Aneurysms & Carotid Artery Surgery

Question 1

Where in the body can aneurisms occur?

Answer 1

Anywhere in the body

Question 2

What is the most common type of aneurism?

Answer 2

The infrarenal abdominal aortic aneurism

Question 3

What is an aneurism?

Answer 3

an abnormal focal dilatation of an arterial wall involving all three layers

Question 4

What is a false aneurism?

Answer 4

An aneurism that does not involve all three layers of rhe arterial wall

Question 5

What is the last normal part of the blood vessel called before an aneurism?

Answer 5

The neck of the aneurism

Question 6

Name 4 factors that can cause aneurisms

Answer 6

1. Smoking
2. Alcohol
3. Hypertension
4. Genetics

Question 7

List the 3 genetic conditions associated with aneurisms

Answer 7

• Ehlers-Danlos
• Marfans
• Pseudoxanthoma elasticum

Question 8

Which gender is more affected by aneurisms?

Answer 8

males

Question 9

What was the conclusion of the UK Small Aneurism Trial?

Answer 9

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.

Question 10

What were the outcomes of the BMJ Aneurism Screening Study?

Answer 10

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.

Question 11

What % of males over 60 will have an aneurism?

Answer 11

5%

Question 12

Which imaging technique is used to screen for aneurisms?

Answer 12

Ultrasound

Question 13

Why are females not screened for aneurisms?

Answer 13

Because aneurisms are not common among females

Question 14

Name the 2 surgical procedures that can be used to repair aneurisms

Answer 14

1. Endovascular Repair of AAA using Stenting

2. Open Repair of AAA

Question 15

What feature prevents stents from migrating away from the site of placement?

Answer 15

They contain barbs which sink into the aortic wall

Question 16

Through which artery are stents fed?

Answer 16

Femoral

Question 17

Name the 4 different types of stent

Answer 17

1. Bare metal
2. Covered
3. Drug eluting
4. Bio-absorbable

Question 18

What kind of stent is most commonly used in AAA stenting?

Answer 18

covered modular stents (nitrol with a fabric covering)

Question 19

Why might a patient not be suitable for endovascular repair?

Answer 19

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.

Question 20

Briefly explain the process of open AAA repair

Answer 20

1. Laparotomy
2. aortic cross clamping & sewing in a waterproof tube graft
3. Post operative ICU care

Question 21

What is the biggest risk associated with open AAA repair?

Answer 21

Serious blood loss

Question 22

What did the EVAR 1 trial demonstrate?

Answer 22

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

Question 23

What did the EVAR 2 trial demonstrate?

Answer 23

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.

Question 24

What happens if the aneurism is too close to the kidneys but the patient is not suitable for open surgery?

Answer 24

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

Question 25

What % of patients with a ruptured AAA will die in the community?

Answer 25

50%

Question 26

What does the Edinburgh Ruptured Aneurism Score Trail measure?

Answer 26

Mortality

Question 27

Which three physiological parameters are measured by the Edinburgh Ruptured Aneurism Score?

Answer 27

The patients are awarded one point for each of the following criteria;

1. Haemoglobin <9
2. Blood pressure <90
3. GCS<15

Question 28

State the mortality associated with an Edinburgh Ruptured Aneurism Score of 0-1, 2 & 3

Answer 28

An ERAS of 0-1 = 29% Mortality

An ERAs 2 = 50% Mortality

An ERAS of 3 = 80% Mortality

Question 29

What did the IMPROVE trial find?

Answer 29

There was found to be no difference in 30-day survival or cost between open surgery Vs Stenting in a ruptured AAA