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FFP leg pain and vascular conditions > Aneurysm > Flashcards

Aneurysm Flashcards

1
Q

What is an aneurysm

A

Localised dilatation of an artery with a permanent diameter that is 1.5x its usual size

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2
Q

What is a true aneurysm

A

wall of the artery forms aneurysm

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3
Q

What is a false aneurysm

A

Other surrounding tissue forms the wall of the aneurysm (small hole in the blood vessel wall allows blood to leak out and pool)

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4
Q

What are the two types of true aneurysms

A

Fisuform- artery wall balloons out symmetrically

Saccular (berry)- Where artery wall only balloons out on one side (possibly due to weakening of that artery wall)

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5
Q

Why does an aneurysm occur

A

1) Due to weakening of blood vessel wall
2) When weakened, BV can’t contain pressure of blood so it dilates (aneurysm)
3) When pressure increases, there is further dilatation of BV wall
4) When the diameter of the vessel lumen increases, the pressure flowing through it increases
5) Leads to a positive feedback loop of continuous bulging of arterial wall so aneurysm gets bigger
6) Therefore as pressure increases, diameter increases which causes further increase in BP

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6
Q

Where do most aneurysms occur

A

Aorta

Abdo aorta most common
–>Mostly below the point where renal arteries branch out of AA

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7
Q

Risk factors for aneurysms

A 
Hypertension
Smoking
Male + >60yo
Diabetes
High LDL levels
Pregnancy 
Coarcation of aorta
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8
Q

What genetic disorders are risk factors for

A

Marfan’s syndrome - fibrillin and other elastic properties are impaired causing weak blood vessel walls

Ehlers Danlos syndrome -Abolity to form collagen is disrupted

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9
Q

Complications of an aneurysm

A

Compressing nearby structures such as IVC

Rupture

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10
Q

Effect of thoracic aneurysm near aortic valve

A

Prevents valve from shutting properly meaning back flow of blood into left ventricle during diastole

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11
Q

What is Grey-Turner’s sign

A

AAA rupture causes blood to flow into retroperitoneal space. Causes a purple discolouration in the flanks

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12
Q

Signs and symptoms of a ruptured aneurysm

A 
Hypotension
Collapse
Tachycardia
Syncope
Vimiting
Shock
Anaemia
severe pain in left flank
Expansile mass in abdomen
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13
Q

Aneurysm investigations

A

Abdo ultrasound to stage and locate

CT angiography- to see if compressing other structures or potential for rupture

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14
Q

Management of aneurysm

A

A-E assessment (ECG, analgesia, inform ITU of potential admission)

Bloods and crossmatch

Imaging (USS to check size and if rupture)

ICU

Fluids (fluid boluses to increase BP then maintenance fluid)

Surgery (EVAR or open surgery)

Major haemorrhage protocol (if signs of acute haemorrhage with significant blood loss)

Vascular team

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15
Q

What are the options for surgery for a ruptured aneurysm

A

EVAR (end-vascular aneurysm repair)

Open surgery

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16
Q

Whats an EVAR

A

aortic graft transmitted through femoral artery into abdo aorta

17
Q

When would you offer surgery for aneurysm if unruptured

A

Symptomatic
or
asymptomatic and >5.5cm
or asymptomatic, larger than 4cm and has grown by more than 1cm in 1 year

18
Q

What is aneurysm surveillance

A

All men >66yo are screened nationally by USS. If they have risk factors, they are at an increased risk of developing aneurysms so these patients also require surveillance

Risk factors:
COPD
Coronary, cerebrovascular or peripheral arterial disease
European family origin 
family history of AAA
Hyperlipidaemia 
Hypertension 
Smoking history

Reduce risk of rupture by modifying behaviours and diseases

19
Q

Presentations of popliteal aneurysm

A

Asymptomatic

  • If chronic, can exhibit mass symptoms on nearby structures such as tibial nerve which can cause leg pain and paraesthesia
  • Can have compression of popliteal vein which can lead to leg swelling
20
Q

Popliteal aneurysm thrombosis presentation

A

Lower extremity ischaemia causing:

-LEg pain, paraesthesia, pallor and cold legs

21
Q

Investigations for popliteal aneurysm

A

Duplex USS scan (screening and diagnostic)

CT or MR angiography (can measure true lumen diameters)

22
Q

management of popliteal aneurysm

A

Conservatively if <2cm and continue with surveillance

Surgical- EVAR, Open

23
Q

What is aortic dissection

A

Where inner layer of aorta tears (intima) tears. Causes blood to surge through the tear causing inner and middle layers (media) to separate

Creates new false lumen which can lead to a rupture

24
Q

Where do dissections usually occur

A

In first 10cm of thoracic aorta

25
Q

What can weakening of aorta lead to

A

Aneurysm or a dissection

FFP leg pain and vascular conditions (6 decks)

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