Aneurysms

Question 1

What is an aneurysm?

Answer 1

Artery with a dilatation of >50% its original diameter

Question 2

What are true aneurysms and false aneurysms?

Answer 2

True: abnormal dilatations that involve all layers of the arterial wall
False: pseudo aneurysms - collection of blood in the outer layer only (adventitia) which communicates with the lumen

Question 3

Give causes of aneurysms

Answer 3

Atheroma, trauma, infection, connective tissue disorders (Marfan’s EDS) inflammatory

Question 4

Where are common sites of aneurysms?

Answer 4

Aorta (infrarenal)
Iliac
Femoral
Popliteal

Question 5

What are complications of aneurysms

Answer 5

Rupture
Thrombosis
Embolism
Fistulae
Pressure on other structures

Question 6

What are symptoms/signs of ruptures abdominal aortic aneurism?

Answer 6

Intermittent or continuous abominal pain (radiates to back, iliac fossa or groins)
Collapse
Expansile abdominal mass - expands and contracts
Shock

Question 7

What is the definition of an unruptured AAA?

Answer 7

> 3cm across

Question 8

Risk factors for AAA?

Answer 8

> 50 years

Male

Question 9

What are causes of AAA?

Answer 9

Degeneration of elastic lamiella and smooth muscle cell loss

Question 10

What are symptoms of AAA?

Answer 10

Often none, may cause abdominal/back pain, often incidental discovery on abdo exam.

Question 11

When is rupture of AAA more likely?

Answer 11

Hypertension
Smoker
Female
FHx

Question 12

When is surgery for AAA indicated?

Answer 12

Aneurysms 5.5cm or greater
Expanding at >1cm/year
Symptomatic aneurysms

Question 13

Describe emergency management of ruptured AAA

Answer 13

ECG, amylase, Hb, crossmatch
IV access 
Treat shock with O negative  if not cross matched
Prophylactic abx 
Clap aorta above leak and insert graft

Question 14

What is aortic dissection? How does it present? What can happen when it extends?

Answer 14

Blood splits the aortic media with sudden tearing chest pain ± radiation to back
As dissection extends, branches of aorta occlude sequentially leading to hemiplegia (carotid after), unequal arm pulses, and BP or acute limn ischaemia, paraplegia (LL - anterior spinal artery), anuria (renal arteries).

Aortic valve incompetence, inferior MI and cardiac arrest if dissection does proximally

Question 15

What are type A dissections and type B dissections?

Answer 15

A - involving the ascending aorta, irrespective of site of tear –> surgical management
B - not involving ascending aorta

Question 16

Describe management for dissections.

Answer 16

Crossmatch 10u blood
ECG CXR
CT or transoesophages echocardiography
ITU
Hypotensives - beta blocker/CCB

Question 17

What is the screening process for AAA?

Answer 17

All males at 65 invited for screening in UK

USS