Abdominal Aortic Aneurysm

ABDOMINAL AORTIC ANEURYSM


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-
  1. 95% infrarenal aorta (MC)
  2. 5% suprarenal aorta
  • Swelling in epigastrium with characteristic expansile pulsation.
  • Back and abdominal discomfort
  • Peripheral vascular disease
  • Classical Triad-
  1. Sudden onset of mid abdominal or flank pain
  2. Shock
  3. 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-
  1. Anterior – peritoneal cavity
  2. 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%

Exam Important

  • It is the MC type of large vessel aneurysm.
  • Most AAA occur below renal arteries (infrarenal AAA)
  • 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-
  1. 95% infrarenal aorta (MC)
  2. 5% suprarenal aorta
  • Swelling in epigastrium with characteristic expansile pulsation.
  • Back and abdominal discomfort
  • Peripheral vascular disease
  • Classical Triad-
  1. Sudden onset of mid abdominal or flank pain
  2. Shock
  3. Pulsatile abdominal mass

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

 

  • MC complication of AAA
  • MC non cardiac complication after AAA repair is renal failure.
  • AAA can rupture-
  1. Anterior – peritoneal cavity
  2. Posterolateral- retroperitoneal space
  • MC site of rupture – left retroperitoneum

 

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