Aneurysms and carotid artery surgery-Presentation investigation and therapy Flashcards
What is aneurysm disease of aorta?
- Dilation of all layers of aorta
- increase diameter of >50%
- Abdominal aorta >3cm
What is the causes of aneurysm disease?
- Degenerative disease
- Connective tissue (Marfans)
- Infection (mycotic aneurysm)
What are the risk factors for degenerative AAA disease?
- Male
- Age
- Smoking
- Hypertension
- Family history
When are men invited for AAA screening in the uk?
65
What are the outcomes of screening?
- A) Normal aorta, discharged
- B)Small AAA
- C) Medium AAA
- D)Large AAA
What is the size of a small AAA?
(3.0-4.4 cm) - annunal scans
What is the size of a medium AAA?
(4.5-5.5cm) monthly scans
What is the large AAA size?
5.5cm
When is AAA symptomatic?
impending rupture
Increasing back pain
What are the symptoms of AAA rupture?
- Abdo/back/flank
- Painful pulsatile mass
- Haemodynamic instability
- Hypoperfusion
What are the unusual presentations of AAA?
- Distal embolism
- Aortocaval fistula (Aotra and VC)
- Aortoenteric fistula (Aorta and oesophagus)
- Ureteric occulsion
- Duodenal obstruction
How do you measure patient fitness?
- Full history
- Bloods
- ECG
- ECHO
- PFTs
- MPS
- CPEX (Exercise test)
What does PFTs for?
Pulmonary function tests (PFTs)
What does MPS stand for?
Myofascial pain syndrome (MPS), a, is a syndrome characterized by chronic pain in multiple myofascial trigger points (“knots”) and fascial (connective tissue) constrictions. It can appear in any body part.
When is treatment conservative for AAA?
- If pateint/aneurysm not fit for repair
- Consider event of rupture
What are the general complications of an open repair?
- Wound infection
- Bleeding
- Pain
- Scar
What are the technical complications of an open repair?
- Damage to bowel, ureters,veins,nerves
- Incisional hernia
- Graft infection
- Distal embolism
- Renal failure
- Colonic ischaemia
What are the patient factors which can complicate open repair?
- DVT/PE
- MI
- Stroke
- Death
What are the general complications of an endovascular repair?
Wound infection bleeding/Haematoma Pain scar Contrast radiation
What are the technical complications of endovasculature repair?
- Endoleak
- Femoral artery dissection/pseudoaneurysm
- Rupture
- Distal emboli/ischaemia/colonic ischaemia
- Damage to femoral vein/ nerve
What are the patient factors of endovasculature repair?
- DVT/PE
- MI
- Stroke
- Death
What is type 1 endoleak?
blood flow from above or below
What is type 2 endoleak?
Blood flow from side branches
Type 3 endoleak?
Between the joint of the two stents
Type 4 endoleak?
General bleeding through stent
What is a TIA?
Transient ischaemic attack
Describe a TIA?
Focal CNS disturbance caused by vasculature events such as microemboli and occulsion leading to cerebral ischaemia?’
What is the definition of a stroke?
Clinical syndrome consisiting of rapidlt developing clinical signs of focal or global disturbance of cerebral function, lasting more than 24hrs or leading to death. with vascular origin
What are the causes of a stroke?
-AF
-Carotid atheroscelrosis
plaque rupture/thrombus
-Endocarditis
-MI
-Carotid artery trauma/dissection
-Drug abuse
-Haemaatological disorder (sickle cell)
What are the three components of Virchow`s triad?
- Coaguability
- Flow
- Vessel wall
What would you find on examination of carotid
Contralateral symptoms of paralysis/paresis/visuospatial neglect, dysphasia, and ipsilateral amaurosis fugax symptoms
What is amaurosis fugax symptoms?
Amaurosis fugax (transient monocular blindness) is a symptom of retinal ischemia just as contralateral hemiparesis and sensory loss are symptoms of cerebral ischemia
What is paresis?
a condition of muscular weakness
What is poiseuille`s law?
As radius of a vessel decreases (i.e. stenosis) velocity increases
What is the best management to prevent aneurysms or carotid atheromas?
- Smoking cessation
- Control of hypertension
- Antiplatelet
- Statin
- Diabetic control
What is carotid doppler?
Ultra sound of carotid
What are complications of carotid endarterectomy?
- Wound infection
- Bleeding
- Scar
- Anaesthetic risks
- Nerve
What can happen during the period before surgery?
Plaque rupture
Hypoperfusion
Virchows triad (raw intiamal surface and thrombus)
When is the most risky time after stroke?
Within first 2 weeks for further
When should carotid surgery by offered?
For all patients with >70% stenosis (except occluded)
