Aneurysm Presentation, Investigation and Therapy Flashcards Preview

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Flashcards in Aneurysm Presentation, Investigation and Therapy Deck (29)
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1

What is an aneurysm?

When an artery exceeds 3cm or is over 50% of the normal size

2

What are the kinds of aneurysm?

Fusiform
Saccular

3

When is there an increased prevalence of aneurysm?

Men aged > 65
Male sex
Smoking
Chronic obstructive airway disease
Hypertension
Peripheral vascular disease
Ischaemic heart disease
Family history

4

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

5

What are some unusual presentations of aneurysm?

Aortic occlusion
Distal embolisation
Ureteric occlusion
Aortocaval fistula
Duodenal obstruction

6

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

7

When is surgery considered in aortic aneurysms?

4.5-5cm and larger

8

At what point is surgery to correct an aortic aneurysm advantageous?

When > 5cm

9

What is the 30 day operative mortality of an aneurysm of 4.5-5cm?

5.8%

10

What investigations are necessary when considering surgical repair of an aortic aneurysm?

PMH
Cardiac and respiratory fitness
Routine bloods
ECG
Echo
Cardiac perfusion scan
CXR
PFTs
CT abdomen

11

What is the main hazard in abdominal aortic aneurysm operations?

Sudden changes in circulatory haemodynamics due to aortic cross-clamping or blood loss

12

What are the potential post-operative complications of an abdominal aortic aneurysm operation?

Haemorrhage
Cardiac complications (6.6-12%
Colonic ischaemia in 33% of ruptured AAA
Infected grafts
Aorto-duodenal fistula

13

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

14

How is an infected graft treated?

Graft removal and antibiotics

15

What should be assumed in all patients > 60 years with new onset renal colic?

Patient has a symptomatic AAA

16

What kind of shock do patients with a ruptured AAA normally have?

Hypovolaemic shock

17

What is the rupture mortality of an AAA?

60% community
50% operative
80-90% overall

18

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
Restrict fluids
Urgent cross-match
Coagulation screen
FBC
U&Es
Straight to theatre
Prep patient prior to anaesthetic

19

What are the general issues with screening for AAA?

Definable disease
Prevalence
Severity of disease
Natural history
Reliable and early detection
Appropriate treatment
Cost
Feasibility
Acceptability

20

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

21

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

22

What are the disadvantages of endovascular repair of AAA?

Endoleak
Possible fragmentation of device
Migration of endovascular stent
Only 50% of patients are suitable
Durability of stents unknown
Long-term follow-up required

23

What patients should EVAR not be offered to?

Young fit patients or very old unfit patients

24

How many patients in the UK have > 70% symptomatic stenosis of the internal carotid artery which is amenable to surgery?

160 per million

25

What investigations can be done for suspected stenosis of the internal carotid artery?

Duplex
MRA
CTA
Angiogram

26

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
Risk-benefit analysis

27

What number of patients receiving carotid endarterectomies is needed to prevent one stroke?

9-12 patients

28

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
MI 1%

29

When should you consider a carotid endarterectomy?

Over 70% stenosis of internal carotid artery
Symptomatic carotid artery disease
Retained cognitive function