aortic aneurysms and carotid artery disease Flashcards
what is the definition of an aortic aneurysm?
dilatation of the all layers of the aorta, leading to an increase in diameter of >50% (abdominal aorta >3cm)
what is a false aneurysm?
not all layers like an aneurysm, can be from blood in the space between intima and media
what is arteriomegaly and subarneurysmal dialatation?
dilatation of an artery less than the required size for aneurysm (i.e. <3cm in abdominal aorta)
where do the majority if abdominal aortic aneurysms (AAA) occur?
between the renal arteries and the bifurcation of the abdominal aorta
what are the 3 causes of aortic aneurysm?
- degenerative disease (atheroma)
- connective tissue disease (eg. Merfan’s)
- infection (mycotic aneurysm)
what are the risk factors for AAA?
male age smoking hypertension family history
which form of AAA is harderst to treat?
infection
whar are the 3 ways thar assymptomatic AAAs can be discovered?
- examination by a clinician
- looking at family history
- incidental finding on imaging eg. CT or US
are AAAs screened for?
yes, men over 65 are screened
what are the outcomes if screening for AAA shows aorta is normal?
discharged
what is the outcome if screening for AAA shows aorta is 3.0-4.4 cm (small aneurysm)?
invited for annual USS scans
what is the outcome if screening for AAA shows aorta is 4.5-5.5 cm (medium aneurysm)?
invited for 3 monthly USS scans
what is the outcome if screening for AAA shows aorta is >5.5cm (large aneurysm)
treatment offered
what are the symptopms for an impending AAA rupture?
increasing back pain
tender AAA
what are the symptoms for AAA rupture?
- abdominal/back/flank pain
- painful pulsatile mass
- haemodynamic instability (abnormal blood flow)
- hypoperfusion (shock)
what are some of the less common presentations of AAA?
distal embolisation aortocaval fistula aortoenteric fitula uretereral occlusion duodenal obstruction
what is an aortocaval fistula?
a joining of the IVC and the aorta, it is caused by a AAA
what is an aortoenteric fistula?
a connection between the aorts and the oesophagus, intestines or stomach, can be caused by AAA
what are the three things that must be considered for asymptomatic AAA for management?
- size of aneurysm
- patient candidate fir repair?
- aneurysm suitable for endovascular or open repair
what is the risk of rupture of an aneurysm 4.0-4.9 cm?
0.5-5%
what is the risk of rupture of an aneurysm 5.0-5.9cm?
3-15%
what is the risk of rupture of an aneurysm 6.0-6.9 cm?
10-20%
what are the tests carried out to determine patient fitness for AAA repair?
Full history and examination Bloods ECG ECHO PFTs MPS-myocardial erfusion scan CPEX -cardiopulmonary exercise testing
what are the pros and cons of using USS for assessing AAA?
pros:
no radiation
no contrast
cheap
cons:
operator dependent
inedequate for surgical planning
what are the pros and cons of udiong CTA/ MRA for assessing AAA?
pros:
quick
not operator dependent
necessary for surgical planning-detailed anatomy
cons:
cantrast
radiation
when is conservative treatment of AAAs used?
- patient/aneurysm not fit for repair
- consider event of rupture
what are the 2 surgical procedure for AAA repair?
open repair
endovascular repair
what are the general complications of open repair of AAA?
Wound infection / dehiscence
Bleeding
Pain
Scar
what are the technical complications of open repair of AAAs?
Damage to bowel, ureters, veins, nerves Incisional hernia Graft infection Distal emboli Renal failure Colonic ischaemia
what are the patient factors for complications in open repair of AAAs
DVT/PE
MI
Stroke
Death
what are the general complications for endovascular repair of AAAS?
Wound infection Bleeding / haematoma Pain Scar Contrast – reaction / kidney injury Radiation
what are the technical complications of endovascular repair of AAAs?
Endoleak
Femoral artery dissection / pseudoaneurysm
Rupture
Distal emboli / ischaemia / colonic ischaemia
Damage to femoral vein / nerve
what are patient complications of endovascular repair ?
DVT/PE
MI
Stroke
Death
what is the advantage of EVAR over open repair of AAAs?
mortality is lower
what is the protocol for emergency open repair of AAA?
- straight to theatre
- massive transfusion
- prep abdomen, rapid anaesthetic
- laparotomy
- occlude aorta proximally
who manages symtoms of strokes?
stroke teams
what is the role of vascular surgeons in strokes?
management of carotid disease to prevent further events
what is a stroke?
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.
what is a TIA?
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
what are the causes if stroke (cerebral infarction)?
AF
Carotid atherosclerotic plaque rupture/thrombus (15%)
Endocarditis
MI
Carotid artery trauma/dissection
Drug abuse
Haematological disorder e.g. sickle cell disease
what is used to diagnose stroke?
history
examination
CT
carotid USS
what happens to the velocity of flow in a vessel as radius decreases?
it increases
what are the management techniques for stroke?
Best medical therapy: Smoking cessation Control of hypertension Antiplatelet Statin Diabetic control
if a carotid artery is fully occluded and there are no symptoms of surgery perfored?
no, only when there is risk of embolism. i.e. partially occluded >70%
what are the interventional procedures for carotid atheroma causing >70% stenosis?
carotid endarterectomy
stenting
what are the complications of carotid endarterectomy?
wound infection bleeding scar anaesthetic risks nerve damage plaque rupture hypoperfusion raw intimal surface can cause thrombosis and constriction of the artery
