Aneurysms Flashcards
What is the aetiology of aneurysms?
Smoking.
Alcohol.
Hypertension.
Genetics.
Males.
How are patients selected for elective repair?
Cardiopulmonary exercise testing.
Cardiopulmonary and renal functional capacity.
Predicted survival.
Concurrent malignancy.
Hernias, stomas, open wounds, aortic morphology.
What is endovascular repair?
Femoral access to the aortic neck.
Fixation and seal.
Access vessel calcification.
What are the different types of stent?
Bare metal - self-expanding via balloon.
Covered; drug eluting; bioabsorbable.
All EVAR stents are covered modular stent (nitinol and a covering fabric).
What is open AAA repair?
Has wider applications; can deal with short necks and poor iliac anatomy.
Requires laparotomy, aortic cross clamping and usually ICU (blood loss).
What is the prevalence of open repair surgeries and EVAR?
Open repair surgeries - decreased.
EVAR - increased.
What is fenestrated EVAR?
The deployment of stents to the right radial, left radial, and superior mesenteric arteries.
A complete angiogram is done.
What is a ruptured AAA?
Measured using ERAS -
* Hb < 9
* SBP < 90
* GCS < 15
ERAS 0-1 = 30% mortality.
ERAS 2 = 50% mortality.
ERAS 3 = 80% mortality.
When treating a ruptured AAA, there is no difference in 30-day survival or cost between EVAR and open repair.
What are the different types of endoleak?
I - failure to create an adequate seal.
II - backflow of blood from aortic collaterals into the anuerysmal sac.
III - secondary to structural failure to endograft.
IV - related to graft fabric porosity.
V - high intrasac pressure following EVAR.
What is the screening for aneurysms?
5% of >60yr old males will have an aneurysm.
Diagnosis - US (easy, cheap, safe, effective).
75% of abdominal aortic aneurysms (AAA) are incidental. A large population of asymptomatic patients require surveillance.
