Aneurysms

Question 1

Define ectasia

Answer 1

Focal dilatation of an artery

Question 2

Define aneurysm

Answer 2

Focal dilatation of an artery >1.5x the normal calibre

Question 3

Define arteriomegaly

Answer 3

DIFFUSE dilatation of an artery

Question 4

Define aneurysmosis

Answer 4

Multiple aneurysms along a normal calibre artery

Question 5

Causes of aneurysms

Answer 5

Degenerative (non-specific, fibromuscukar displasia, intimomedial mucoid degeneration)

Infective (HIV, TB, Syphylis, Salmonella)

Immunologic (SLE, RA)

Vasculitic (Takayasu, Becgets, giant cell arteritis, Kawasaki, Panarteritis nodosa)

Connective tissue disorders (Marfan’s

Trauma

Post stenotic (thoracic outlet syndrome, Coarctation)

Congenital (Tuberous sclerosis, Turner’s, Menke’s)

Question 6

Most common site for abdominal aneuryms

Answer 6

Infrarenal abdominal aotra

Question 7

Complications of aneurysms

Answer 7

Rupture (usually aortic)
Acute/chronic thrombotic occlusion (usually peripheral)
Thromboembolism
Pressure on external structures
Spontaneous fistulation

Question 8

Define true aneurysm

Answer 8

The wall of the aneurysm contains all the layers of the artery

Question 9

Define false aneurysm

Answer 9

The wall of the aneurysm contains the adventitia and compressed surrounding connective tissue only.

Question 10

How to classify aneurysms

Answer 10

Anatomical (aortic/ non-aortic)
Type (true/ false)
Shape (fusiform/ saccular)
Size (small [4-5.5cm] / large [>5.5cm])
Aetiology

Question 11

Risk factors for aneurysms

Answer 11

HPT
Smoking
Family history
Previous aneurysm
Age 
Sex (Males 5:1)
Race (white)

Question 12

Symptomatic AAA

Answer 12

Vague abdo pain
Backache
Vomiting (duodenal compression)
Constipation
Flank pain (ureteric compression)
Chronic venous disease

Question 13

Complicated AAA

Answer 13

Acute lower limb ischaemia (thrombus)
Blue toe syndrome (emboism)
Rupture
Aortoenteric fistula
Aortocaval fistula

Question 14

First line investigation to diagnose AAA

Answer 14

Abdominal duplex ultrasound

Question 15

Investigation used for treatment planning of AAA

Answer 15

CT angiogram

Question 16

In whom is screening for AAAs recommended

Answer 16

White males >65yr
Elderly with peripheral anuerysms
Documented TAAAs
Family history

Question 17

Rationale for screening

Answer 17

· The overall mortality for a ruptured AAA is ~ 90%
· Approximately 70% of patients are asymptomatic prior to rupture
· Up to 75% die before reaching
· Operative mortality ruptured AAA is ~ 50%
· Operative mortality for elective AAA repair is 50% AAA-related mortality
reduction using screening programmes

Question 18

Indications for surgical intervention in AAA

Answer 18

· All symptomatic AAAs
· All complicated AAAs
· Asymptomatic AAA > 5.5 cm in males
· Asymptomatic AAAs > 5 cm in females
· Small AAAs on surveillence with rapid enlargement ( > 1
cm after 1 year on repeat scan)
· Asymptomatic AAA with a large iliac aneurysm > 3cm
· Asymptomatic saccular AAA > 3 cm (these tend to rupture at smaller diameters)

Question 19

Management for AAA

Answer 19

Lifestyle modifications
Surveillance
Antiplatelet/lipid lowering drugs
Surgery (if indicated) [open or endovascular]

Question 20

In whom is open repair of AAA the standard of care?

Answer 20

Young
Fit
Life expectancy > 5yrs

Question 21

Classic triad of AAA presentation

Answer 21

Sudden onset severe back pain
Shock
Pulsatile abdo mass

Question 22

What scoring system is used to evaluate risk of intervention in AAA

Answer 22

Hardman risk index (1 = 20%, 2 = 70%, >3 = 100% mortality)

• Age >79
• BP 179 (190)
• Hb

Question 23

Site for aneurysms in order of prevalence

Answer 23

AAA, TAAA, TAA, Popliteal, Femoral

Rare: Subclavian, Extracrnial carotid, Mesenteric, Renal artery