Aneurysm, Aortic dissection

Question 1

Aneurysm definition

Answer 1

Dilatation of a blood vessel > 50%

Question 2

True aneurysm definition

Answer 2

Involves all layers of vessel wall

Question 3

Types of true aneurysm

Answer 3

Fusiform

Saccular

Question 4

Example of fusiform

Answer 4

AAA

Question 5

Example of saccular

Answer 5

Berry

Question 6

False aneurysm definition

Answer 6

Collection of blood around vessel wall which communicates with vessel lumen

Question 7

Causes of false aneurysm

Answer 7

Usually iatrogenic - eg. cannulation, puncture

Question 8

Risks with aneurysms

Answer 8

Rupture

Thrombosis

Question 9

Popliteal aneurysm Sx

Answer 9

Easily palpable popliteal pulse

50% bilateral

Question 10

Risks with popliteal aneurysm

Answer 10

Rarely ruptures

Thrombosis and distal embolism

Question 11

Acute mx of popliteal aneurysm

Answer 11

embolectomy

fem-distal bypass

Question 12

Chronic mx of popliteal aneurysm

Answer 12

elective grafting + tie off vessels

Question 13

Normal size of abdominal aorta

Answer 13

<3 cm

Question 14

Most common place for aortic aneurysm

Answer 14

90% infrarenal

30% involve iliac arteries

Question 15

AAA sx?

Answer 15

Usually asymptomatic

Back pain radiating to groin

Acute limb ischaemia

Blue toe syndrome - distal embolus

Acute rupture

Question 16

AAA O/E

Answer 16

Expansile mass

Bruits

Question 17

Ix for AAA

Answer 17

AXR - calcifications

Abdo US

CT/MRI - gold standard

Angiography

Question 18

RFs for AAA rupture

Answer 18

HTN

Smoker

F (M get it more, F ruptures more easily)

FH

Question 19

AAA screening

Answer 19

U/S 65 yo men

Question 20

General mx of chronic AAA

Answer 20

> 3cm - yearly monitoring

> 4.5 cm - 6 monthly monitoring

> 5.5 cm - consider surgery

Question 21

Indications for surgical management of AAA

Answer 21

Symptomatic/complications

Diameter > 5.5 cm

Rapidly expanding > 1 cm/yr

Question 22

Surgical options for AAA

Answer 22

EVAR

Open repair

Question 23

EVAR of AAA

Answer 23

Endovascular aneurysm repair

“Stent” placed within aorta - reduces strain upon vessel wall

Question 24

Open repair of AAA

Answer 24

Clamp aorta + bypass

Question 25

AAA rupture presentation

Answer 25

Pain (Sudden onset abdo pain, radiates to back or flanks)

Collapse / shock

Cullen’s sign

Grey-Turner’s sign

Question 26

Cullen’s sign

Answer 26

bruise around umbilicus

also a sign of pancreatitis

Question 27

Grey-turners sign

Answer 27

bruise across flanks

also a sign of pancreatitis

Question 28

Management of AAA rupture

Answer 28

O2 Fluids (keep SBP<100)

Cross-match 10 u

Major haemorrhage protocol

Analgesia

Cef + Met

Surgery

Question 29

Congenital causes of anaeurysm

Answer 29

AD polycistic kidneys -> Berry aneurysm

Marfans

Ehler-Danlos syndrome

Question 30

Dissection definition

Answer 30

Dilatation by blood forming a lumen within the separated vessel wall

Question 31

Different types of aortic dissection

Answer 31

Type A 70%

Type B 30%

Question 32

Type A aortic dissection

Answer 32

if it includes ascending aorta

Question 33

Type B aortic dissection

Answer 33

Any dissection excluding ascending aortic

Question 34

Mx of type A dissection

Answer 34

consider urgent surgery

Question 35

Mx of type B

Answer 35

may be managed medically, case dependent

Question 36

Emergency mx of dissection

Answer 36

Xmatch 10u

CXR/ echo TOE

Keep BP below 100, labetolol/esmolol/CCB