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Surgery > Aortic Aneurysms > Flashcards

Aortic Aneurysms Flashcards

1
Q

define aneurysm

A

focal
1.5x increase in normal diameter

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2
Q

define ectasia

A

diffuse dilatation of an artery
increase in diameter >50%

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3
Q

define arteriomegaly

A

diffuse enlargement of an artery

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4
Q

define pseudo aneurysm

A

frequently due to trauma

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5
Q

define true aneurysm

A

incorporates all three layers of the vessel

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6
Q

associates aneurysms that aortic aneurysms may hev

A

aortoiliac - 41%
femoro-popliteal - 15%

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7
Q

associated medical conditions with aortic aneurysms

A

carotid artery stenosis
smoker
male
HTN

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8
Q

reasons aortic aneurysm develops (aetiology)

A
  • atherosclerosis
  • cystic medial necrosis
  • dissection
  • Ehlers-danlos syndrome
  • syphilis
  • familial associated (Lysol oxidase syndrome)
  • degenerative
  • mycotic
  • inflammatory
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9
Q

how can aortic aneurysm be degenerative

A

decrease in elastic and collagen in arterial wall
elastic becomes fragmented - arterial elongation and dilatation
increase in the collagenase and elastase activity

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10
Q

how can aortic aneurysm be mycotic

A

degradation of media and intimal layers by S. cocci and E. coli

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11
Q

Laplace’s law

A

tension = pressure x radius

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12
Q

clinical presentation of aortic aneurysm

A

asymptomatic: 70-75%
symptoms: early satiety, abdominal flank or back pain
abrupt onset of pain = rupture or expansion of aneurysm
frequently incidental discovery

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13
Q

ruptured aneurysms locations

A

usually occurs postero-laterally
can rupture in vena cava creating aorta-caval fistula

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14
Q

ruptured aneurysms locations

A

usually occurs postero-laterally
can rupture in vena cava creating aorta-caval fistula
occasionally can rupture anterior which is rally fatal

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15
Q

limitation of arteriography for aortic aneurysm diagnosis

A

cannot determine aneurysm size because of mural thrombus

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16
Q

indications for obatining an ateriogrpahy

A

suspicion of visceral ischaemia
occlusive disease of iliac and femoral arteries
severe HTN, or impair renal function
horseshoe kidney
suprarenal of TAAA component
femora-popliteal aneurysms

17
Q

ways that ultrasound for aortic aneurysm is helpful

A

establishes diagnosis easily
accurately measures infrarenal diameter
widely available, quick, no rick, cheap

18
Q

ways that US for AA is not helpful

A

difficult to visualise thoracic or suprarenal aneurysms
difficult to establish relationship to renal arteries
technician dependant

19
Q

ways that CT scan for AA is helpful

A

reliable and reproducible
can image entire aorta
can visualise relationship to visceral vessels
most useful

20
Q

ways that CT scan for AA is not helpful

A

longer to obtain and more expensive
requires contract agent which can cause renal toxicity

21
Q

MRA (magnetic resonance angiography) for AA

A

now widely available
more expensive than CT and US
no contract agent needed
spacial resolution less than CT

22
Q

complications for AAs

A

thrombosis
distal embolisation
rupture

23
Q

how high is risk of rupture in AA

A

23.4% of aneurysms 4-5cm will rupture

24
Q

what increases likelihood of rupture

A

patients with COPD and HTN have increased risk

25
Q

likelihood of survival of rupture

A

half die before reaching hospital
an additional quarter die before repair

26
Q

how to reduce mortality associated with surgical repair

A

endovascular techniques are reducing surgical mortality

27
Q

indications for treatment of AA

A

infrarenal aneurysm >5cm without comorbid medical conditions
repair smaller aneurysms f rate of enlargement is larger than expected
repair all symptomatic aneurysms

28
Q

indications for treatment in patients with AA and comorbid conditions

A

wait until risk of repair and rupture are equal (usually about 6cm)

29
Q

standard surgical repair for AA

A

replace diseased aorta with synthetic material
requires 7 day hospital stay

30
Q

potential complications in standard repair of AA

A

cardiac
renal
respiratory
bowel ischameia
spinal ischaemia (rare)

31
Q

EVAR stands for

A

endovascular aneurysm repair

32
Q

what is EVAR

A

percutaneous access through groin with expandable prosthesis under fluoroscopic guidance

33
Q

why do EVAR

A

significantly reduced m&m
long term result good in selected patients
life long surveillance recommended
hospital stay 2 days

Surgery (18 decks)

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