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AAA Flashcards

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1
Q

What are the two shapes of AAA?

A

Fusiform - spindle like

Saccular - pouch like

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2
Q

What is the definition of an AAA

A

when the maximum diameter exceeds more than 50% of normal

therefore a diameter of 3cm

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3
Q

Which shape of AAA is more likely to contain ulcers?

A

saccular

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4
Q

How is the usually patient to present with AAA

A

Male over 65

smoking and COPD increases the risk so the patient may also present with these

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5
Q

Do AAA run in families ?

A

yes

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6
Q

What is the percentage of risk for a 1st degree male relative to have an AAA if someone else has already had one?

A

30%

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7
Q

In an emergency situation when the aorta is about to rupture, how would the patient present?

A

sudden onset of severe central and lumbar pain
patient may have hypovoleamic shock (high blood volume loss)
hypotensive and pale

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8
Q

What size of AAA can be operated on?

A

5.5cm

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9
Q

What three uncommon presentations can a patient with AAA present with?

A
  • fistula (aortoenteric, aortocaval)
  • distal obstruction (can cause gangrene)
  • occlusion (aortic, ureteric)
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10
Q

Which shape of AAA carry more risks?

A

saccular

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11
Q

What is the % risk of rupture of an AAA below 5.5cm per year?

A

below 1%

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12
Q

What are the two forms of surgical repair?

A

open surgery

endovascular repair

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13
Q

What six investigations should be done before surgery?

A 
CT of abdomen 
Echo 
ECG 
FBC 
Cardiac perfusion scan 
CXR
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14
Q

For the patient to be able to survive having their aorta clamped, what does the patient have to have in terms of circulation?

A
  • good collaterals to allow the blood flow to be diverted
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15
Q

What are the four main complications of open surgery ?

A
  • infected graph
  • haemorrhage
  • cardiac complications
  • colonic ischaemia due to the clamped aorta
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16
Q

What happens during open surgery ?

A

the aorta is clamped to prevent high volume blood lose when the aorta is opened up
the aneurysm part of the aorta is removed and replaced with an artificial graph

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17
Q

What happens during endovascular surgery ?

A

a graph is instead into the aorta through small groin incisions using x ray to guide the graph up into place
the aneurysm is still present but the graph allows a thinner passage for blood to flow through and slows down the progression of the aneurysm

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18
Q

What are the advantages of endovascular repair?

A
  • small damage to skin as only small incisions are made
  • faster recovery time
  • more patients will become suitable for the operation
  • shorter clinically effective follow up compared to open surgery
  • reduced complications
  • shorter stay in hospital
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19
Q

What are the disadvantages of endovascular repair?

A
  • the graph (stent) may migrate
  • endoleak is a complication when there is blood flow outside the graph in the aneurysm sac
  • higher reintervention rates compared to open surgery
  • higher complications compared to open surgery
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20
Q

What four ways can risk factors be treated?

A

aspirin
statins
smoking cessation
antihypertensives

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21
Q

What is the % mortality of a ruptured AAA?

A

80-90%

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22
Q

By giving aspirin and statins, what risk does this reduce?

A
  • stroke
  • peripheral embolism
  • embolisms
  • further event
  • coronary disease
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23
Q

What is a TIA?

A

transient ischaemic attack

symptoms of a stroke which lasts below 24 hours

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24
Q

What would be the most important investigation to do for a TIA?

A

Duplex scan!!!

