Aortic aneurysm, Dissection PVD Flashcards
1
Q
What is an aneurysm
A
bulge in vessel wall caused by weakening of vessel wall followed by dilation due to increased wall stress
2
Q
Epidemiology of AAA
A
- AAAs have a reported prevalence of 1.3-12.7% in the UK
- M>F
- Most common in the elderly: >60
3
Q
RFs of AAA
A
- Age
- Male
- Smoking
- HT
- Diabetes
- EDS and Marfans
- FH
4
Q
pathogenesis of aortic aneurysm
A
- Degradation of tunica media + adventitia > vessel dilation
- In atherosclerosis Chronic inflammation results in release of matrix metalloproteinases enzymes - degrade ECM in tunica media, weakening aortic wall
5
Q
most common location for aortic aneurysm
A
- Below level of renal arteries - knows as infra- renal aneurysm
- Below this level abdominal aorta lacks vasa vasorum - makes tunica media susceptible to ischaemia
- Thickening of intima makes it harder for O2 to diffuse into tunica media
between renal and inferior mesenteric arteries
6
Q
What is inflammatory AAA
A
type of AAA that usually affectsyounger patientsand is associated with smoking, atherosclerosis and vasculitis, accounting for 5-10% of aortic aneurysms cases. An inflammatory AAA presents similarly to a normal AAA but may also be associated withfever.
7
Q
Presentation of aortic aneurysm
A
- mostly asymptomatic
- found below renal arteries
- pulsatile mass on palpitation if it is big
8
Q
Signs of an AAA
A
- Pulsatile abdominal mass
- Tachycardia and hypotension: red flags signifying ruptured AAA
- Grey-Turner’s sign: flank bruising secondary to retroperitoneal haemorrhage
- Cullen’s sign: pre-umbilical bruising
9
Q
Symptoms of AAA
A
- Flank, back or abdominal pain
- Pulsating abdominal sensation
10
Q
How would you diagnose an aortic aneurysm
A
1st line investigation - ultrasonography
11
Q
major complications of aneurysm
A
- AAA Rupture
- thromboembolism
- fistula
- ureteric obstruction
12
Q
Management of an aneurysm
A
- require urgent repair
- for asymptomatic AAA surveillence > repair
- open repair or endovascular anuerysm EVAR
13
Q
when you would you repair AAA
A
When diameter exceeds 5.5cm in men or 5.0 in women
14
Q
presentation of ruptured AAA
A
- Acute onset of severe tearing abdominal pain
- painful pulsatile mass
- hypovolemic shock
- syncope
- nausea
15
Q
screening and repeat screening principles for AAA
A
- men over 65 are screened
- if small aaa 3.4-4cm then yearly us
- if medium aaa 4.5-5.5 repeat every 3 months
- if large aaa 5.5 or more then surgery
16
Q
what is an aortic dissection
A
a tear in the intimal layer of the aorta which leads to a collection of blood between the intima and medial layers
17
Q
Aortic dissection epidemiology
A
- Aortic dissection has a worldwide incidence of 0.5 to 2.95 per 100,000 people annually
- M>F
- Most common between the ages of 50-70 and is rare below 40
18
Q
pathophysiology of aortic dissection
A
- Tear in tunica intima of aorta - High pressure blood flow through aorta tunnels between intima and media seperating the 2 layers
- High pressure blood continues to cut more tunica intima off tunica media > blood pools between layers increasing diameter of BV - area where blood collects called false lumen
19
Q
Where does Aortic dissection typically occur in?
A
Ascending aorta + Aortic Arch
20
Q
what arteries can be the false lumen be in ?
A
- coronary
- brachiocephalic
- intercostal
- visceral
- renal
- iliac
21
Q
risk factors for aortic dissection
A
- hypertension
- trauma
- smoking
- FH
- vasculitis
- cocaine use
- connective tissue disorder
22
Q
Signs of AD
A
- Weak downstream pulses: radio-radial and/or radio-femoral delay
- A difference in blood pressure between two arms: >10 mmHg
- Hypertension
- Tachycardia and hypotension: as condition progresses
- Diastolic murmur: due to aortic regurgitation
23
Q
clinical features of aortic dissection
A
- sudden and severe tearing pain in chest radiating to back
- hypotension
- asymmetrical blood pressure
- syncope - red flag symptom
24
Q
Stanford Classication of AD
A
- Type A: Dissection involves ascending aorta +- involvement of arch and descending aorta - proximal to left subclavian artery
- Tybe B: No ascending aorta - only descending thoracic or abdominal aorta - distal to left subclavian artery
25
Debakey classification of Aortic Dissection
- **Type I**: originates in the ascending aorta and involves at least the aortic arch, but can extend distally
- **Type II**: originates and confined to the ascending aorta
- **Type III**: originates in the descending aorta and extends distally, but can extend proximally
26
diagnostic tools for AD
- ECG - T wave inversion or ST segment depression
- CHEST X RAY
- Contrast enhanced CT - GS
27
Type A management of Aortic Dissection
- **Blood transfusion**
- **Beta blocker e.g.** **IV labetalol**: aim for a systolic blood pressure of 100-120 mmHg; high pressures are associated with extension of the dissection
- **Urgent surgical repair/ stenting**: open surgery with replacement of the ascending aorta should be performed immediately upon diagnosis
28
Type B management for Aortic Dissection
- **Conservative management**: bed rest and analgesia
- **Beta blocker e.g. IV labetalol**: aim for a systolic blood pressure of 100-120 mmHg; patients are usually monitored closely on the high dependency or intensive care unit
- **Thoracic endovascular aortic repair (TEVAR)**:
29
Complications of Aortic Dissection
- Aortic regurgitation
- MI
- Stroke
- Renal failure
30
What is peripheral vascular disease
major circulatory disorder characterised by arterial obstruction, leading to reduced blood supply and ischaemia in the lower limbs
31
pathophysiology of PVD
- commonly atherosclerosis leading to claudication of vessels
32
rx for PVD
SMOKING
DIABETES
HTN
SEDENTARY LIFESTYLE
HYPERLIPIDAEMIA
33
Presentation of PVD
pulse less
pallor
pain
pressingly cold
paralysis
parasthesia
34
investigation for PVD
Ankle brachial pressure
35
Treatment for PVD
Smoking cessation
regular exercise
weight reduction
BP CONTROL, DM CONTROL
STATIN
36
complication of PVD
acute limb ischemia
37
Most common location of an aneurysm
Infra renal aorta
38
what happens to the plaque when we get an acute clinical complication
rupture with thrombus formation
39
what is the most potent risk factor for PAD
SMOKING
40
6ps in ishaemia
pain
pallor
parasthesia
paralysis
41
most common location of aneurysm
infra renal aorta
42
define aneurysm
dilatation of artery to 2x normal normal involving all 3 layers
43
Stanford classification of aortic dissection
Type a - involves ascending aorta , arch of aorta
Type b - involves the descending aorta
44
Clinical signs of aortic dissection
Radio radial delay
Radio femoral delay
Blood pressure differential between arms
45
Definitive diagnosis for aortic dissection
CT ANGIOGRAM
46
Definitive management for aortic dissection
Type a - usually requires surgical management
Type b - managed with observation and blood pressure control
47
What is commonly seen on CXR for patients with aortic dissection
Widened mediastinum
