Abdominal Aortic Aneurysm

Question 1

What is the definition of an aneurysm?

Answer 1

Dilation of a vessel by more than 50% of its normal diameter. Slide 3

Question 2

What is the difference between a true and false aneurysm?

Answer 2

True aneurysms:
The vessel wall is still intact
False aneurysm:
There is a breach in the vessel wall but surrounding structures act as the vessel wall. Slide 4

Question 3

What are the types of morphology of an aneurysm?

Answer 3

Saccular
Fusiform
Mycotic
Slide 5

Question 4

What are the risk factors for an AAA?

Answer 4

Age, gender, smoking, hypertension, atherosclerosis. Slide 6

Question 5

What is the presentation of symptomatic AAA and a ruptured AAA?

Answer 5

Symptomatic AAA
Pain; may mimic renal colic
‘Trashing’ of the toes
Rupture.

Rupture AAA
Sudden onset of epigastric/central chest pain.
May radiate through to back.
Collapse
Slide 8+9

Question 6

Only when the size of the AAA has the AP diameter of >5.5cm is when they would operate. True or False?

Answer 6

True.

There is a higher risk of the surgery to the patient than the aneurysm rupturing. Slide 12

Question 7

What is the difference between the Duplex Ultrasound and the CT angiogram when scanning for an AAA?

Answer 7

The Duplex Ultrasound can only identify if an AAA is present or not.
The CT angiogram can show whether there is a rupture.
Slide 14-16

Question 8

What are the treatment options for an AAA?

Answer 8

Open repair:
Laparotomy and put in a tube/bifurcated (dacron) graft
Endovascular Aneurysm Repair (EVAR):
Insert graft through peripheral artery.
Slide 20-22

Question 9

What are causes of acute limb iscahemia?

Answer 9

Embolism
Arterial dissection
Trauma
Extrinsic compression
Slide 28

Question 10

What are the clinical features of acute limb ischaemia and what should be checked in PMH?

Answer 10

6 Ps:
Pain
Pallor
Pulseless
Perishingly cold
Paraesthesia
Paralysis. 

PMH: claudication, known cause for embolism, contralateral pulses.
Slide 29

Question 11

When a patient has had acute limb ischaemia for >12 hrs what is the presentation and is the leg salvageable?

Answer 11

Fixed mottling
Non blanching
Compartments tender/red
Paralysis
NON salvageable. Slide 31

Question 12

What manangement can you do to treat acute limb ischaemia?

Answer 12

Embolectomy
Thrombolysis
Fasciotemies (to relive pressure when the blood flow returns)
Slide 34

Question 13

What leads to Diabetic food sepsis?

Answer 13

Diabetic neuropathy
Peripheral vascular disease
Infection
Slide 39

Question 14

What is the source of sepsis?

Answer 14

A simple puncture wound
Infection from ingrown toenail
Neuro-ischaemic ulcer due to icnreased pressure
Slide 40

Question 15

Why does the infection become such a problem?

Answer 15

As the infection tracks into rigid compartments of the foot through the soft tissues.
The build up of pus cannot escape increasing pressure which can cause impairment of blood flow.
Slide 41+42

Question 16

How do patients present with Diabetic Foot Sepsis?

Answer 16

Pyrexia
Tachycardic
Tachypnoeic
Confused
Kussmauls breathing (acidotic)
Slide 46

Question 17

What can diabetic foot sepsis look like?

Answer 17

Swollen affected digit or forefoot.
Tenderness
Ulcer with pus
Erythema
Patches of necrosis
Crepitus form gas from organisms. Slide 47

Question 18

What treatment can be given to patients with diabetic foot sepsis?

Answer 18

Vascular surgical emergency to remove all infected tissue.
Give antibiotics, often polymicrobial so broad spectrum.
Slide 48-50

Question 19

Diabetic foot sepsis is mainly to do with ischaemia. True or False?

Answer 19

False, it starts due to a problem of pressure first. Slide 53