Aneurysms Flashcards
Risk factors for carotid artery stenosis
Smoking Diabetes Family history Male Hypertension Hyperlipidaemia/Hypercholestermia Obesity Age
Management of TIA
Smoking cessation Control of hypertension Antiplatlet (e.g. aspirin/clopidogrel) Statin Diabetic control Carotid Doppler Carotid enderectomy Stenting
Causes of aneurysm disease
Degenerative disease
Connective tissue disease e.g Marfans
Infection (mycotic aneurysm)
Risk factors for degenerative AAA disease
Male Age Smoking Hypertension Family history (prevalence of 30% in 1st degree male relatives)
Presentation of AAA
Can be asymptomatic on clinical examination (e.g. abdominal pain)
On examination, two hands on either side of the abdomen to feel for the aorta. An aneurysm will expand the hands outwards and move them up and down.
Symptomatic AAA = impeding rupture!
- Increasing back pain
- Tender AAA
- Subtle signs of inflammation on CT
Ruptured AAA:
- Abdominal/back (flank) pain
- Painful pulsatile mass
- Haemodynamic instability
- Hypoperfusion (peripherally shut down e.g. getting cold)
Outcomes of AAA screening
Normal aorta; discharged Small AAA (3-4.4cm) will be invited for annual USS scans Medium AAA (4.5-5.5cm) will be invited for 3 monthly USS scans Large AAA (>5.5cm) sent to nearest vascular unit for further work up
Criteria for any disease screening
Definable disease Prevalence Severity Natural history Reliable detection Early detection confers advantage Treatment options available Cost (effective) Feasibility Acceptability
Patient fitness for treatment
Full history and examination Bloods ECG ECHO PFTs MP CPEX End of bed test Patient preference
Assessment of AAA - imaging:
USS
CTA/MRA: contrast scans
Treatment of AAA
Conservative - Patient/aneurysm not fit for repair - Consider event of rupture Endovascular repair Open repair
