Aneurysm

Question 1

What is an aneurysm

Answer 1

A localised diltation of an artery with at least 50% increase in diameter compared to the normal diameter

Question 2

WHat is a true aneurysm

Answer 2

An aneurysm involving all three layers of the arterial wall

Question 3

What is a false/pseudoaneurysm?

Answer 3

WHere there is a hole in the arterial wall, or a pusatile haematoma contained by adventitia and surrounding tissues

Question 4

What are the complications of aneurysms

Answer 4

Expansion to compress/erode adjacent structures, rupture, distal embolisation, thrombosis

Question 5

What are the risk factors of AAA

Answer 5

Male 65+ smoking hypertension 1st degree relative with AAA

Question 6

How is AAA managed?

Answer 6

Antiplatelet and statin, smoking cessation, treat hypertension

Surgery (another flashcard)

Question 7

What are the indications for AAA management by diameter

Answer 7

<3cm no followup if 65+
3-4.5 cm 12 month ultrasound
4.5-5.5 3-6 month ultrasound
>5.5cm consider surgery

Question 8

What are indications for AAA surgery

Answer 8

if diameter is >5,5cm or groys by over a cm in a year

If rupture, pain/tenderness (Impending rupture), distal embolisation ACS or blue toe syndrome)

If not fit, anticoagulate

Question 9

WHat does EVAR stand for

Answer 9

Endovascular aneurysm repair (stent)

Question 10

What are the advantages and disadvantages of open repair vs EVAR

Answer 10

Open: Higher early mortality, HDU bed, long hospital stay and recovery.

Lower late mortality and cost

EVAR: Lower early mortality, ward bed, shorter hospital stay and recovery, higher late mortality and cost

Question 11

What is an endoleak

Answer 11

Blood flowing outside the stent graft but inside the aneurysm sac.

Type 1: Poor seal between graft and aneurysm neck

Tpe 2: Backbleeding lumbar arteries