Aortic aneurysms and Carotid Artery Disease Flashcards
What is an aortic aneurysm?
Dilatation of all layers of the aorta, leading to an increase in diameter of > 50% (AA > 3cm)
What causes an aneurysm?
Degenerative disease (atheroma)
Connective tissue disease (i.e. Marfan)
Infection (mycotic aneurysm)
What are risk factors for AAA disease?
Male Age Smoking Hypertension FH
What are the symptoms of impending AAA?
Asymptomatic
Increasing back pain
Tender AAA
What are AAA screening?
Detects dangerous swelling of the aorta (ultrasound scan of men > 65)
What is a false aneurysm?
Dilatation of the T adventitia of an artery and not all layers like an aneurysm
What is the outcome if screening for AAA shows aorta is 3-4.4 cm (small aneurysm)?
Annual USS scans
What is the outcome if screening for AAA shows aorta is 4.5-5.5 cm (medium aneurysm)?
3 monthly USS scans
What is the outcome if screening for AAA shows aorta is >5.5 cm (large aneurysm)?
Treatment offered
What are the symptoms of a ruptured AAA?
Abdo/back/flank pain
Painful pulsatile mass
Haemodynamic instability (abnormal blood flow)
Hypoperfusion (shock)
What less common presentations of a ruptured AAA?
Distal embolisation Aortocaval fistula Aortaenteric fistula Ureteric occlusion Duodenal obstruction
What is an aortocaval fistula?
Abnormal connection between aorta and IVC, caused by AAA
What is an aortoenteric fistula?
A connection between the aorta and oesophagus, intestines or stomach, can be caused by AAA
What are 3 things to consider for an asymptomatic AAA?
Is aneurysm a size to consider repair?
Is the patient a candidate for repair?
Is aneurysm suitable for endovascular or open repair?
What are the tests carried out to determine patient fitness for AAA repair?
Full history and exam Bloods: FBC, U+Es ECG Echo PFT Myocardial perfusion scan Cardio-pulmonary exercise test
What are the pros and cons of using USS for assessing AAA?
No radiation No contrast Cheap BUT Operator dependent Inadequate for surgical planning
What are the pros and cons of using CTA/MRA for assessing AAA?
Quick not operator dependent Necessary for surgical planning - detailed anatomy BUT Uses contrast and radiation
When is conservative treatment of AAAs used?
Patient or aneurysm not fit for repair
Consider event of rupture
What are the 2 surgical procedure for AAA repair?
Endovascular repair
Open repair
What are the general complications of open repair of AAA?
Wound infection
Bleeding
Pain
Scar
What are the technical complications of open repair of AAA?
Damage to bowel, ureters, veins, nerves Incisional hernia Graft infection Distal emboli Renal failure Colonic ischaemia
What are the patient factors for complications of open and endovascular repair of AAA?
DVT/PE
MI
Stroke
Death
What are the general complications of endovascular repair of AAA?
Same of open repair, as well as:
Contrast causes kidney injury
Radiation
What are the technical complications of endovascular repair of AAAs?
Endoleak Femoral artery dissection/pseudoaneurysm Rupture Distal emboli/ischaemia Damage to femoral vessels
What is the management for symptomatic AAA?
ABCDE
History
Examination
CTA
What is ABCDE management?
Airway obstruction Breathing Circulation Disability Exposure
What is a TIA?
Focal CNS disturbance by vascular events such as micro emboli and occlusion, leading to cerebral ischaemia - lasts less then 24hrs
What is a stroke?
Rapidly developing signs of disturbance of cerebral function, lasting more than 24hrs or leading to death, with no other causes than vascular origin
What are causes of a stroke (/TIA)?
AF Carotid atheroma rupture/thrombus Endocarditis MI Carotis artery trauma/dissection IVDA Haematological disorder (i.e. sick cell disease)
How is diagnosis made for stroke (/TIA)?
History
Examination: Neuro, cardiac, auscultate carotids
CT
Carotid USS
What happens to the velocity of flow in a vessel as radius decreases (Poiseullie’s Law)?
As radius of a vessel decreases (i.e. stenosis), velocity increases
What is the best medical therapy for stroke?
Smoking cessation Control of HPT Antiplatelet Statin (lower cholesterol) Diabetic control
What is a carotid doppler test?
Test that uses high-frequency sound waves to measure the amount of blood flow through your arteries and veins
How is a TIA confirmed?
Left sided symptoms
Carotid doppler: right internal artery occluded
What are surgical methods that can be used to prevent a stroke?
Carotid endarecomy to remove plaque
Stenting
What are the possible complications of a carotid endarectomy?
Wound infection Bleeding Scar Anaesthetic risk Nerve damage Perioperative stroke (plaque rupture or hypo perfusion)
When is surgery considered as prophylaxis for stroke?
Men with 50-69% stenosis
Asymptomatic stenosis > 70%
