Aneurysms and Carotid Artery Surgery Flashcards
What is an aneurysm?
Dilatation of all layers of the aorta, leading to an increase in diameter of >50%
In abdominal, this equates to >3cm
What are the causes and risk factors for an aneurysm?
Degenerative diseases
Connective tissue disease e.g. Marfan’s
Infection
Risk factors
- Male
- Age
- Smoking
- Hypertension
- FH
3% prevalence
What is are the symptoms of an (unruptured) aneurysm?
Asymptomatic
Increased back pain and tender abdominal aorta? Impending rupture
After screening, what actions may be taken depending on size of AAA?
Normal? Discharged
3.0-4.4cm? Annual US
4.5-5.5cm? Monthly US
>5.5? Intervention
What are the symptoms of a ruptured aneurysm?
Abdominal/back/flank pain
Painful pulsatile mass
Haemodynamic instability
Hypoperfusion
Unusual presentations:
- distal embolisation
- aortacaval fistula
- aortaenteric fistula
- ureteric occlusion
- duodenal obstruction
What investigations might be done to assess patient fitness for intervention?
Full history/exam Bloods ECG ECHO Pulmonary function tests MPS (Myofascial pain syndrome?) CPEX - cardio-pulmonary exercise testing Patient preference
How is an AAA assessed using imaging? Pros and cons of each?
USS
- no radiation
- no contrast
- cheap
- operator dependent
- inadequate for surgical planning
CTA/MRA
- quick
- not operator dependent
- necessary for surgical planning (detailed anatomy)
- contrast/radiation
What treatments are used in aneurysms? What are some complications common to both? What are some complications specific to each?
Endovascular repair
Open repair
Wound infection Bleeding Pain Scar DVT/PE MI Stroke Colonic ischaemia Distal emboli
Endovascular?
- femoral artery dissection
- rupture
- contrast reaction
- damage to femoral vein/nerve
Open?
- damage to bowel
- graft infection
- incisional hernia
- renal failure
What are the differences in outcomes in aneurysm interventions?
Open vs EVAR
- 3x reduction in mortality with EVAR
- QOL improvements lost with increased reintervention for EVAR
- no difference in overall mortality
What is carotid disease?
Atherosclerosis of the the carotid arteries
Associated with transient ischaemic attacks and ischaemic stroke
What is the difference between a TIA and a stroke?
TIA
- focal CNS disturbances caused by vascular events leading to cerebral ischaemia. Symptoms last less than 24 hours and there are no permanent sequelae
Stroke
- clinical syndrome consisting of rapidly devolving clinical signs of focal or global disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.
What are the causes of TIA/Stroke?
Cerebral infarction (84%)
- AF
- carotid atherosclerotic plaque rupture/thrombus
- endocarditis
- MI
- carotid artery trauma/dissection
- drug abuse
- haematological disorder e.g. sickle cell
Primary intracerebral haemorrhage (10%) Subarachnoid haemorrhage (6%)
What are the risk factors for carotid artery atherosclerosis?
Smoking Diabetes Family history Male sex Previous DVT Hypertension Hyperlipidaemia Obesity Age
How is carotid disease/TIA/stroke diagnosed?
History/Exam
Neurological examination
- paralysis, paresis, visuospatial neglect, dysphasa, ipsilateral amaursis fugax
- cardiac issues
- auscultate carotids
CT
Carotid US
What management might be used in carotid disease?
Antiplatelet Statin Control of hypertension Diabetic control Smoking cessation All = Best medical therapy - given to all patients
Endarterectomy
Stent
