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3: Surgery Y3 - Vascular [20] > [3] Peripheral and Visceral Artery Aneurysms > Flashcards

[3] Peripheral and Visceral Artery Aneurysms Flashcards

1
Q

What is an aneurysm?

A

A persistent, abnormal dilation of an artery above 1.5x the normal diameter

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2
Q

What vessel is most commonly affected by aneurysms?

A

Abdominal aorta

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3
Q

What is the aetiology of peripheral and visceral aneurysm?

A

Largely unknown

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4
Q

What are the possible causes of peripheral and visceral aneurysms?

A

Trauma
Infection
Connective tissue disease
Inflammatory disease

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5
Q

Give an example of a connective tissue disease that can cause peripheral and visceral aneurysms

A

Marfans disease

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6
Q

Give an example of an inflammatory disease that can cause peripheral or visceral aneurysms

A

Takyasus aortitis

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7
Q

What are the risk factors for peripheral and visceral aneurysms?

A

Smoking
Hypertension
Hyperlipidaemia
Family history

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8
Q

What are the categories of presentations of peripheral and visceral aneurysms?

A

Asymptomatic (found incidentally)
Symptomatic, but not ruptured
Symptomatic secondary to rupture

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9
Q

How can peripheral or visceral aneurysms that are symptomatic secondary to a rupture be further classified?

A

Stable or unstable

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10
Q

How are peripheral and visceral aneurysms usually best investigated?

A

With CT angiography

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11
Q

Can MR angiography be used to investigate peripheral or visceral aneurysms?

A

Yes, it is a good alternative to CT

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12
Q

When in particular is MR angiography a good alternative to CT angiography in investigating peripheral or visceral aneurysms?

A

It has a reduced risk of kidney damage, so good in renal failure etc

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13
Q

When are US duplex scans useful in investigating peripheral and visceral aneurysms?

A

In detection and follow up

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14
Q

What is the limitation of US duplex scanning in peripheral and visceral aneurysms?

A

It is not helpful for planning treatment

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15
Q

What will management of peripheral and visceral aneurysms involve?

A

Either watchful waiting or surgical intervention

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16
Q

What are the options for surgical intervention in peripheral and visceral aneurysms?

A

Endovascular or open

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17
Q

What does the decision to wether to manage conservatively or surgically depend on?

A

The location and size, as well as associated symptoms

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18
Q

Where do peripheral artery aneurysms most commonly occur?

A

Popliteal artery

Femoral artery

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19
Q

What % of peripheral aneurysms are popliteal aneurysms?

A

70-80%

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20
Q

Why is active management advised for popliteal aneurysms?

A

Because they have a high risk of embolisation

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21
Q

How do popliteal aneurysms present?

A

Usually present symptomatically as either acute limb ischaemia or less commonly as intermittent claudication

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22
Q

Why can popliteal aneurysms cause acute limb ischaemia?

A

Due to aneurysm formation or distal emboli

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23
Q

When might popliteal aneurysm be found incidentally?

A

In patients being worked up for AAA or awaiting knee replacement

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24
Q

Is the rupture of popliteal artery aneurysms common?

A

No, it is rare

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25
Q

What will be found on clinical examination with popliteal artery aneurysms?

A

Pulsatile mass felt in the popliteal fossa

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26
Q

What are popliteal artery aneurysms often associated with?

A

Popliteal artery aneurysms in the other knee

Abdominal aortic aneurysms

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27
Q

What is the initial investigation for a popliteal artery aneurysm?

A

An ultrasound duplex scan

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28
Q

Why is a ultrasound duplex scan the first line investigation for a popliteal artery aneurysm?

A

As it will allow differentiation between other causes of popliteal fossa swelling
Looks for signs of aneurysm thrombosis

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29
Q

What other causes of popliteal swelling can be differentiated from popliteal aneurysms on Doppler ultrasound?

A

Bakers cyst

Lymphadenopathy

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30
Q

What further imaging may be done in popliteal artery aneurysms?

A

CT angiogram or MR angiogram

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31
Q

What is the use of CT angiogram or MR angiogram in popliteal artery aneurysms?

A

They allow good anatomical assessment of the aneurysm, which is useful for operative planning
Useful in the assessment of distal arteries to assess their patency

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32
Q

When should symptomatic popliteal aneurysms be treated?

A

Always, regardless of their size

33
Q

Why should symptomatic popliteal arteries always be treated?

A

Due to the risk of embolic events

34
Q

How will the detection of a thrombus on imaging in the investigation of popliteal artery aneurysms change the management?

A

It should warrant treatment at an early stage

35
Q

When should asymptomatic popliteal artery aneurysms be treated?

A

If they are greater than 2cm

36
Q

How should asymptomatic popliteal artery aneurysms be managed if they are under 2cm in size?

A

Routinely monitored with US scans

37
Q

What are the surgical options for popliteal artery aneurysms?

A

Open and endovascular repair options

38
Q

What does endovascular repair in popliteal artery aneurysms involve?

A

Stent insertion across the aneurysm

39
Q

What does endovascular repair of popliteal artery aneurysm require?

