vascular (aorta) Flashcards
pathophysiology of AAA
failure of elastic proteins –> dilation of vessel
RF AAA
smoking, hypertension, ehlers danlos, marfans, syphilis
what screening is in place for AAAs
single abdo USS for males aged 65
what is a normal AAA scan at USS + what follow up
<3cm –> nothing
what is small anuerysm AAA scan at USS + what follow up
3-4.4cm –> rescan 12 months
what is a medium aneurysm AAA scan at USS + what follow up
4.5-5.5cm –> rescan 3 months
what is a large aneurysm AAA scan at USS + what follow up
> 5.5cm –> refer 2 week vascular
what is a low rupture risk AAA
asymptomatic + <5.5 cm (small + medium)
what is a high rupture AAA
symptomatic // >5.5cm // growing fast (1cm/year)
how are unruptured AAA’s managed
elective endovascular repair (EVAR) (stent) or open repair
presentation ruptured AAA
severe central abdo pain –> back // pulsatile mass // shock +/- collapse
mx ruptured AAA
surgical emergency
what invx for ruptured AAA if clinical doubt
CT angio
what is aortic dissection
tear in tunica intima –> pain
what biggest RF for aortic dissection
hypertension
other rf for aortic dissection
trauma // bicuspid aortic valve // collagen def // Turner’s // pregnancy // syphilis
where do type A aortic dissections occur + where would pain occur
ascending aorta (more dangerous) + chest pain
where do type B aortic dissections occur + where would pain occur
descending aorta + upper back pain
presentation aortic dissection
chest or back pain // weak pulses or variation between arms // aortic regurg
if coronary arteries are involved in aortic dissection what sympoms can occur
angina
if spinal arteries are involved in aortic dissection what symptoms can occur
paraplegia
if distal aorta are involved in aortic dissection what sympoms can occur
limb ischamia
what classifications are used for aortic dissection
standford (type A + B) // DeKabey (type I,II,III)
imaging in aortic dissection (3)
CXR = widened mediastinum // CT angio chest, abdo, pelvis: false lumen // TOE
when would transoesophageal echo (TOE) be indicated in aortic dissection
patients who are too unstable for CT
mx type A aortic dissection
surgical + systolic BP 100-120 (IV labetolol)
mx type B aortic dissection
IV labetolol + bed rest
complications of a backwards aortic tear
aortic regurg // MI
complications of a forwards aortic tear
unequal BP in arms // stroke // renal failure
what is takayasu’s arteritis
large vessel vasculitis –> occlusion of aorta
who normally develops takayasu’s arteritis
femals 10-40 asian
symptoms takayasu’s arteritis
weak peripheral pulse // unequal arm BP // carotid bruit // aortic regurg // limb claudication // headache + malaise
assoc with takayasu’s arteritis
renal artery stenosis
imaging takayasu’s arteritis
MRA or CT angio
