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Aortic aneurysms Flashcards

1
Q

what is an aneurysm?

A

artery that has a localised dilation with a permanent diameter of >1.5 times that of expected for that particular artery

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2
Q

what are the classification of the different types of aneurysm?

A

true or false
pulsatile or expansile
fusiform or sac-like

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3
Q

true aneurysm

A

the wall of the artery forms the wall of the aneurysm

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4
Q

false aneurysm

A

aka pseudoaneurysm
other surrounding tissues form the wall of the aneurysm
most common in femoral artery

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5
Q

what are the possible shapes of the aneurysm?

A

fusiform

sac-like

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6
Q

fusiform aneurysm

A

tapered at both ends like a rain drop

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7
Q

sac-like aneurysm

A

rounded

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8
Q

expansile aneurysm

A

expands and contracts

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9
Q

pulsatile aneurysm

A

doesn’t expand and contract

transmits pulse

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10
Q

most frequent locations of aneuryms

A 
abdominal aorta 
iliac artery
popliteal artery
femoral artery 
thoracic aorta 
aorta in general
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11
Q

risk factors for aortic aneurysms?

A 
hypertension 
smoking 
age
diabetes 
obesity 
high LDL levels 
sedentary lifestyle 
genetics - 10% have 1st degree relative with aneurysmal disease 
co-arctation of aorta 
marfan's syndrome 
connective tissue disorders 
previous aortic surgery 
pregnancy - 3rd trimester
trauma 
being male 
COPD
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12
Q

complications of aortic aneurysm

A 
local obstruction 
impaired blood flow 
thrombosis 
embolism 
dissection 
rupture
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13
Q

where does an aortic aneurysm most commonly rupture?

A

into retroperitoneal space

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14
Q

presentation of aortic aneurysm

A

often asymptomatic
often incidentally discovered
mean age of presentation = 65
risk of dissection/rupture increases with increased diameter

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15
Q

diagnosis of aortic aneurysm

A 
examination 
AXR - 65% show up 
ultrasound 
CT 
ultrasound used for staging
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16
Q

when to treat aortic aneurysm?

A

> 5.5cm in diameter
below this the risk of dissection is outweighed by the risk of surgery
smaller symptomatic aneurysms may be operated on
presence of thrombo-embolism

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17
Q

annual rupture risks

A

5.5cm diameter = 25%
6.5cm diameter = 35%
>7cm diameter = 75%

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18
Q

risk factors for aneurysm rupture

A

pain

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19
Q

what are the treatment options for aortic aneuryms

A

open laparotomy

endoluminal surgery

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20
Q

open laparotomy

A

affected segment of aorta is clamped and replaced by prosthetic segment - Dacron graft
graft failure is rare
affected artery segment can be bypassed

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21
Q

endoluminal surgery

A

endovascular aneurysm repair

aortic graft inserted through femoral artery and into abdominal aorta

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22
Q

suitability for endoluminal surgery

A

must be 2.5cm at least of normal aorta between aneurysm and renal arteries
preferred method

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23
Q

complications and risks associated with open laparotomy

A 
complications are rare 
kidney proplems
paraplegia 
ischaemic colitis 
fistula formation with small bowel 
infection
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24
Q

mortality with open laparotomy

A

5-8% elective asymptomatic AAA repair
10-20% in symptomatic AAA repair
50% for ruptured AAA repair
long-term survival is similar to general population

