Aneurysm, Aortic dissection Flashcards Preview

MS4 - Vascular > Aneurysm, Aortic dissection > Flashcards

Flashcards in Aneurysm, Aortic dissection Deck (36)
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1

Aneurysm definition

Dilatation of a blood vessel > 50%

2

True aneurysm definition

Involves all layers of vessel wall

3

Types of true aneurysm

Fusiform

Saccular

4

Example of fusiform

AAA

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Example of saccular

Berry

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False aneurysm definition

Collection of blood around vessel wall which communicates with vessel lumen

7

Causes of false aneurysm

Usually iatrogenic - eg. cannulation, puncture

8

Risks with aneurysms

Rupture

Thrombosis

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Popliteal aneurysm Sx

Easily palpable popliteal pulse

50% bilateral

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Risks with popliteal aneurysm

Rarely ruptures

Thrombosis and distal embolism

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Acute mx of popliteal aneurysm

embolectomy

fem-distal bypass

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Chronic mx of popliteal aneurysm

elective grafting + tie off vessels

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Normal size of abdominal aorta

<3 cm

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Most common place for aortic aneurysm

90% infrarenal

30% involve iliac arteries

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AAA sx?

Usually asymptomatic

Back pain radiating to groin

Acute limb ischaemia

Blue toe syndrome - distal embolus

Acute rupture

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AAA O/E

Expansile mass

Bruits

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Ix for AAA

AXR - calcifications

Abdo US

CT/MRI - gold standard

Angiography

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RFs for AAA rupture

HTN

Smoker

F (M get it more, F ruptures more easily)

FH

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AAA screening

U/S 65 yo men

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General mx of chronic AAA

> 3cm - yearly monitoring

> 4.5 cm - 6 monthly monitoring

> 5.5 cm - consider surgery

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Indications for surgical management of AAA

Symptomatic/complications

Diameter > 5.5 cm

Rapidly expanding > 1 cm/yr

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Surgical options for AAA

EVAR

Open repair

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EVAR of AAA

Endovascular aneurysm repair

"Stent" placed within aorta - reduces strain upon vessel wall

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Open repair of AAA

Clamp aorta + bypass

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AAA rupture presentation

Pain (Sudden onset abdo pain, radiates to back or flanks)

Collapse / shock

Cullen's sign

Grey-Turner's sign

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Cullen's sign

bruise around umbilicus

also a sign of pancreatitis 

27

Grey-turners sign

bruise across flanks

also a sign of pancreatitis

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Management of AAA rupture

O2 Fluids (keep SBP<100)

Cross-match 10 u

Major haemorrhage protocol

Analgesia

Cef + Met

Surgery

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Congenital causes of anaeurysm

AD polycistic kidneys -> Berry aneurysm 

Marfans

Ehler-Danlos syndrome

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Dissection definition

Dilatation by blood forming a lumen within the separated vessel wall

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Different types of aortic dissection

Type A 70%

Type B 30%

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Type A aortic dissection

if it includes ascending aorta

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Type B aortic dissection

Any dissection excluding ascending aortic 

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Mx of type A dissection

consider urgent surgery

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Mx of type B

may be managed medically, case dependent

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Emergency mx of dissection

Xmatch 10u

CXR/ echo TOE

Keep BP below 100, labetolol/esmolol/CCB