Aortic aneurysm and dissection

Question 1

what does the artery have if it has an aneurysm

Answer 1

dilatation >50% of its original diameter

Question 2

what is a true aneurysm

Answer 2

abnormal dilatations involving all layers of the arterial wall

Question 3

what is a false aneurysm

Answer 3

collection of blood in outer layer only (adventitia), communicated with the lumen

Question 4

what are the typical causes of an AA

Answer 4

atheroma, trauma, infection, CT disorders, inflammatory

Question 5

where are the common sites of an AA

Answer 5

aorta (infra renal most common), iliac, femoral, popliteal

Question 6

complications of AA

Answer 6

rupture, thrombosis, embolism, fistulae, pressure on other structures

Question 7

what age and gender does screening take place AA

Answer 7

all men at 65 years

Question 8

symptoms + signs of ruptured AAA

Answer 8

intermittent or continuous abdo pain radiating to the back, iliac fossae or groins. collapse; expansile abdo mass; shock

Question 9

what is the definition of an unruptured AAA

Answer 9

> 3cm across

Question 10

what is the cause of unruptured AAA

Answer 10

degeneration elastic lamellae and smooth muscle loss

Question 11

what are the signs of unruptured AAA

Answer 11

often none, may cause abdo/back pain

Question 12

when is rupture more likely AA

Answer 12

increased bp, smoker, female, strong family history

Question 13

when is elective surgery done for AA

Answer 13

aneurysms> 5.5cm ; or expanding at 1cm/yr

Question 14

what are the complications from elective surgery AA

Answer 14

spinal or visceral ischaemia, distal trash from dislodged thrombus debris

Question 15

what other than surgery can be used for AA

Answer 15

stenting- EVAR (endovascular repair) but higher graft complications

Question 16

what is a thoracic aortic dissection

Answer 16

blood splits the aortic media with sudden tearing chest pain +/- radiation to the back

Question 17

what happens as the dissection extends

Answer 17

branches of aorta occlude sequentially leading to hemiplegia (carotid artery), unequal arm pulses and BP or acute limb ischaemia, paraplegia (anterior spinal artery) and anuria (renal arteries)

Question 18

what is hemiplegia due to (AD)

Answer 18

carotid artery

Question 19

what is paraplegia due to (AD)

Answer 19

anterior spinal artery

Question 20

what is anuria due to (AD)

Answer 20

renal arteries

Question 21

what would happen if the dissection moved proximally

Answer 21

aortic valve incompetence, anterior MI, cardiac arrest

Question 22

what is a Type A aortic dissection and what % of dissections are A

Answer 22

involve ascending aorta irrespective of site of tear. 70%

Question 23

what is a Type B aortic dissection and what % of dissections are B

Answer 23

not involving the ascending aorta. 30%

Question 24

which type should definitely be considered for surgery AD

Answer 24

type A

Question 25

investigations in aortic dissection

Answer 25

ECG and CXR- expanded mediastinum rare; CT/MRI/TOE.

Question 26

management aortic dissection

Answer 26

take to ITU; hypotensives keep systolic at 100-110; labetol or esmotol by IVI (calcium channel blockers if B blocker contraindications)

Question 27

what is the acute operative mortality of AD

Answer 27

<25%