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Tim CP3 @ UoN - Medicine & Surgery > Aneurysms > Flashcards

Aneurysms Flashcards

1
Q

Define an aneurysm

A

A permanent and irreversible dilatation of a blood vessel >150% the expected diameter

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2
Q

How can aneurysms present?

A

Mass effects
Embolic events
Haemorrhag3e

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3
Q

What are the causes of an aneursym?

A 
Atherosclerotic (aortic, popliteal)
Developmental (berry)
Infective (mycotic, syphillitic)
Developmental (marfans)
Trauma
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4
Q

What are the common sites for arterial aneurysms?

A 
Aorta (most commonly infrarenal)
Iliac
Thoracic
Coronary
Cerebral
Femoral
Popliteal
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5
Q

What is the pathophysiology underlying a thoracic aortic dissection?

A

Blood splits aortic media

As dissection extends branches occlude sequentially, causing Sx

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6
Q

What are the main symptoms of thoracic aortic dissection?

A 
Sudden tearing chest pain (radiation to back)
Hemiplegia/Paraplegia
Unequal pulses/BP
Acute limb ischaemia
Anuria
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7
Q

What arteries are occluded, leading to the symptoms of a thoracic aortic dissection?

A 
Coronary - MI
Brachiocephalic Trunk - Hemiplegia, central neuro sx
Renal - Haematuria, anuria, AKI
SMA/IMA - Acute mesenetric ischaemia
Iliac - Acute lower limb ischaemia
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8
Q

What are the major complications of a thoracic aortic dissection?

A

External rupture - massive fatal haemorrhage
Internal rupture - blood tracks back into lumen, double channelled aorta
Cardiac tamponade

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9
Q

When can complications of a thoracic aortic dissection occur?

A

If dissection moves proximally

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10
Q

What is the mortality of a thoracic aortic dissection?

A

Acute operative mortality = 25%

75% w/i 2 weeks untreated`

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11
Q

What are the symptoms/signs of a ruptured abdominal aortic aneurysm?

A 
Intermittent/continuous epigastric pain 
-radiates to back/iliac fossae/groins
Collapse
Pulsatile, expansile abdominal mass
Shock
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12
Q

What is an Abdominal Aortic Aneurysm?

A

Dilation of abdominal aorta to >3cm

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13
Q

What is surveillance monitoring of AAA?

A 
Regular ultrasound
Small aneurysms (<5.5cm) monitored
Larger aneurysms (>5.5cm) considered for surgery
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14
Q

Why do we monitor rather than repair all AAAs?

A

No evidence for early benefit in small aneurysms where rupture risk is low

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15
Q

How regularly do we monitor AAAs?

A

Depends on diameter of aneurysm at detection
3-4cm (annually)
4.5-5.4 (3 monthly)
>5.5 (consider surgery, 3 monthly)

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16
Q

What are the risk factors for rupture?

A

HTN
Family history
Smokers
Females

17
Q

What is the emergency management of an AAA?

A

A-E resuscitation

Clamp aorta above leak and insert graft (theatre)

18
Q

What is the mortality of a rupture AAA?

A

50% die before reaching hospital

50% of those who do die in theatre

19
Q

What are the indications for surgical management of an unruptured AAA?

A

> 6cm
Expanding >1cm/yr
Symptomatic aneurysms

20
Q

How are unruptured AAAs repaired?

A

Endovascular aneurysm repair (EVAR)

-fluoroscopic surgery

21
Q

What is a major risk of EVAR?

A

CKD, contrast nephrotoxic and prolonged ischaemia due to aorta clamping during surgery

22
Q

How do popliteal aneurysms present?

A

Associated w/ other aneurysms
Asymptomatic OR:
-Acute limb ischaemia
-Distal emboli (chronic limb ischaemia, DVT)

23
Q

How should popliteal aneurysms be investigated?

A

USS

Angiography

24
Q

How should popliteal aneurysms be managed?

A

Femoral to distal popliteal bypass grafts

25
Q

Define a true aneurysm

A

All layers of arterial wall involved

26
Q

Define a false/pseudoaneurysm

A

Blood vessel damaged (trauma) and blood contained by soft tissues

27
Q

What are the causes of aortic dissection?

A

HTN
Atheroma
Congenital disease

28
Q

What are the two patterns of aortic dissection?

A 
Type A (70%) - Involve ascending aorta
Type B (30%) - Do not involve ascending aorta
29
Q

What investigations are appropriate in suspected aortic dissection?

A

CXR - Widened mediastinum
CT - Confirm dx
ECG - Patterns similar to MI

30
Q

What is the management of an aortic dissection?

A

A-E resuscitation (ITU)
BP controlled to keep SBP around 100 (IV esmolol)
Type A - Surgical grafting of aortic root (high mortality)
Type B - Medical management)

Tim CP3 @ UoN - Medicine & Surgery (136 decks)

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