Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Vascular Surgery > 2: Arterial Aneurysms > Flashcards

2: Arterial Aneurysms Flashcards

1
Q

Define aneurysm

A

Dilation of a blood vessel to more than 50% of it’s original diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define an abdominal aortic aneurysm

A

Dilation of abdominal aorta to more than 3cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What age is the peak incidence for AAA

A

60-70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which gender is AAA more common in

A

Males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What ethnicity is AAA more common in

A

Caucascians

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What factors are thought to cause AAA

A

Atherosclerosis
Connective tissue diseases (Marfan, Ehlers)
Infection (Syhphillis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most important risk factor for AAA

A

Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are 5 risk factors for AAA

A 
HTN
Hyperlipidaemia
FH
Male
Smoking 
Age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a protective factor for AAA

A

Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do the majority of AAA present

A

Incidentally on screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If AAAs present clinically, what symptoms may they present with

A

Back Pain
Limb ischaemia - due to embolisation
Pulsatile abdominal mass
Abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain the NHS screening program for abdominal aortic aneurysms

A

Men are invited for a one-off abdominal US scan at 65 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If a males screening test returns as below 3cm what is done

A

This is the normal diameter of the abdominal aorta so they are not invited for screening again

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If AAA is >5.5cm on screening, how soon should individuals have a vascular review

A

Within 2W

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If AAA is >3-5.4 cm on screening, how soon should individuals have a vascular review

A

Within 12W

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What additional imaging option should be done for individuals with AAA >5.5cm

A

CT w/contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How often should an individual with an AAA of 3-4.4 be followed by AUS

A

Annually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How often should an individual with AAA of 4.5-5.4 be followed by AUS

A

3 monthly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the risk of AAA 3 - 5.4 cm rupturing

A

3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How should AAA of 3-5.4cm be managed

A

Optimise risk factors including:

  • anti-HTN
  • Smoking cessation
  • Statin
  • Diabetic medication
  • Aspirin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the three indications for operating on an AAA

A
  1. > 5.5cm
  2. Expanding at a rate of >1cm/year
  3. Symptomatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What rate does an AAA have to be expanding per year to be operated

A

> 1 cm per year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the two treatment options for repairing a non-ruptured AAA

A
  1. Endovascular repair

2. Open repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Explain an Endovascular repair

A

Graft is inserted through the femoral artery into AAA and stent put across

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the advantage of Endovascular repair in the short-term

A
  • Shorter hospital stay

- 30d mortality rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the problem with Endovascular repair in long-run

A

Higher rates of re-innervation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the 2-year mortality rate for endovascular repair compared to open

A

Same

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what does open repair involve

A

Midline laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what are four complications of AAA

A
  1. Rupture
  2. Distal embolisation
  3. Retroperitoneal leak
  4. Aorta-duodenal fistula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is a true aneurysm

A

dilation of all three layers of the vascular wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is a false aneurysm

A

rupture in intima - meaning haematoma collects between vascular layers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the most common site of AAA

A

infra-renal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Is AAA or thoracic aortic aneurysm more common

A

AAA

34
Q

What is the most common site of a thoracic aorta

A

ascending aorta

35
Q

Who should receive a statin

A
  1. Individuals with cardiovascular disease including TIA, Cerebrovascular disease, IHD, PAD
  2. QRISK2 score >10%
  3. T1DM diagnosed over 10-year ago or aged >40Y with known nephropathy
36
Q

What time of day should statins be taken and why

A

Night time - as this is when majority of cholesterol synthesis occurs

37
Q

What are the criteria for primary prevention dose of statins

A
  1. QRISK2 >10%
  2. CKD eGFR <60
  3. T1DM
38
Q

What dose of statins is given as primary prevention

A

20mg

39
Q

What is the criteria for secondary prevention statins

A

established cardiovascular disease

40
Q

What dose is given as secondary prevention

A

80mg

41
Q

How will an individual with a ruptured AAA present

A
  • abdominal pain that radiates to the back

- haemodynamically compromised

42
Q

How will individual with ruptured thoracic aortic aneurysm present

A

tearing chest pain radiating to the back

43
Q

As the thoracic dissection expands, what arteries are affected if a person presents with following symptoms

a. hemiplegia
b. paraplegia
c. anuria

A

a. carotid arteries
b. anterior spinal arteries
c. renal arteries

44
Q

What is a complication of endovascular aneurysm repair

A

endoleak

45
Q

what is an Endoleak

A

there is a leak in the prosthetic graft used to stent the aneurysm

46
Q

what is the problem with Endoleaks

A

leaks are asymptomatic until severe and individual haemodynamically compromised - therefore requires regular post-op US

