Abdominal Aortic Aneurysm

Overview

Abdominal Aortic Aneurysm (AAA) is a dilated abdominal aorta (increased circumference)

Ruptured AAA is when the aneurysm “pops” and starts bleeping into the abdominal cavity

Risk Factors are the same as for Peripheral Arterial Disease (see above)

Presentation

  • Often asymptomatic
  • Symptoms of peripheral vascular disease
  • Non-specific abdominal pain
  • Palpable expansile pulsation in abdomen when palpated with both hands
  • Found incidentally on abdominal Xray
  • Diagnosis by ultrasound or angiography (CT or MRI)

 

Management of AAA

  • Treat reversible risk factors
  • Monitoring size
  • Treating peripheral arterial disease
  • Surgical (usually considered >5.5cm)
    • Endovascular stenting
    • Laparoscopic repair
    • Open surgical repair

 

Rupture AAA

The risk of rupture increases with the diameter of aneurysm (roughly 5% for 5cm aneurysm, 40% for 8 cm aneurysm). Ruptured AAA is very dangerous and has an extremely high mortality (>75%).

Presentation:

  • Known AAA or pulsatile mass in abdomen
  • Severe abdominal pain (non- specific, possibly radiating to the back or loin)
  • Haemodynamic instability (hypotension, tachycardia)

Patients with suspected AAA that are haemodynamically unstable should be transferred directly to theatre from A&E resus. As the mortality is so high, transfer to theatre for surgical repair should not be delayed by getting imaging.

Diagnosis of the rupture can be confirmed or excluded by immediate CT abdomen in patients that are haemodynamically stable.

In patients that have co-morbidities that make the prognosis with surgery very poor, a discussion needs to be had with senior doctors, the patient and their family about palliative care.

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