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25
complications of endoluminal
``` more common graft complications graft failure cannot treat rupture lower risks than open laparotomy ```
26
how many people with a ruptured AAA will die?
10%
27
AAA rupture
wall of aorta completely fails and blood escapes into body | usually into abdominal cavity
28
dissection vs rupture
different things | dissection often leads to rupture
29
what is AAA dissection?
``` blood escapes through innermost layer of artery wall and prises apart the tunica media creates a new lumen can create a double-barelled aorta may be stable or may rupture can compromise aortic valve medical emergency ```
30
classification of dissecting AA
type A | type B
31
type A AA
2/3 of cases | involving the ascending aorta and potentially descending aorta
32
type B AA
affects only descending aorta
33
symptoms of AAA
``` pain - sudden onset, severe, tearing pain radiates to back hypotension expansile mass in abdomen shock tachycardia anaemia sudden death testicular similar to renal colic/diverticulitis non-specific back pain ```
34
what causes non-specific back pain in AA
erosion of vertebral bodies with long-standing aneurysm
35
AA of ascending aorta pain
pain in chest
36
AA of descending aorta pain
pain in back
37
investigations for AA
clinical diagnosis | need to diagnose quickly
38
treatment for AA dissection
type A = emergency open surgery using Dacron graft | type B = less urgent than A, endoluminal surgery but open laparotomy is preferred
39
AAA
most commonly in infrarenal segment of aorta pain below level of renal artery rapid expansion/rupture causes epigastric pain pain radiates to the back pain in groin, iliac fossa and testicles contant or intermittent pain think of renal colic as differential
40
thoracic aortic aneurysm
asymmetrical brachial/radial/carotid pulses if dissection involves aortic arch different BP in each arm
41
pathogenesis of AAA
permanent dilation of vessel wall atheromatous degeneration most common cause of true aneurysm ischaemia of aortic media due to atherosclerotic plaque - release of macrophage enzymes which break down elastic fibres, collagen and elastin loss of normal elastic nature of media so it can expand
42
what is marfan's syndrome
connective tissue disorder | very common
43
causes of marfan's syndrome
mutation of fibrinin gene on chromosome 15
44
inheritance of marfan's syndrome
autosomal dominant 25% de novo mutation males and females equally affected
45
testing for marfan's syndrome
genetic testing for fibrillin-1 gene | the mutation in 80% of cases
46
clinical features of marfan's syndrome
``` arachnodactyly - long and thin fingers bent back at MCP joint hypermobility scoliosis chest deformity high arched palate dislocation of eye lens patients are tall/thin/long limbs heart valve defects predisposition to aneurysms lung disorders dura disorders ```
47
treatment of marfan's syndrome
beta blockers monitoring of aortic dilatation elective replacement of ascending aorta to prevent dissection avoid endurance sports/ activities
48
monitoring aortic dilatation in marfan's syndrome
``` CXR MRI Echo CT needs close attention in pregnancy as both pregnancy and marfans are risk factors for aortic aneurysms ```
49
pregnancy, marfans syndrome and aortic aneurysms
if aortic root >4cm then C section | beta blocker can be continued through pregnancy to reduce risk of aortic dilatation
50
prognosis of marfan's syndrome
good less than general population surgical interventions increase life-expectancy by 13 years
51
how does a leaking/ruptured AAA present?
``` pain - flank/back collapse hypotension pulsatile abdominal mass cold sweaty faint syncope vomiting pale tachycardia thread/weak pulse tender mass bruit ```
52
management of ruptured AAA
``` large bore cannula IV access group and cross match need large supplies of blood products - FFP, blood and platelets arrange theatre immediately resuscitation of hypovolaemic shock NICE recommends open surgery ```
53
screening for AAA
ultrasound of abdomen 10-15 minutes instant results
54
who is eligible for AAA screening?
men during the year they turn 65 not offered to those already being treated for AAA can request a screening if there is a family history and GP believes it is important will be done 5 years younger than the age of the relative when they were found to have an AAA it is optional People with marfan's syndrome are extensively monitored/screened
55
AAA screening possible results
no aneurysm - <3cm diameter small AAA medium AAA large AAA
56
Small AAA
``` 3-4.4cm diameter of aorta no treatment needed as risk of rupture is small annual scans to check size treated if it becomes large advice on how to prevent enlargement 1% of cases ```
57
medium AAA
``` 4.5-5.4cm diameter of aorta no treatment needed 3 monthly scans to check size treated if enlargement occurs advice to prevent enlargement 0.5% of cases ```
58
large AAA
5.5cm < diameter of aorta high risk of bursting if untreated referral to specialist surgeon within 2 weeks of result to discuss treatment smaller risk of surgery than if left untreated
59
how to prevent AAAs or enlargement of AAAs?
``` stop smoking balanced/healthy diet maintain healthy weight regular exercise reduce alcohol intake treat underlying health conditions ```
60
what are the types of aortic aneurysms?
abdominal and thoracic | cerebral aneurysms - not aortic
61
abdominal aortic aneurysms
most common severe internal bleeding can occur from rupture risk of dissection
62
thoracic aortic aneurysm symptoms
back pain hoarseness shortness of breath tenderness/pain in chest prior to rupture
63
complications of aortic aneurysms
``` local obstruction impaired blood flow to lower limbs thrombosis embolism dissection and rupture life-threatening internal bleed surgical complications ```
64
signs/ symptoms of thoracic aortic aneurysm rupture
``` sudden intense and persistent chest/back pain pain radiates to back trouble breathing low BP loss of consciousness SOB dysphagia stroke weakness/paralysis ```
65
cerebral aneurysms
``` above aorta in brain most common in aged 30-60 can be tiny - large rupture causes bleeding on brain potentially fatal ```

2nd year (48 decks)

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