Aneurysms and Carotis Artery Surgery

Question 1

What is aneurysm disease?

Answer 1

Dilatation of all layers of the aorta, leading to an increase in diameter of more than 50%

Question 2

How large is the diameter of an abnormal aorta?

Answer 2

Larger than 3cm

Question 3

What are the possible causes of aneurysm disease?

Answer 3

Degenerative disease
Connective tissue disease
Infection

Question 4

Give an example of a connective tissue disease

Answer 4

Marfan’s disease

Question 5

What is an aneurysm caused by infection called?

Answer 5

Mycotic aneurysm

Question 6

What are the risk factors for degenerative abdominal aortic aneurysm disease?

Answer 6

Male sex 
Age 
Smoking 
Hypertension 
Family history

Question 7

What preventative method is in place for AAA disease?

Answer 7

Ultrasound screening of men aged 65 and over

Question 8

What are the 4 possible outcomes of screening?

Answer 8

1. Normal aorta, discharged
2. Small AAA, will be invited for annual USS scan
3. Medium AAA, will be invited for 3 monthly USS scans
4. Large AAA

Question 9

What is the size of a small AAA?

Answer 9

3 - 4.4cm

Question 10

What is the size of a medium AAA?

Answer 10

4.5 - 5.5cm

Question 11

What is the size of a large AAA?

Answer 11

5.5cm or larger

Question 12

What are the symptoms of an impending rupture of an AAA?

Answer 12

Increasing back pain

Tender AAA

Question 13

What are the symptoms of a ruptured AAA?

Answer 13

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

Question 14

What are the unusual presentation of an AAA?

Answer 14

Distal embolisation 
Aortocaval fistula 
Aortoenteric fistula 
Ureteric occlusion 
Duodenal obstruction

Question 15

What is the management of an AAA when asymptomatic?

Answer 15

If the aneurysm is the right size and the patient is able then either endovascular or open repair will be done

Question 16

At what size of AAA does surgery confer any benefits?

Answer 16

> 5.5cm

Question 17

What imaging is required for surgical planning?

Answer 17

CTA/MRA

Question 18

What is the treatment of an AAA?

Answer 18

Endovascular repair

Open repair

Question 19

What complications can come of open repair?

Answer 19

Wound infection
Bleeding 
Pain 
Scar 
Damage to bowel,ureters, veins, nerves 
Incisional hernia 
Graft infection 
Distal emboli 
Renal failure 
Colonic ischaemia 
MI 
Stroke 
Death 
DVT
Pulmonary embolism

Question 20

What complications can come from endovascular repair?

Answer 20

Wound infection 
Bleeding 
Pain 
Scar 
Radiation 
Kidney injury 
Endoleak 
Femoral artery dissection 
Rupture 
Distal emboli 
Damage to femoral vein/nerve 
DVT 
Pulmonary embolism 
MI 
Stroke 
Death

Question 21

What is the morbidity rate of emergency open repair?

Answer 21

30-50% morbidity

Question 22

What can atherosclerosis of the carrots arteries cause?

Answer 22

Ischaemic attacks and ischaemic strokes

Question 23

What is a transient ischaemic attack?

Answer 23

CNS disturbance caused by microemboli and occlusion leading to cerebral ischaemia

Question 24

What are the consequences of TIA?

Answer 24

Symptoms less than 24 hours and no permanent neurological sequelae

Question 25

What is a stroke?

Answer 25

Focal or global disturbance of cerebral function because of vascular problems

Question 26

What are the consequences of a stroke?

Answer 26

Lasts more the 24 hours or leads to death

Question 27

What are the causes of stroke?

Answer 27

Cerebral infarction Primary intracerebral haemorrhage Subarachnoid haemorrhage

Question 28

What can cause a cerebral infarction?

Answer 28

``` AF Carotid atherosclerotic plaque rupture Endocarditis MI Carotis artery trauma Drug abuse Haematological disorder ```

Question 29

What are the risk factors for carotid artery atherosclerosis?

Answer 29

``` Smoking Diabetes Family history Male sex Hypertension Hyperlipidaemia Hypercholesterolaemia Obesity Age ```

Question 30

What are the neurological symptoms of carotid disease?

Answer 30

``` Paralysis Paresis Visuospatial neglect Dysphasia Ipsilateral amaurosis fugax ```

Question 31

What should be done during diagnosis of carotid disease?

Answer 31

History Examination CT Carotid USS

Question 32

What should be done during examination for carotid disease?

Answer 32

Neurological examination Cardiac examination Auscultate carotids

Question 33

What is the best medical therapy for carotid disease?

Answer 33

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

Question 34

When is a carotid endarterectomy used?

Answer 34

When there are severely narrowed carotid arteries

Question 35

What is a carotid endarterectomy?

Answer 35

When the carotid artery is opened and plaque is removed

Question 36

What are the possible complications of a carotid endarterectomy?

Answer 36

``` Wound infection Bleeding Scar Anaesthetic risks Nerve damage Preoperative stroke ```

Question 37

What can preoperative stroke after a carotid endarterectomy be caused by?

Answer 37

Plaque rupture Hypoperfusion Virchow's triad