Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Systems: Cardiovascualar AB > Aneurysms and Carotid Surgery- Presentation, Investigation and Therapy > Flashcards

Aneurysms and Carotid Surgery- Presentation, Investigation and Therapy Flashcards

1
Q

What is aneurysm disease?

A

Dilatation of all layers of the aorta leading to an increase in diameter >50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the size of an abdominal aortic aneurysm?

A

> 3cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where are the most common sites of aneurysms?

A
  • Infrarenal

- Aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the causes of aneurysm disease?

A
  • Degenerative disease
  • Connective tissue disease
  • Infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Give an example of a connective tissue disease that can lead to aneurysm disease?

A

Marfan’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the risk factors for degenerative AAA disease?

A
  • Male
  • Age
  • Smoking
  • Hypertension
  • Family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How can aneurysms present?

A
  • Asymptomatic
  • Through AAA screeing
  • Symptomatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the criteria or screening programmes?

A
  • Definable disease
  • Prevalence
  • Severity of disease
  • Natural history
  • Reliable detection confers advantage
  • Treatment options available
  • Cost
  • Feasibility
  • Acceptability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 4 outcomes after screening?

A
  1. Normal aorta= discharges
  2. Small AAA (3-4.4cm)= invited for annual USS scans
  3. Medium AAA(4.5-5.5cm)= invited for 3 monthly USS scans
  4. Large AAA(>5.5cm)= sent to the nearest vascular surgeon for work up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When will an AAA present?

A
  • Impending rupture

- Rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the symptoms of impending rupture?

A
  • Increasing back pain

- Tender AAA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the symptoms of a ruptured AAA?

A
  • Abdo/back/flank pain
  • Painful pulsatile mass
  • Haemodynamic instability
  • Hypoperfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are unusual presentations of AAA?

A
  • Distal embolization
  • Aortocaval fistula
  • Aortoenteric fistula
  • Uretic occlusion
  • Duodenal obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 3 questions to think about when it comes to management of asymptomatic patients?

A
  • Is the aneurysm a size to consider repair?
  • Is the patient a candidate for repair?
  • Is the aneurysm suitable for endovascular or open repair?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does risk of rupture vary with aneurysm size?

A

As the size of aneurysm increases so does the risk or rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is patient fitness assessed?

A
  • Full history and eamination
  • Bloods
  • ECG
  • ECHO
  • PFTs
  • Myocardial perfusion tests
  • CPEX
  • End of bed test
  • Patient preference
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What 2 imaging techniques can be used in the investigation of AAA?

A
  • Ultrasound

- CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the advantages of CT?

A
  • Quick
  • Not operator dependent
  • Necessary for surgical planning as it provides detailed anatomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the disadvantages of CT?

A
  • Contrast

- Radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the advantages of ultrasound?

A
  • No radiation
  • NO contrast
  • Cheap
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the disadvantages of ultrasound?

A
  • Operator dependent

- Inadequate for surgical planning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the 3 options for treatment/ management?

A
  • Conservative
  • Endovascular repair
  • Open repair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why may a conservative approach be used?

A
  • Patient/ aneurysm not fir for repair

- Patients wishes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What must be planned if a conservative approach is taken?

A

Event of rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the general complications in open repair?

A
  • Wound infection/ dehiscence
  • Bleeding
  • Pain
  • Scar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the technical complications in open repair?

A
  • Damage to bowel, ureters, veins, nerves
  • Incisional hernia
  • Graft infection
  • Distal emboli
  • Renal failure
  • Colonic ischaemia
27
Q

What are the patient factor complications in open surgery?

A
  • DVT/PE
  • MI
  • Stroke
  • Death
28
Q

What are the general complications in endovascular repair?

A
  • Wound infection
  • Bleeding/ haematoma
  • Pain
  • Scar
  • Reaction to contrast/ kidney injury
  • Radiation
29
Q

What are the technical complications in endovascular repair?

A

-Endoleak
-Femoral artery dissection/ pseudo aneurysm
-Rupture
-Distal emboli/ ischaemia/ colonic ischaemia
Damage to femoral vein/ nerve

30
Q

What are the patient factor complications in endovascular repair?

A
  • DVT/ PE
  • MI
  • Stroke
  • Death
31
Q

What is endoleak?

A

When the is blood leaking into the aneurysm sac

32
Q

What are the types of endoleak?

A
  • Type I: from above or below the graft
  • Type II: from a branch
  • Type III: at the graft joint
  • Type IV: through the graft
  • Type V: unknown origin
33
Q

What management should a symptomatic patient receive?

A
  • ABCDE
  • History, check records
  • Examination
  • CT
34
Q

How should an emergency open repair be carried out?

