Aortic Disease

Question 1

Between which two layers of the aorta does blood go between in an aortic dissection?

Answer 1

Tunica intima and tunica media

Question 2

What is an aortic dissection?

Answer 2

• Tear in aortic wall tunica intima allows blood to split intima from media, causing branches of the aorta to occlude sequentially
• Acute vascular involvement

Question 3

What are the two types of aortic dissection?

Answer 3

1) Type A (70%) - ascending aorta involvement

2) Type B (30%) - no ascending aorta involvement

Question 4

What are risk factors for aortic dissection?

Answer 4

• HTN
• Atherosclerosis
• Aortic aneurysm
• Connective tissue disorders i.e. Marfan’s, Ehlers-Danlos

Question 5

What is the key symptom of aortic dissection?

Answer 5

Sudden onset chest pain

• Tearing
• Radiating to the back

Question 6

What are other potential symptoms of aortic dissection?

Answer 6

• Acute limb ischaemia
• Hemi/paraplegia
• Unequal arm pulses/BP
• Anuria

Question 7

What are complications of aortic dissection?

Answer 7

• Aortic regurgitation
• Inferior MI
• Cardiac arrest

Question 8

How do you diagnose aortic dissection?

Answer 8

• CT angiogram
• Transoesophageal echo
• MR angiography

Question 9

What other investigations might you do in someone presenting with aortic dissection?

Answer 9

ECG, CXR, troponin

Question 10

How do you immediately manage a patient with aortic dissection?

Answer 10

• ATLS
• Beta blocker e.g. labetalol or CCB
• Opioid analgesia

Question 11

How do you definitively treat all type A aortic dissections?

Answer 11

Open surgery

Question 12

How do you treat some type B aortic dissections?

Answer 12

Open surgery or endovascular stent-graft

Question 13

What medication should people be put on post aortic dissection?

Answer 13

Anti-HTN

Question 14

What is an arterial aneurysm?

Answer 14

Dilation of artery > 50% diameter, involving all layers of the wall

Question 15

What is the diameter of an (unruptured) AAA?

Answer 15

> 3cm across

Question 16

What are causes of AAA?

Answer 16

• Atheroma
• Trauma
• Infection
• Connective tissue disorders i.e. Marfan’s, Ehlers-Danlos
• Inflammatory (Takayasu’s aortitis)

Question 17

What are the symptoms of an unruptured AAA?

Answer 17

• Asymptomatic

- Abdo/back pain

Question 18

What are symptoms of a ruptured AAA?

Answer 18

• Abdo pain radiating to back/iliac fossa/groin
• Syncope/collapse
• Expansile abdo mass

Question 19

What are complications of a ruptured AAA?

Answer 19

• Shock
• Thrombosis + emboli
• Pressure on other structures

Question 20

How is screening carried out for AAA?

Answer 20

All men at aged 65 are invited for screening to reduce mortality from ruptured AAA

Question 21

How is an unruptured AAA diagnosed/monitored?

Answer 21

• Clinical
• O/E - expansile abdo mass
• Abdo US ± CT/MRA

Question 22

How is a ruptured AAA diagnosed?

Answer 22

Clinical

Question 23

How do you treat unruptured AAA?

Answer 23

• Monitoring
• RF modification
• Elective surgery if diameter >5.5cm OR EVAR stenting

Question 24

How do you treat a ruptured AAA?

Answer 24

• Refer to vascular surgeon and anaesthetist
• ECG, bloods (amylase, Hb, crossmatch), catheterise bladder
• Treat shock with O rhesus negative blood if not cross matched - keep systolic < 100mmHg to avoid rupturing a contained leak (raised BP is common early on)
• Prophylactic antibiotics e.g. co-amoxiclav IV 625mg
• Surgery