aortic aneurysm and carotid artery disease Flashcards
what is the definition of a aneurysm
when there is dilatation of all layers of the aorta - increase by over 50%
what is the size of a abdominal aortic aneurysm
greater than 3.5cm
what are the 3 layers of the aora (and for tht most arteries)
tunica intima
tunica media
tunica externa
what are the 3 overarching causes of aneyrism
degenerative disease
connective tissue disease
infection
what are the risk factors for degenerative Abdominal Aortic Aneyrisms (AAA)
sex - male old age smoking hypertension family history
who is offered AAA screening
men over the age of 65 with other risk factors
what is the size of a small AAA
3.0 - 4.4cm
what is the size of a medium AAA
4.5 - 5.5cm
what is the size of a lare AAA
> 5.5cm
what is the presentation of a impending rupture
increasing back pain
tender AAA
what is the presentation of a rupture
abdo/back/flank pain
haemodynamic instability
hypo perfusion
what is the management of asymptomatic aneurysms
conservative,
endovascular repair
open repair
what are the two methods to image a AAA
Ultra sound
CT angiogram
why would you choose conservative treatment
patient/aneurysm not fit for repair
consider event of rupture
what are the complications associated with open repair
DVT/PE
MI
stroke
damage to bowel, veins, nerves
graft infection
what are complications with endovascular repair (EVAR)
DVT/PE
MI stroke
Endoleak
femoral artery dissection
what is endoleak
leakage around the graft - happens in about 30% of patients
what is the difference between Open repair and EVAR
3 fold reduction in operatively mortality for EVAR vs OR
no difference in overall mortality but quality of life is better with EVAR initially
what is carotid disease
Atherosclerosis of the carotid arteries is associated with transient ischaemic attacks and ischaemic stroke.
what is the definition of transient ischemic attack (TIA)
CNS disturbance caused by vascular events such as micro emboli
symptoms last less than 24hrs - no long lasting neurological damage
what is a stroke
Clinical syndrome of disturbance of cerebral function, lasting more than 24hours or leading to death with only vascular cause
what are the causes of stroke/ TIA
majority its cerebral infarction
primary intracerebral haemorrhage (10%) subarachnoid haemorrhage (6%)
what causes cerebral infarction
AF
endocarditis MI
carotid artery dissection/trauma
carotid atherosclerotic plaque rupture/ thrombus
what is Virchow’s triad
flow
vessel wall
coagulability
what are the risk factors
smoking
diabetes
family history
male sex
how do you diagnose stroke/ TIA
history
examination - neurological symptoms
cardiac
auscultate carotid
carotid ultrasound
FAST face arm speech time
what happens as radius of vessel decreases (stenosis)
velocity increases
what is the management of carotid disease using medical therapy
smoking cessation control of hypertension antiplatelet statin diabetic control
what is a carotid endarterectomy
removal of the plaque from the carotid arteries by opening it up - prevents stroke
what are the complications of a carotid endarterectomy
wound infection
bleeding
nerve damage
periopretive stroke
why would a perioperative stroke occur
plaque rupture
hypoperfusion
what are the 3 treatments to reduce the risk of stroke
carotid endarterectomy
best medical therapy
stenting
surgery is prophylactic
what is the difference between sexes in treatment
surgery isn’t given to women unless there is sever stenosis as they react better on medical therapy
when should surgery be considered in men
50-69% stenosis
when should surgery be considered in women
over 70%
when is the most risky period for further brain attacks
within the first 2 weeks after the initial event
