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Year 3 - Surgery > 4.02 Vascular Surgery - Arterial Disease > Flashcards

4.02 Vascular Surgery - Arterial Disease Flashcards

1
Q

What is an abdominal aortic aneurysm (AAA)?

A

Dilatation of the abdominal aorta greater than 3cm.

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2
Q

What are the risk factors of AAA?

A
  • smoking
  • hypertension
  • hyperlipidaemia
  • family history
  • male gender
  • increasing age
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3
Q

What are the clinical features of AAA?

A

Many are asymptomatic and detected on incidental finding or screening.

Symptomatic patients can present with:
- abdominal pain
- back or loin pain
- distal embolisation producing limb ischaemia
- aortoenteric fistula

On examination, a pulsatile mass can be felt in the abdomen.

NB if AAA has ruptured, patient presents with abdominal, back or loin pain and a degree of shock or syncope.

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4
Q

Describe the screening programme for AAA.

A

NAAASP offer abdominal US scan for all men in 65th year to identify AAA.

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5
Q

What is the main differential in patients who present symptomatically with back pain and no other symptoms?

A
  • renal colic
  • diverticulitis
  • IBD
  • GI haemorrhage
  • appendicitis
  • ovarian torsion
  • splenic infarction
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6
Q

What investigations are warranted for suspected AAA?

A
  • ultrasound scan
  • follow up CT with contract (diameter >5.5cm)
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7
Q

What is the management of AAA of diameter:

a) 3.0-4.4cm

b) 4.5-5.4cm

c) >5.5cm

A

a) yearly ultrasound with conservative measures

b) 3-monthly ultrasound with conservative measures

c) open or endovascular repair

NB if AAA>6.5cm, notification to the DVLA and driving disqualification warranted.

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8
Q

What are the main complications of AAA?

A
  • rupture
  • retroperitoneal leak
  • embolisation
  • aortoduodenal fistula
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9
Q

What are the risk factors for AAA rupture?

A
  • increase diameter of aneurysm
  • smoking
  • hypertension
  • female sex
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10
Q

Presentation of AAA rupture.

A
  • abdominal pain
  • back pain
  • syncope
  • vomiting

On examination they will be haemodynamically compromised, with a pulsatile abdominal mass and tenderness.

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11
Q

What is the classic triad of ruptured AAA?

A
  • flank or back pain
  • hypotension
  • pulsatile abdominal mass
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12
Q

What percentage of AAA ruptures occur:

a) anteriorly into the peritoneal cavity

b) posteriorly into the retroperitoneal space?

A

a) 20% - associated with very poor prognosis

b) 80% - associated with a better prognosis as peritoneal temporarily tamponades rupture

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13
Q

What is the management of suspected AAA rupture?

A
  • high flow oxygen
  • IV access
  • urgent bloods (FBCs, U&Es, clotting, group & save)
  • fluid bolus to maintain BP≤100mmHg
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14
Q

Why should blood pressure be kept at a maximum of 100mmHg in suspected ruptured AAA?

A

Permissive hypotension prevents excessive blood loss, by not raising the pressure so high that a tamponaded retroperitoneal rupture does not break its seal.

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15
Q

What are the three layers to the wall of an artery?

A
  • tunica intima
  • tunica media
  • tunica adventitia
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16
Q

What is an aortic dissection?

A

A tear in the tunica intima of the aortic wall, allowing blood to flow between and splic apart the tunica intima and tunica media.

NB it can be defined as acute (<14 days) or chronic (>14 days).

17
Q

In which direction do

a) antegrade

b) retrograde

aortic dissections propagate?

A

a) towards iliac arteries

b) towards the aortic valve*

*retrograde aortic dissections can result in prolapse of the aortic valve, bleeding into the pericardium, and cardiac tamponade.

18
Q

What classification systems are used for aortic dissections?

A

Stanford classification

DeBakey classification

19
Q

What are the risk factors for aortic dissection?

A
  • hypertension
  • atherosclerotic disease
  • male gender
  • connective tissue disorders (e.g. Marfan’s or EDS)
  • bicuspid aortic valve
20
Q

What are the clinical features of aortic dissection?

A
  • tearing chest pain
  • radiates to back
  • tachycardia
  • hypotension
  • aortic regurgitation murmer
  • signs of end-organ hypoperfusion
21
Q

Why does hypotension occur following aortic dissection?

A

Secondary to hypovolaemia from blood loss into the dissection, or cardiogenic from severe aortic regurgitation or cardiac tamponade.

22
Q

Give the differentials for chest pain.

A
  • myocardial infarction
  • aortic dissection
  • pulmonary embolism
  • pericarditis
  • musculoskeletal back pain
23
Q

Which investigations are warranted to explore a suspicion of aortic dissection?

A
  • baseline blood tests (FBC, U&Es, LFTs, troponin, coagulation)
  • Group&Save
  • ABG
  • ECG (exclude cardiac pathology)
  • CT angiogram first line imaging
24
Q

What is the management of aortic dissection?

A
  • high flow oxygen
  • IV access
  • cautious fluid resuscitation
  • surgical or medical management
25
Q

What are the complications of aortic dissection?

A
  • aortic rupture
  • aortic regurgitation
  • myocardial ischaemia (secondary to coronary artery dissection)
  • cardiac tamponade
  • stroke
  • death
26
Q

What is carotid artery disease?

A

The build up of atherosclerotic plaques in one or both common and internal carotid arteries, resulting in stenosis or occlusion.

27
Q

What are the risk factors for carotid artery disease?

A
  • increasing age
  • smoking
  • hypertension
  • hypercholesterolaemia
  • obesity
  • diabetes mellitus
  • PMHx / FHx cardiovascular disease
28
Q

What are the clinical features of carotid artery disease?

A

Often asymptomatic until plaque rupture, when it presents as a focal neurological deficit.

Transient ischaemic attack (TIA) is a neurological deficit lasting less than 24 hours before full resolution.

Strokes are neurological deficit lasting more than 24 hours without full resolution.

Carotid bruit may be auscultated in the neck.

29
Q

What are initial investigations warranted for carotid artery disease?

A
  • urgent non-contrast CT head
  • bloods (FBC, U&Es, clotting, lipid profile, glucose)
  • ECG (look for AF or other rhythm abnormalities)
30
Q

What is the acute management of a suspected stroke?

A
  • high flow oxygen
  • optimise blood glucose (4-11mmol)
  • swallowing screeeen assessment made on admission

If CT confirms ischaemic stroke, prescribe IV tPA and 300mg aspirin.

If CT confirms haemorrhagic stroke, correct coagulopathy and refer to neurosurgery for clot evacuation.

31
Q

What are the complications of stroke?

A
  • mortality
  • dysphagia
  • seizures
  • incontinence
  • depression
  • anxiety
  • cognitive decline

Year 3 - Surgery (30 decks)

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