ABDOMINAL AORTIC ANEURYSM

• AAA is abnormal focal dilation of the aorta.
• For AAA, transverse diameter 3cm or greater.
• It is the MC type of large vessel aneurysm.
• Most AAA occur below renal arteries (infrarenal AAA)

 

RISK FACTORS-

• Genetic
• Tobacco, smoking
• Age- 80- 85years
• More common in males
• Atherosclerosis (MC cause)
• Thrombus formation
• Syphilis, necrosis, trauma and vasculitis

 

CLINICAL FEATURES-

• Site-

a) 95% infrarenal aorta (MC)

b) 5% suprarenal aorta

• Swelling in epigastrium with characteristic expansile pulsation.
• Back and abdominal discomfort
• Peripheral vascular disease
• Classical Triad-

i)  Sudden onset of mid abdominal or flank pain

ii)  Shock

iii) Pulsatile abdominal mass

 

INVESTIGATIONS-

• Radiograph- eggshell pattern of calcification
• Investigation of choice- morphology of the aneurysm is best assessed by CT scan .
• MRI- if patient has renal failure

 

TREATMENT-

1. Lower risk AAA

• Drug used- α- blockers, NSAIDS
• MMP inhibitors- doxycycline

 

     2. High risk AAA

• Endovascular aneurysmal repair (EVAR)
• AAA repair- ≥5.5 cm/ >5cm females
• Symptomatic aneurysm

 

Techniques of Open repair-

• Transperitoneal approach
• Retroperitoneal approach
• Minimal incision aortic surgery

  

 

 

COMPLICATIONS OF AAA

• MC complication of AAA
• MC non cardiac complication after AAA repair is renal failure.
• AAA can rupture-

a)      Anterior – peritoneal cavity

b)      Posterolateral- retroperitoneal space

• MC site of rupture – left retroperitoneum

 

CLINICAL FEATURES-

• Back and abdominal pain
• Pallor
• Diaphoresis and syncope

 

INVESTIGATIONS-

• CT scan establishes diagnosis.

 

TREATMENT-

• Immediate surgical repair
• For unstable patient- transferred to OT
• For stable patient- CT->  open surgical repair –> control haemorrhage -> resuscitation ->aneurysm repair
• Postoperative mortality rate is 45%

 

 

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