Aneurysms & Carotid Artery Surgery Flashcards
Where in the body can aneurisms occur?
Anywhere in the body
What is the most common type of aneurism?
The infrarenal abdominal aortic aneurism
What is an aneurism?
an abnormal focal dilatation of an arterial wall involving all three layers
What is a false aneurism?
An aneurism that does not involve all three layers of rhe arterial wall
What is the last normal part of the blood vessel called before an aneurism?
The neck of the aneurism
Name 4 factors that can cause aneurisms
- Smoking
- Alcohol
- Hypertension
- Genetics
List the 3 genetic conditions associated with aneurisms
- Ehlers-Danlos
- Marfans
- Pseudoxanthoma elasticum
Which gender is more affected by aneurisms?
males
What was the conclusion of the UK Small Aneurism Trial?
The process of repairing an aneurism comes with a mortality risk of 5.8%. Thus, if your aneurism is small, it is safer to keep it and if your aneurism is large, it is safer to repair it.
What were the outcomes of the BMJ Aneurism Screening Study?
If an aneurism is identified and it is <5.5cm, the patient is enrolled in a surveillance programme.
If the aneurism is >5.5cm they are referred to vascular surgeons on the day and they will receive a CT angiogram to allow surgeons to visualise the aneurism.
If there is no aneurism, the patient is discharged from screening.
What % of males over 60 will have an aneurism?
5%
Which imaging technique is used to screen for aneurisms?
Ultrasound
Why are females not screened for aneurisms?
Because aneurisms are not common among females
Name the 2 surgical procedures that can be used to repair aneurisms
- Endovascular Repair of AAA using Stenting
2. Open Repair of AAA
What feature prevents stents from migrating away from the site of placement?
They contain barbs which sink into the aortic wall
Through which artery are stents fed?
Femoral
Name the 4 different types of stent
- Bare metal
- Covered
- Drug eluting
- Bio-absorbable
What kind of stent is most commonly used in AAA stenting?
covered modular stents (nitrol with a fabric covering)
Why might a patient not be suitable for endovascular repair?
Some patients may have a very short landing zone/aneurism neck (the area where the top of the stent sits) so it would not be possible to fit the stent without occluding the renal arteries. Other patients may have very calcified/narrowed iliac vessels so it would not be possible to feed the stent up.
Briefly explain the process of open AAA repair
- Laparotomy
- aortic cross clamping & sewing in a waterproof tube graft
- Post operative ICU care
What is the biggest risk associated with open AAA repair?
Serious blood loss
What did the EVAR 1 trial demonstrate?
in the short term, patients who underwent open surgery were more likely to die as a result of operative complications compared to those who underwent endovascular repair HOWEVER long term survival rates were better in the group that underwent open AAA repair compared to those who underwent endovascular repair
What did the EVAR 2 trial demonstrate?
that if someone is very old and frail and has an aneurism, there is no point in repairing the aneurism because it has no impact on mortality. While stenting may prevent them from dying as a result of a rupture aneurism, the stress of the procedure makes it more likely that they will die of other causes.
What happens if the aneurism is too close to the kidneys but the patient is not suitable for open surgery?
Fenestrated stents can be fitted over the renal arteries and this allows blood to flow into the renal arteries
or additional stents can be fitted down the side of the main stent
What % of patients with a ruptured AAA will die in the community?
50%
What does the Edinburgh Ruptured Aneurism Score Trail measure?
Mortality
Which three physiological parameters are measured by the Edinburgh Ruptured Aneurism Score?
The patients are awarded one point for each of the following criteria;
- Haemoglobin <9
- Blood pressure <90
- GCS<15
State the mortality associated with an Edinburgh Ruptured Aneurism Score of 0-1, 2 & 3
An ERAS of 0-1 = 29% Mortality
An ERAs 2 = 50% Mortality
An ERAS of 3 = 80% Mortality
What did the IMPROVE trial find?
There was found to be no difference in 30-day survival or cost between open surgery Vs Stenting in a ruptured AAA