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25
What is a duplex scan used to show?
duplex scan sued ultrasound to show the blood flow through a vessel different colours are used to show the different directions that the blood is flowing if the blood is flowing faster at one point then this could show that the blood vessel is thinner at that point and hence there may be atheromatous plaque at that point.
26
State three advantages of using the duplex scan?
- non invasive - painless - quick
27
What other three investigations should be done for a TIA apart from duplex scan?
- MRA (magnetic resonance angiogram) - CTA (computer tomography angiogram) - Angiogram
28
What are risk factors of developing a TIA and stroke?
- high LDLs in blood - hypercholesterolaemia - hypertension (more turbulent flow and hence higher risk of embolism) - smoking - obesity - lack of exercise - diabetes
29
What is the surgical procedure performed to unblock a carotid artery for severe symptomatic stenosis?
carotid endoarterectomy
30
What happens during carotid endarterectomy ?
Arteries are clamped Artery is opened up to remove the plaque Prophylactics operation
31
How many people have to be operated on (carotid endarterectomy) to prevent a stroke form occurring?
1 in 9-12 patients are prevented form having a stroke
32
When would carotid endoarterectomy be considered?
- >70% stenosis of the internal carotid artery - if the patient is symptomatic - if the patient has cognitive function
33
What are the 6 main complications that can occur after carotid endoarterectomy?
- stroke - MI - death - neurological event - neck haemorrhage - hyper fusion syndrome - cranial nerve injury
34
What is the trial called that if surgery and medication was better than just medication on its own for treating TIAs ?
ACAS trial
35
IS CEA (carotid endoarterectomy) better than stenting?
yes
36
What medication should be given if someone has a suspected carotid stenosis and TIA?
anti platelets | aspirin + clopidogrel (or dipyridamole)
37
Between what time period is a patient most likely to have a second event after the primary event?
2 weeks
38
where are the four areas that the aorta can dilate?
ascending descending arch abdominal
39
state some symptoms for AAA
``` asymptomatic SOB Dysphagia Sharp chest pain radiating to their back Hypotension ```
40
What is a false aneurysm ?
When there is a tear in one of the layers of the vessel and blood leaks into the tear between the tunica layers, causing a swelling but the diameter of the lumen doesn't decrease. the blood is contained in the tunica adventitial.
41
State three causes for false aneurysms
inflammation traumatic iatrogenic
42
What are three signs of false aneurysms ?
bruits thrill pulsatile mass in the abdomen
43
State two complications of a false aneurysm ?
ischaemia | haemorrhage
44
what are four causes of aortic dissection ?
trauma hypertension marfans atheromateous plaque
45
what is the difference between chronic and acute aortic dissection ?
chronic - blood flows out slowly | acute - blood flows out fast
46
State what the histology of an aortic dissection is described as?
Cystic medial necrosis = Loss of elastin and muscle fibres in media with accumulation of mucopolysaccharides in cyst-like spaces
47
where are the three areas the blood can go after an aortic dissection?
back into the lumen into the mediastinum externally into the pericardium
48
state some symptoms of aortic dissection (2)
severe chest pain that can radiate to their back | collapse
49
state some findings for aortic dissection on examination
absent/reduced peripheral pulses hyper/hypotension pulmonary oedema
50
How is the treatment of aortic dissection split into two categories ?
dissection affecting the ascending aorta | dissection not affecting ascending aorta
51
how should an aortic dissection be treated affecting the ascending aorta?
surgery
52
how should an aortic dissection be treated not affecting the ascending aorta?
BP control | b blocker
53
What is an infection that can cause infected endocarditis ?
syphyllis
54
what is the gram negative bacteria that causes syphyllis ?
Treponema pallidum
55
What are the three stages of syphyllis called?
primary secondary tertiary
56
describe primary phase of syphyllis
- Chancre - single, firm, painless, non-itchy skin ulceration with a clean base and sharp borders.
57
describe secondary phase of syphyllis
- Most commonly involve the skin, mucous membranes, and lymph nodes Symmetrical, reddish-pink, non-itchy rash on the trunk and extremities, including the palms and soles - usually occurs 4-10 weeks after primary infection symptoms
58
Describe tertiary phase of syphyllis
¥ Late neuro-syphillis ¥ Gummatous syphillis ¥ Cardiac syphilis (10-30 years post infection)
59
Is inflammation of vessels more common in males or females?
females
60
What is Takayasus arteritis
inflammation of vessels that can result in: - stenosis - thrombosis - aneurysm - renal artery stenosis
61
What is the treatment of inflamed vessels ?
steroids | surgery
62
State three congenital causes of aortic aneurysm
marfans syndrome bicuspid valve coarctation
63
What are the signs of coarctation ?
cold legs reduced/absent pulses in legs notching of the ribs on a CXR radio-femoral delay
64
What are the symptoms of coarctation in early and later in life ?
early - failure to thrive, heart failure | later in life - hypertension
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