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cardiovascular system > Aneurysms & Carotid Artery Surgery - Presentation, Investigation & Therapy > Flashcards

Aneurysms & Carotid Artery Surgery - Presentation, Investigation & Therapy Flashcards

1
Q

What is aneurysm disease?

A

Dilation of all layers of the aorta leading to an increase in diameter of >50% (abdominal aorta > 3.5cm)

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2
Q

What is dilation of all layers of the aorta leading to an increase in diameter of >50% (abdominal aorta > 3.5cm) called?

A

Aneurysm

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3
Q

What is the aetiology of aneurysm disease?

A

Degenerative disease

Connective tissue disease (such as Marfan’s disease)

Infection (such as mycotic aneurism)

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4
Q

What are some risk factors for degenerative abdominal aortic aneurism?

A

Male sex

Age

Smoking

Hypertension

Family history

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5
Q

What is the prevalence of abdominal aneurysm in the UK?

A

3%

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6
Q

What can be said about abdominal aneurysm always presenting with symptoms?

A

It often does not have any presentations and so is asymptomatic

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7
Q

What is used to detect dangerous swelling of the aorta?

A

Abdominal aortic aneurysm screening

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8
Q

When are men invited to abdominal aortic aneurysm screening?

A

When they turn 65

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9
Q

What is the criteria for screening to be used in general?

A

Definable disease

Prevalance

Severity of disease

Natural history

Reliable detection

Early detection confers advantage

Treatment options are available

Cost

Feasibility

Acceptability

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10
Q

What are the potential outcomes for screening?

A

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

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11
Q

What is classified as a small abdominal aortic aneurysm?

A

3-4.4cm

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12
Q

How often do people with a small abdominal aortic aneurysm getting an ultrasound?

A

Once a year

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13
Q

What is classified as a medium abdominal aortic aneurysm?

A

4.5-5.5cm

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14
Q

How often do people with a medium abdominal aortic aneurysm get an ultrasound?

A

Once every 3 months

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15
Q

What is classified as a large abdominal aortic aneurysm?

A

More than 5.5cm

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16
Q

What is the presentation of abdominal aortic aneurysm when it is impending rupture?

A

Increasing backpain

Tender abdominal aorta

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17
Q

What is the presentation of abdominal aortic aneurysm once it has ruptured?

A

Abdominal/back/flank pain

Painful pulsatile mass

Haemodynamic instability

Hypoperfusion

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18
Q

What are some unusual presentations of abdominal aortic aneurysm?

A

Distal embolism

Aortocaval fistula

Aortoenteric fistula

Ureteric occlusion

Duodenal obstruction

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19
Q

What are questions to ask when deciding how to manage an asymptomatic patient?

A

Is the aneurysm a size to consider repair?

Is the patient a candidate for repair?

Is the aneurysm suitble for endovascular or open repair?

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20
Q

How does the risk of rupture change with aneurysm size?

A

It increases

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21
Q

What is patient fitness determined by?

A

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

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22
Q

What does ECHO stand for?

A

Echocardiogram

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23
Q

What is an echocardiogram (ECHO)?

A

Ultrasound used to make pctures of heart valves and chambers

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24
Q

What is an ultrasound used to make pctures of heart valves and chambers called?

