Abdominal Aortic Aneurysm
Approach
- Expose as for abdominal examination
- Inspect
- Evidence of vascular disease - fat
- Midline pulsating mass visible
- Abdominal scars
- Palpate
- Hand examination nomral
- 9 quadrants
- Pulsatile mass identified in epigastrium
- Mass should be measured bringing lateral sides of index fingers of both hands togehter to identify borders of the aneursym and estimating distance between fingers
- Expansile mass moves fingers laterally with each pulse; aneurysms are expansile as well as plsative
- Take care not to palpate foot fimrly
- Palpate over the course of the common iliac arteries
- Continue the examination by palpating the femoral arteries in the groin and the popliteal artieres
- Percussion
- Auscultate
- Aortic / iliac bruits
Completion
- Examine the heart
- Carotid vessels
- Legs for concurrent cardiac, carotid, peripheral vascular disease
Risk factors for AAA
- Men
- >60 years
- Smoking
- Hypertension
- Family history
- Infections - Chlamydia
Repair of aneurysms
- Symptomatic: back pain, tenderness, distal emboli, rupture, leakage
- > 5.5cm (risk of rupture 10% per year, increasing with size of aneurysm)
- Operative mortality = 5% elective, 50% emergency (50% people die before getting to hospital!) - usually post op MI, haemorrhage or renal failure
Surgical options
- Endosvascular stenting
- Lower operative mortality
- Significant failure rate (25%: endoleaks)
- Laproscopic repair - under clinical trials
- Open surgery with graft
Screening for aneurysms
- No agreed UK screening programme
- Suggested USS men at age 65 decreased risk of death from rupture by 42%
