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A- Resp and cardio > Aortic aneurysm > Flashcards

Aortic aneurysm Flashcards

1
Q

What is an aneurysm

A

Local abnormal dilatation of a blood vessel >1.5 x normal diameter

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2
Q

Common sites AA

A

Carotid artery, aortic arch, ascending aorta
Thoracic aorta
Renal artery
AAA
Femoral, politeal

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3
Q

Risk for rupture of AAA

A

Smoking (development and rupture)
HPTN
Vascular disease
COPD
Hyperlipidaemia
Diabetes
Male
Obesity
Age
FH - connective tissue disorders eg marfans, EDS

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4
Q

Presentation of AAA rupture

A

Collapse
Shock
Sudden onset abdo pain radiating to back
Loin to groin pain esp in elderly
Distal ischaemia
Palpable, tender, pulsatile and expansile AAA
V high mortality

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5
Q

Immediate management of AAA rupture

A

A-E resus
Lower BP target - stop further blood loss
Early decision -> theatre
Palleative i cant operate

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6
Q

When do you get screening for abdominal aneurysm

A

65 years old male

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7
Q

What is the normal size for the abdominal aorta

A

<3cm diameter

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8
Q

What management when AA 3-4.4cm

A

Annual re scans

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9
Q

What management when AA 4.5-5.4cm

A

3 monthly rescans

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10
Q

What management when AA >5.5cm

A

Refer to vascular surgery

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11
Q

When does risk of rupture per year start increasing

A

> 5cm - 1-10%
7cm =30-50%

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12
Q

Indications for surgical repair of AA

A

aneurysm >5.5cm
Rapid expansion >0.5cm <6 months
Evidence of AAA tenderness
Rupture

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13
Q

Types of surgery for AA

A

CT angiography (evaluate pre-op)
Endovascular AA repair - EVAR
Open repair

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14
Q

Surgical EVAR vs ooen benefits

A

EVAR - minimally invasive, faster recovery, reduced mortality
Open repair - better long term outcomes, 5% mortality
Emergency repair - 50% mortality

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15
Q

Complications of AAA

A

Rupture
Occlusion
Distal embolism

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16
Q

Men vs women AAA

A

75% AAA patients are male and screening only for me
Risk of rupture for women much higher with much maller aneurysms

17
Q

What is the greatest risk for AAA

A

Smoking

18
Q

Screening test for AAA

A

US abdomen

19
Q

Gold standard imaging for AAA

A

CT angiogram

20
Q

Blood tests for ruptured AAA

A

FBC - ascertian if low platelet count and need transfusion for surgery
U+Es - endovascular - pre renal failure
Coagulationscreen - no underlying bleeding risk heparin
Valid blood grouping - essential for surgeyr

21
Q

Ruptured AAA

A

Acute pancreatitis
Back pain
Renal colic
Lower limb ishcaemia

22
Q

Management of AAA

A

Anatomy of the aneurysm
Baseline health of the patient
Clinical state of the patient on admission

23
Q

Ruptured AAA repair

A

Open surgical repair
Endovascular aneurysm repair (EVAR)
Palliative care

24
Q

What artery is sacrificed or occluded in endovascular repiar

A

Inferior mesenterica artery
Can lead to bowel ischaemia if marginal supply to L colon inadequate

25
Q

Complications of ruptured AAA

A

Bowel ischaemia from IM artery occlusion in surgery - Can be detected and fixed if open surgery
Acute limb ischaemia clot from RAAA
Abdominal compartment syndrome
Graft infection
Bood transusion complications eg coagulopathy, electrolyte disturbance, lung injury

26
Q

WHat is abdominal comparmtent syndrome

A

Following AAA repair
INta abdominal pressure -> fall in renal perfusion, compression of IV reduceing cardiac preload and systemic perfsion -> splinting of diaphragm, resp compromise and T2 resp failure

27
Q

Complications ass w open srugery for R AAA

A

Abdo wound dehisecence immediately post op
Large laporotomy -> incisional hernias

28
Q

Complications from endovascular reapir for RAAA

A

Haematomas or pseudoanurysms in groin at access site to germoral arteries-> on going bleeding
Leakage of blood around stent graft into aneurysm sac-> enlargement of aneurysm around graft = endoleak
-> CT angiograms for monitoring for rest of life

29
Q

Survival rates AAA

A

50% patients who reach hospital and receive intervention survive
33% OF PATIETNS DIE BEFORE reaching hospital
Screening reducing number of deaths

30
Q

WHen rescan every 12 months AAA

A

3-4.4cm - small aneurysm

31
Q

Low AAA rupture risk

A

asymptomatic, aortic diameter < 5.5cm (i.e. small and medium aneurysms)
abdominal US surveillance (on time-scales outlines above) and optimise cardiovascular risk factors (e.g. stop smoking)

32
Q

High AAA rupture risk

A

symptomatic, aortic diameter >=5.5cm or rapidly enlarging (>1cm/year)
treat with elective endovascular repair (EVAR) or open repair if unsuitable. In EVAR a stent is placed into the abdominal aorta via the femoral artery to prevent blood from collecting in the aneurysm. A complication of EVAR is an endo-leak,

A- Resp and cardio (58 decks)

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