Approach

• Expose as for abdominal examination

1. Inspect
   • Evidence of vascular disease - fat
   • Midline pulsating mass visible
   • Abdominal scars
2. 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
3. Percussion
4. Auscultate
   • Aortic / iliac bruits

Completion

1. Examine the heart
2. Carotid vessels
3. Legs for concurrent cardiac, carotid, peripheral vascular disease

Risk factors for AAA

1. Men
2. >60 years
3. Smoking
4. Hypertension
5. Family history
6. Infections - Chlamydia

Repair of aneurysms

1. Symptomatic: back pain, tenderness, distal emboli, rupture, leakage
2. > 5.5cm  (risk of rupture 10% per year, increasing with size of aneurysm)
3. Operative mortality = 5% elective, 50% emergency (50% people die before getting to hospital!) - usually post op MI, haemorrhage or renal failure

Surgical options

1. Endosvascular stenting
   • Lower operative mortality
   • Significant failure rate (25%: endoleaks)
2. Laproscopic repair - under clinical trials
3. Open surgery with graft

Screening for aneurysms

1. No agreed UK screening programme
2. Suggested USS men at age 65 decreased risk of death from rupture by 42%