Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery M4 part 1 > arterial aneurysm > Flashcards

arterial aneurysm Flashcards

1
Q

What is the definition of an aneurysm?

A

permanent & irreversible localized dilation of a blood vessel that has atleast a 50% increase in diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the difference between an aneurysm & arterial ectasia?

A

aneurysm: > 50% increase in diameter
ectasia: <50% localized arterial dilatation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the types of aneurysms according to their wall?

A
  • TRUE: all layers of artery are involved
  • FALSE: only fibrous tissue lined from inside by endothelium
  • DISSECTING: patch of intima tears & blood forcibly dissects its way between the inner & outer layer of the media
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes a pseudoaneurysm?

A

partial tear of arterial wall -> extravasation of blood -> formation of hematoma surrounded by fibrin network connected to lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where does a dissecting aneurysm usually occur?

A

thoracic & abdominal aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 2 morphological types of aneurysms?

A

SACCULAR
- on one side of the vessel wall

FUSIFORM
- the whole lumen is diffusely enlarged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What arteries are more prone to saccular aneurysms?

A

peripheral arteries in neck & limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which arteries are more prone to fusiform aneurysms?

A

large internal arteries (aorta)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which morphological aneurysm type is more dangerous?

A

saccular is more prone to rupture than fusiform but it spontaneously regresses unlike fusiform

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the most common locations for a congenital (saccular) aneurysm?

A
  • Circle of Willis causing subarachnoid hemorrhage
  • splenic, renal & celiac arteries leading to hemorrhage into peritoneal cavity
  • Ehler-Danlos syndrome & Marfan’s Syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the most common locations for a congenital (saccular) aneurysm?

A
  • Circle of Willis causing subarachnoid hemorrhage
  • splenic, renal & celiac arteries leading to hemorrhage into peritoneal cavity
  • Ehler-Danlos syndrome & Marfan’s Syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most common cause of acquired aneurysms & what is the commonest site it occurs in?

A

atheroscrelosis

INFRA-RENAL ABDOMINAL AORTA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the different types of acquired aneurysms?

A
  • degenerative: atherosclerosis
  • infective (mycotic): bacterial or fungal emboli may lodge in arterial wall resulting in weakness
  • mechanical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the types of mechanically acquired aneurysms?

A
  • post-stenotic aneurysms: in association with coarcitation, cervical rib, & popliteal artery entrapment
  • traumatic aneurysms: false aneurysms due to pulsating hematoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the commonest site for an aneurysm?

A

infra-renal abdominal aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the commonest site for a peripheral true aneurysm?

A

popliteal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the commonest site for a false aneurysm?

A

Femoral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the commonest site for a false aneurysm?

A

Femoral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the usual clinical picture of an aneurysm?

A

ASYMPTOMATIC
if symptomatic -> swelling
-> pressure manifestations
-> PAIN (impeding rupture)
-> distal ischemia
-> if popliteal artery is easily palpable consider aneurysm

19
Q

if there are recurrent attacks of acute ischemia affecting distal foot with normal cardiac examination (no AF) what should be suspected?

A

investigate for popliteal artery aneurysms

20
Q

What signs are seen upon inspection of a patient presenting with an aneurysm?

A
  • swelling on anatomical course of a main artery
  • expansile pulsations
  • pulsates synchronously with heart beat
21
Q

What will be felt upon palpation of an aneurysm?

A
  • smooth cystic swelling
  • moves transversely across the line of the artery but not longitudinally
  • compressible
  • proximal compression of artery -> shrinkage of swelling with loss of pulsations
  • distal compression of artery -> increase in tension & pulsations
  • palpable thrill
22
Q

What will be heard upon auscultation of an aneurysm?

A

audible systolic bruit

23
Q

What is the difference between an aneurysm & an AV fistula?

A

ANEURYSM AV FISTULA

                           - on anatomical site 
                           - distal ischemia 
                           - expansile pulsations 
                           - cystic 
                           - compressible 
                           - palpable thrill  - no hyperdynamic circulation                      - hyperdynamic circulation - no venous hypertension                             - venous hypertension  - proximal compression -> decrease size    - proximal compression-> decrease size & Branham's bradycardia  - audible bruit is systolic                               - audible bruit is continuous
24
Q

What are the complications of an aneurysm?

