Aneurysms and Carotis Artery Surgery Flashcards
What is aneurysm disease?
Dilatation of all layers of the aorta, leading to an increase in diameter of more than 50%
How large is the diameter of an abnormal aorta?
Larger than 3cm
What are the possible causes of aneurysm disease?
Degenerative disease
Connective tissue disease
Infection
Give an example of a connective tissue disease
Marfan’s disease
What is an aneurysm caused by infection called?
Mycotic aneurysm
What are the risk factors for degenerative abdominal aortic aneurysm disease?
Male sex Age Smoking Hypertension Family history
What preventative method is in place for AAA disease?
Ultrasound screening of men aged 65 and over
What are the 4 possible outcomes of screening?
- Normal aorta, discharged
- Small AAA, will be invited for annual USS scan
- Medium AAA, will be invited for 3 monthly USS scans
- Large AAA
What is the size of a small AAA?
3 - 4.4cm
What is the size of a medium AAA?
4.5 - 5.5cm
What is the size of a large AAA?
5.5cm or larger
What are the symptoms of an impending rupture of an AAA?
Increasing back pain
Tender AAA
What are the symptoms of a ruptured AAA?
Abdominal/back/flank pain
Painful pulsatile mass
Haemodynamic instability
Hypoperfusion
What are the unusual presentation of an AAA?
Distal embolisation Aortocaval fistula Aortoenteric fistula Ureteric occlusion Duodenal obstruction
What is the management of an AAA when asymptomatic?
If the aneurysm is the right size and the patient is able then either endovascular or open repair will be done
At what size of AAA does surgery confer any benefits?
> 5.5cm
What imaging is required for surgical planning?
CTA/MRA
What is the treatment of an AAA?
Endovascular repair
Open repair
What complications can come of open repair?
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
What complications can come from endovascular repair?
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
What is the morbidity rate of emergency open repair?
30-50% morbidity
What can atherosclerosis of the carrots arteries cause?
Ischaemic attacks and ischaemic strokes
What is a transient ischaemic attack?
CNS disturbance caused by microemboli and occlusion leading to cerebral ischaemia
What are the consequences of TIA?
Symptoms less than 24 hours and no permanent neurological sequelae
What is a stroke?
Focal or global disturbance of cerebral function because of vascular problems
What are the consequences of a stroke?
Lasts more the 24 hours or leads to death
What are the causes of stroke?
Cerebral infarction
Primary intracerebral haemorrhage
Subarachnoid haemorrhage
What can cause a cerebral infarction?
AF Carotid atherosclerotic plaque rupture Endocarditis MI Carotis artery trauma Drug abuse Haematological disorder
What are the risk factors for carotid artery atherosclerosis?
Smoking Diabetes Family history Male sex Hypertension Hyperlipidaemia Hypercholesterolaemia Obesity Age
What are the neurological symptoms of carotid disease?
Paralysis Paresis Visuospatial neglect Dysphasia Ipsilateral amaurosis fugax
What should be done during diagnosis of carotid disease?
History
Examination
CT
Carotid USS
What should be done during examination for carotid disease?
Neurological examination
Cardiac examination
Auscultate carotids
What is the best medical therapy for carotid disease?
Smoking cessation Control of hypertension Antiplatelet Statin Diabetic control
When is a carotid endarterectomy used?
When there are severely narrowed carotid arteries
What is a carotid endarterectomy?
When the carotid artery is opened and plaque is removed
What are the possible complications of a carotid endarterectomy?
Wound infection Bleeding Scar Anaesthetic risks Nerve damage Preoperative stroke
What can preoperative stroke after a carotid endarterectomy be caused by?
Plaque rupture
Hypoperfusion
Virchow’s triad
