Aneurysms & Carotid Artery Surgery - Presentation, Investigation & Therapy Flashcards
What is aneurysm disease?
Dilation of all layers of the aorta leading to an increase in diameter of >50% (abdominal aorta > 3.5cm)
What is dilation of all layers of the aorta leading to an increase in diameter of >50% (abdominal aorta > 3.5cm) called?
Aneurysm
What is the aetiology of aneurysm disease?
Degenerative disease
Connective tissue disease (such as Marfan’s disease)
Infection (such as mycotic aneurism)
What are some risk factors for degenerative abdominal aortic aneurism?
Male sex
Age
Smoking
Hypertension
Family history
What is the prevalence of abdominal aneurysm in the UK?
3%
What can be said about abdominal aneurysm always presenting with symptoms?
It often does not have any presentations and so is asymptomatic
What is used to detect dangerous swelling of the aorta?
Abdominal aortic aneurysm screening
When are men invited to abdominal aortic aneurysm screening?
When they turn 65
What is the criteria for screening to be used in general?
Definable disease
Prevalance
Severity of disease
Natural history
Reliable detection
Early detection confers advantage
Treatment options are available
Cost
Feasibility
Acceptability
What are the potential outcomes for screening?
Normal aorta (discharged)
Small abdominal aortic aneurysm, 3-4.4cm (invited for annual ultrasound)
Medium abdominal aortic aneurysm,4.5-5.5cm (incited for 3 monthly ultrasound scan)
Large abdominal aortic aneurysm, >5.5cm
What is classified as a small abdominal aortic aneurysm?
3-4.4cm
How often do people with a small abdominal aortic aneurysm getting an ultrasound?
Once a year
What is classified as a medium abdominal aortic aneurysm?
4.5-5.5cm
How often do people with a medium abdominal aortic aneurysm get an ultrasound?
Once every 3 months
What is classified as a large abdominal aortic aneurysm?
More than 5.5cm
What is the presentation of abdominal aortic aneurysm when it is impending rupture?
Increasing backpain
Tender abdominal aorta
What is the presentation of abdominal aortic aneurysm once it has ruptured?
Abdominal/back/flank pain
Painful pulsatile mass
Haemodynamic instability
Hypoperfusion
What are some unusual presentations of abdominal aortic aneurysm?
Distal embolism
Aortocaval fistula
Aortoenteric fistula
Ureteric occlusion
Duodenal obstruction
What are questions to ask when deciding how to manage an asymptomatic patient?
Is the aneurysm a size to consider repair?
Is the patient a candidate for repair?
Is the aneurysm suitble for endovascular or open repair?
How does the risk of rupture change with aneurysm size?
It increases
What is patient fitness determined by?
Full history and examination
Bloods
ECG
ECHO
Pulmonary function tests (PFT)
Myocardial perfusion scan (MPS)
Cardiopulmonary exercise testing
End of the bad test
Patient preferance
What does ECHO stand for?
Echocardiogram
What is an echocardiogram (ECHO)?
Ultrasound used to make pctures of heart valves and chambers
What is an ultrasound used to make pctures of heart valves and chambers called?
Echocardiogram
What does PFTs stand for?
Pulmonary function tests
What are pulmonary function tests?
Non-invasive tests that show how well the lungs are working
What are non-invasive tests that show how well the lungs are working called?
Pulmonary function tests
What does MPS stand for?
Myocardial perfusion scan
What is a myocardial perfusion scan?
Uses radioactive substance to show blood flow to the heart
What uses radioactive substance to show blood flow to the heart?
Myocardial perfusion test
What does CPEX stand for?
Cardiopulmonary exercise testing
What is cardiopulmonary exercise testing?
Tests the function of the heart and lungs as a combined unit
What tests the function of the heart and lungs as a combined unit?
Cardiopulmonary exercise testing
What is used to determine if the aneurysm is suitible for endovascular or open repair?
Ultrasound
CT/MRI
What are the advantages of ultrasound?
No radiation
No contrast
Cheap
What are the disadvantages of ultrasound?
Operator dependent
Inadequate for surgical planning