Abdominal Aortic Aneurysms

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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


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