aortic aneurysm and carotid artery disease

Question 1

what is the definition of a aneurysm

Answer 1

when there is dilatation of all layers of the aorta - increase by over 50%

Question 2

what is the size of a abdominal aortic aneurysm

Answer 2

greater than 3.5cm

Question 3

what are the 3 layers of the aora (and for tht most arteries)

Answer 3

tunica intima
tunica media
tunica externa

Question 4

what are the 3 overarching causes of aneyrism

Answer 4

degenerative disease

connective tissue disease

infection

Question 5

what are the risk factors for degenerative Abdominal Aortic Aneyrisms (AAA)

Answer 5

sex - male
old age
smoking
hypertension 
family history

Question 6

who is offered AAA screening

Answer 6

men over the age of 65 with other risk factors

Question 7

what is the size of a small AAA

Answer 7

3.0 - 4.4cm

Question 8

what is the size of a medium AAA

Answer 8

4.5 - 5.5cm

Question 9

what is the size of a lare AAA

Answer 9

> 5.5cm

Question 10

what is the presentation of a impending rupture

Answer 10

increasing back pain

tender AAA

Question 11

what is the presentation of a rupture

Answer 11

abdo/back/flank pain

haemodynamic instability

hypo perfusion

Question 12

what is the management of asymptomatic aneurysms

Answer 12

conservative,
endovascular repair
open repair

Question 13

what are the two methods to image a AAA

Answer 13

Ultra sound

CT angiogram

Question 14

why would you choose conservative treatment

Answer 14

patient/aneurysm not fit for repair

consider event of rupture

Question 15

what are the complications associated with open repair

Answer 15

DVT/PE
MI
stroke

damage to bowel, veins, nerves

graft infection

Question 16

what are complications with endovascular repair (EVAR)

Answer 16

DVT/PE
MI stroke

Endoleak

femoral artery dissection

Question 17

what is endoleak

Answer 17

leakage around the graft - happens in about 30% of patients

Question 18

what is the difference between Open repair and EVAR

Answer 18

3 fold reduction in operatively mortality for EVAR vs OR

no difference in overall mortality but quality of life is better with EVAR initially

Question 19

what is carotid disease

Answer 19

Atherosclerosis of the carotid arteries is associated with transient ischaemic attacks and ischaemic stroke.

Question 20

what is the definition of transient ischemic attack (TIA)

Answer 20

CNS disturbance caused by vascular events such as micro emboli

symptoms last less than 24hrs - no long lasting neurological damage

Question 21

what is a stroke

Answer 21

Clinical syndrome of disturbance of cerebral function, lasting more than 24hours or leading to death with only vascular cause

Question 22

what are the causes of stroke/ TIA

Answer 22

majority its cerebral infarction

primary intracerebral haemorrhage (10%)
subarachnoid haemorrhage  (6%)

Question 23

what causes cerebral infarction

Answer 23

AF
endocarditis MI
carotid artery dissection/trauma

carotid atherosclerotic plaque rupture/ thrombus

Question 24

what is Virchow’s triad

Answer 24

flow
vessel wall
coagulability

Question 25

what are the risk factors

Answer 25

smoking diabetes family history male sex

Question 26

how do you diagnose stroke/ TIA

Answer 26

history examination - neurological symptoms cardiac auscultate carotid carotid ultrasound ``` FAST face arm speech time ```

Question 27

what happens as radius of vessel decreases (stenosis)

Answer 27

velocity increases

Question 28

what is the management of carotid disease using medical therapy

Answer 28

``` smoking cessation control of hypertension antiplatelet statin diabetic control ```

Question 29

what is a carotid endarterectomy

Answer 29

removal of the plaque from the carotid arteries by opening it up - prevents stroke

Question 30

what are the complications of a carotid endarterectomy

Answer 30

wound infection bleeding nerve damage periopretive stroke

Question 31

why would a perioperative stroke occur

Answer 31

plaque rupture hypoperfusion

Question 32

what are the 3 treatments to reduce the risk of stroke

Answer 32

carotid endarterectomy best medical therapy stenting surgery is prophylactic

Question 33

what is the difference between sexes in treatment

Answer 33

surgery isn't given to women unless there is sever stenosis as they react better on medical therapy

Question 34

when should surgery be considered in men

Answer 34

50-69% stenosis

Question 35

when should surgery be considered in women

Answer 35

over 70%

Question 36

when is the most risky period for further brain attacks

Answer 36

within the first 2 weeks after the initial event