Aneurysm

Question 1

Define aneurysm

Answer 1

Localised dilatation of an artery greater than twice normal diameter

Question 2

Where do AAA’s happen?

Answer 2

Below where renal arteries come off

Question 3

Commonest peripheral aneurysm

Answer 3

Popliteal aneurysm
50% of those have one on other side
50% have AAA
Get bigger and press on nerves = pain
On outside get thrombus = down leg = DVT

Question 4

AAA define

Answer 4

> 3cm diameter
10% growth per year
in men over 65 yrs
Ruptures = high chance of death

Question 5

RF of AAA

Answer 5

FH
Caucasian, N Europeans
Smoking increases risk by 2 times
High cholesterol
HTN
Diabetes actually related to slower progression

Question 6

Classification of aneurysms

Answer 6

Saccular = more worrying, round circles
Fusiform = squashed oval, elongated
Ruptured

Question 7

AAA Indications for surgery

Answer 7

> 5.5cm diameter
rapid enlargement >1cm/yr and already >4
Symptomatic - assess risk and dealing with symtpoms before operating

Question 8

AAA Open Surgery

Answer 8

OPEN SURGERY
Put clamp on aorta above aneurysm and below it
Open up aneurysm sac
Remove clot
Stitch graft at healthy neck at top

Question 9

Risks of AAA open surgery

Answer 9

Mortality
MI
Multi-organ failure
Paraplegia
Haemorrhage
Infections (wound/graft)
Fistulae
Hernia

Question 10

AAA Endovascular Repair

Answer 10

Modular stents to seal healthy neck and vessels below
Blood flows through these
Overtime sac gets smaller as no blood through it

Question 11

EVAR Benefits

Answer 11

Lower mortality
2 day hospital stay
Can be percutaneous without cut

Question 12

EVAR Costs

Answer 12

Immediate costs less
LT costs higher as LT surveillance
May have to re-intervene
Durability?

Question 13

What may AAA be misdiagnosed as? (in order of frequency)

Answer 13

Renal colic!! - unlikely for first time in elderly
Diverticulitis
GI bleed
Acute MI
Back pain
Sepsis

Question 14

AAA screening

Answer 14

men
over 65
single trans-abdominal US
<3cm = fine
>3cm = surveillance programme so if/when >5cm = plan interventions
Elective surgery better than emergency surgery

Question 15

Define true aneurysm

Answer 15

Abnormal dilatations involving all layers of arterial wall

Question 16

Define false aneurysm

Answer 16

Collection of blood in tunica adventitia layer that communicates with the lumen

Question 17

Causes of false aneurysms

Answer 17

Trauma puncturing the artery
Percutaneous surgical procedures
Artery use for injection

Question 18

Common sites of aneurysms

Answer 18

Infrarenal aorta
Iliac
Femoral
Popliteal

Question 19

Signs & Symptoms of an AAA

Answer 19

Central abdominal pain
Radiating to the back
Sudden collapse? or more subacute (persisting pain)
Shock? - tachycardia and hypotension
History of CV disease

Question 20

Surveillance of AAA if it is 4.5-5.4cm

Answer 20

Every 3 months

Question 21

Surveillance of AAA if it is 3-4.4cm

Answer 21

Every 2 years

Question 22

Complications of AAA

Answer 22

Fluid shifts
Infection 
Haemorrhage
Renal failure
Colon ischaemia
Impaired sexual function - autonomic nerves along distal aorta

Question 23

Infection prophylaxis

Answer 23

ABs - cefazolin 1g/24 hours

Question 24

Cardiac monitoring due to AAA complication

Answer 24

Haematocrit needs to be >28%

Question 25

Ruptured AAA differentials

Answer 25

Acute abdomen
Acute pancreatitis
Perforation
Renal colic
Biliary colic
Inferior MI

Question 26

Percentage of those with AAA that get popliteal aneurysms?

Answer 26

10%

Other way round is 50%