Aortic Aneurysm / AAA

• What is an abdominal aortic aneurysm (AAA)?


  An AAA is a condition characterized by an abdominal aorta diameter greater than 3 cm.
• Where is an abdominal aortic aneurysm most frequently located?


  It is most frequently located between the renal and inferior mesenteric arteries.
• What are key signs and symptoms of an AAA?


  Key signs include typically asymptomatic presentation and occasionally a pulsatile, expansile abdominal mass.
• How is an abdominal aortic aneurysm primarily diagnosed?


  Diagnosis primarily relies on abdominal ultrasound screening.
• What factors influence the follow-up frequency for AAA screening?


  Follow-up frequency varies based on the aneurysm size.
• What are the management strategies for AAA?


  Management strategies focus on surgical repair for sizes >5.5 cm or rapid expansion.
• What are the two types of surgical repair for AAA?


  The two types are open repair and Endovascular Aneurysm Repair (EVAR).
• Who is predominantly affected by abdominal aortic aneurysms?


  Older adults, especially those over 65 years of age, are predominantly affected.
• Which gender has a higher prevalence of AAA?


  AAA is more prevalent among men than women.
• What geographic and ethnic variations exist in the prevalence of AAA?


  There is a higher prevalence reported in Western countries.
• What primarily causes abdominal aortic aneurysms?


  They occur primarily due to the failure of elastic proteins within the extracellular matrix.
• What does the dilation of an aneurysm represent?


  Aneurysms typically represent dilation of all layers of the arterial wall.
• What is associated with the process of aneurysm formation?

  This process is associated with increased proteolytic activity and lymphocytic infiltration.
• What are some risk factors for developing AAA?


  Risk factors include smoking, cardiovascular disease, advanced age, hypertension, family history, syphilis, Ehlers Danlos Type 1, and Marfan’s Syndrome.
• What is the most classical finding on physical examination for AAA?


  The most classical finding is a pulsatile, expansile abdominal mass.
• What does abdominal or back pain indicate in AAA?


  Pain usually suggests rapid expansion or impending rupture of the aneurysm.
• What are signs of AAA rupture?


  Signs include sudden, severe pain, hypotension, and signs of shock.
• How can AAA rupture present in some cases?


  It may present with features of acute abdomen or gastrointestinal bleeding.
• What symptoms can arise from distal embolization in AAA?


  Symptoms related to ischemia, such as blue toe syndrome, can occur.
• What symptoms may a large aneurysm cause due to compression?


  Symptoms may include early satiety, nausea, weight loss, altered bowel habits, and deep venous thrombosis.
• How does renal colic typically present?


  It presents with severe, sudden onset flank pain that can radiate to the groin.
• What characterizes pancreatitis?


  It is characterized by persistent, severe epigastric pain radiating to the back.
• What are common symptoms of peptic ulcer disease?


  Common symptoms include burning epigastric pain relieved by eating, weight loss, and potential signs of bleeding.
• How does diverticulitis typically present?


  It usually presents with left lower quadrant pain, fever, and changes in bowel habits.
• What is the initial investigation of choice for AAA?


  Abdominal ultrasound is the initial investigation of choice.
• Why is abdominal ultrasound preferred for AAA screening?


  It is non-invasive, low cost, and has no radiation exposure.
• At what age is an abdominal ultrasound scan offered in the UK for AAA screening?


  It is offered at age 65.
• What is the follow-up for small AAA (3-4.4 cm)?


  Yearly repeat ultrasound is offered.
• What is the follow-up for medium AAA (4.5-5.4 cm)?


  Repeat ultrasound every 3 months is offered.
• What is generally recommended for large AAA (>5.5 cm)?


  Surgical intervention is generally recommended, with referral within 2 weeks.
• What is the imaging modality of choice for preoperative evaluation of AAA?


  CT angiography is the imaging modality of choice.
• What information does CT angiography provide for AAA?


  It provides detailed information about the size, shape, and extent of the AAA.
• Why is CT angiography preferred in suspected rupture cases?


  It has rapid acquisition time and high sensitivity and specificity.
• What is Magnetic Resonance Angiography (MRA) used for?


  MRA is an alternative to CT angiography for patients who cannot be exposed to ionizing radiation.
• What are the limitations of MRA compared to CT angiography?


  MRA is less readily available and takes more time than CT.
• What blood tests are typically evaluated prior to AAA surgery?


  Tests include complete blood count, coagulation profile, renal function tests, and electrolyte levels.
• What is the management for low rupture risk AAA?


  Management includes abdominal ultrasound surveillance and optimizing cardiovascular risk factors.
• What is the management for high rupture risk AAA?


  Management includes referral to vascular surgery for probable intervention.
• What is involved in elective endovascular repair (EVAR)?


  In EVAR, a stent is placed into the abdominal aorta via the femoral artery.
• What is a complication of EVAR?


  A complication is an endo-leak, where the stent fails to exclude blood from the aneurysm.