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Cardiovascular > AAA > Flashcards

AAA Flashcards

1
Q

What is the definition of an aneurysm?

A

An artery with a dilation of >50% its original diameter

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2
Q

What are the different classifications of aneurysms?

A

True and false (pseudoaneurysm)

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3
Q

What is a true aneurysm?

A

An aneurysm that involves all layers of the arterial wall.

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4
Q

What is a pseudoaneurysm?

A

An aneurysm that involves a collection of blood in the outer layer (adventita) that still communicates with that lumen.

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5
Q

What can aneurysms be in the shape of?

A

Fusiform (symmetrical) (most AAAs)

Sac-like (unsymmetrical, berry-aneurysms)

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6
Q

What are the causes of aneurysms?

A 
atheroma
trauma
infection
connective tissue disorders (ehler's danlos)
inflammatory
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7
Q

Which common aneurym causing infections are there?

A

Endocarditis - mycotic aneurysm

Tertiary syphilis - thoracic

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8
Q

Give an example of a connective tissue disease

A

Marfan’s Syndrome

Ehlers-Danlos

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9
Q

Give an inflammatory cause of aneurysms

A

Takayasu’s aortitis

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10
Q

What are the most common sites of aneurysms?

A 
Aorta (infrarenal)
Thoracic aorta
Suprarenal
Iliac
Femoral
Popliteal
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11
Q

What are the complications of an aneurysm?

A 
Rupture
Thrombosis (DVT)
Pressure on other structures (ureter)
Embolism (PE/stroke)
AV Fistulae
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12
Q

Is there screening for AAA?

A

Yes. All men aged over 65 are invited for screening in the UK. This decreases mortality from rupture.

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13
Q

What are the signs/symptoms of an AAA?

A

Intermittent or continuous abdominal pains radiating to back/iliac/fossa/groin
Collapse
Abdominal mass
Shock

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14
Q

What is the sizes of an AAAs?

A

Ectasia<3.5cm
Small aneurysm <4.5cm
Large >5.5cm

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15
Q

How big is a normal aorta for men and women?

A

Women 2cm

Men 2.5cm

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16
Q

How does prevalence of AAA change with sex?

A

Men 3x more than women

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17
Q

What, pathologically, causes AAAs?

A

Generation of elastic lamaellae - atherosclerosis

There is a genetic component

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18
Q

What is the size at which we begin to worry? and why?

A

> 5.5cm (5.2cm female)
If <5.5cm there is a less than 1% risk of rupture/yr.
At 6cm roughly 7%
At 8cm roughly 50%

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19
Q

What increases the chances of rupture?

A

> BP
Smoking
Familial history
Male

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20
Q

What are the surgical options?

A

Elective surgery to replace with plastic graft, tube or bifucation.
BIG OPERATION
EVAR

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21
Q

When do we do elective surgery?

A

When aneurysm is >5.5cm, growing by >1cm per year, or symptomatic

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22
Q

What is EVAR?

A

Endovascular arterial repair

Go up through the femoral artery and stent the aorta using a metal coil an synthetic graft, guided by X-ray

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23
Q

What are the risks of EVAR and elective surgery?

A

EVAR - smaller risk of death but higher graft complication risk e.g. stent leak (endoleak)

ES - 5% complications including spinal/visceral ichaemia and emboli

24
Q

What is the plan of action for an AAA in an emergency situation?

A

Activate major haemorrhage protocol
Give blood to maintain SBP of about 90mmHg
Summon vascular surgeon and anaesthetist
Do ECG, bloods for amylase, Hb, coag, U+Es, crossmatch, ABG
Catheterise the bladder
2x large bore IV access
Take to theatre straight away, but if uncertain, a CT scan might help.

25
Q

What are the risk factors for an AAA?

A

HTN
CAD
Smoking

26
Q

What does emergency surgery involve?

A

Clamping the aorta above the leak and inserting a Dacron graft (tube graft).

If an iliac aneurysm, can do trouser graft to the iliac artery.

27
Q

How many people die ruptured AAA?

A

41% with surgery

100% without

28
Q

What are the common causes of sudden, severe abdominal pain with high pulse and low BP?

A 
Perforation
Acute pancreatitis
Biliary colic/acute cholangitis
Mesenteric Occlusion
Ruptured AAA
29
Q

Does a clinical examination always pick up AAA?

A

No, high chance you can miss it

30
Q

What are differences in leg symptoms with AAA and dissection/PVD?

A

Ruptured AAA would cause bilateral limb ischaemia whereas PVD/dissection are more likely to cause unilateral leg ischaemia

31
Q

What does an expansile mass make your fingers do?

A

Pulse outwards

32
Q

What are the branches of the coeliac trunk?

A

Left gastric
Common hepatic
Splenic

33
Q

At which level does the coeliac trunk lie?

A

L1

34
Q

What are the branches of the abdominal aorta?

A 
Inferior Phrenic
Coeliac
Suprarenal
Renal 
SMA
Gonads
IMA
Lumbar
35
Q

Which types of clamping can occur in open AAA repair?

A

Supra-coeliac clamping
Supra-renal clamping
Infra-renal clamping

36
Q

What are the pros and cons of the different types of clamping?

A

Supra-coeliac - highest stress on the heart and ischaemia to all organ of the gut and below (w/reperfusion injury) risk of renal failure

Supra-renal - high stress on the heart with ischaemia and repe injury to organs of mid, hind gut and below, risk of renal failure

Infra-renal - relatively less stress on the heart but ischaemia to all the organs below the kidneys (mid and hind gut)

37
Q

What do we call dilations that aren’t quite aneurysms yet?

A

Ectasia if up to 50%

Arteriomegaly if generalised dilation

38
Q

What is the most common AAA?

A

Infrarenal

39
Q

How does smoking increase the chance of an AAA?

A

1 in 25 random

1 in 6 smoking

40
Q

What is the typical AAA patient?

A 
Male
over 60
HTN
Smoker
FH
41
Q

Where do you palpate for an aortic aneurysm?

A

Above umbilicus

42
Q

What is the major risk of open surgery with AAA?

A

Where you put the clamp, due to stress on heart and renal failure

43
Q

What is the mortality of open surgery?

A

5%

44
Q

What is the mortality of endovascular surgery?

A

2%

45
Q

How many people are suitable for EVAR?

A

around 70%

46
Q

What is the follow up of EVAR?

A

Lifelong with duplex/CT

6-8% need more surgery due to leak or increased pressure

47
Q

Which is the most dangerous aneurysm to repair?

A

Thoracic

48
Q

Which aneurysm are often bilateral?

A

Popliteal

49
Q

What are the complications of popliteal aneurysm?

A

Acute limb ischaemia

50
Q

What is the triad of collapse?

A

Hypotension
Collapse
Lower back/flank pain

51
Q

What is the significance of triad of collapse?

A

ANYONE WHO PRESENTS WITH THIS HAS A RUPTURED ANEURYSM UNTIL PROVEN OTHERWISE

52
Q

What is AAA a local manifestation of?

A

Arterial disease

53
Q

What is indapamide?

A

Thiazide like diuretic

54
Q

What are side effects of sitagliptin and amlodipine?

A

Ankle oedema!

55
Q

What is tazocin?

A

It is a penicillin antibiotic

Cardiovascular (7 decks)

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