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Abdominal Aortic Aneurysms - Coggle Diagram
Abdominal Aortic Aneurysms
Defintion
Aneurysm
Focal permanent dilation of a blood vessel >1.5 normal
Abdominal aortic aneurym
.>3cm
Types
Location
Juxtarenal
Shape
Fusiform
Saccular
True/false
True
Invole all 3 layers of the wall
False
Does not involveall 3walls of the vessel
Epidemiology
Older Men
Negligible before 55-60 y/o
Increases eith older age
Decreasing incidence in recent years
Major decline in incidence of rupture
Natural History
RESCAN STUDY
Avereage growth of 2mm/year
Smoking increases growth by 0.35mm/year
-Diabetes slow growth by 0.51
Annual Rupture Rates
Risk Factors
Modifiable
Those associated with atherosclerosis with exception of DM
Non-modifiable
Older age
Male
Fhx
Other large artery aneurysms (ilial, femoral, popliteal)
Caucasian
Protective
Women
DM
Non caucasian
Pathogenesis
Multifactorial
PRotease inflammation
Clinical Features
Usually asymptomatic
Pulsatile mass
Exam unreliable in obesity
Tender AAA or back pain radiation to groins
Compression - duodenum, ureter, leg oedema
Distal embolism
Rupture
Renal colic 1st presentation in pt over 60
Diagnosis
1️⃣ Ultrasound
Highly accurate
Cheap readilty availabil
Obesity, bowl gas
Operator dependednt
Can't plan repair
Cant diagnose rupture
CT Angiography
Use
assessment
tx planning
confirm rupture
follow uo
Advantages
Accurate but overestimates compared to USS
Disadvantages
Radioation / nephrotoxic contract
Management
Small
US surveillance
3.39cm: 2-3 year intervals
4-4.9: Annual
5cm= : 3-6months
Elective repair at 5cm
Reduce growth
Smoking cessation
Reduction of CVS risk
Statins
Antiplatelet
Antihypertensive
Exercise and diet
Threshold for elective repair
5.5cm cut off
Symptomatic
1cm growth per year
5cm cut off poor evidence
Women
Underepresented
Higher rupture rates
Large AAA and Unfit
EVAR 2 Tiral
No beneft with repair
2/3 pt dead within 5 yrs
Extend surveillance optimise fitness
Elective Repair
Vascular anatomy
Risk Assessment
Cardiac
Pulmonary
Kidney
Nutritional
Open surgical repair
EVAR
EVAR
Inserting stents to exclude the aneurysm
Well tolerated
2% mortality
Low mobitidy
Less durable than open
1/6 require reintervention
Specific anatomical requirements - renal neck, iliacs, femoral arteries
Complications
MI
AKI
Vascular Injury
Endoleak
DEvice migration
Component separation
Stent fracture
Limb thombosis
Infection
Open Repair
4-5% mortality
Durable
Younger, fitter patients
Tube graft or bifurcated graft
Management of Ruptured AAA
Presentation
Hypotension
Abdominal back pain
Pulsatile mass in 50%
Renal colic
Often misdiagnosed - MI, ureteric colic
CT
EVAR prefered
Premissve hypotension
Urgernt transfer to theatre
Clear communication essential
Complications
Bowel ischaemia
\
5-10%
Worsening organ failure
Early laparotomy needed
REsection / stoma
Left hemicolectomy and end stoma usually
Abdominal compartment syndrome
Intra abdominal pressire 12+
ACS-20mmhg with new orgna dysfunction
10-20% ger ACS
ORgan fx inpaired
CArdica
Tx
Drain
Improve abdo wall complicance
Evacuate content
Cotect fluids
Leg ischamia
Renal failure
CArdiac complications