Aortic aneurysm

Question 1

Define aortic aneurysm

Answer 1

Dilation of all layers of the aorta radius more than 50%

For abdominal: more than 3.5cm

Question 2

What is the 3 main disease causes in aetiology?

Answer 2

Degenerative
Connective tissue disease eg: marfan
Infection eg: staph/enterococcus

Question 3

What are the risk factors in the aetiology?

Answer 3

Smoking
Obesity
Diabetes
Age 
Hypertension
FH
Athlerotic disease

Question 4

Which gender is this condition most common in?

Answer 4

Male

Question 5

Roughly, describe the pathophysiology process of the development of aneurysm

Answer 5

Lymphocytes, macrophages and lipid enter vessel wall to the tunica intima.

This causes

1. Smooth muscle loss and thinning of the tunica media
2. Destruction of elastin

Therefore, this all leads to aneurysm forming

Question 6

Roughly, describe the possible pathophysiology and any linked symp/sign from the formation of an aneurysm to its rupture

Answer 6

3 things can occur:

1. Occlusion through thrombosis /emboli which can lead to = ischaemia, necrosis if irreversible.
2. Inflammation/Infection of the aortic wall = fever
3. Rapid expansion

As it builds up, it becomes a symptomatic non-rupture aneurysm = pulsating and painful mass

Eventually it ruptures 
= 
haemorrage
severe and constant pain
hypotension (syncope/MI/Renal failure)

Question 7

What are the clinical symptoms of an unruptured aneurysm?

Answer 7

Asymptomatic

Question 8

What are the clinical symptoms of a ruptured aneurysm?

Answer 8

Severe and constant pain
Syncope
Pulsatile mass

Question 9

What are the signs of aneurysm?

Answer 9

Ischemia
Hemorrhage 
Hyper/Hypotension
Pulsating mass
Claudication (if abdominal?)
Syncope

Question 10

What is the screening program for aneurysm?

Answer 10

Aimed for men over the age of 65
Involves doing an ultrasound 
If aorta dilation is under 3 = discharge
SMALL 3 to 4.4 = annual USS
MEDIUM 4.4 to 5.5 = 3 monthly USS
LARGE over 5.5

Question 11

Describe the investigation for aneurysm

Answer 11

USS
-measure the size of dilation
CTA/MRA

Question 12

Describe the treatment for unruptured aneurysm

Answer 12

Either open surgery or EVAR

Question 13

What are the factors involved in EVAR

Answer 13

Endovascular repair

• For those with good aortic necks and illiac anatomy
• Less invasive as it uses the femoral artery
• Uses locoregional anaesthesia
• Stent used to open circulation

Question 14

What are the general and technical complications involved in EVAR?

Answer 14

General:

• Infection
• Bleeding
• Scar/Pain

Technical:

• Distal emboli
• Rupture
• ENDOLEAK

Question 15

What is endoleak?

Answer 15

Its occurs often after EVAR

Its when the blood is able to infiltrate the aneurysm sack

This requires reintervention

Question 16

What are factors involved in open surgery?

Answer 16

• Good for bad aortic necks and illiac anatomy
• Invasive+Blood loss
• Need Laparotomy
• Need aortic cross clamping + ICU care

Question 17

What are the general and technical complications involved in open surgery?

Answer 17

General:

• Infection
• Bleeding
• Scar/Pain

Technical:

• Blood vessel/Nerve damage
• Incision hernia
• Distal emboli

Question 18

Which is better? Open or EVAR?

Answer 18

Depends:
QOL improved initially for EVAR bu then the mortality rates are equal overall

For unfit patients for open vs EVAR, there is no difference: all cause mortality or QOL

Question 19

What is the open repair treatment involve generally for rupture?

Answer 19

Massive transfusion protocol
Rapid anesthetic
Laparotomy xiphisternum to pubic symphisis