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2nd year > Aortic aneurysms > Flashcards

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
Q

complications of endoluminal

A 
more common 
graft complications 
graft failure 
cannot treat rupture 
lower risks than open laparotomy
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26
Q

how many people with a ruptured AAA will die?

A

10%

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27
Q

AAA rupture

A

wall of aorta completely fails and blood escapes into body

usually into abdominal cavity

28
Q

dissection vs rupture

A

different things

dissection often leads to rupture

29
Q

what is AAA dissection?

A 
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
Q

classification of dissecting AA

A

type A

type B

31
Q

type A AA

A

2/3 of cases

involving the ascending aorta and potentially descending aorta

32
Q

type B AA

A

affects only descending aorta

33
Q

symptoms of AAA

A 
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
Q

what causes non-specific back pain in AA

A

erosion of vertebral bodies with long-standing aneurysm

35
Q

AA of ascending aorta pain

A

pain in chest

36
Q

AA of descending aorta pain

A

pain in back

37
Q

investigations for AA

A

clinical diagnosis

need to diagnose quickly

38
Q

treatment for AA dissection

A

type A = emergency open surgery using Dacron graft

type B = less urgent than A, endoluminal surgery but open laparotomy is preferred

39
Q

AAA

A

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
Q

thoracic aortic aneurysm

A

asymmetrical brachial/radial/carotid pulses if dissection involves aortic arch
different BP in each arm

41
Q

pathogenesis of AAA

A

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
Q

what is marfan’s syndrome

A

connective tissue disorder

very common

43
Q

causes of marfan’s syndrome

A

mutation of fibrinin gene on chromosome 15

44
Q

inheritance of marfan’s syndrome

A

autosomal dominant
25% de novo mutation
males and females equally affected

45
Q

testing for marfan’s syndrome

A

genetic testing for fibrillin-1 gene

the mutation in 80% of cases

46
Q

clinical features of marfan’s syndrome

A 
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
Q

treatment of marfan’s syndrome

A

beta blockers
monitoring of aortic dilatation
elective replacement of ascending aorta to prevent dissection
avoid endurance sports/ activities

48
Q

monitoring aortic dilatation in marfan’s syndrome

A 
CXR
MRI
Echo 
CT
needs close attention in pregnancy as both pregnancy and marfans are risk factors for aortic aneurysms
49
Q

pregnancy, marfans syndrome and aortic aneurysms

A

if aortic root >4cm then C section

beta blocker can be continued through pregnancy to reduce risk of aortic dilatation

50
Q

prognosis of marfan’s syndrome

A

good
less than general population
surgical interventions increase life-expectancy by 13 years

51
Q

how does a leaking/ruptured AAA present?

A 
pain - flank/back
collapse 
hypotension
pulsatile abdominal mass
cold
sweaty
faint 
syncope 
vomiting
pale
tachycardia
thread/weak pulse
tender mass bruit
52
Q

management of ruptured AAA

A 
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
Q

screening for AAA

A

ultrasound of abdomen
10-15 minutes
instant results

54
Q

who is eligible for AAA screening?

A

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
Q

AAA screening possible results

A

no aneurysm - <3cm diameter
small AAA
medium AAA
large AAA

56
Q

Small AAA

A 
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
Q

medium AAA

A 
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
Q

large AAA

A

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
Q

how to prevent AAAs or enlargement of AAAs?

A 
stop smoking
balanced/healthy diet 
maintain healthy weight
regular exercise 
reduce alcohol intake
treat underlying health conditions
60
Q

what are the types of aortic aneurysms?

A

abdominal and thoracic

cerebral aneurysms - not aortic

61
Q

abdominal aortic aneurysms

A

most common
severe internal bleeding can occur from rupture
risk of dissection

62
Q

thoracic aortic aneurysm symptoms

A

back pain
hoarseness
shortness of breath
tenderness/pain in chest prior to rupture

63
Q

complications of aortic aneurysms

A 
local obstruction
impaired blood flow to lower limbs
thrombosis
embolism
dissection and rupture 
life-threatening internal bleed
surgical complications
64
Q

signs/ symptoms of thoracic aortic aneurysm rupture

A 
sudden intense and persistent chest/back pain 
pain radiates to back 
trouble breathing 
low BP 
loss of consciousness 
SOB
dysphagia 
stroke
weakness/paralysis
65
Q

cerebral aneurysms

A 
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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