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CVS Pathology > Aneurysms > Flashcards

Aneurysms Flashcards

1
Q

What is atherosclerosis of the carotid arteries associated with?

A

TIA and ischaemic stroke

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2
Q

Causes of stroke

A 
Cerebral infarction (84%)
- AF
- Carotid atherosclerotic plaque rupture/thrombosis
- Endocarditis
- MI
- Carotid artery trauma/dissection 
- Drug abuse
- Haematological disorder e.g. sickle cell 
Primary Intracerebral haemorrhage (10%)
SAH (6%)
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3
Q

What does SAH stand for?

A

Subarachnoid haemorrhage

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4
Q

Risk factors for carotid artery stenosis

A 
Smoking
DM
FH
Male
HTN
Hyperlipidaemia/Hypercholesteraemia 
Obesity
Age
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5
Q

What is Poiseuilles Law in terms of a vessel?

A

As the radius of the vessel decreases (stenosis), velocity increases

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6
Q

Investigations for carotid artery stenosis / stroke

A 
Neurological examination 
Cardiac exam 
Auscultate carotids
CT
Carotid USS
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7
Q

Treatment of TIA / Stroke

A 
Smoking cessation 
Control of HTN
Antiplatelet (aspirin / clopidogrel)
Statin 
Diabetic control 
Carotid doppler
Carotid endarterectomy 
Stenting
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8
Q

If one of the carotid arteries are occluded, how is the brain still perfused?

A

Due to the circle of willis

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9
Q

What can an diseased carotid artery further increase the risk of and why?

A

Stroke / TIA - emboli could be showered from high velocity flow in a diseased carotid artery, causing distal ischaemia

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10
Q

Should patients with asymptomatic carotid stenosis be treated?

A

If high grade stenosis (60-99%)

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11
Q

What is an aortic aneurysm disease?

A

Dilation of all layers of the aorta, leading to an increase in diameter of > 50% (abdominal aorta >3cm)

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12
Q

Causes of aneurysm disease

A

Degenerative disease
Connective tissue disease (e.g. marfans)
Infection (mycotic aneurysm)

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13
Q

Is a mycotic aneurysm common?

A

No

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14
Q

Risk factors for degenerative AAA

A 
Male
Age
Smoking
HTN
FH
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15
Q

Prevalence of AAA in 1st degree male relatives

A

30%

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16
Q

What is protective in AAA?

A

Diabetes

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17
Q

Presentation of AAA

A 
Asymptomatic 
Aneurysm pulsating 
Increasing back pain 
Tender abdomen around aorta 
Abdo / back / flank pain 
Painful pulsatile mass 
Haemodynamic instability (single or progressive)
Hypoperfusion
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18
Q

What does a symptomatic AAA indicate?

A

Impending rupture

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19
Q

Unusual presentations of AAA

A 
Distal embolization 
Aortocaval fistula 
Aortoenteric fistula
Ureteric occlusion 
Duodenal obstruction
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20
Q

What is an aortocaval fistula?

A

Aortic blood going back into the venous system without perfusing the limbs

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21
Q

What is an aortoenteric fistula?

A

Connection between aorta and intestines, stomach or oesophagus, there can be significant loss of blood into the intestines

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22
Q

Who gets abdominal aortic aneurysm screening?

A

Men > 65 y/o in England

23
Q

Criteria for disease screening

A 
Definable disease
Prevalence
Severity of disease
Natural history 
Reliable detection 
Early detection confers advantage 
Treatment available
Cost effective 
Feasibility
Acceptability
24
Q

What would be done in screening if the aorta is found to be normal?

A

Discharged

25
Q

How big is a small AAA, and if found in screening, what would be done?

A

3.0 - 4.4cm

Annual USS scans

26
Q

How big is a medium AAA, and if found in screening, what would be done?

A

4.5 - 5.5cm

3 monthly USS scans

27
Q

How big is a large AAA, and what would be done if found during screening?

A

> 5.5cm

Send to nearest vascular unit for further work up

28
Q

Risk of rupture for aneurysm < 4cm

A

<0.5% per year

29
Q

Risk of rupture for aneurysm 5 - 5.9cm

A

3 - 15% per year

30
Q

Risk of rupture for aneurysm 7 - 7.0cm

A

20 - 40% per year

31
Q

Risk of rupture of aneurysm > 8cm

A

30 - 50%

32
Q

What must be determined before repair of an aneurysm?

A

Is it a size to consider to repair?
Is the patient a candidate for repair?
Is the aneurysm suitable for endovascular or open repair?

33
Q

What size of aneurysms can sit comfortably with frequent surveillance?

A

< 5.5cm small aneurysms

34
Q

In the UK, at what size is treatment usually offered for aneurysms?

A

> 5.5cm

35
Q

How to determine the patients fitness for repair

A 
History and exam 
Bloods
ECG
ECHO
PFTs
MPS
CPEX
EOB assessment 
Patient preference
36
Q

What does MPS stand for?

A

Myocardial perfusion scans

37
Q

What does CPEX stand for?

A

Cardiopulmonary exercise test

38
Q

Investigations of AAA

A

USS

CTA/MRA (contrast scans)

39
Q

Treatment of asymptomatic AAA

A 
Conservative
- not fit for repair
- consider in event of rupture
Endovascular repair
Open repair
40
Q

How does open repair of AAA work?

A

Sew in a tube so blood will flow down the tube instead of the aneurysm sac

41
Q

Complications of open repair of AAA

A 
Wound infection, bleeding, pain, scar
Damage to bowel, uterus, veins, berves 
Distal emboli
Renal failure
Colonic ischaemia 
DVT/ PE / MI / Stroke
Death
42
Q

How does an endovascular repair of AAA work?

A

Femoral arteries in groin used
Catheter with graft - unzip graft and so pings open in the aneurysm sac
Only leaves small scar at groin

43
Q

Complications endovascular vs open repair

A

Endovascular much less

44
Q

Complications of endovascular repair of AAA

A 
Wound infection / Bleeding / Pain / Scar
Contrast reaction / kidney injury 
Radiation 
Endoleak 
Femoral artery dissection 
Damage to femoral vein / nerve 
Distal emboli 
DVT / PE / MI / Stroke / Death
45
Q

What is an endoleak?

A

When despite the graft, blood is still leaking into the sac

46
Q

Treatment of symptomatic AAA

A

ABCDE
Support circulation
Emergency open repair
Emergency EVAR

47
Q

Why should the patient be kept awake while preparing the abdomen in symptomatic AAA?

A

The muscles in the abdomen are keeping the bleeding

48
Q

Mortality of emergency open repair of symptomatic AAA

A

30 - 50%

49
Q

What does emergency EVAR have a risk of?

A

Abdominal compartment syndrome

50
Q

Branches of common carotid artery

A

Internal carotid artery

External carotid artery

51
Q

Where does the internal carotid artery go?

A

Inside brain

52
Q

Complications of carotid endarterectomy

A

Wound infection, Bleeding, Scar
Nerve damage
Perioperative stroke due to plaque rupture

53
Q

What is an indication for urgent synchronised DC cardioversion in AF?

A

Signs of HF

CVS Pathology (19 decks)

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