clinical shock Collapse
Thoracic aortic dissection
Symptoms: Sudden tearing chest pain Radiates to back Hemiplegia/paraplegia
80%
The rough mortality for a ruptured AAA
2.5%
The rough mortality for elective AAA repair
Type A
The type of thoracic aortic dissection that requires emergency surgery
CT
This investigation is only used in stable patients to provide more information their AAA eg. for elective surgery
Ultrasound
This investigation is used for the initial assessment of an AAA
Spiral CT
This investigation is used to confirm the size of an AAA
Endovascular repair
This method of treating AAA has less early mortality but increased complications and is more costly
Abdominal aorta aneurysm
Treatment: Open surgery Endovascular stenting graft
Impotence
Underdiagnosed and under reported, affects more than 25% after aorta reconstruction
