abdominal aortic aneurysms Flashcards
what are the common causes of aneurysms?
smoking, alcohol, and hypertension (think Rab Nesbitt)
what did the small aneurysm study show?
Distinguished between yearly rupture risk of small aneurysms (<1% per year) and large aneurysms (10%) and all-comers 30-day mortality in repair group- 5.8%.
so if aneurysm is lesser than 5.5cm better keeping it, if more, better to have it fix
what is used to screen for aneurysms?
ultrasound
it is very cheap, safe, and effective
Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. BMJ, 2009 (NEED TO KNOW THIS TRIAL)
what are the findings of the EVAR 1 trial?
Open surgery more invasive but more durable, stenting is less invasive but less durable
what is the most common type of AAA?
infrarenal abdominal aortic aneurysm
what is the criteria for a true aneurysm compared to a false?
true is an abnormal focal dilatation involving all 3 layers, if not all 3 layers, false aneurysm
describe the stent?
less invasive procedure
Got barbs which go into aortic wall and prevent it from moving
usually have a waterproof covering fabric over the wire frame
when can we use open AAA repair?
We use this is if patients have short landing zone below renal arteries or very calcified iliac arteries have to use this instead
deals with short necks (bit above bulge and below renal arteries) and poor iliac anatomy
what is the EVAR 1 trial findings?
Way we know what treatment best for patient is the EVAR 1 trial
Open surgery more invasive but more durable, stenting is less invasive but less durable
what are type 1 and 2 endoleaks (complications of stent)?
Type one, barb isn’t sitting nice and a leak coms out into the sac
Type 2, lumbar artery is open and blood is coming in
what is the findings of the EVAR-2 trial?
Compares stenting to not having anything in older people so see what was best such thing to do with unfit patients
Tells us if someone is very old and frail, no point in fixing it as their all cause mortality isn’t changed so stress of procedure means they are mole likely to die of other causes (e.g. renal failure, stroke)