A

Echocardiogram

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25
What does PFTs stand for?
Pulmonary function tests
26
What are pulmonary function tests?
Non-invasive tests that show how well the lungs are working
27
What are non-invasive tests that show how well the lungs are working called?
Pulmonary function tests
28
What does MPS stand for?
Myocardial perfusion scan
29
What is a myocardial perfusion scan?
Uses radioactive substance to show blood flow to the heart
30
What uses radioactive substance to show blood flow to the heart?
Myocardial perfusion test
31
What does CPEX stand for?
Cardiopulmonary exercise testing
32
What is cardiopulmonary exercise testing?
Tests the function of the heart and lungs as a combined unit
33
What tests the function of the heart and lungs as a combined unit?
Cardiopulmonary exercise testing
34
What is used to determine if the aneurysm is suitible for endovascular or open repair?
Ultrasound CT/MRI
35
What are the advantages of ultrasound?
No radiation No contrast Cheap
36
What are the disadvantages of ultrasound?
Operator dependent Inadequate for surgical planning
37
What are the advantages of CT/MRI?
Quick Not operator dependent Necessary for surgical planning (shows detailed anatomy)
38
What are the disadvantages of CT/MRI?
Contrast Radiation
39
What are the treatment options of abdominal aortic aneurysm?
Conservative Endovascular repair Open repair
40
What is endovascular repair?
Using a small graft guided by an X-ray
41
42
What is open repair?
Large incision and then graft inserted
43
What are some potential consequences of open repair?
Wound infection Bleeding Pain Scar Damage to veins or nerves
44
What are some potential consequences of endovascular repair?
Wound infection Bleeding Pain Scar Contrast Radiation Endoleak
45
What is endoleak?
Persistant blood flow outside of the lumen of an endoluminal graft but within the aneurysm sac, caused by an incomplete seal of the aneurysm sac
46
Compare open vs vascular repair?
3 fold reduction in operative mortality for endovascular vs open Improved quality of life initially with endovascular Quality of life improvements lost with increase reintervention and surveillance for endovascular repair No difference in overall mortality
47
What is the process of managing someone who is symptomatic?
ABCDE (first aid) History, check records Examination Maybe coronary CT angiography
48
What does CTA stand up for?
CT angiography
49
What is a CT angiography?
CT along with intravenous contrast to obtain 3D pictures of the moving heart and great vessels
50
What can occur after a CTA in an emergency?
Emergency open repair or emergency endovascular repair
51
What should be remembered about exposure to abdominal aortic aneurysm patients?
It will be as an incidental finding through screening or sympomatic
52
What is the treatment as the aneurysm gets bigger?
Always curveillance until the abdominal aorta reaches 5.5 cm, then assess the patient for surgery and decide if open repair or endovascular repair
53
What is carotid disease?
Plaque builds up in the carotid arteries
54
What is atherosclerosis of the carotid arteries associated with?
Transient ischaemic attacks and ischaemic stroke
55
Who are the symptoms of stroke managed by?
Stroke teams
56
Who is involved with the management of carotid disease other than stroke teams?
Vascular surgeons to prevent further events
57
What does TIA stand for?
Transient ischaemic attacks
58
What is a transient ischaemic attack?
Focal CNS disturbance caused by vascular events such as microemboli and occlusion, leading to cerebral ischaemia, symptoms are less than 24 hours and there is no permanent neurological damage
59
What is focal CNS disturbance caused by vascular events such as microemboli and occlusion, leading to cerebral ischaemia, symptoms are less than 24 hours and there is no permanent neurological damage called?
Transient ischaemic attack
60
61
What is a stroke?
Clinical syndrome consisting of rapidly developing clinical signs of focal or global disturbance of cerebral function, symptoms lasting more than 24 hours or leading to death, with no apparent origin other than vascular
62
What is clinical syndrome consisting of rapidly developing clinical signs of focal or global disturbance of cerebral function, symptoms lasting more than 24 hours or leading to death, with no apparent origin other than vascular called?
Stroke
63
64
What are possible causes of stroke?
Cerebral infarction (84%) Primary intracerebral haemorrhage (10%) Subarachnoid haemorrhage (6%)
65
What can cause cerebral infarction?
Atrial fibrillation Carotid atherosclerotic plaque rupture/thrombosis Endocarditis Myocardial infarction Carotid artery trauma/dissection Drug abuse Haemotological disorder
66
What are some risk factors for carotid artery atherosclerosis?
Smoking Diabetes Family history Male sex Previous deep vein thrombosis Hypertension Hyperlipidaemia/hypercholesterolaemia Obesity Age
67
Are females or males more susceptible to carotid artery atherosclerosis?
Males
68
What does the diagnosis of carotid plaque involve?
History Examination: neurological cardiac auscultate carotids Investigations CT carotid ultrasound scan
69
What investigations are used to diagnose carotid plaque?
CT Carotid ultrasound scan
70
How does the velocity of blood change as the radius of a vessel changes?
As the radius decreases the velocity increases
71
What is the velocity of blood through the carotid at \<50% stenosis?
\<125cm/s
72
What is the velocity of blood at 50-69% stenosis?
\>125 cm/s
73
What is the velocity of blood as 70-79% stenosis?
\>270cm/s
74
What is the end diastolic velocity of blood at 80-99% stenosis?
End diastolic velocity
75
What does the mangement of carotid plaques involve?
Medical therapy Carotid doppler
76
What does the medical therapy for carotid plaque involve?
Smoking cessation Control of hypertension Antiplatelet Statin Diabetic control
77
What is carotid doppler?
Imaging test that uses ultrasound to examine the carotid arteries
78
How is the brain still perfused even if the carotid arteries are blocked?
Circle of Willis
79
When the carotid arteries are blocked, what is the further risk of stroke?
Emboli being showered from high velocity causing distal ischaemia
80
What is performed if the occlusion of the carotid artery is severe enough?
Carotid endarterectomy
81
What is an endarterectomy?
Surgical procedure to removed the atheromatous plaque material, or blockage in the lining of an artery
82
What is a surgical procedure to removed the atheromatous plaque material, or blockage in the lining of an artery?
Endarterectomy
83
What are some potential complications of endarterectomy?
General (wound infection, bleeding, scar, anaesthetic risks) Nerve damage Perioperative stroke
84
What is a treatment option for carotid plaques other than endarterectomy?
Stenting
85
What is stenting?
Insertion of a small mesh tube to treat weak arteries and restored blood flow through a narrow or blocked artery
86
What is insertion of a small mesh tube to treat weak arteries and restored blood flow through a narrow or blocked artery called?
Stenting
87
What is NNT?
Number of patietns needed to treat to prevent 1 additional bad outcome
88
How does the NNT for stenting change with time?
Increases exponentially (is 5 for within 2 weeks but 125 for longer than 12 weeks)
89
What does CEA stand for?
Carotid andarterectomy
90
What is the management for asymptomatic patients with carotid plaque?
CEA should be considered when high grade stenosis CEA may be of more benefit for males patients \<70 years CEA should only be performed by operators with a low (\<3%) perioperative stroke or death rate
91
When should carotid surgery be offered to all symptomatic patients?
When stenosis is \>70%

cardiovascular system (41 decks)

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