Exam pointsGeneral Surgery

Abdominal Aortic Aneurysm (USMLE)

Abdominal Aortic Aneurysm (AAA) 

Splenic artery Aneurysm                         General Surgery                                   Free Questions                                           


Age - 60 years

Sex - Male

Who are at risk - Smokers, Hypertension 

Specific Questions - Associated with Ehler Danlos and MArfan Syndrome - So common in families


Most commons for abdominal aortic Aneurysm

Most common location - Infra renal (MCQ) 

Most common Cause - Atherosclerosis

Most common complication - Rupture

Most common Size and Shape - Fusiform and more than 3 cm


At what size are the chances of rupture>?  5 - 5.5 cm

What is the growth rate of  AAA - 0.2 -03. cm/year 

What is the most common presentation - Asymptomatic, If symptomatic then back pain

What is the most common finding - Expansile pulsation

Most common complication after surgery - Renal Insufficiency


Surgery and Management

Do not give muscle relaxant. It diminishes the tamponade effect

Surgery is excision with Aorto bifemoral graft

Indications for surgery for Abdominal Aortic Aneurysm

(a) Aneurysm > 5.5 cm in largest diameter

(b) Increase in diameter of more than 1cm per year

(c) Symptomatic aneurysm – back pain, tenderness on palpation, distal embolism, ruptured/leaking aneurysm


Complications of Surgery for Aortic aneurysm

Early 

1. Acute myocardial infarction – 

2. Stroke (due to hypotension or embolism) 

3. Renal insufficiency

4. Colon ischaemia – occurs in 2-6%

5. Trash foot – embolism of thrombus from the aneurysm

6. Infection of graft

7. Spinal cord ischaemia (quite uncommon)

8. Haemorrhage

Late
1. Aortoenteric fisula – frank PR bleeding, torrential
2. Late infection of prosthetic graft material
3. Sexual dysfunction