Aneurysm surgery Flashcards
What is aneurysm disease?
Dilation of all layers of the aorta, leading to an increase in diameter of at least 50%
How big does the aorta need to be before it is considered an aneurysm?
> 3.5cm
Where on the aorta can an abdominal aortic aneurysm take place?
95% are infrarenal
Between the branching of the left & right renal arteries and the bifurcation into the common Iliac arteries
What arteries branch off the aorta in the section in which AAA’s can be located?
Superior mesenteric artery (leaves at roughly the same level as the renal arteries)
Inferior mesenteric artery (about half way in between the renal branches & the Iliac bifurcation)
What are the 3 layers of an artery?
Tunica intima
Tunica media
Tunica externa
Where are the internal and external elastic membranes found?
Internal - Between the intima & media
External - Between the media & externa
What are the non modifiable risk factors for abdominal aortic aneurysm?
Male gender
Being old
Strong family history
CT diseases - Marfan’s, Ehlers-Danlos syndrome)
What are non-modifiable risk factors or secondary causes of AAAs?
Hypertension
Hypercholesterolaemia
Smoking
What diseases n shite can cause AAA’s?
Atherosclerosis
Infection (mycotic) - Syphilis, Ecoli, Salmonella
Trauma
Marfan’s, Ehlers-Danlos syndrome
Give an example of a connective tissue disease that would cause aneurysms
Marfan’s syndrome
what Michael Phelps has - fun fact
Give an example of an aneurysm that is associated with infection
What group of people is most likely to get this sort of infection?
Mycotic aneurysm
Caused by injection with non sterile needles - infection
Injected drug users often get mycotic aneurysms
What are the risk factors for degenerative AAA disease?
Male Elderly Smoker Hypertension Family history
Why is family history an important risk factor for degenerative AAA?
Prevalence of 30% in 1st degree male relatives
basically, if a man has a DAAA then his son has a 30% of also having a DAAA in his lifetime
How common is AAA in the UK?
3% prevalence
Aneurysms often present as asymptomatic
How are they identified?
Examination (for something else)
Identified as at risk on family tree and then found on investigation
Incidental finding on imaging (CT etc)
Screening programme for AAA
What are the 2 main criteria for the AAA screening programme?
1) Age 65 and above
2) Male
What imaging does the screening programme use?
An ultrasound scan
What are the 4 screening programmes in the uk?
Breast cancer
Cervical cancer
Bowel cancer
Aortic aneurysm
List the criteria to be considered for a screening programme to be introduced
Definable disease Prevalence Severity of the disease Natural history Reliable detection Early detection confers advantage Treatable Cost Feasibility Acceptability
For screening:
Why must the disease be definable?
Got to to know what we’re looking for
For screening:
Why is prevalence important?
The disease has got to be common enough for a screening programme to be worth doing
If some spicy disease only affects 1 in 200 million people, a multimillion pound screening programme is pointless
For screening:
Why must the disease be severe?
Screening programmes aim to stop people dying
If it’s not severe enough to kill people, then there’s no point investing money into preventing it
For screening:
Why is natural history important?
Screening programmes aim to detect the early stage of a disease, providing the disease ‘naturally’ progresses to become worse
For screening:
Why must detecting the disease early be advantageous & why must treatment options be available?
What the point in having a screening programme for something which can’t be cured once theyve found it
If spicy disease X is only detectable when it’s probably going to kill the person then screening serves no benefit to society
