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Aortic dissection and aneurysm Flashcards

1
Q

What is an aneurysm?

A

This is a permanent, localised dilatation of an artery of more than 50% of the local arterial diameter (>3cm)

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2
Q

What are the 2 types of aneurysm?

A

True aneurysm
False aneurysm

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3
Q

What is meant by a true aneurysm?

A

A dilatation of an artery in which all 3 layers of the blood vessel wall are involved

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4
Q

What is meant by a false aneurysm?

A

A dilatation of an artery in which there is a defect in the wall, meaning that only 1 layer is involved

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5
Q

What usually forms in the extra luminal space of an aneurysm?

A

A platelet rich clot, caused by collagen exposure

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6
Q

What is the suspected pathogenesis of abdominal aortic aneurysms?

A

It is thought to be caused by abnormal regulation of elastin and collagen proteins in the aortic wall by enzymatic agents

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7
Q

What are some risk factors of abdominal aortic aneurysm?

A

Age (Risk increases with age)
Sex (M:F = 6:1)
Genetics
Smoking
Hypertension
Atherosclerosis

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8
Q

Which region of the aorta is most susceptible to aneurysm and why?

A

The abdominal aorta below the T2 vertebrae, as this section loses its vasa vasorum in its tunica adventitia, and so is more susceptible to ischaemia

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9
Q

What percentage of AAAs are asymptomatic until rupture?

A

75%

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10
Q

What are some possible symptoms of abdominal aortic aneurysm?

A

Epigastric pain, radiating to the back
Hiccups due to obstruction of phrenic nerve
Dysphagia due to obstruction of oesophagus

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11
Q

What are some clinical signs of abdominal aortic aneurysm?

A

Trash feet - Throwing off clots
Tachycardia
Hypotension
Collapse

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12
Q

What are the 2 forms of investigation in abdominal aortic aneurysm?

A

Echocardiography (USS)
CT scan

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13
Q

What are some pharmacological managements used in aortic aneurysm, to reduce underlying causes?

A

Anti-hypertensives
Smoking cessation
Lipid lowering medication

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14
Q

When is surgical intervention indicated in AAA?

A

When an asymptomatic aneurysm reaches an AP (Anterior-Posterior) diameter of >5.5cm

If the AAA is symptomatic

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15
Q

What is meant by trash feet?

A

This is the dusky discolouration of the toes, caused by micro emboli moving down into the feet due to breaking apart of the clots in an aneurysm

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16
Q

What are the 2 forms of surgery indicated for AAA?

A

EVAR
Open repair

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17
Q

What is meant by EVAR in AAA?

A

Endovascular Aneurysm repair, in which a stent is inserted via percutaneous catheterisation, allowing a tube to be placed through the aneurysm, preventing the risk of rupture
This is X-ray guided

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18
Q

What are some possible complications of EVAR?

A

Stent misplacement
Endoleak
Stent migration and dislocation

19
Q

What are some advantages of EVAR over open repair?

A

Lower mortality risk (2% vs 4%)
Faster recovery (10 days vs 8 months)

20
Q

What are some advantages of open repair over EVAR?

A

Open repair is possible in most people, whereas 25% of people are not indicated for EVAR

21
Q

What occurs in open repair of AAA?

A

Laparotomy is given and the aorta and iliac arteries are clamped
Dacron grafting is then performed in which a new aortic wall is stitched in place of the old wall

22
Q

What are some possible complications of open repair in AAA?

A

MI
CVA
Pneumonia
DVT
PE
Ischaemia
Death

23
Q

What are some tests required to check fitness for intervention in AAA?

A

Echocardiogram for EF
PFTs
Cardiopulmonary exercise test
Renal assessment
ABPI
Anaesthetic assessment

24
Q

Who is placed into surveillance for AAA?

A

Asymptomatic patients with an aneurysm between 3 and 5.5cm in diameter

25
Q

Who is screened for AAA?

A

All makes >65 by ultrasound scan

26
Q

What are the 3 conditions that make up the acute aortic syndrome?

A

Penetrating Aortic Ulcer (PAU)
Intra-Mural Haematoma (IMH)
Aortic dissection

27
Q

What is a penetrating aortic ulcer?

A

This is the formation of a small in-pouching of the tunica intima, into the wall of the aorta

28
Q

What is meant by an intra-mural haematoma?

A

This is the rupture of a penetrating aortic ulcer, leading to bleeding into the vessel wall

29
Q

What is an aortic dissection?

A

This is the flowing of blood between the tunica media and intima, forming a new blood track and splitting the walls of the aorta

30
Q

What are some risk factors for aortic dissection?

A

Genetic mutations
Connective tissue disorders
Trauma

31
Q

What are some genetic mutations that predispose to aortic dissection?

A

Fibrillin-1
Transforming growth factor ß1

32
Q

What are some connective tissue disorders that can predispose to aortic dissection?

A

Ehlers Danlos syndrome
Marfans syndrome
Loeys dietz syndrome

33
Q

Describe the pathophysiology of an aortic dissection

A

A tear in the tunica intima can allow blood the propagate within the medial layer, breathing a flap between true lumen and false lumen

34
Q

Describe the pathophysiology of an aortic dissection

A

A tear in the tunica intima can allow blood the propagate within the medial layer, breathing a flap between true lumen and false lumen

35
Q

Where can a tear in the tunica intima propagate to?

A

Aortic arch
Aortic valve
Coronary arteries
Mesenteric and renal arteries
Iliac arteries

36
Q

How are aortic dissections classified?

A

Standford type A
Stanford type B

37
Q

What is meant by a Stanford type A aortic dissection?

A

Proximal - Affects the aorta near the subclavian artery, involving the ascending aorta and arch

38
Q

What is meant by a Stanford type B aortic dissection?

A

Distal - Affects anywhere from the left subclavian and down, involving the descending thoracic aorta distal to the left subclavian

39
Q

What are some possible complications of aortic dissection propagation?

A

Aortic regurgitation
MI
Cardiac tamponade
Stroke
Ischameia
Paraplegia (Spinal cord ischaemia)

40
Q

What are some symptoms of aortic dissection?

A

Acute excruciating pain, radiating to the back, described as tearing
Abdominal pain
Syncope
Hypotension
Ischaemia
Paraplegia

41
Q

How is a diagnosis of aortic dissection made?

A

CT angiogram from aortic arch to femoral arteries

42
Q

What are some pharmacological management strategies in aortic dissection?

A

IV ß-Blockers
Ca2+ channel blockers
ACEi
Sodium nitroprisside

43
Q

What is the target blood pressure and heart rate in aortic dissection pharmacological management?

A

100-120mmHg systolic
<60bpm

44
Q

What are the 2 surgical options in treatment of aortic dissection?

A

Thoracic Endovascular repair (TEVR)
Open repair

New cardio (28 decks)

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