47
Q

what is the most common type of Endoleaks following thoracic AA repairs

A

type 1

48
Q

what is a type 1 endoleak

A

leak at the end of the graft due to an inadequate seal

49
Q

what is the most common type of Endoleaks in AAA repairs

A

type 2

50
Q

what is a type 2 endoleak

A

leak at branching vessels

51
Q

what is a type 3 endoleak

A

leak occurs due to defect in fabric graft

52
Q

what is a type 4 endoleak

A

leak due to porosity in the graft

53
Q

what is a type 5 endoleaks

A

continued aneurysm expansion with no demonstrable leak

54
Q

what are four risk factors for rupture of AAA

A
  1. Size of aneurysm
  2. Female
  3. Smoking
  4. HTN
55
Q

what is the classical triad of symptoms for ruptured AAA

A
  1. Back pain
  2. Hypotension
  3. Pulsatile abdominal mass
56
Q

what other symptoms may a ruptured AAA present with

A

Syncope

Vomiting

57
Q

explain emergency work-up and management of patient with ruptured AAA

A
  1. ECG
  2. Bloods (Cross-Match, Amylase, U+Es)
  3. IV access - Rh O-ve blood if compromised maintain systolic BP <100 to contain leak
  4. Transfer to vascular unit
58
Q

if patient with ruptured AAA is unstable what is done

A

Immediate transfer to surgery for open repair

59
Q

if patient with ruptured AAA is stable what is done

A

CT angiogram and EVAR

60
Q

how can a thoracic aortic aneurysm be divided

A

Anatomically into:

  • Ascending aorta (60%)
  • Aortic arch (10%)
  • Descending aorta (40%)
  • Thoracoabdominal aorta (10%)
61
Q

what has a higher mortality TAA or AAA

A

TAA

62
Q

what are 6 causes of thoracic AA

A
  • Connective tissue disease
  • Bicuspid aortic valve
  • Aortic dissection
  • Tertiary syphillis
  • Takayasu’s arteritis (Inflammation)
  • Trauma
63
Q

what connective tissue diseases may cause thoracic AA

A

Ehlers Danlos

Marfans

64
Q

which condition has a higher risk of bicuspid aortic valve and hence thoracic AA

A

Turner’s syndrome

65
Q

Give 5 risk factors for thoracic aortic aneurysms

A 
Smoking
HTN
Atherosclerosis
Age 
FH
Obese 
Male
66
Q

How are thoracic aortic aneurysms most commonly identified

A

incidental finding on imaging

67
Q

In symptomatic individuals, how does TAA present

A

pain depending on site of aneurysm

68
Q

If pain is in the ascending aorta, where is the TAA

A

anterior chest pain

69
Q

If pain is in the neck, where is the TAA

A

aortic arch

70
Q

If the aneurysm is in the descending thoracic aorta where is the thoracic aortic aneurysm

A

pain between the shoulder blades

71
Q

Why may an individual have the following in thoracic aortic aneurysm

a. back pain
b. hoarse voice
c. distended neck veins
d. heart failure
e. dyspnoea

A

a. due to aneurysm compressing spinal cord
b. recurrent laryngeal nerve compression
c. SVC compression
d. aortic valve involvement
e. tracheal obstruction

72
Q

What is first-line investigation for thoracic abdominal aneurysm

A

CXR

73
Q

what will be seen on CXR in thoracic abdominal aneurysm

A

widened mediastinum with possible tracheal deviation

74
Q

what other imaging must be offered to those with thoracic AA to make a diagnosis

A

CT with contrast

75
Q

what medical management is offered to those with thoracic aortic aneurysms

A 
RF control:
Smoking cessation
Statin
Anti-HTN
Diabetic control 
Aspirin
76
Q

when should ascending aortic aneurysms be operated on

A

> 5.5cm

77
Q

if the aortic valve is involved in an ascending aortic aneurysm what procedure is performed

A

Bentall procedure

78
Q

what does the bentall procedure involve

A

Graft contains a prosthetic aortic valve

79
Q

what is criteria for operating on aortic arch aneurysm

A

> 5.5cm

80
Q

what is criteria for operating on descending aortic aneurysm

A

> 6cm

81
Q

what type of thoracic aortic aneurysm has the highest mortality

A

aortic arch aneurysm

Vascular Surgery (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions