Podcast
Questions and Answers
Which of the following is believed to be the primary cause of abdominal aortic aneurysms (AAA)?
Which of the following is believed to be the primary cause of abdominal aortic aneurysms (AAA)?
- Connective tissue disorders directly weakening the aorta
- Genetic predisposition causing inherent aortic wall defects
- Atherosclerosis leading to ischaemia and weakening of the aortic wall (correct)
- Hypertension directly causing aortic wall dilation
The risk of rupture is higher in males than in females.
The risk of rupture is higher in males than in females.
False (B)
At what diameter (in cm) is an AAA typically considered for elective surgical repair?
At what diameter (in cm) is an AAA typically considered for elective surgical repair?
5.5
Patients undergoing elective AAA surgery typically require cross-matching for ________ units of red blood cells.
Patients undergoing elective AAA surgery typically require cross-matching for ________ units of red blood cells.
Match each endoleak type with its description.
Match each endoleak type with its description.
A patient presents with sudden abdominal pain, flank pain, and signs of shock. What condition should be suspected?
A patient presents with sudden abdominal pain, flank pain, and signs of shock. What condition should be suspected?
AAA screening is offered to all adults over the age of 50.
AAA screening is offered to all adults over the age of 50.
What is the definitive imaging modality for diagnosing a ruptured AAA?
What is the definitive imaging modality for diagnosing a ruptured AAA?
EVAR involves inserting a ________ graft through the femoral arteries.
EVAR involves inserting a ________ graft through the femoral arteries.
Match each AAA size with its recommended surveillance frequency.
Match each AAA size with its recommended surveillance frequency.
Which of the following is NOT a typical component of the initial management of a ruptured AAA?
Which of the following is NOT a typical component of the initial management of a ruptured AAA?
EVAR is generally preferred over open repair for healthier patients due to its lower risk of long-term complications.
EVAR is generally preferred over open repair for healthier patients due to its lower risk of long-term complications.
At what rate of growth (in cm per year) does an AAA typically warrant elective surgical repair, regardless of its absolute size?
At what rate of growth (in cm per year) does an AAA typically warrant elective surgical repair, regardless of its absolute size?
The abdominal aorta begins at the level of vertebra ________ and ends at the level of vertebra ________.
The abdominal aorta begins at the level of vertebra ________ and ends at the level of vertebra ________.
Match the type of EVAR graft with its fixation point:
Match the type of EVAR graft with its fixation point:
Which of the following is NOT considered a risk factor for developing an abdominal aortic aneurysm?
Which of the following is NOT considered a risk factor for developing an abdominal aortic aneurysm?
A Type 2 endoleak typically requires immediate surgical intervention to prevent AAA rupture.
A Type 2 endoleak typically requires immediate surgical intervention to prevent AAA rupture.
What type of prophylaxis is administered the evening following AAA surgery to prevent VTE?
What type of prophylaxis is administered the evening following AAA surgery to prevent VTE?
Fenestrated EVAR allows blood flow to the renal arteries and the ________ and ________ arteries.
Fenestrated EVAR allows blood flow to the renal arteries and the ________ and ________ arteries.
Match the management strategy to the endoleak type:
Match the management strategy to the endoleak type:
Which of the following statements is true regarding EVAR?
Which of the following statements is true regarding EVAR?
Aortic ultrasound is the definitive imaging modality for ruptured AAA.
Aortic ultrasound is the definitive imaging modality for ruptured AAA.
Following EVAR, imaging is recommended at one, six, and twelve months to check on the graft and to detect potential ________.
Following EVAR, imaging is recommended at one, six, and twelve months to check on the graft and to detect potential ________.
Open aortic repair usually necessitates arterial line, central venous line, epidural, and ________ catheter insertion.
Open aortic repair usually necessitates arterial line, central venous line, epidural, and ________ catheter insertion.
Match each symptom with its corresponding clinical presentation:
Match each symptom with its corresponding clinical presentation:
Why are atherosclerotic plaques believed to contribute to the development of AAAs?
Why are atherosclerotic plaques believed to contribute to the development of AAAs?
AAA size between 3.0-4.4cm requires surveillance every 3 months.
AAA size between 3.0-4.4cm requires surveillance every 3 months.
What does EVAR stand for?
What does EVAR stand for?
Patients with suspected AAA who are unstable should be assessed, scanned, and transferred to theatre within ________ minutes.
Patients with suspected AAA who are unstable should be assessed, scanned, and transferred to theatre within ________ minutes.
Match each AAA size to its imaging modality:
Match each AAA size to its imaging modality:
In the context of AAA management, what does 'conservative management' typically refer to?
In the context of AAA management, what does 'conservative management' typically refer to?
Open repair is preferred in healthier patients.
Open repair is preferred in healthier patients.
What blood test result would you expect in a ruptured AAA?
What blood test result would you expect in a ruptured AAA?
Aneurysms between 4.5-5.4cm should be seen by a vascular specialist within ________ weeks.
Aneurysms between 4.5-5.4cm should be seen by a vascular specialist within ________ weeks.
Match the phrase with the intervention:
Match the phrase with the intervention:
Which of the following is the best reason to use a fenestrated EVAR?
Which of the following is the best reason to use a fenestrated EVAR?
After imaging post-EVAR, annual CT angiography is recommended.
After imaging post-EVAR, annual CT angiography is recommended.
What is the normal diameter of the abdominal aorta, in centimeters?
What is the normal diameter of the abdominal aorta, in centimeters?