A

A normal calibre artery above and below the aneurysm

40
Q

Why does endovascular repair of a popliteal artery aneurysm require normal calibre artery above and below the aneurysm?

A

So the stent can seal in

41
Q

What are the risks of endovascular repair of a popliteal artery aneurysm?

A

Continued aneurysm sac filling through collateral vessels

In stent thrombosis

42
Q

What anaesthetic is required for the endovascular repair of popliteal artery aneurysms?

A

Local anaesthetic

43
Q

Where is endovascular repair of popliteal artery aneurysms the preferred choice?

A

In unfit patients

44
Q

What does surgical repair of popliteal artery aneurysms involve?

A

Ligation of the aneurysm or resection of the aneurysm with a bypass graft

45
Q

What is used for a bypass graft in the repair of a popliteal artery aneurysm?

A

Either a vein from the patient (preferred) or a prosthetic graft

46
Q

What approach can be taken in a bypass graft in popliteal aneurysm repair?

A

Above knee popliteal bypass

Posterior approach to knee, opening aneurysm sac, then inserting a tube graft from top to bottom

47
Q

What are the major causes of the development of a femoral artery aneurysm?

A

Percutaneous vascular interventions

Intravenous drug users who inject into the groin

48
Q

What causes symptoms and signs of a femoral artery aneurysm?

A

Thrombosis, rupture, or embolisation of the aneurysm

49
Q

What may be present in cases of femoral artery aneurysms caused by IVDU?

A

Infection

50
Q

How do femoral artery aneurysms present?

A

With varying degrees of claudication or acute limb ischaemia

Often no symptoms other than swelling in the groin

51
Q

How should femoral artery aneurysms be investigated initially?

A

US duplex scan

52
Q

What further imaging is done in femoral artery aneurysms?

A

CT angiography and MR angiography

53
Q

What is the purpose of CT angiography and MR angiography in femoral artery aneurysms?

A

Further anatomical imaging and operative planning

54
Q

What is the mainstay of treatment for femoral artery aneurysms?

A

Open surgical repair

55
Q

What visceral arteries are most commonly affected by aneurysm formation?

A

Splenic artery
Hepatic artery
Renal artery

56
Q

What % of total visceral artery aneurysms are splenic artery aneurysms?

A

Around 60%

57
Q

What are the main risk factors for the development of splenic artery aneurysms?

A

Female sex
Multiple pregnancies
Portal hypertension
Pancreatitis or pancreatic pseudocyst formation

58
Q

How do splenic artery aneurysms present?

A

Those who are symptomatic present with vague epigastric or LUQ pain

59
Q

How do ruptured splenic arteries present?

A

Severe abdominal pain and haemodynamic compromise

60
Q

What is the mainstay of investigation of splenic arterery aneurysms?

A

CT angiography or MR angiography

61
Q

What is the first line management of splenic artery aneurysms?

A

Endovascular repair

62
Q

How is endovascular repair of splenic artery aneurysms best performed?

A

Using embolisation or stent grafts once the patient is haemodynamically stable

63
Q

What management may be recommended in splenic artery aneurysm when the patient is haemodynamically unstable?

A

Open repair

64
Q

What % of total visceral artery aneurysms are hepatic artery aneurysms?

A

20%

65
Q

What are the causes of hepatic artery aneurysms?

A

Percutaneous instrumentation
Trauma
Degenerative disease
Post-liver transplantation

66
Q

What % of hepatic artery aneurysms are associated with percutaneous instrumentation?

A

50%

67
Q

How can hepatic artery aneurysms form post liver transplants?

A

False aneurysms can form around the vessel anastomoses

68
Q

How do hepatic artery aneurysms present?

A

Most cases are asymptomatic, yet stable symptomatic cases can often present with vague RUQ or epigastric pain

69
Q

When may jaundice present in hepatic artery aneurysms?

A

If there is biliary obstruction

70
Q

What is the mainstay of investigation for hepatic artery aneurysms?

A

CT angiography or MR angiography

71
Q

What is the first line management of hepatic artery aneurysms?

A

Endovascular repair

72
Q

How is endovascular repair best done in hepatic artery aneurysms?

A

Embolisation or stent grafts

73
Q

When might open repair be advised in hepatic artery aneurysms?

A

Haemodynamically unstable patients

Those with unsuitable anatomy

74
Q

How is a renal artery aneurysm usually discovered?

A

Incidentally (is asymptomatic)

75
Q

What symptoms may be caused by renal artery aneurysms?

A

Haematuria
Resistant hypertension
Loin pain

76
Q

How should renal artery aneurysms be investigated?

A

CT angiography or MR angiography

77
Q

What is the mainstay of treatment in renal artery aneurysms?

A

Endovascular repair

78
Q

When can a stent be inserted easily in the endovascular repair of renal artery aneurysms?

A

If the aneurysm is affecting the main renal artery

79
Q

How can endovascular repair be performed in a renal artery aneurysm affecting the hilum?

A

With coils and self-expanding stents

3: Surgery Y3 - Vascular [20] (10 decks)

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