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Aorta (AAA (Path: Atherosclerosis Gender and :smoking: matter most (Pt:…

- - - - Dx: US :loudspeaker: (screening :older_man::skin-tone-2: >65y ever :smoking: gets 1x screen)
        
        ~~CT scan~~ :radioactive_sign: for initial dx.
        
        Usually AAA is found incidentally while looking for something else.
        
        ~~Arteriogram~~: the aneurysm may be atherosclerotic (not filled w/ blood), showing normal lumen.
        
        May miss aneurysm if only looking within the Aorta.
        
        infrarenal location
        
        Tx:
        If > 3.5cm = AAA
        
        annual screening thereafter
        
        If > 4.5 cm = AAA
        
        q6m screening
        
        If > 5cm or growing > 0.5cm/6months = Surgery :hocho:
        Other circumstances: watchful waiting
        
        :pencil2:endovascular repair (EVAR) = open surgery
        
        eg presentation: Older man :older_man: who has :smoking:, w/ pulsatile & tender mass w/ back px.
        
        this back px is referred pain from aorta
        
        this is about to burst
        
        CT scan or US and emergent surgery
- - - - :pencil2:Practically speaking: if someone has CP, just take BP on both arms :muscle::skin-tone-3: for a quick r/o
        :warning:If :check:, really consider dissection.
      - 2 dissections to consider
        
        Sanford A (Ascending)
        
        Sanford B (after great vessels)
        
        Non-HTN risk factors: Marfan's & Syphilitic Aortitis (check w/ RPR)
        
        Dx: CT Angiogram :radioactive_sign:
        
        looking for false lumen
        
        ~~Arteriogram~~: may pop the dissection :skull_and_crossbones:
        :pencil2: If renal failure, no CT, use TEE = MRI (pick the one thats available)
        
        Tx:
        
        type A = surgery :hocho:, evaluate need to replace AV :<3:
        
        type B = medical tx: IV BBlockers :trumpet: (gets HR & BP down)
        
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