2cm width 4 main parts Many branches Bifurcation: ~L4

Abnormal localised dilatation of a blood vessel due to weakness of the vessel wall

Most commonly abdominal aorta Usually asymptomatic

› May have back pain Often discovered incidentally

› NHS AAA screening programme

Men > women Increased age PMH:

› Hypertension› Hypercholesterolaemia› Atherosclerosis› Marfan’s syndrome

FH:› Aortic aneurysm

HISTORY› Abdominal or back pain› Family history› Risk factors

EXAMINATION› Palpation of abdomen

Mortality >80%; 50% don’t reach hospital 13th commonest cause of death in UK 12,000 deaths/year in UK

Source: BHF Factfile 1, 2008

AAA Diameter (cm)

Annual Rupture Rate

4 - 5.4 0.5 – 1.5 %5.5 - 5.9 5 – 15 %6 - 6.9 10 – 20 %7 - 7.9 20 – 40 %> 8 30 – 50 %

Presentation:› Pain.

Thoracic: chest AAA: severe back pain, often radiates to groin

› Abdominal tenderness & pulsatile mass› Shock:

Cold, clammy Tachycardia Hypotension

› Syncope› Vomiting (haemoptysis)

Emergency surgery

No effective medical treatment› Can target cardiovascular risk factors

Only operate if risk of rupture greater than risk of surgery

>5.5cm More if higher risk to surgery due to co-

morbidities Otherwise re-scan at regular intervals

Longitudinal midline incision

Aorta clamped above and below aneurysm

Aneurysmal part of aorta replaced with artificial graft

4-5hrs

Lower mortality, more expensive Graft inserted through femoral artery X-ray used to guide positioning Stent expands to size of normal aorta

above and below aneurysm Requires ‘neck’ below

renal arteries to attach stent graft

2-3hrshttp://www.youtube.com/watch?v=j9aK2ECcFEY

Renal failure Emboli MI Graft infection

Aneurysm = localised dilatation of blood vessel

1/15 men over 65, 1/35 women Rupture has > 80% mortality Surgical repair has ~5% mortality

(varies) Aneurysm >5.5cm surgery Open repair, EVAR