Flashcards in Aneurysm Presentation, Investigation and Therapy Deck (29)
What is an aneurysm?
When an artery exceeds 3cm or is over 50% of the normal size
What are the kinds of aneurysm?
When is there an increased prevalence of aneurysm?
Men aged > 65
Chronic obstructive airway disease
Peripheral vascular disease
Ischaemic heart disease
What is the typical presentation of an aneurysm?
May be asymptomatic and found incidentally on examination or ultrasound
Emergency presentation with impeding or actual rupture - severe sudden onset back pain
What are some unusual presentations of aneurysm?
What is the risk of rupture of an aneurysm < 5.5cm, and > 6cm
1% risk of rupture per year when < 5.5cm
10% risk of rupture per year when > 6cm
When is surgery considered in aortic aneurysms?
4.5-5cm and larger
At what point is surgery to correct an aortic aneurysm advantageous?
When > 5cm
What is the 30 day operative mortality of an aneurysm of 4.5-5cm?
What investigations are necessary when considering surgical repair of an aortic aneurysm?
Cardiac and respiratory fitness
Cardiac perfusion scan
What is the main hazard in abdominal aortic aneurysm operations?
Sudden changes in circulatory haemodynamics due to aortic cross-clamping or blood loss
What are the potential post-operative complications of an abdominal aortic aneurysm operation?
Cardiac complications (6.6-12%
Colonic ischaemia in 33% of ruptured AAA
What percentage of patients will get a post-operative graft infection? What is the mortality of this infection?
Infected grafts in 1% with over 50% mortality
How is an infected graft treated?
Graft removal and antibiotics
What should be assumed in all patients > 60 years with new onset renal colic?
Patient has a symptomatic AAA
What kind of shock do patients with a ruptured AAA normally have?
What is the rupture mortality of an AAA?
What should be done in the immediate management of a ruptured AAA?
Diagnosis with clinical history and examination
CXR to exclude thoracic component
US or CT if unclear
Straight to theatre
Prep patient prior to anaesthetic
What are the general issues with screening for AAA?
Severity of disease
Reliable and early detection
What screening is offered for AAA in Scotland? When was this started?
All men aged 65 are offered an ultrasound scan
Started in Scotland in 2012
What are the advantages of endovascular repair of AAA?
Less invasive, shorter hospital stay
Reduced systemic complications
Feasible and reasonably safe
Clinically effective on short-term follow up
Continuing improvement in technique and devices
More patients likely to become suitable
What are the disadvantages of endovascular repair of AAA?
Possible fragmentation of device
Migration of endovascular stent
Only 50% of patients are suitable
Durability of stents unknown
Long-term follow-up required
What patients should EVAR not be offered to?
Young fit patients or very old unfit patients
How many patients in the UK have > 70% symptomatic stenosis of the internal carotid artery which is amenable to surgery?
160 per million
What investigations can be done for suspected stenosis of the internal carotid artery?
What needs to be explained to the patient when gaining consent for a carotid endarterectomy?
Emphasise that it is a prophylactic operation
Discuss likelihood of a further neurological event with best medical therapy
Explain fully the risks
What number of patients receiving carotid endarterectomies is needed to prevent one stroke?
What are the potential complications of carotid endarterectomy?
Major stroke/death 3%
Overall neurological events 6%
Neck haematoma 5.5%
Cranial nerve injuries - 7% permanent