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Surgery II > Cardio: Aneurysms > Flashcards

Cardio: Aneurysms Flashcards

1
Q

what is an aneurysm?

A

an abnormal dilatation of an artery

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2
Q

classification of aneurysms

A
  • true aneurysm

- false aneurysm

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3
Q

what is a true aneurysm?

A

this contains all layers of the vessel wall; appears as either a fusiform or a saccular dilatation

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4
Q

what is a false aneurysm?

A

these do not contain all layers of the arterial wall; usually involves only a collection of blood in the adventitia

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5
Q

causes of true aneurysm

A
  • congenital: berry aneurysm of circle of Willis, aneursymal varices associated with AV fistula, connective tissue disorders (Marfan’s, Ehlers-Danlos), inflammatory (Takayasu’s aortitis)
  • acquired: trauma (irradiation) infection (syphilis, mycotic aneurysm), degeneration (arteriosclerosis, cystic medical necrosis), atheroma
  • the bigger the aneurysm, the quicker it will expand
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6
Q

causes of false aneurysm

A

trauma

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7
Q

common sites of aneurysm

A
  • aorta (more commonly, infrarenal)
  • iliac artery
  • femoral artery
  • popliteal artery
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8
Q

complications of an aneurysm

A
  • rupture
  • thrombosis
  • distal emboli
  • fistula
  • pressure on other structures
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9
Q

types of aortic aneurysms

A
  • thoracic
  • thoracoabdominal
  • abdominal
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10
Q

where can the aorta dilate

A

from the ascending aorta to the aortic bifurcation

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11
Q

why do aneurysms occur?

A

degeneration of the elastic lamellae and smooth muscle loss

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12
Q

from when is aorta considered to have an aneurysm?

A

greater than 3cm across

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13
Q

risk factors for aneurysms

A
  • elastic degeneration due to increased levels of metalloproteinases
  • flow dynamics
  • hypertension (involved in formation and rate of expansion)
  • atherosclerosis
  • collagen defects
  • genetic association
  • smoking (associated with a more rapid expansion)
  • associated with emphysema and inguinal hernias
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14
Q

symptoms of aneurysms

A
  • mainly asymptomatic
  • backache (pressure on the vertebral bodies)
  • sign: pulsatile abdominal mass just above the umbilicus
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15
Q

investigation of aneurysms

A
  • ultrasound (assess the diameter)
  • CT scan
  • pre-op investigations: FBC, U&E, clotting studies, ECG, CXR, lung function tests, ABGs, echo
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16
Q

where can aneurysm bleed into?

A

retroperitoneal or intraperitoneal or into the IVC (AV fistula)

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17
Q

management of aortic aneurysm

A
  • depends on the size
  • <5cm: monitored annually if <4.5cm or biannually if >4.5cm
  • > 5cm: investigated to check whether he is fit for surgery
  • only aneurysms >5.5cm (>5cm in women) are considered for surgery or if the patient is symptomatic
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18
Q

treatment options of aortic aneurysm

A
  • EVAR (endovascular repair - stenting)

- open surgery

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19
Q

risk factors for aortic dissection

A
  • hypertension
  • smoking
  • female
  • strong family history
  • COPD
  • shape of aneurysm (saccular>cylindral)
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20
Q

symptoms of ruptured abdominal aortic aneurysm

A
  • intermittent/continuous abdominal pain
  • radiating to the back, iliac fossae or groins
  • expansile abdominal mass
  • collapse and shock
21
Q

how do you know that the patient has an adequate blood pressure

A

conscious and talking

22
Q

what happens if the aorta dissects and there is an AV fistula with the IVC

A
  • severe heart failure

- massive lower limb oedema

23
Q

investigations of dissected AAA

A
  • should be clinically obvious

- if not, CT and US

24
Q

management of dissected AAA

A
  • emergency style
  • call the vascular surgeon before doing anything else
  • amylase, Hb, crossmatch, ECG
  • take the patient straight to theatre
25
Q

what are inflammatory aneurysms?

