Abdominal Aortic Aneurysms

A lightening quick review of the emergency management of a ruptured AAA.

 

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Video Duration: 3 minutes

  • Abdominal Aortic Aneurysms
    Created by Dr Ed Wallitt
    General
    Epidemiology

    5% over 50y, M:F = 3:1

    Pathology

    Dilatation of the aorta > 3cm. 90% are infrarenal

    Top three causes

    Think metabolic syndrome

    Clinical Features
    Symptoms

    Usually asymptomatic and discovered incidentally

    May present as rupture - abdominal pain radiating to the back/groin

    May also present as acute limb ischaemia

    Signs

    Expansile mass above the umbilicus +/- bruits

    Presence of shock suggestion rupture.

    Investigations
    Cultures

    None

    Bloods

    FBC (baseline FBC), crossmatch and group and save, U&Es (renal dysfuction)

    Imaging

    AXR - may see calcification

    Abdo US - for screening and monitoring

    CT - gold standard

    Scopic/Biopsy

    Angiography may be used to determine extent of involvement of renal arteries

    Functional

    None

    Treatment
    Conservative
    1. Manage cardiovascular risk factors
    2. UK Small Aneurysm Trial suggestions if AAA <5.5cm then should be US monitored
    Medical

    Manage cardiovascular risk factor e.g. blood pressure with anti-hypertensives

    Surgical

    Either open or EVAR (5% elective mortality, 50% emergency)

    Indicated if

    1. Symptomatic/rupture
    2. Diameter > 5.5cm
    3. Expanding > 1cm per year
    4. Throwing off emboli distally