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Abdominal Aortic Aneurysm (aetiology (risk factors (atherosclerosis, COPD,…
Abdominal Aortic Aneurysm
focal dilatation of the abdominal aorta with at least 50% increase over the vessel's normal diameter.
pathophysiology
degeneration of the media lead to widening of the vessel lumen and loss of structural integrity.
biomechanical wall stress
aetiology
unclear.. degenerative
risk factors
atherosclerosis
COPD
prev aneurysm repair
CAD/PVD
HTN
congenital
marfan's
ehlers-danlos
incidence
M>F
increasing with age
prognosis
guarded if rupture occurs pre-hospitalisation
good if surgically repaired
associated with co-morbidities
complications
disease
death
rupture
peripheral embolisation
surgery
false aneurysm
death
endoleaks
type 1
blood flow into aneurysm sac due to incomplete seal or ineffective seal at end of graft
type 2
blood flow into aneurysm sac due to backflow from collateral vessels
type 3
blood flow into aneurysm sac due to inadequate of ineffective sealing or overlapping of graft joints or rupture of graft fabric
type 4
blood flow into aneurysm sac due to porosity of graft fabric
clinical
symptoms
asymptomatic unless ruptured/expanded
incidental finding
unimpressive back, flank, abdominal, or groin pain for some time before rupture
signs
pulsatile mass
acute abdomen if ruptured
diagnosis
clinical
USS
ancillary
CT - surgery planning
treatment
surgery
elective
open
EVAR
emergency (ruptured)
medical
antihypertensives
beta blockers
calcium channel blockers
analgesia
IV morphine sulphate (acute)
fentanyl