AAA

• What is a AAA?

  Aneurysm -> caused by force weakening all 3 layers of abdominal aorta -> ballooning of artery

  Diameter > 3cm = aneurysm
• Men are more likely to have a AAA, but women are more likely rupture.
• What is the mortality of a ruptured AAA?

  Around 80%
• What are the RFs of AAA?

  Men

  Increased age

  Smoking

  Obesity

  Poor diet

  Alcohol excess

  HTN
• What is the screening for AAA?

  Men get an USS at 65 yrs

  If aorta diameter is > 3cm = referral to vascular team & need regular USS

  • 3 - 4.4 cm = annual USS
  • 4.4 - 5.5 cm = 3 monthly USS
• When does a AAA require urgent repair?

  > 5.5 cm in diameter

  Increasing in size > 1 cm per year

  Become symptomatic
• What are the 'Big 3' signs & symptoms of AAA?

  Pulsatile, expansible abdominal mass

  Pain (classically back pain, sometimes abdo pain)

  Hypotension
• What are the signs & symptoms of AAA rupture/leak?

  Pulsatile, expansible abdominal mass

  Pain (classically back pain, sometimes abdo)

  Hypotension

  Pallor (often look grey)

  Dizziness

  Syncope

  Tachypnoea (due to anaemia & pain)

  Tachycardia

  Bruit
• What are the Inx of AAA?

  Obs

  Full Hx & examination

  ECG

  Bloods (FBC, U&Es, group & save, coag, VBG, LFTs)

  USS (in screening)

  CT angio (whole aorta)

  • done when symptoms are present
  • important to see if renal arteries are involved -> when repairing will need to clamp above & below so can lead to renal failure
• What is the management of a ruptured AAA?

  A-E approach

  IV fluids & transfusion (need to control BP, but don't let the BP get too high as it will worsen the bleed)

  Nil by mouth

  Analgesia

  Call vascular reg

  Surgery

  • stent (endovascular arterial repair (EVAR))
  • open repair (better prognosis)
• What are the possible complications of ruptured AAA?

  Renal failure

  Death

  Ileus & bowel ischaemia

  Acute limb ischaemia

  Spinal cord syndrome

  • due to possible clamping of spinal arteries -> spinal cord ischaemia
• When doing open surgery for AAA (or any endarterectomy) what do you need to do after? Why?

  Flush heparin into artery

  Due to possible 'trashing' -> when removing plaque from inside artery, parts of the plaque can flow down & cause ischaemia further down
• Ruptured AAAs can bleed anteriorly & posteriorly.

  Which one would be 'better'?

  Posterior

  There is limited space so will tamponade itself (fill space & put pressure on the bleed)

  If bleed anterior, there is lots of peritoneal space to bleed into -> more blood loss