Aneurysms

Question 1

What happens to the 3 layers of the aorta during an aneurysm?

Answer 1

All 3 layers dilate

Question 2

What is a true aneurysm?

Answer 2

AAA that involved all 3 layers

Question 3

A pseudo/false -aneurysm?

Answer 3

Collection of blood/rupture in outer adventitia layer or surrounding soft tissue

Question 4

How does a false aneurysm present in an examination?

Answer 4

• Thrills
• Bruits
• Pulsatile mass

Question 5

What can a false aneurysm result in?

Answer 5

• Ischaemia
• Rupture of full aorta

Question 6

What is a false aneurysm caused by?

Answer 6

• Inflammation
• Trauma
• Iatrogenic

Question 7

What does iatrogenic mean?

Answer 7

Caused by a medical examination or treatment

Question 8

Back to true aneurysms - what are some common sites?

Answer 8

• Aorta
• Illiac
• Femoral
• Popliteal

Question 9

Complications of aneurysms?

Answer 9

• Rupture
• Thrombosis
• Embolism
• Fistula’s
• Pressure on other structures

Question 10

What causes aneurysms?

Answer 10

• Degenerative disease
• CT disease - marfans
• Infection - mycotic aneurysm
• Atheroma
• Trauma
• Inflammation

Question 11

Risk factors?

Answer 11

• Males
• Age
• Smoking
• Hypertension
• Family history

Question 12

How does it present?

Answer 12

Asymptomatically - will probably be found incidentally via screening

Question 13

What screening is in place?

Answer 13

Abdo Aortic Aneurysm screening for all over 65 yr old males - ultrasound scan

Question 14

How are aneurysms classed and managed?

Answer 14

1. Normal - discharged
2. Small - 3-4.4 cm - annual scans
3. Medium - 4.5-5.5 cm - monthly scans
4. Large >5.5 cm - consider surgical options

Question 15

What are the unruptured symptoms?

Answer 15

None really - may have some abdo/back pain

Question 16

Impending rupture symptoms?

Answer 16

• Increasing back pain
• Tender AAA

Question 17

Symptoms and signs upon a rupture?

Answer 17

• Abdo/back/flank pain
• Painful pulsatile mass
• Hypo-perfusion
• Haemodynamic instability (unstable BP)

Question 18

How is an unruptured small - medium aneurysm treated?

Answer 18

• Control risk factors - stop smoking control BP as if these high has higher chance of rupture
• Monitor closely

Question 19

What types of imaging is used to assess the AAA?

Answer 19

• Ultrasound
• CT/MRI

Question 20

Ultrasound pos and negs?

Answer 20

1. Pos - cheap, no radiation or contrast
2. Neg - operator dependent and inadequate for surgical planning

Question 21

MRI pos and negs?

Answer 21

• Pos Quick Not op dependant Needed for surgical planning as it shows detailed anatomy
• Neg Uses contrast and radiation

Question 22

When is surgery considered?

Answer 22

Size of 5.5 cm or more If it expands >1 cm in a year If patient has symptoms

Question 23

What should be taken into account pre surgery?

Answer 23

• Size and risk of rupture
• Patient suitability
• Can aneurysm have an EVAR or open surgery?

Question 24

Complications of open surgery?

Answer 24

• Infection
• Bleeding
• Pain
• Scar
• Damage to nearby structures

Question 25

Complications of endovascular surgery?

Answer 25

* Wound infection * Bleeding * Pain * Scar * Contrast/Radiation reaction = kidney injury * Endoleak * Damage to arteries veins, nerves

Question 26

What is endoleak?

Answer 26

Persistant blood flow within the aneurysm sac following an endovascular aneurysm repair (EVAR)

Question 27

Steps for an emergency open repair?

Answer 27

1. Straight to theatre 2. Massive transfusion protocol 3. Prep abdomen, rapid anaesthetic 4. Laparotomy xiphisternum to pubic symphysis 5. Occlude aorta proximally

Question 28

Steps to consider about an emergency EVAR?

Answer 28

Is anatomy suitable Local anesthetic should be given Is there time to assess anatomy?