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Abdominal Aortic Aneurysm (Viva (Hx (Presentation: usually incidental…
Abdominal Aortic Aneurysm
Examination
Completion
Cardiovascular system
Peripheral vascular system
Inspection
Midline pulsating mass: esp. on deep inspiration
Abdominal scars
Palpation
Pulsatile and expansile mass on deep palpation in the epigastrium.
Expansile: moves fingers laterally w/ each pulse
Estimate size using lateral margins of index fingers
Palpate for other aneurysms
Course of common iliacs
Femorals
Popliteals
Auscultation for Bruits
Aortic
Renal
Iliac
Viva
Hx
Presentation: usually incidental finding
Symptoms
Abdominal or back pain
Tenderness over aneurysm
Distal embolic events
Leak
Other peripheral or cardio-vascular disease
CV risk factors
Definition
Abnormal dilatation of the abdominal aorta to >50% of its normal diameter = ≥3cm
Risk Factors
Male
Age >60yrs (prevalence: ~5%)
Smoking
HTN
FHx
Ix
Abdo US: used for surveillance and screening
CT/MRI: Ix of choice
Angio: useful to delineate relationship of renal arteries
Operate
Indications
Symptomatic aneurysms
Asymptomatic
≥5.5cm
Expanding >1cm/yr
Complications
Death
MI
Renal failure
Spinal or mesenteric ischaemia
Distal trash from thromboembolism
Anastomotic leak
Graft infection
Aortoenteric fistula
Operative Mortality
Open
Emergency: 50%
But only 50% reach hospital alive
Elective: 5% (lower in specialist centres)
↑ if IHD, LVF, CRF, COPD
EVAR
↓ perioperative mortality (1% vs. 5%)
No mortality benefit after 5yrs
Significant late complications: e.g. endoleaks
EVAR not better cf. medical care in unfit pts.
Popliteal Aneurysm
Examination
Inspection
Pulsatile popliteal swelling
Ischaemic patches on foot: emboli
Palpation
If asked just to examine the pulses, start w/ femorals
Comment on presence and character
Aneurysmal popliteals are very easily palpable
Popliteal aneurysm ≥2cm in diameter
50% bilateral: examine the other knee
Distal pulses may not be palpable
Completion
Complete peripheral vascular examination
Abdominal examination for AAA
Present in 50%
Viva
Presentation
Popliteal aneurysms represent 80% of all non-aortic aneurysms
Lump behind the knee
50% present w/ distal limb ischaemia: thromboembolism
<10% rupture
Mx
Surgical Indications
Symptomatic aneurysms
Aneurysms containing thrombus
Aneurysms >2cm
Acute: embolectomy or fem-distal bypass
Stable: excision bypass