A
  • Straight to theatre
  • Massive transfusion protocol
  • Prep abdomen, rapid anaesthetic
  • Laparotomy xiphisternum to pubic symphysis
  • Occlude the aorta proximally
35
Q

What needs to be considered before emergency EVAR?

A
  • Anatomical suitability

- Logistics

36
Q

How do you examine a patient for and AAA?

A
  • Use 2 hands either side to check if there is a pulsatile expanding mass
  • Check above umbilicus
37
Q

What is atherosclerosis of the carotid arteries associated with?

A
  • Ischaemic attacks

- Ischaemic strokes

38
Q

Who manages the symptoms of strokes?

A

Stroke teams

39
Q

Who is involved in the management of carotid disease to prevent further events?

A

-Vascular surgeons

40
Q

TIA

A

Focal CNS disturbance caused by vascular events such as microemboli and occlusion, leading to cerebral ischaemia. Symptoms last less than 24 hrs and there are no permanent neurological sequelae

41
Q

Stroke

A

Clinical syndrome consisting od rapidly developing clinical signs of focal or global disturbance of cerebral function, lasting more than 24 hrs or leading to death, with no apparent cause other than that vascular origin

42
Q

What are the 3 main cause of stroke/TIA?

A
  • Cerebral infarction
  • Primary intracerebral haemorrhage
  • Subarachnoid haemorrhage
43
Q

What can cause a cerebral infarction?

A
  • AF
  • Carotid atherosclerosis plaque rupture/ thrombus
  • Endocarditis
  • MI
  • Carotid artery trauma/ dissection
  • Drug abuse
  • Haematological disorder
44
Q

What are the 3 components of Virchow’s triad?

A
  • Coaguability
  • Flow
  • Vessel wall
45
Q

What are the risk factor for carotid artery atherosclerosis?

A
  • Smoking
  • Diabetes
  • Family history
  • Male
  • Hypertension
  • Hyperlipidaemia/ hypercholesterolemia
  • Obesity
  • Age
46
Q

How is a diagnosis of carotid artery disease made?

A
  • History
  • Examination
  • CT
  • Carotid ultrasound
47
Q

What is involved in examination for carotid artery disease?

A
  • Neurological
  • Cardiac
  • Auscultate carotids
48
Q

What is involved in the neurological examination for carotid artery disease?

A

Contralateral:

  • Paralysis
  • Paresis
  • Visuopatial neglect
  • Dysphasia

Ipsilateral:
-Amaurosis fugax symptoms

49
Q

What happens to the velocity as the radius of a vessel decreases?

A

Increases

50
Q

How can velocity indicate degree of stenosis?

A
  • <125cm/s: <50% stenosis
  • > 125cm/s: 50-69% stenosis
  • > 270cm/s: 70-79% stenosis
  • End diastolic velocity> 140cm/s: 80-99% stenosis
51
Q

What best medical therapy management is there for carotid artery disease?

A

-Smoking cessation
-Control of hypertension
-Antiplatelet
-Statin
Diabetic control

52
Q

How does the brain remain perfused on both side/

A

Circle of Willis

53
Q

Where does risk of further stroke arise from?

A

Emboli being showered from high velocity flow in a diseased carotid artery, causing distal ischaemia

54
Q

When is there no risk of emboli?

A

No flow

55
Q

What may prevent stroke if you have a severely narrowed carotid artery?

A

Carotid endarterectomy

56
Q

What are the branches of the external carotid artery?

A
  • Posterior auricular
  • Occipital
  • Facial
  • Lingual
  • Ascending pharyngeal
  • Superior thyroid
57
Q

What complications may there be form endarterectomy?

A
  • Wound infection
  • Bleeding
  • Scar
  • Anaesthetic risks
  • Nerve damage
  • Perioperative stroke
58
Q

What nerves may damaged during endarterectomy?

A
  • Glossopharyngeal nerve
  • Hypoglossal nerve
  • Vagus nerve
59
Q

What may cause a perioperative stroke?

A
  • Plaque rupture
  • Hypoperfusion
  • Virchow’s triad
60
Q

Who should be treated for carotid artery disease according to current guidelines?

A

Asymptomatic patients with 60-99% stenosis who are under 75 yrs old

61
Q

Why is there a clear benefit for treatment in women with a higher grade stenosis?

A

-There is a higher operative risk in women and a more rapid reduction in the risk of stroke recurrence on medical therapy in women

62
Q

Who requires BMT?

A

All patients

63
Q

When should surgery be considered for men with carotid artery disease?

A

50-69% stenosis

Systems: Cardiovascualar AB (42 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions