aortic aneurysms and carotid artery disease

Question 1

what is aneurysm disease?

Answer 1

Dilatation of all layers of the aorta, leading to an increase in diameter of >50%

Question 2

causes of anuerysm disease

Answer 2

Degenerative disease
Connective tissue disease (e.g. Marfan’s disease)
Infection (mycotic aneurysm)

Question 3

risk factors for degenerative aortic aneurysm?

Answer 3

Male sex
Age
Smoking
Hypertension
Family history (prevalence of 30% in 1st degree male relatives)

Question 4

true or false:

aortic aneurysm is asymptomatic

Answer 4

true

Question 5

what is abdominal aortic aneurysm screening?

Answer 5

AAA screening aims to detect a dangerous swelling of the aorta, the largest blood vessel in the body

Question 6

what are the outcomes of screening for AAA? (4)

Answer 6

A) Normal aorta, discharged

B) Small AAA (3.0-4.4cm) will be invited for annual USS scans

C) Medium AAA (4.5-5.5cm) will be invited for 3 monthly USS scans

D) Large AAA (>5.5cm)

Question 7

what are symptoms of impending rupture?

Answer 7

Increasing back pain

Tender AAA

Question 8

what are symptoms of rupture of AAA?

Answer 8

Abdo/back/flank pain
Painful pulsatile mass
Haemodynamic instability (single episode or progressive)
Hypoperfusion

Question 9

what are unusual presentations of AAA

Answer 9

Distal embolisation
Aortocaval fistula
Aortoenteric fistula
Ureteric occlusion
Duodenal obstruction

Question 10

what three questions should you ask yourself when deciding on the repairing of asymptomatic AAA?

Answer 10

Is the aneurysm a size to consider repair?

Is the patient a candidate for repair?

Is the aneurysm suitable for endovascular or open repair?

Question 11

how likely is an aneurysm of >8 cm to rupture>

Answer 11

30-50%

Question 12

what are the positives and negatives when assessing AAA with ultrasound?

Answer 12

No radiation
No contrast
Cheap

Operator dependent
Inadequate for surgical planning

Question 13

what are the positives and negatives when assessing AAA with CT or MRA

Answer 13

Quick
Not operator dependent
Necessary for surgical planning – detailed anatomy

Contrast
Radiation

Question 14

what is the treatment of AAA

Answer 14

Patient / aneurysm not fit for repair
Consider event of rupture

Endovascular repair

Open repair

Question 15

what are the general complications of an open repair of AAA

Answer 15

General:
Wound infection / dehiscence
Bleeding
Pain
Scar

Question 16

what are the technical complications of an open repair of AAA

Answer 16

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

Question 17

what are the patient complications of an open repair AAA

Answer 17

DVT/PE
MI
Stroke
Death

Question 18

what are the general complications of na endovascular repair?

Answer 18

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

Question 19

what are the technical complications of an endovascular repair?

Answer 19

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

Question 20

what are the patient complications of an endovascular repair?

Answer 20

DVT/PE
MI
Stroke
Death

Question 21

what is atherosclerosis of the carotid arteries associated with?

Answer 21

transient ischaemic attacks and ischaemic stroke

Question 22

what is transient ischaemic attack?

Answer 22

Focal CNS disturbance caused by vascular events such as microemboli and occlusion, leading to cerebral ischaemia.

Question 23

how long does symptoms last for in transient ischaemic attack?

Answer 23

less than 24 hours

Question 24

what is a stroke?

Answer 24

Clinical syndrome consisting of rapidly developing clinical signs of focal or global disturbance of cerebral function

Question 25

how long does symptoms last for stroke?

Answer 25

lasting more than 24hours or leading to death, with no apparent cause other than that of vascular origin.

Question 26

what are the causes of stroke?

Answer 26

Cerebral infarction (84%)

Primary intracerebral haemorrhage (10%)

Subarachnoid haemorrhage (6%)

Question 27

what are the cerebral infarctions that cause stroke?

Answer 27

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

Question 28

what are risk factors for carotid artery atherosclerosis?

Answer 28

Smoking
Diabetes
Family history
Male sex
Previous DVT 2° to flight
Hypertension
Hyperlipidaemia/hypercholesterolaemia
Obesity
Age

Question 29

what management would you use for carotid artery disease?

Answer 29

Smoking cessation
Control of hypertension
Antiplatelet
Statin
Diabetic control

Question 30

how is brain still perfused when having a stroke?

Answer 30

circle of willis

Question 31

what surgery would you use for carotid disease?

Answer 31

Carotid endarterectomy

removes plaque

Question 32

what are complications of Carotid endarterectomy

Answer 32

Wound infection, bleeding, scar, anaesthetic risks
Nerve damage

Perioperative stroke

Question 33

what makes up the wall in artery

Answer 33

elastic- 3 layers

tunica externa, tunica media, tunica intima

Question 34

whats the criteria for screening

Answer 34

Definable disease
Prevalence
Severity of disease
Natural history
Reliable detection
Early detection confers advantage
Treatment options available
Cost
Feasibility
Acceptability

Question 35

what’s the best test to determine the fitness for cardiovascular surgery?

Answer 35

end of bed test

Question 36

what is an endoleak

Answer 36

putting in a new graft that already has a hole in it

Question 37

whats the most common EVAR endoleak?

Answer 37

2