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Gen Surg (Vascular) > Aortic Aneurysms, Dissections & Carotid Artery Disease > Flashcards

Aortic Aneurysms, Dissections & Carotid Artery Disease Flashcards

1
Q

What defines an AAA?

A

An abdominal aorta with a diameter > 50% wider than normal (i.e. > 3cm)

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2
Q

In what age group are AAAs most common? In which ethnic group are they most common?

A

65-75 / Caucasians

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3
Q

In < 5% of cases, AAAs are caused by an underlying disease process, what condition can this be?

A

Marfan’s syndrome

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4
Q

What investigation is used for screening for AAAs? Who gets this screening?

A

Abdominal ultrasound - offered to all men aged > 65

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5
Q

What is the outcome if an abdominal ultrasound shows an AAA of 3-4.4cm?

A

Rescan every 12 months

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6
Q

What is the outcome if an abdominal ultrasound shows an AAA of 4.5-5.4cm?

A

Rescan every 3 months

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7
Q

What is the outcome if an abdominal ultrasound shows an AAA of 5.5cm or more?

A

2 week referral to vascular surgery

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8
Q

What is the characteristic symptom of a ruptured AAA?

A

Severe abdominal pain radiating to the back

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9
Q

A ruptured AAA is a clinical diagnosis based on a triad of what three things?

A

Abdominal pain, shock, palpable abdominal mass

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10
Q

What investigation is used to look for an AAA in an emergency setting?

A

Abdominal ultrasound

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11
Q

What investigation is used to look for an AAA in surgical planning?

A

Abdominal CT

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12
Q

What conservative management options can be used to slow the progression of AAA?

A

Smoking cessation, treatment of hypertension and hypercholesterolaemia

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13
Q

What is an aortic dissection?

A

A tear in the tunica intima of the aorta

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14
Q

In what age group is aortic dissection most common? In which ethnic group are they most common?

A

Those aged 5-65 / Afro-Caribbeans

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15
Q

What are some congenital causes predisposing to aortic dissection?

A

Connective tissue diseases e.g. Marfan’s, bicuspid aortic valves, coarctation of the aorta

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16
Q

What are some acquired causes of aortic dissection?

A

Hypertension, AAA, pregnancy

17
Q

What are some surgical procedures which come with a risk of aortic dissection?

A

Aortic/mitral valve replacement, CABG, PCI

18
Q

What investigation is used to detect, measure and monitor dilatation of the aortic arch so that intervention can be performed before dissection occurs?

A

Transthoracic ECHO

19
Q

What is meant by type A aortic dissection?

A

Involves the ascending aorta

20
Q

What is meant by type B aortic dissection

A

Involves the descending aorta

21
Q

An aortic dissection typically causes a sudden, severe, tearing pain. Radiation to where would suggest type A aortic dissection?

A

Neck

22
Q

An aortic dissection typically causes a sudden, severe, tearing pain. Radiation to where would suggest type B aortic dissection?

A

Back

23
Q

What is a clinical sign that is highly suggestive of an aortic dissection?

A

A difference in blood pressure > 20mmHg between the right and left arms

24
Q

Aortic dissection can lead to what cardiac valvular problem? What type of murmur does this cause?

A

Aortic regurgitation causing an early diastolic murmur

25
Q

What is the gold standard investigation for diagnosing an aortic dissection?

A

CT chest/abdo

26
Q

In addition to a CT chest/abdo, what are some other investigations which may be useful for someone with aortic dissection?

A

CXR, transthoracic ECHO, bloods, ECG

27
Q

How are type A aortic dissections managed?

A

Surgically

28
Q

How are type B aortic dissections managed?

A

Medically

29
Q

What are the only symptoms of carotid artery disease?

A

Stroke or TIA

30
Q

How may carotid artery disease be detected incidentally?

A

By auscultating a carotid bruit on examination

31
Q

What investigation is used to diagnose carotid artery disease?

A

Duplex US

32
Q

What are some conservative management options for carotid artery disease?

A

Prescribe a statin and aspirin, maintain tight control of hypertension and diabetes

33
Q

When would surgery be considered for someone with carotid artery disease?

A

If they are symptomatic or have > 75% stenosis

34
Q

What surgical options are available for treating carotid artery disease?

A

Carotid endarterectomy or angioplasty + stenting

Gen Surg (Vascular) (2 decks)

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