A
  • rupture
  • pressure effects on
    nerves -> pain, paralysis, sensory changes
    veins -> edema & congestion
    bones -> erosion
    viscera -> obstruction
  • infection & suppuration (rupture & fatal secondary hemorrhage)
  • consolidation (coagulation)
25
Q

What are the complications of a dissecting aneurysm?

A
  • pressure of false lumen on true lumen with ischemic manifestations
  • internal rupture -> spontaneous cure
  • external rupture -> severe fatal hemorrhage
  • proximal propagation -> aortic valve incompetence
  • distal propagation -> renal, iliac, or femoral arteries -> obstruction of their lumens
26
Q

What is the gold standard for diagnosis of aneurysm?

A

duplex

- detects size & mural thrombus

27
Q

What is the gold standard for pre-op preparation of aneurysm?

A

Multi-slice CT

- shows sac, feeding artery & collateral vessels

28
Q

When should conservative management be used?

A

in small asymptomatic aneurysms

29
Q

What are the indications of surgical treatment?

A
  • symptomatic aneurysm (painful or ischemic)
  • large aneurysms
  • rapidly enlarging aneurysms
  • uncontrolled hypertensive patient
  • if asymptomatic popliteal artery aneurysm exceeds 2 cm in diameter
30
Q

What are the surgical options for surgical intervention for an aneurysm?

A
  • excision & grafting
    (ideal if local conditions permit it)
    (excision is hazardous if dense adhesions are present)
  • ligation & bypass
    (excluded sac will later thrombose & shrink)
  • excision & ligation
    (only in small arteries that have many collaterals)
  • exclusion graft (
    stent inserted inside graft without removing sac)
31
Q

How is femoral pseudoaneurysm treated?

A

ultrasound guided fibrin injection

32
Q

What is the clinical picture of an abdominal aortic aneurysm without rupture?

A

PAIN
may be due to - spinal erosion (prolonged compression)
- expanding aneurysm
- pain in thigh & groin due to nerve compression

EMBOLIZATION TO PERIPHERAL ARTERIES

33
Q

What is the best screening & diagnostic method for an abdominal aortic aneurysm?

A

ABDOMINAL US (replacement for duplex)

34
Q

What is the best method of investigation for pre op preparation of abdominal aortic aneurysm?

A

abdominal CT & MRI

35
Q

when should angiography be used?

A
  • pre-operatively to delineate the proximal & distal extent to decide what stent size should be used
36
Q

What are the indications for surgery in an abdominal aortic aneurysm?

A
  • symptomatic aneurysms
  • asymptomatic aneurysms -> over 5.5cm
    - > 4-5cm with evidence of more than 0.5 enlargement in 6 months or more than 1cm in a year
37
Q

What are the types of surgeries used in abdominal aortic aneurysms?

A
  • open surgical technique

- endovascular aortic aneurysm repair (EVAR)

38
Q

How is EVAR preformed & what are its advantages?

A

access to aorta is via femoral arteries

  • lower morbidity
  • under local anesthesia
  • small groin incision
  • day case with short recovery time
39
Q

What are the disadvantages of EVAR?

A
  • less durability (5 years vs 25 years with open)
  • expensive
  • endoleak
40
Q

What are the types of endoleak?

A

I -> incomplete seal or ineffective seal at end of stent graft
II -> retrograde branch flow from collateral vessels
III -> inadequate or ineffective sealing of overlapping graft joints or rupture of graft fabric
IV -> porosity of graft fabric
V -> no clear evidence

41
Q

what are the complications of an AAA rupture?

A
  • less than 50% of patients survive to reach the hospital
  • anterior rupture: into peritoneal cavity
  • posterior rupture: into retroperitoneal space (more fatal)
  • rupture into IVC: large AV fistula
  • rupture into duodenum: upper GIT bleeding
42
Q

What is the clinical picture of an AAA rupture?

A
  • sudden severe back pain & chest pain that could be confused with MI
  • pulsatile mass palpable in the abdomen
  • femoral pulses in one or both groins may be diminished
42
Q

What is the clinical picture of an AAA rupture?

A
  • sudden severe back pain & chest pain that could be confused with MI
  • pulsatile mass palpable in the abdomen
  • femoral pulses in one or both groins may be diminished
43
Q

How is a ruptured AAA managed?

A

operation immediately when cross matched blood is available & EVAR used if available

44
Q

What is the most common surgical intervention for small arteries?

A

grafting

Surgery M4 part 1 (47 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions