Aneurysms

Question 1

define an aneurysm

Answer 1

permanent, localised dilatation in an artery of more than 50% its normal diameter

Question 2

normal aortic diameter

Answer 2

1.2 - 2cm

Question 3

classification of aneurysms

Answer 3

1. true

2. false

Question 4

what is a true aneurysm?

Answer 4

all 3 layers of the artery involved

Question 5

what is a false/ pseudoaneurysm?

Answer 5

defect in the wall of the artery and it is the surrounding structures (skin, fat, fascia) that keep the aneurysm restrained

Question 6

morphology of aneurysms

Answer 6

1. fusiform

2. saccular

Question 7

causes of aneurysms

Answer 7

• congenital e.g. Berry in Circle of Willis, Marfan’s
• degeneration e.g. atherosclerosis
• trauma
• infection= bacterial arteritis
• inflammatory e.g. Kawasaki disease

Question 8

what causes true aneurysms?

Answer 8

abnormal regulation of elastin and collagen proteins in aortic wall by enzymatic agents such as metallo-proteinases which leads to dilatation from wall stress

Question 9

causes of false aneurysms

Answer 9

iatrogenic (post-catheter angiogram, orthopaedic surgery, arterial anastomosis)
IV drug use
trauma

Question 10

risk factors for AAA

Answer 10

age
sex (male)
FH
smoking
hypertension

Question 11

presentation of AAA

Answer 11

most asymptomatic until rupture
sudden onset epigastric/ central abdominal pain radiating to the back
collapse, hypotension
renal colic
expansile pulsatile mass
trashing

Question 12

why should prevention surgery be done in AAA

Answer 12

there is often continual expansion until rupture occurs

Question 13

criteria for AAA intervention

Answer 13

5.5cm AP diameter
rapid expansion of >1cm/ year
symptomatic
rupture

Question 14

two surgical options in AAA repair?

Answer 14

open

endovascular aneurysm repair (EVAR)

Question 15

open repair of AAA

Answer 15

GA
laparotomy
aortic and iliac vessels clamped
graft hand sewn

Question 16

graft options in AAA

Answer 16

Dacron

PTFE

Question 17

is lifelong follow up required in open AAA repair?

Answer 17

not if successful

Question 18

complications of AAA repair

Answer 18

death
MI
CVA
DVT/ PE
pneumonia
infection
UTI
graft infection
renal failure
mesenteric ischaemia
trash foot
erectile dysfunction

Question 19

presentation of mesenteric ischaemia

Answer 19

abdominal pain after eating

fear of eating, weight loss

Question 20

management of mesenteric ischaemia

Answer 20

bypass graft

resection of bowel if infarction

Question 21

EVAR procedure

Answer 21

radiological imaging
local/ regional anaesthesia
groin incision with stent going up common femoral > iliac

Question 22

what must there be in EVAR?

Answer 22

disease-free iliacs

Question 23

does EVAR require lifelong follow-up?

Answer 23

yes

Question 24

complications of EVAR

Answer 24

stent misplacement
endoleak
migration, dislocation

Question 25

where do most AAA rupture?

Answer 25

retroperitoneal (contained)

intraperitoneal fatal

Question 26

who is screening offered to for AAA?

Answer 26

all males>65 with USS

Question 27

complication of aortic surgery

Answer 27

aortoenteric fistula

Question 28

what is an aortoenteric fistula?

Answer 28

connection between aorta and usually the duodenum/jejunum

Question 29

presentation of aortoenteric fistula

Answer 29

brisk GI bleeding

hypotension

Question 30

diagnosis of aortoenteric fistula

Answer 30

upper GI endoscopy

CT

Question 31

management of aortoenteric fistula

Answer 31

emergency surgery with graft placement

poor prognosis

Question 32

which conditions are mycotic aneurysms present in?

Answer 32

endocarditis

tertiary syphilis

Question 33

what should systolic BP be kept below in AAA rupture?

Answer 33

<100mmHg to prevent further rupture

use labetalol?

Question 34

how large must AAA be to inform DVLA?

Answer 34

> 6cm

Question 35

when in AAA must you stop driving?

Answer 35

> 6.5cm