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Cardiovascular system > aortic aneurysms and carotid artery disease > Flashcards

aortic aneurysms and carotid artery disease Flashcards

1
Q

what is the definition of an aortic aneurysm?

A

dilatation of the all layers of the aorta, leading to an increase in diameter of >50% (abdominal aorta >3cm)

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2
Q

what is a false aneurysm?

A

not all layers like an aneurysm, can be from blood in the space between intima and media

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3
Q

what is arteriomegaly and subarneurysmal dialatation?

A

dilatation of an artery less than the required size for aneurysm (i.e. <3cm in abdominal aorta)

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4
Q

where do the majority if abdominal aortic aneurysms (AAA) occur?

A

between the renal arteries and the bifurcation of the abdominal aorta

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5
Q

what are the 3 causes of aortic aneurysm?

A
  • degenerative disease (atheroma)
  • connective tissue disease (eg. Merfan’s)
  • infection (mycotic aneurysm)
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6
Q

what are the risk factors for AAA?

A 
male
age
smoking
hypertension
family history
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7
Q

which form of AAA is harderst to treat?

A

infection

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8
Q

whar are the 3 ways thar assymptomatic AAAs can be discovered?

A
  • examination by a clinician
  • looking at family history
  • incidental finding on imaging eg. CT or US
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9
Q

are AAAs screened for?

A

yes, men over 65 are screened

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10
Q

what are the outcomes if screening for AAA shows aorta is normal?

A

discharged

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11
Q

what is the outcome if screening for AAA shows aorta is 3.0-4.4 cm (small aneurysm)?

A

invited for annual USS scans

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12
Q

what is the outcome if screening for AAA shows aorta is 4.5-5.5 cm (medium aneurysm)?

A

invited for 3 monthly USS scans

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13
Q

what is the outcome if screening for AAA shows aorta is >5.5cm (large aneurysm)

A

treatment offered

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14
Q

what are the symptopms for an impending AAA rupture?

A

increasing back pain

tender AAA

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15
Q

what are the symptoms for AAA rupture?

A
  • abdominal/back/flank pain
  • painful pulsatile mass
  • haemodynamic instability (abnormal blood flow)
  • hypoperfusion (shock)
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16
Q

what are some of the less common presentations of AAA?

A 
distal embolisation
aortocaval fistula
aortoenteric fitula
uretereral occlusion
duodenal obstruction
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17
Q

what is an aortocaval fistula?

A

a joining of the IVC and the aorta, it is caused by a AAA

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18
Q

what is an aortoenteric fistula?

A

a connection between the aorts and the oesophagus, intestines or stomach, can be caused by AAA

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19
Q

what are the three things that must be considered for asymptomatic AAA for management?

A
  • size of aneurysm
  • patient candidate fir repair?
  • aneurysm suitable for endovascular or open repair
20
Q

what is the risk of rupture of an aneurysm 4.0-4.9 cm?

A

0.5-5%

21
Q

what is the risk of rupture of an aneurysm 5.0-5.9cm?

A

3-15%

22
Q

what is the risk of rupture of an aneurysm 6.0-6.9 cm?

A

10-20%

23
Q

what are the tests carried out to determine patient fitness for AAA repair?

A 
Full history and examination
Bloods
ECG
ECHO
PFTs
MPS-myocardial erfusion scan
CPEX -cardiopulmonary exercise testing
24
Q

what are the pros and cons of using USS for assessing AAA?

A

pros:
no radiation
no contrast
cheap

cons:
operator dependent
inedequate for surgical planning

25
Q

what are the pros and cons of udiong CTA/ MRA for assessing AAA?

A

pros:
quick
not operator dependent
necessary for surgical planning-detailed anatomy

cons:
cantrast
radiation

26
Q

when is conservative treatment of AAAs used?

A
  • patient/aneurysm not fit for repair

- consider event of rupture

27
Q

what are the 2 surgical procedure for AAA repair?

A

open repair

endovascular repair

28
Q

what are the general complications of open repair of AAA?

A

Wound infection / dehiscence
Bleeding
Pain
Scar

29
Q

what are the technical complications of open repair of AAAs?

A 
Damage to bowel, ureters, veins, nerves
Incisional hernia
Graft infection
Distal emboli
Renal failure
Colonic ischaemia
30
Q

what are the patient factors for complications in open repair of AAAs

A

DVT/PE
MI
Stroke
Death

31
Q

what are the general complications for endovascular repair of AAAS?

A 
Wound infection
Bleeding / haematoma
Pain
Scar
Contrast – reaction / kidney injury
Radiation
32
Q

what are the technical complications of endovascular repair of AAAs?

A

Endoleak
Femoral artery dissection / pseudoaneurysm
Rupture
Distal emboli / ischaemia / colonic ischaemia
Damage to femoral vein / nerve

33
Q

what are patient complications of endovascular repair ?

A

DVT/PE
MI
Stroke
Death

34
Q

what is the advantage of EVAR over open repair of AAAs?

A

mortality is lower

35
Q

what is the protocol for emergency open repair of AAA?

A
  1. straight to theatre
  2. massive transfusion
  3. prep abdomen, rapid anaesthetic
  4. laparotomy
  5. occlude aorta proximally
36
Q

who manages symtoms of strokes?

A

stroke teams

37
Q

what is the role of vascular surgeons in strokes?

A

management of carotid disease to prevent further events

38
Q

what is a stroke?

A

Clinical syndrome consisting of rapidly developing clinical signs of focal or global disturbance of cerebral function, lasting more than 24hours or leading to death, with no apparent cause other than that of vascular origin.

39
Q

what is a TIA?

A

Focal CNS disturbance caused by vascular events such as microemboli and occlusion, leading to cerebral ischaemia. Symptoms last less than 24hours and there are no permanent neurological sequelae.
Stroke

40
Q

what are the causes if stroke (cerebral infarction)?

A

AF
Carotid atherosclerotic plaque rupture/thrombus (15%)
Endocarditis
MI
Carotid artery trauma/dissection
Drug abuse
Haematological disorder e.g. sickle cell disease

41
Q

what is used to diagnose stroke?

A

history
examination
CT
carotid USS

42
Q

what happens to the velocity of flow in a vessel as radius decreases?

A

it increases

43
Q

what are the management techniques for stroke?

A 
Best medical therapy:
Smoking cessation
Control of hypertension
Antiplatelet
Statin
Diabetic control
44
Q

if a carotid artery is fully occluded and there are no symptoms of surgery perfored?

A

no, only when there is risk of embolism. i.e. partially occluded >70%

45
Q

what are the interventional procedures for carotid atheroma causing >70% stenosis?

A

carotid endarterectomy

stenting

46
Q

what are the complications of carotid endarterectomy?

A 
wound infection
bleeding
scar
anaesthetic risks
nerve damage
plaque rupture
hypoperfusion
raw intimal surface can cause thrombosis and constriction of the artery

Cardiovascular system (40 decks)

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