aneurysms

Question 1

what is thee difference between true and false aneurysm ?

Answer 1

true - all 3 layers ooff the wall are involved
false - hematoma communicating with the lumen of the artery through a partial tear

Question 2

what is the clinical picture of aneurysms ?

Answer 2

most of them are discovered incidentally
pulsatile swelling
back pain
compressing the surrounding structures
complicated

Question 3

what is the most common cause of aneurysms ?

Answer 3

atherosclerosis

Question 4

what is the most serious complication of AAA ?

Answer 4

rupture

Question 5

what are the types of pseudo aneurysms ?

Answer 5

traumatic
post surgical

Question 6

what artery is associated with traumatic pseudo aneurysms ?

Answer 6

femoral artery

Question 7

how should a diagnosis of pseudo aneurysms be made ?

Answer 7

duplex

Question 8

what is the management of pseudo aneurysms ?

Answer 8

1- small and asymptomatic can be treated conservatively
2- false aneurysms larger than 2.5 cm are treated by thrombin injection under U/S
3- open surgical repair

Question 9

what risk factor is associated with rupture off the AAA ?

Answer 9

smoking

Question 10

what is the most common site of aneurysm in the aorta ?

Answer 10

infra renal

Question 11

what are the differential diagnosis of AAA rupture ?

Answer 11

pancreatitis
peritonitis
duodenal perforation
myocardial infarction

Question 12

what are the methods of screening and surveillance in AAA ?

Answer 12

ultrasonography

Question 13

what methods of investigations are used for planning in AAA ?

Answer 13

CTA and MRA

Question 14

at what age should screening start in men ?

Answer 14

above 65
above 55 if there is a positive family history

Question 15

at what age should screening start in women ?

Answer 15

above 65 if positive family history or a personal smoking history

Question 16

what are the different approaches to elective management ?

Answer 16

1- aneurysms under 5.5 without risk factors
close surveillance sing USGG or CT scan yearly
2- cessation of smoking, control of hypertension
3- doxycycline

Question 17

what are the indications of elective repair in AAA ?

Answer 17

1- symptomatic aneurysms
2- 5.5 in men 4.5 in women
3- saccular aneurysm ( due to increased risk of infection)
4- smaller in size, but associated with COPD and poorly controlled hypertension

Question 18

what are the different options for repair

Answer 18

open repair - transperitoneal approach , retroperitoneal approach

endovascular aortic repair - EVAR

Question 19

when should EVAR be used ?

Answer 19

1- older higher risk patients
2- patient with hostile abdomen
3- patient with such clinical conditions where open repair is risky

Question 20

what are thee indications for retroperitoneal repair ?

Answer 20

hostile abdomen with multiple operations
extension of aneurysm to suprarenal segment
horseshoe kidney
ascites

Question 21

what are thee complications associated with repair ?

Answer 21

renal injury
paraplegia
ischemic colitis
prosthetic graft infection
aorto enteric fistula

Question 22

what can a ruptured AAA be easily mistaken for ?

Answer 22

renal or ureteri colic

Question 23

what is the management of ruptured AAA ?

Answer 23

resuscitation and allow for permissive hypotension
urgent CTA followed by surgical intervention

Question 24

most common visceral artery aneurysm ?

Answer 24

splenic artery aneurysm

Question 25

what are the indications for treatment of splenic artery aneurysm ?

Answer 25

1- presence of symptoms
2- documented enlargement
3- diameter of greater than 2.5
4- preegnancy or anticipated pregnancy

Question 26

what must happen pre operatively for patients undergoing repair for splenic artery aneurysm ?

Answer 26

must give vaccinations as if going in for a splenectomy

Question 27

what is the most common shape associated with renal artery aneurysm ?

Answer 27

saccular

Question 28

what is the most common cause of a true renal artery aneurysm ?

Answer 28

medial fibroplasia

Question 29

what are the indications for surgery in renal artery aneurysms ?

Answer 29

difficult to control hypertension
size greater than 2 cm

Question 30

where are peripheral aneurysms usually found ?

Answer 30

in the femoral and popliteal

Question 31

what is the most common cause off peripheral aneurysms ?

Answer 31

atherosclerosis and are more common in men

Question 32

prominent popliteal pulsation ?

Answer 32

most likely an aneurysm

Question 33

what are the indications for intervention in femoral and popliteal aneurysms ?

Answer 33

surgical intervention in femoral larger than 2.5 and larger than 2 in popliteal