A

one where the walls become thickened and inflamed

26
Q

which arteries can iliac artery aneurysms involve

A
  • common iliac

- internal iliac

27
Q

associations of iliac artery aneurysm

A
  • associated with AAA

- rarely occur in isolation

28
Q

management of iliac artery aneurysm

A
  • open surgery using Dacron
  • endovascular stenting
  • in internal iliac artery, ligation if the other is still patent
29
Q

symptoms and signs of femoral artery aneurysm

A
  • asymptomatic pulsatile mass in the groin
  • associated with AAA
  • compression of local structures, thrombosis, ischaemia, distal emboli and rupture
30
Q

causes of false aneurysms in the femoral artery

A
  • percutaneous catheterisation for angiography; stab wounds

- previous surgery, especially with prosthetic grafts (infection)

31
Q

treatment of femoral aneurysms

A
  • small: monitor or treat if symptomatic
  • if rapidly expanding, surgery
  • iatrogenic false: compression therapy
32
Q

signs and symptoms of popliteal aneurysm

A
  • mass behind the knee
33
Q

complications of popliteal aneurysm

A
  • thrombosis with compromise of the distal circulation and distal embolism
  • compression of local structure
34
Q

treatment of popliteal aneurysm

A
  • considered if >2cm
  • open surgery is preferred
  • exclusion bypass
  • in-lay graft
35
Q

what are the visceral artery?

A
  • splenic artery
  • hepatic artery
  • superior mesenteric artery
  • renal artery
36
Q

signs and symptoms of visceral artery aneurysms

A
  • abdominal/flank pain

- renal: haematuria/hypertension

37
Q

how are visceral aneurysms diagnosed?

A
  • ultrasound scanning

- arteriography

38
Q

why are splenic artery aneurysms important?

A
  • they can present at the 3rd trimester of pregnancy

- if >2.5cm, they should be treated

39
Q

affects of a thoracic aortic dissection

A
  • carotid artery: hemiplegia
  • anterior spinal artery: unequal arm pulses and blood pressure, acute limb ischaemia, paraplegia
  • renal arteries: anuria
40
Q

complications of thoracic aortic dissection

A
  • aortic valve incompetence
  • inferior myocardial infarction
  • cardiac arrest
41
Q

types of thoracic aortic dissections?

A

type A and type B

42
Q

what are type A dissection?

A
  • ascending aorta

- consider these for surgery

43
Q

what are type B dissection?

A
  • medical management

- surgery is reserved for distal dissections that are leaking, ruptured or compromising vital organs

44
Q

management of thorcic aortic dissection

A
  • crossmatch 10U blood
  • ECG & CXR
  • CT/MRI or TOE
45
Q

what is a false aneurysm?

A
  • pulsating haematoma, the cavity of which is in contact with the arterial lumen
  • made of a fibrous capsule made of adventitia
46
Q

what happens in IVDU with false aneurysm

A
  • infection might be present (has to be treated)
  • if all of the vessels have been damaged, ligate all the vessels
  • this is associated with a high rate of limb loss and disabling claudication
47
Q

how would you do an open surgery?

A
  • umbilical/paraumbilical/transverse incision
  • push the omentum and bowel out of way
  • put a banding around the neck of the aneurysm
  • clamp any arteries found in the surroundings
  • open the sac to remove the thrombus
  • put a piece of graft in according to the patient’s aorta and then, suture the sac around it
48
Q

how would you do an EVAR?

A
  • small transverse cut in the groin
  • pass the wire through the artery into the heart
  • mount the graft onto the tube
  • the graft is fixed in placed via barbs on top
  • once the position is good, the spring opens and seals the graft onto the vessel
  • this is monitored using CT/angiography
  • the aneurysmal sac should thrombose and shrink with time

Surgery II (19 decks)

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