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Year 3 - CR > Arterial Aneurysms > Flashcards

Arterial Aneurysms Flashcards

1
Q

What are the two types of aneurysms

A
  • true

- false

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2
Q

What is the definition of the aneurysm

A
  • Aneurysm is defined if there is permanent dilatation of the artery to twice the normal diameter
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3
Q

Define a true aneurysm

A
  • this is when the arterial wall forms the wall of the aneurysm
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4
Q

what are arteries that are most frequently involved in true aneurysms

A
  • abdominal aorta (just below the renal arteries)
  • iliac
  • popliteal
  • femoral arteries
  • thoracic aorta
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5
Q

Define a false aneurysm

A
  • the surrounding tissues form the wall of the aneurysm
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6
Q

When do false aneurysms occur

A
  • false aneurysms occur following a femoral artery puncture
  • a haematoma is formed because of inadequate compression of the entry site and continued bleeding into the surrounding compressed soft tissue forms the wall of this aneurysm
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7
Q

where do abdominal aortic aneurysms commonly occur

A
  • these most commonly occur below the renal arteries
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8
Q

What can cause an abdominal aortic aneurysm

A
  • Atherosclerosis
  • Infection
  • Trauma
  • Genetic
  • Marfan syndrome
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9
Q

What are risk factors for abdominal aortic aneurysms

A
  • Age
  • Male
  • Strong family history
  • Smoking
  • Hypertension
  • Hypercholestrolaemia
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10
Q

Describe the screening program for aortic abdominal aneurysms

A
  • be offered to men aged 65-74 years who will receive an abdominal ultrasound
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11
Q

What are the sizes of abdominal aortic aneurysms seen on abdominal ultrasound and what does this mean

A
  • Normal or less than 3cm - will not require treatment or further scans
  • Small - 3-4.4 cm - aorta will require annual ultrasound surveillance and GP review to optimise lifestyle
  • Medium - 4.5-5.4cm - aorta requires quarterly ultrasound surveillance and cardiovascular secondary prevention therapy
  • large greater than 5.5cm - aorta will be referred for assessment and possible elective repair
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12
Q

What are the symptoms of aortic abdominal aneurysm

A
  • asymptomatic mostly
  • serve pain - epigastric pain that radiates to the back

Ruptured AAA

  • hypotension
  • tachycardia
  • profound anaemia
  • sudden death
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13
Q

What is the signs of an aortic abdominal aneurysm

A

pulsatile, expansile, abdominal mass is felt

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14
Q

What is the medical management of an abdominal aortic aneurysm

A
  • control of hypertension
  • smoking cessation
  • lipid lowering medication
  • patients with an AAA greater than 5.5cm are followed up by regular ultrasound surveillance
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15
Q

What is the surgical treatment for abdominal aortic aneurysms

A
  • Open surgery with a graft

- Endovascular stent

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16
Q

What is the emergency management of a ruptured abdominal aneurysm

A
  1. ECG
    1. Blood for amylase, Hb, crossmatch 10-40 units of blood
    2. Catheterize bladder
    3. Gain IV access with large bore cannula - use type O negative blood
    4. Keep systolic blood pressure less than 100mmHg to avoid rupturing a contained leak
    5. Take patients to theatres
    6. Give prophylactic antibiotics - Co-amoxiclav 625mg IV
      Open surgery to insert a Dacron graft
17
Q

How does an endovascular stent work

A
  • endovascular stent is inserted via the femoral or iliac arteries
18
Q

What is the difference between an open surgical repair and an endovascular stent

A
  • Endovascular stent has lower mortality and a reduced hospital stay but more complications than open surgery
19
Q

What are the symptoms of a thoracic abdominal aneurysm

A
  • Asymptomatic
  • severe pain (chest radiating to the upper back) and rupture is associated with hypotension, tachycardia and death

Chest symptoms

  • stridor
  • haemoptysis
  • hoarseness
  • aorta-oesophageal fistula
20
Q

Who do thoracic abdominal aneurysms occur with

A
  • Marfan syndrome or hypertensive patients
  • atherosclerosis
  • rarely due to syphilis
21
Q

What investigations are used in an thoracic abdominal aneurysm

A
  • Ultrasound (abdominal)
  • CT or MRI
  • aortography
  • transoesophageal echocardiography (thoracic)
22
Q

How do you manage a thoracic abdominal aneurysm

A
  • if the aneurysm is greater than 6cm then operatively repair or stent may be appropriate
  • these carry a high risk of mortality and paraplegia
  • EVAR is usually used at present
23
Q

What do acute aortic syndromes include

A
  • aortic dissection
  • intramural haematoma
  • penetrating aortic ulcers
24
Q

When does aortic dissection happen

A
  • usually begins with a tear in the intima

- blood penetrates the diseased medical layer and then cleaves the intimal laminal plain leading to dissection

25
Q

What is intramural haematoma considered a precursor of

A
  • aortic dissection
26
Q

How is aortic dissection classified

A

Timing of diagnosis form the origin of symptoms

  • Acute is less than 2 weeks
  • Subacute - 2-8 weeks
  • Chronic - longer than 8 weeks
27
Q

How is aortic dissection diagnosed anatomically

A

Type A

  • involves the aortic arch and aortic valve proximal to the left subclavian artery origin
  • De bakey type 1 - extends to the abdominal aorta
  • de bakey type II - localised to the ascending aorta

Type B

  • involves the descending thoracic aorta distal to the left subclavian artery origin
  • this category includes de bakey type III
28
Q

What are the symptoms of aortic dissection

A
  • sudden onset of severe and central chest pain
  • radiates to the back and down the arms
  • pain described as tearing in nature
29
Q

What are the signs of aortic dissection

A
  • shocked
  • neurological symptoms secondary to loss of blood supply to the spinal cord
  • develop aortic regurgitation, coronary ischaemia, cardiac tamponade
  • Distal extension may produce acute kidney failure, acute lower limb ischaemia or visceral ischaemia
  • peripheral pulses may be absent or unequal in each arm
30
Q

What is management of aortic dissection

A
  • at least 50% of patients require antihypertensive medication to reduce blood pressure - IV beta blockers and GTN used
  • type A dissections should undergo surgery
  • Type B should be managed conservatively unless they develop complications
  • long term follow up with CT or MRI
31
Q

What are the common complications of aortic aneurysm

A
  • Tears in the wall of the aorta
  • rupture
  • death
  • MI
  • ischameia of organs

Year 3 - CR (44 decks)

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