Aortic Aneurysms, Dissections & Carotid Artery Disease Flashcards
What defines an AAA?
An abdominal aorta with a diameter > 50% wider than normal (i.e. > 3cm)
In what age group are AAAs most common? In which ethnic group are they most common?
65-75 / Caucasians
In < 5% of cases, AAAs are caused by an underlying disease process, what condition can this be?
Marfan’s syndrome
What investigation is used for screening for AAAs? Who gets this screening?
Abdominal ultrasound - offered to all men aged > 65
What is the outcome if an abdominal ultrasound shows an AAA of 3-4.4cm?
Rescan every 12 months
What is the outcome if an abdominal ultrasound shows an AAA of 4.5-5.4cm?
Rescan every 3 months
What is the outcome if an abdominal ultrasound shows an AAA of 5.5cm or more?
2 week referral to vascular surgery
What is the characteristic symptom of a ruptured AAA?
Severe abdominal pain radiating to the back
A ruptured AAA is a clinical diagnosis based on a triad of what three things?
Abdominal pain, shock, palpable abdominal mass
What investigation is used to look for an AAA in an emergency setting?
Abdominal ultrasound
What investigation is used to look for an AAA in surgical planning?
Abdominal CT
What conservative management options can be used to slow the progression of AAA?
Smoking cessation, treatment of hypertension and hypercholesterolaemia
What is an aortic dissection?
A tear in the tunica intima of the aorta
In what age group is aortic dissection most common? In which ethnic group are they most common?
Those aged 5-65 / Afro-Caribbeans
What are some congenital causes predisposing to aortic dissection?
Connective tissue diseases e.g. Marfan’s, bicuspid aortic valves, coarctation of the aorta
What are some acquired causes of aortic dissection?
Hypertension, AAA, pregnancy
What are some surgical procedures which come with a risk of aortic dissection?
Aortic/mitral valve replacement, CABG, PCI
What investigation is used to detect, measure and monitor dilatation of the aortic arch so that intervention can be performed before dissection occurs?
Transthoracic ECHO
What is meant by type A aortic dissection?
Involves the ascending aorta
What is meant by type B aortic dissection
Involves the descending aorta
An aortic dissection typically causes a sudden, severe, tearing pain. Radiation to where would suggest type A aortic dissection?
Neck
An aortic dissection typically causes a sudden, severe, tearing pain. Radiation to where would suggest type B aortic dissection?
Back
What is a clinical sign that is highly suggestive of an aortic dissection?
A difference in blood pressure > 20mmHg between the right and left arms
Aortic dissection can lead to what cardiac valvular problem? What type of murmur does this cause?
Aortic regurgitation causing an early diastolic murmur
What is the gold standard investigation for diagnosing an aortic dissection?
CT chest/abdo
In addition to a CT chest/abdo, what are some other investigations which may be useful for someone with aortic dissection?
CXR, transthoracic ECHO, bloods, ECG
How are type A aortic dissections managed?
Surgically
How are type B aortic dissections managed?
Medically
What are the only symptoms of carotid artery disease?
Stroke or TIA
How may carotid artery disease be detected incidentally?
By auscultating a carotid bruit on examination
What investigation is used to diagnose carotid artery disease?
Duplex US
What are some conservative management options for carotid artery disease?
Prescribe a statin and aspirin, maintain tight control of hypertension and diabetes
When would surgery be considered for someone with carotid artery disease?
If they are symptomatic or have > 75% stenosis
What surgical options are available for treating carotid artery disease?
Carotid endarterectomy or angioplasty + stenting
