aortic aneurysms and carotid artery disease Flashcards
what is aneurysm disease?
Dilatation of all layers of the aorta, leading to an increase in diameter of >50%
causes of anuerysm disease
Degenerative disease
Connective tissue disease (e.g. Marfan’s disease)
Infection (mycotic aneurysm)
risk factors for degenerative aortic aneurysm?
Male sex Age Smoking Hypertension Family history (prevalence of 30% in 1st degree male relatives)
true or false:
aortic aneurysm is asymptomatic
true
what is abdominal aortic aneurysm screening?
AAA screening aims to detect a dangerous swelling of the aorta, the largest blood vessel in the body
what are the outcomes of screening for AAA? (4)
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)
what are symptoms of impending rupture?
Increasing back pain
Tender AAA
what are symptoms of rupture of AAA?
Abdo/back/flank pain
Painful pulsatile mass
Haemodynamic instability (single episode or progressive)
Hypoperfusion
what are unusual presentations of AAA
Distal embolisation Aortocaval fistula Aortoenteric fistula Ureteric occlusion Duodenal obstruction
what three questions should you ask yourself when deciding on the repairing of asymptomatic AAA?
Is the aneurysm a size to consider repair?
Is the patient a candidate for repair?
Is the aneurysm suitable for endovascular or open repair?
how likely is an aneurysm of >8 cm to rupture>
30-50%
what are the positives and negatives when assessing AAA with ultrasound?
No radiation
No contrast
Cheap
Operator dependent
Inadequate for surgical planning
what are the positives and negatives when assessing AAA with CT or MRA
Quick
Not operator dependent
Necessary for surgical planning – detailed anatomy
Contrast
Radiation
what is the treatment of AAA
Patient / aneurysm not fit for repair
Consider event of rupture
Endovascular repair
Open repair
what are the general complications of an open repair of AAA
General: Wound infection / dehiscence Bleeding Pain Scar
what are the technical complications of an open repair of AAA
Damage to bowel, ureters, veins, nerves Incisional hernia Graft infection Distal emboli Renal failure Colonic ischaemia
what are the patient complications of an open repair AAA
DVT/PE
MI
Stroke
Death
what are the general complications of na endovascular repair?
Wound infection Bleeding / haematoma Pain Scar Contrast – reaction / kidney injury Radiation
what are the technical complications of an endovascular repair?
Endoleak
Femoral artery dissection / pseudoaneurysm
Rupture
Distal emboli / ischaemia / colonic ischaemia
Damage to femoral vein / nerve
what are the patient complications of an endovascular repair?
DVT/PE
MI
Stroke
Death
what is atherosclerosis of the carotid arteries associated with?
transient ischaemic attacks and ischaemic stroke
what is transient ischaemic attack?
Focal CNS disturbance caused by vascular events such as microemboli and occlusion, leading to cerebral ischaemia.
how long does symptoms last for in transient ischaemic attack?
less than 24 hours
what is a stroke?
Clinical syndrome consisting of rapidly developing clinical signs of focal or global disturbance of cerebral function
how long does symptoms last for stroke?
lasting more than 24hours or leading to death, with no apparent cause other than that of vascular origin.
what are the causes of stroke?
Cerebral infarction (84%)
Primary intracerebral haemorrhage (10%)
Subarachnoid haemorrhage (6%)
what are the cerebral infarctions that cause stroke?
AF
Carotid atherosclerotic plaque rupture/thrombus (15%)
Endocarditis
MI
Carotid artery trauma/dissection
Drug abuse
Haematological disorder e.g. sickle cell disease
what are risk factors for carotid artery atherosclerosis?
Smoking Diabetes Family history Male sex Previous DVT 2° to flight Hypertension Hyperlipidaemia/hypercholesterolaemia Obesity Age
what management would you use for carotid artery disease?
Smoking cessation Control of hypertension Antiplatelet Statin Diabetic control
how is brain still perfused when having a stroke?
circle of willis
what surgery would you use for carotid disease?
Carotid endarterectomy
removes plaque
what are complications of Carotid endarterectomy
Wound infection, bleeding, scar, anaesthetic risks
Nerve damage
Perioperative stroke
what makes up the wall in artery
elastic- 3 layers
tunica externa, tunica media, tunica intima
whats the criteria for screening
Definable disease Prevalence Severity of disease Natural history Reliable detection Early detection confers advantage Treatment options available Cost Feasibility Acceptability
what’s the best test to determine the fitness for cardiovascular surgery?
end of bed test
what is an endoleak
putting in a new graft that already has a hole in it
whats the most common EVAR endoleak?
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