Aneurysms - Presentation, Investigation and Therapy

Question 1

Describe the clinical presentation of arterial occlusive disease

Answer 1

a

Question 2

Describe the clinical presentation of aneurysmal disease

Answer 2

• Asymptomatic: incidental, suspected through FH
• Impending rupture: increasing back pain, tender AAA
• Rupture: PAIN, pulsatile mass, haemodynamic instability, hypoperfusion

Question 3

Discuss the strengths and weaknesses of carotid endarterectomy

Answer 3

a

Question 4

Describe the unusual clinical presentation of aneurysmal disease

Answer 4

• Distal embolisation
• Aortocaval fistula
• Aortoenteric fistula
• Ureteric occlusion
• Duodenal obstruction

Question 5

Describe the staging of AAA

Answer 5

• Small: 3.0-4.4cm
• Medium: 4.5-5.5cm
• Large: >5.5cm

Question 6

Describe the staging of AAA

Answer 6

• Small: 3.0-4.4cm, annual USS
• Medium: 4.5-5.5cm, USS every 3 months
• Large: >5.5cm, urgent referral to vascular surgeon

Question 7

Define sensitivity

Answer 7

The ability of a test to correctly diagnose someone with a disease (true positive rate).

Question 8

Define specificity

Answer 8

The ability of a test to correctly reject healthy patients without a condition (true negative rate).

Question 9

Describe the criteria for screening;

Answer 9

• Definable disease
• Prevalence
• Severity
• Reliable detection: sensitivity and specificity
• Early detection confers advantage
• Cost
• Feasibility
• Treatment options available
• Acceptability

Question 10

Discuss the strengths and weaknesses of USS

Answer 10

• No contrast
• No radiation
• Cheap
• Operator dependent
• Not suitable for surgical planning

Question 11

Discuss the strengths and weaknesses of CTA/MRA

Answer 11

• Quick
• Not operator dependent
• Necessary for surgical planning
• Contrast: renal failure
• Radiation

Question 12

Describe the complications of open repair

Answer 12

a

Question 13

Describe endoleak

Answer 13

• Complication of endovascular repair

- Some blood flow still remains in aneurysmic cavity

Question 14

Describe the outcome of the six essential Lancet studies

Answer 14

EVAR vs open repair;

1. Surgery did not confer advantage for AAA <5.5cm
2. Reduction in operative mortality and increase in QOL with EVAR, QOL lost with reintervention, no diff. in mortality
3. No diff. in mortality or QOL

CEA vc BMT;

4. No benefit from surgery if <50% stenosis, dramatic benefit with >70% stenosis
5. The more stenosis present, the higher the risk of stroke and death

CEA vs CAS;
6. risk of stroke higher in CAS, risk of MI higher in CEA

Question 15

Describe transient ischaemic attack (TIA)

Answer 15

• Focal CNS disturbance caused by micro emboli or occlusion, that lead to cerebral ischaemia
• Lasts <24 hours