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Abdominal Aortic Aneurysm (Causes & Risk Factors (Male, Increasing age…
Abdominal Aortic Aneurysm
Epidemiology
AAA's are present in 5% of the population above 60
More common in men than women
Incidence increases with age
Abdominal aneurysm is classified as an aortic diameter exceeding 3cm
Most commonly occur BELOW the renal arteries (infra-renal)
Causes & Risk Factors
Male
Increasing age
Tobacco smoking
Hypertension
Family history
COPD
Severe atherosclerotic damage
Trauma
Most have no specific identifiable causes
Hyperlipidaemia
Pathophysiology
The dilation affects ALL THREE LAYERS of the vascular tunic
If it doesn't then it is a pseudoaneurysm
Degradation of the elastic lamellae resulting in leukocyte infiltrate causing enhanced proteolysis and smooth muscle cell loss
Clinical Presentation
Unruptured AAA
Pain in abdomen, back, loin or groin
Pulsatile abdominal swelling (less pronounced)
Often asymptomatic and only picked up via a routing abdominal examination of plain X-ray
Ruptured AAA
Collapse
Hypotension
Pulsatile abdominal swelling (more pronounced)
Tachycardia
Intermittent or continuous abdominal pain (radiates to the back, iliac fossa or groin)
Profound anaemia
Rupture is more likely if there is; increased BP, female, smoker, strong family history
Sudden death
Differential Diagnosis
MSK pain
Perforated GI ulcer
Ischaemic bowel
Pyelonephritis
GI bleed
Appendicitis
Diagnosis
Abdominal ultrasound - can assess aorta to degree of 3mm
CT and/or MRI angiography scans
Treatment
Smoking cessation
Vigorous BP control
Modify risk factors e.g. smoking and diet
Lowering of lipid in blood
Treat underlying causes
Surgery
Open surgical repair
Endovascular repair - stent inserted via femoral or iliac arteries
Patients tend to do better if aneurysm is symptomatic, larger than 5.5cm and expanding yearly
Small aneurysms below 5.5cm are generally just monitored