Vascular Flashcards
What is an aortic aneurysm?
An enlargement of the aorta >1.5x normal size (>3cm)
Where is most common for an AAA?
Infra renal (85%)
Why does it matter where an AAA is located?
Because it affects the treatment. Suprarenal and juxta renal AAAs involve visceral vessels and typically require complex intervention with open AAA repair or complex EVAR (endovascular aneurysm repair). Infra renal aneurysms are more ‘simple’ and can be treated by standard EVAR.
How do AAAs present?
Most are asymptomatic (large painless pulsatile expansile abdominal mass)
Symptomatic (leak)- back pain, Cullen’s/ Grey-turner’s sign
Rupture- intense abdominal pain/ back pain, shock, collapse
What is the screening for AAA
In the UK men >65 years are invited to a one-off AAA screening using abdominal duplex ultrasound. No aneurysm- not invited back. 3.0-4.4 (small)- surveillance USS every 12 months. 4.5-5.4 (medium)- surveillance USS every 3 months. >5.5 (large) = refer for surgical consultation. (NOTE; threshold are slightly different for thoracic aneurysms).
What is the first line investigation for aneurysms (unless they are ruptured)
Duplex ultrasound
What are the risk factors for an AAA?
Male, increasing age (>50), smoking, family history, hypertension, high cholesterol, heart or other blood vessel disease (ask about MI/stroke), marfan’s or Ehlers-Danlos syndrome (connective tissue diseases)
What investigation do you do prior to intervention (unless its an unstable rupture)?
CT angiogram (CTA)
What are the two main surgical interventions for an AAA?
Open repair or endovascular repair (EVAR)
When does open repair vs EVAR tend to be used?
Open repair if young, fit or complex AAA not for EVAR
EVAR if old, or comorbid
If ruptured and patient unstable -> emergency open repair
If stable rupture = emergency EVAR is preferred
What is meant by permissive hypotension in the content of AAA?
The only reason the patient is alive after a ruptured AAA and not dead yet is because the bleed is temporarily tamponaded by surrounding tissue. If you put the BP up too high in resus, this can burst the tamponaded leak and the patient will deteriorate faster- hence allow them to be hypotensive
What symptoms of claudication might a patient experience in PAD of femoral occlusion vs common iliac occlusion?
Femoral occlusion = calf and thigh claudication
Common iliac occlusion = buttock pain
What test can you do to assess the extent of PAD/ severity of limb ischaemia?
Buerger’s test/ angle
What might indicate that someone with PAD has critical limb ischaemia?
Patients often complain of waking up at night with leg pain which resolves after they dangle their leg off the bed for a while. Rest pain (at night), tissue loss, absent pulses
How do you work out ABPI?
SBP in ankle divided by the highest brachial SBP
