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Cardiovascular System > Aneurysms > Flashcards

Aneurysms Flashcards

1
Q

Definition of an aneurysm

A

Dilatation of all layers of the aorta leading to an increase in diameter of over 50% (in AA the diameter will be >3.5cm)

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2
Q

Causes of aneurysm

A

Degenerative disease
Connective tissue disease eg Marfan’s
Infection (mycotic aneurysm)

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3
Q

Risk factors

A 
Male
Age 
Smoking
Hypertension
Family history (30% in 1st degree male relatives)

Prevalence of 3% in the uk

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4
Q

Presentation of AAA

A

Asymptomatic, screening is used

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5
Q

Criteria for a screening test

A 
Definable 
Prevalence 
Severity 
Natural history
Reliable detection
Early detection confers advantage
Treatment available
Cost
Feasibility
Acceptability
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6
Q

4 outcomes of AAA screening

A 
Normal 
Small AAA (3-4.4cm) annual scans
Medium AAA (4.5-5.5cm) 3 monthly scans
Large AAA (over 5.5cm)
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7
Q

Impending rupture of AAA symptoms

A

Increasing back pain and is tender

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8
Q

Symptoms of AAA rupture

A

Abdo/back/flank pain
Painful pulsatile mass
Haemodynamic instability
Hypoperfusion

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9
Q

Unusual presentation of ruptured AAA

A 
Distal embolism
Aorticaval fissure
Aortoenteric fistula
Ureteric occlusion 
Duodenal obstruction
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10
Q

UK small aneurysm trial Lancet

A

Surgical repair of 4-5.5cm aneurysms doesn’t confer any benefit

With surgery 30day mortality is 5.8%
Risk of rupture is 1% per year

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11
Q

Patient fitness for surgery criteria

A 
Full history and examination
Bloods
ECG 
ECGI
PFTs
MPS
CPEX
End of bed test
Patient preference
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12
Q

Different advantages of USS Vs CTA/MRA

A

USS- no radiation or contrast and is cheap but operator dependant and can’t plan surgery

CTA/MRA- quick, not operator dependant, needed for surgery planning (detail) but uses contrast and radiation

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13
Q

Treatment

A

Conservative (not fit) and consider event of rupture

Endovascular repair

Open repair

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14
Q

Complications of open repair

A

There are many
Eg wound infect etc
Damage to bowels and ureters veins and nerves hernias embolus

DVT/PE
MI
Stroke
Death

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15
Q

Complications of endovascular repair

A

Same as open but endoleak, femoral dissection, ischaemia etc

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16
Q

Types of endoleak

A

type I: leak at graft ends (inadequate seal) - most common after repair of thoracic aortic aneurysms 4

type II: sac filling via branch vessel (e.g. lumbar or inferior mesenteric artery)
most common after repair of abdominal aortic aneurysms 4 (80%)
sometimes referred to as a “retroleak”
most spontaneously resolve and require no treatment

type III: leak through a defect in graft fabric (mechanical failure of graft)

type IV: a generally porous graft (intentional design of graft)

type V: endotension

17
Q

EVAR study 1 and 2

A

1 sees 3fold reduction in operative mortality for EVAR and improved qol but no difference in overall mortality for open surgery

2 was against no intervention if unfit for open surgery
No difference in mortality, 9% opmort and 9% rupture rate per year

18
Q

Emergency open repair

A 
Straight to theatre
Massive transfusion protocol
Rapid anaesthetic
Laparotomy xiphisternum to public symphysis
Occlude aorta proximally
30-50% mortality
19
Q

Emergency EVAR

A

Only if anatomical suitability
Local anaesthetic
For rupture no difference in mortality from open surgery

20
Q

Carotid disease

A

Atherosclerosis is associated with ischaemic stroke and Tia

Vascular surgeons involved to manage for prevention

21
Q

Virchow’s triad

A

Flow
Vessel wall
Coaguability

22
Q

Diagnosis of carotid artery atherosclerosis stroke or tia

A

Normal stroke exam

Plus auscultation and USS of carotids

23
Q

Poiseuilles law

A

As radius of a vessel decreases, velocity increases
<125cm/s <50% stenosis
>125 50-69% stenosis
>270 70-79% stenosis
End diastolic velocity >140 80-99% stenosis

24
Q

Management of carotid Artery disease

A 
Smoking cessation
Control of hypertension
Antiplatelets
Statins 
diabetic control
25
Q

Carotid endarterectomy

A

Incision
plaque removed
Artery closed

May prevent stroke

26
Q

Complications of carotid endarterectomy

A

Wound infection, scar etc

Nerve damage (vagus and hypoglossal)

Perioperative stroke from plaque rupture, hypoperfusion

27
Q

When is stenting or endarterectomy used instead of best medical treatment

A

Over 50-70% (nascet-ECST) stenosis

28
Q

Management of asymptomatic patients

A

CEA more benefits in males or bilateral disease

Asymptomatic should only be operated on by operators with good risks and for stenosis of 60-89% in under 75s

Cardiovascular System (33 decks)

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