aneurysms

Question 1

what is an aneurysm?

Answer 1

Abnormal dilatation of an artery.

>1.5 x normal size

Question 2

types of shapes in aneurysms?

Answer 2

Question 3

aetiology of aneurysm?

Answer 3

Atherosclerotic (degenerative)
Genetic factors
Congenital
Connective tissue disorders
Marfan’s
Ehler’s-Danlos
Inflammatory
Infective (Mycotic)
Mechanical

Question 4

ehler’s danlos syndrome?

Answer 4

Ehlers–Danlos syndrome (EDS) (also known as Cutis hyperelastica[1]) is a group of inherited connective tissue disorders, caused by a defect in the synthesis of collagen (Type I or III). The collagen in connective tissue helps tissues resist deformation. Collagen plays a very significant role in the skin, joints, muscles, ligaments, blood vessels and visceral organs; abnormal collagen leads to increased elasticity within these structures. Depending on the individual, the severity of the mutation can vary from mild to life-threatening. There is no cure, and treatment is supportive, including close monitoring of the digestive, excretory and particularly the cardiovascular systems. Physical therapy, bracing, and corrective surgery may help with the frequent injuries and pain that tend to develop in certain types of EDS, although extra caution and special practices are advised to prevent permanent damage.[2]
The syndrome is named after two doctors, Edvard Ehlers of Denmark, and Henri-Alexandre Danlos of France, who identified it at the turn of the 20th century.[3]

Question 5

anatomical sites of aneurysm?

Answer 5

Abdominal aorta (infrarenal)
Iliacs
Popliteal
Thoraco-abdominal
Femoral
Other

Question 6

compliations of aneurysm?

Answer 6

RUPTURE !!
Embolisation
Trash Foot
Thrombose

(Not Dissection)

Question 7

type of dissections?

Answer 7

Question 8

dissetions symptoms?

Answer 8

Asymptomatic
Visible pulsation
Pain
abdominal
lumbar
Acute ischaemia
embolisation
thrombosis

Abdominal examination
AXR / L/S spine
Ultrasound
CT
MRI

Question 9

indications for dissection surgery?

Answer 9

>5.5cm
Rapidly growing >1cm / yr
Pain
Complications
embolisation

Question 10

complications?

Answer 10

Mortality 5-10%
Cardiovascular
MI
Arrythmias
Haemorrhage
Coagulopathy
Respiratory

Renal failure
Multi-organ failure
Ischaemic colitis
Embolisation
Graft Infection

Question 11

advantages of endovascular repair (EVAR) stent?

Answer 11

No abdominal incision
Reduced respiratory complications
Shorter stay
No cross clamp
Reduced cardiovascular / renal complications
Regional anaesthesia
Reduced Blood loss

Endovascular aneurysm repair (or endovascular aortic repair) (EVAR) is a type of endovascular surgery used to treat an abdominal aortic aneurysm (AAA) or thoracic aortic aneurysm, the procedure then specifically termed TEVAR (thoracic endovascular aortic/aneurysm repair). In certain occasions, a specially designed custom-made graft device, which has holes (fenestrations) on the graft body to maintain the patency of certain important blood vessels, is used for the procedure, which is called FEVAR (fenestrated endovascular aortic/aneurysm repair).

The procedure is carried out in a sterile environment, usually a theatre, under x-ray fluoroscopic guidance. It is usually carried out by an interventional radiologist or vascular surgeon. The patient is either given a full GA (general anaestheic) or regional anaesthesia.
Vascular ‘sheaths’ are introduced into the patient’s femoral arteries, through which the guidewires, catheters and eventually, the Stent Graft is passed.

Question 12

ruptured aneurysm?

Answer 12

Assess patient
Co-morbidity
Minimal resuscitation
Imaging
Early surgery

Question 13

rutptured surgery?

Answer 13

Anaethetise in Theatre
Access if crashes
Release of abdominal tamponade
Anaesthesia in hypovolaemic patient
Don’t delay for lines
Cross clamp
Rapid infuser

Question 14

aneurysm screening?

Answer 14

65yr old Males
Ultrasound scan
Aorta >3cmsurveillance