Aortic Aneurysm Flashcards

1
Q

What is an aneurysm defined as?

A
  • AAA dilatation > 1.5 times normal AP diameter
  • True aneurysm: dilatations involve all layers of the arterial wall
  • False (pseudo)aneurysm: blood collection in outer layer (adventitia) only
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the two forms of aneurysms?

A
  • Fusiform (most AAAs)
  • Sac-like (Berry aneurysms)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes of aneurysms?

A
  • Atheroma
  • Infections
  • Inflammatory
  • Connective tissue disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Complications of aneurysms?

A
  • Fistulae
  • Rupture
  • Thrombosis/embolism
  • Pressure on other structures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Screening of aneurysms?

A
  • Men offered abdominal US from 65-75
  • Selective screening based on risk factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Symptoms & signs of a ruptured AAA?

A
  • Abdominal pain radiating to the back
  • Expansile abdominal mass (expands and contracts)
  • Shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe an unruptured AAA?

A
  • >3cm diameter
    • Normal after 50 yrs(Men 1.7cm, women 1.5cm)
  • Failure of elastic proteins within the ECM
  • Often asymptomatic and incidental finding on abdominal exam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What makes AAA rupture more likely?

A
  • Smoking
  • Female sex
  • Hypertension
  • Positive family history
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe surgery for unruptured AAA?

A
  • Surgery for:
    • Aneurysms >5.5cm, expanding >1cm/yr, symptomatic
  • Stenting (EVAR) procedure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe overview of open AAA repair?

A
  • Laparotomy, dissection to the AA
  • Clamping of the artery below renal arteries and in the iliac arteries
  • Aneurysm is opened:
    • IMA and lumbar arteries ligated
    • Tube or bifurcated graft are sutured into the aorta to exclude the aneurysm
  • Aneurysms sac is sutured over the graft to reduced infection rates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe EVAR?

A
  • Endovascular stent inserted via the femoral artery
  • Less mortality than major surgery but higher graft complications
    • eg endoleak: blood may leak into aneurysm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Complications of open AAA repair?

A
  • Intra-operative complications:
    • Haemorrhage
    • Injury to surrounding structures
  • Early complications:
    • Infection
    • Blood clots
  • Late complications:
    • Hernia
    • Adhesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the emergency management of a ruptured abdominal aneurysm?

A
  • Inform vascular surgeon, experienced anaesthetist
  • Crossmatch blood, catheterise
  • Insert 2 large bore cannulase
    • Treat shock with O rhesus negative blood
  • Prophylactic antibiotics eg co-amoxiclav
  • Surgery:
    • Clamping of aorta above the leak
    • Tube graft inserted
    • If iliac aneurysm: trouser graft, leg attached to each iliac artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What infectious disease is an ascending aortic aneurysm associated with?

A

Tertiary syphilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name another cause of an adominal pulsatile mass?

A
  • Tumour of pancreas or stomach
    • Aortic passess between these structures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Abdominal aorta anatomy

A
17
Q

Pathophysiology of AAA?

A
  • Obliteration of collage and elastin in the media and adventitia
  • Smooth muscle loss
  • Infiltration of lymphocytes and macrophages
18
Q

What are the different classifications of AAA?

A
  • Congenital
    • Accelerated in patients with Biscupid AV or Marfans
  • Infectious
    • Staphylococcus and salmonella are most common causes
  • Inflammatory
19
Q

Common presentations of AAA

A
20
Q

Differentials for AAA?

A
  • Diverticulitis
    • No pulsatile abdominal mass
    • CT scan shows normal aorta
  • Irritable bowel syndrome (IBS)
    • Bloating, stool frequency
    • More common in women
  • Appendicitis
21
Q

What is the most common site for aneurysmal disease required treatment?

A

Infrarenal aorta

22
Q

What reasons might a patient survive a ruptured AAA?

A
  • Bleed into retroperitoneum which tamponades the leak
  • Intense vasoconstriction of nonessential circulatory beds
  • Development of an intense prothrombotic state
  • BP drops which limits blood loss
23
Q

What must be screened for in patients with AAA?

A
  • Popilteal aneurysms
    • Ultrasound
24
Q

Describe the management of popliteal aneurysms?

A
  • Exclusion of the aneurysm
  • With bypass using the long saphenous vein