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

3.  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

5.  Men > women
 Increased age
 PMH:
› Hypertension
› Hypercholesterolaemia
› Atherosclerosis
› Marfan’s syndrome
 FH:
› Aortic aneurysm

6.  HISTORY
› Abdominal or back pain
› Family history
› Risk factors
 EXAMINATION
› Palpation of abdomen

7.  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 %

8.  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

9.  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

10.  Longitudinal midline
incision
 Aorta clamped above
and below aneurysm
 Aneurysmal part of aorta
replaced with artificial
graft
 4-5hrs

11.  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
 2-3hrs
http://www.youtube.com/watch?
v=j9aK2ECcFEY

12.  Renal failure
 Emboli
 MI
 Graft infection

13.  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