If the AAA is greater than or equal to ________ cm, they should be seen by a vascular specialist within 2 weeks.
If the AAA is greater than or equal to ________ cm, they should be seen by a vascular specialist within 2 weeks.
Match the surgical procedure with the potential patient candidates:
Match the surgical procedure with the potential patient candidates:
Which of the following is NOT a general principle of surgical management?
Which of the following is NOT a general principle of surgical management?
Flashcards
Abdominal Aortic Aneurysm (AAA)
Abdominal Aortic Aneurysm (AAA)
Bulging of the abdominal aorta, often asymptomatic but can rupture causing haemorrhage and rapid death.
AAA Aetiology
AAA Aetiology
Atherosclerotic plaques compress the aortic media, leading to ischaemia and wall weakening.
AAA Risk Factors
AAA Risk Factors
Smoking, family history, age, hyperlipidaemia, atherosclerosis, hypertension, COPD, connective tissue disorders, European ancestry.
AAA Symptoms
AAA Symptoms
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AAA Investigations
AAA Investigations
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AAA Management
AAA Management
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Abdominal Aorta Location
Abdominal Aorta Location
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AAA Referral Size
AAA Referral Size
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AAA Surveillance Intervals
AAA Surveillance Intervals
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AAA Surgical Repair Criteria
AAA Surgical Repair Criteria
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AAA Surgical Options
AAA Surgical Options
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EVAR Benefits
EVAR Benefits
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EVAR Drawbacks
EVAR Drawbacks
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Type 1 Endoleak Definition
Type 1 Endoleak Definition
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Type 2 Endoleak Definition
Type 2 Endoleak Definition
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Type 3 Endoleak Definition
Type 3 Endoleak Definition
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Type 4 Endoleak Definition
Type 4 Endoleak Definition
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Type 5 Endoleak Definition
Type 5 Endoleak Definition
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AAA Blood Tests
AAA Blood Tests
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CTA findings in ruptured AAA
CTA findings in ruptured AAA
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Study Notes
- Abdominal aortic aneurysm (AAA) involves a bulging of the abdominal aorta.
- Rupture leads to haemorrhage and death.
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- 3% of men over 65 in the UK are affected.
- Atherosclerosis is believed to cause ischaemia, weakening the aortic wall.
- Risk factors include smoking, family history, age, hyperlipidaemia, atherosclerosis, hypertension, COPD, connective tissue disorders, and European ancestry.
- Males are more prone to AAAs, but females face a higher rupture risk.
- AAAs are usually asymptomatic.
- Rupture symptoms include sudden abdominal, flank, or back pain, shock, and loss of consciousness.
- Screening involves ultrasound for AAA >3cm.
- CT angiography is used for suspected rupture.
- Pre-op includes blood tests and ECG.
- Conservative management is suitable for AAA 3.0-5.4cm.
- Immediate management of ruptured AAA includes IV access, limited fluid resuscitation, analgesia, and antibiotics.
- Activate major haemorrhage protocol.
- Blood transfusion if Hb3cm.
- Seen by a specialist within 2 weeks if ≥5.5 cm.
- Seen by a specialist within 8 weeks if 4.5-5.4 cm.
Aetiology
- Exact cause unknown, associated with atherosclerosis.
- Atherosclerotic plaques compress the aortic media, causing ischaemia and weakening.
Anatomy
- The abdominal aorta is a continuation of the descending thoracic aorta.
- It supplies abdominal organs, pelvis, and lower limbs.
- It begins at T12 and ends at L4, dividing into common iliac arteries.
- Normal diameter is 3cm.
Surveillance
- Annually for AAA 3.0-4.4cm.
- Every 3 months for aneurysms 4.5-5.4cm.
Surgical Management
- Surgical repair is needed if the aneurysm is ≥5.5cm or growing >1cm per year.
- Principles are antibiotic prophylaxis and VTE prophylaxis.
- Options: Open aortic repair or endovascular aortic repair (EVAR).
- Open repairs involve arterial line, central venous line, epidural, urinary catheter, and NG tube.
- Elective AAA surgery requires 2 units of cross-matched RBCs and cell salvage.
EVAR
- EVAR may be considered for patients with co-morbidities, women, and men >70 years due to lower perioperative mortality and shorter hospital stays.
- EVAR has a 48% risk of graft-related complications.
- Fenestrated EVAR is needed for juxta-renal or supra-renal AAAs.
- Fenestrated EVAR enables blood flow to the renal, coeliac, and superior mesenteric arteries.
- EVAR is performed by inserting a stent graft through the femoral arteries using radiology.
- The stent diverts blood through the graft, bypassing the aneurysm.
- Post-EVAR, imaging is recommended at one, six, and twelve months.
- Annual ultrasound is recommended.
- Endoleaks are a key complication.
Endoleak Classification and Management
- Type 1 is managed with open or endovascular repair.
- Type 2 requires monitoring with CT angiography.
- Type 3 is managed with open or endovascular repair.
- Type 4 usually self-resolves.
- Type 5 requires further investigation.
Open Aortic Repair
- Open surgery is considered for healthier patients and men 60 years old, or have a history of smoking, or hypertension.
Assessment and Investigations
- ABCDE assessment and clinical review is required.
- Aortic ultrasound is done at bedside.
- Blood tests: cross match, coagulation profile, FBC.
- CT angiography (CTA) is the definitive imaging for ruptured AAA.
- CTA shows retroperitoneal haematoma and contrast extravasation.
- Patients should be assessed, scanned, and transferred to theatre within 30 minutes.
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