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Aneurysms Flashcards

1
Q

What is atherosclerosis of the carotid arteries associated with?

A

TIA and ischaemic stroke

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2
Q

Causes of stroke

A 
Cerebral infarction (84%)
- AF
- Carotid atherosclerotic plaque rupture/thrombosis
- Endocarditis
- MI
- Carotid artery trauma/dissection 
- Drug abuse
- Haematological disorder e.g. sickle cell 
Primary Intracerebral haemorrhage (10%)
SAH (6%)
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3
Q

What does SAH stand for?

A

Subarachnoid haemorrhage

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4
Q

Risk factors for carotid artery stenosis

A 
Smoking
DM
FH
Male
HTN
Hyperlipidaemia/Hypercholesteraemia 
Obesity
Age
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5
Q

What is Poiseuilles Law in terms of a vessel?

A

As the radius of the vessel decreases (stenosis), velocity increases

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6
Q

Investigations for carotid artery stenosis / stroke

A 
Neurological examination 
Cardiac exam 
Auscultate carotids
CT
Carotid USS
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7
Q

Treatment of TIA / Stroke

A 
Smoking cessation 
Control of HTN
Antiplatelet (aspirin / clopidogrel)
Statin 
Diabetic control 
Carotid doppler
Carotid endarterectomy 
Stenting
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8
Q

If one of the carotid arteries are occluded, how is the brain still perfused?

A

Due to the circle of willis

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9
Q

What can an diseased carotid artery further increase the risk of and why?

A

Stroke / TIA - emboli could be showered from high velocity flow in a diseased carotid artery, causing distal ischaemia

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10
Q

Should patients with asymptomatic carotid stenosis be treated?

A

If high grade stenosis (60-99%)

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11
Q

What is an aortic aneurysm disease?

A

Dilation of all layers of the aorta, leading to an increase in diameter of > 50% (abdominal aorta >3cm)

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12
Q

Causes of aneurysm disease

A

Degenerative disease
Connective tissue disease (e.g. marfans)
Infection (mycotic aneurysm)

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13
Q

Is a mycotic aneurysm common?

A

No

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14
Q

Risk factors for degenerative AAA

A 
Male
Age
Smoking
HTN
FH
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15
Q

Prevalence of AAA in 1st degree male relatives

A

30%

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16
Q

What is protective in AAA?

A

Diabetes

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17
Q

Presentation of AAA

A 
Asymptomatic 
Aneurysm pulsating 
Increasing back pain 
Tender abdomen around aorta 
Abdo / back / flank pain 
Painful pulsatile mass 
Haemodynamic instability (single or progressive)
Hypoperfusion
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18
Q

What does a symptomatic AAA indicate?

A

Impending rupture

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19
Q

Unusual presentations of AAA

A 
Distal embolization 
Aortocaval fistula 
Aortoenteric fistula
Ureteric occlusion 
Duodenal obstruction
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20
Q

What is an aortocaval fistula?

A

Aortic blood going back into the venous system without perfusing the limbs

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21
Q

What is an aortoenteric fistula?

A

Connection between aorta and intestines, stomach or oesophagus, there can be significant loss of blood into the intestines

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22
Q

Who gets abdominal aortic aneurysm screening?

A

Men > 65 y/o in England

23
Q

Criteria for disease screening

A 
Definable disease
Prevalence
Severity of disease
Natural history 
Reliable detection 
Early detection confers advantage 
Treatment available
Cost effective 
Feasibility
Acceptability
24
Q

What would be done in screening if the aorta is found to be normal?

A

Discharged

25
How big is a small AAA, and if found in screening, what would be done?
3.0 - 4.4cm | Annual USS scans
26
How big is a medium AAA, and if found in screening, what would be done?
4.5 - 5.5cm | 3 monthly USS scans
27
How big is a large AAA, and what would be done if found during screening?
> 5.5cm | Send to nearest vascular unit for further work up
28
Risk of rupture for aneurysm < 4cm
<0.5% per year
29
Risk of rupture for aneurysm 5 - 5.9cm
3 - 15% per year
30
Risk of rupture for aneurysm 7 - 7.0cm
20 - 40% per year
31
Risk of rupture of aneurysm > 8cm
30 - 50%
32
What must be determined before repair of an aneurysm?
Is it a size to consider to repair? Is the patient a candidate for repair? Is the aneurysm suitable for endovascular or open repair?
33
What size of aneurysms can sit comfortably with frequent surveillance?
< 5.5cm small aneurysms
34
In the UK, at what size is treatment usually offered for aneurysms?
>5.5cm
35
How to determine the patients fitness for repair
``` History and exam Bloods ECG ECHO PFTs MPS CPEX EOB assessment Patient preference ```
36
What does MPS stand for?
Myocardial perfusion scans
37
What does CPEX stand for?
Cardiopulmonary exercise test
38
Investigations of AAA
USS | CTA/MRA (contrast scans)
39
Treatment of asymptomatic AAA
``` Conservative - not fit for repair - consider in event of rupture Endovascular repair Open repair ```
40
How does open repair of AAA work?
Sew in a tube so blood will flow down the tube instead of the aneurysm sac
41
Complications of open repair of AAA
``` Wound infection, bleeding, pain, scar Damage to bowel, uterus, veins, berves Distal emboli Renal failure Colonic ischaemia DVT/ PE / MI / Stroke Death ```
42
How does an endovascular repair of AAA work?
Femoral arteries in groin used Catheter with graft - unzip graft and so pings open in the aneurysm sac Only leaves small scar at groin
43
Complications endovascular vs open repair
Endovascular much less
44
Complications of endovascular repair of AAA
``` Wound infection / Bleeding / Pain / Scar Contrast reaction / kidney injury Radiation Endoleak Femoral artery dissection Damage to femoral vein / nerve Distal emboli DVT / PE / MI / Stroke / Death ```
45
What is an endoleak?
When despite the graft, blood is still leaking into the sac
46
Treatment of symptomatic AAA
ABCDE Support circulation Emergency open repair Emergency EVAR
47
Why should the patient be kept awake while preparing the abdomen in symptomatic AAA?
The muscles in the abdomen are keeping the bleeding
48
Mortality of emergency open repair of symptomatic AAA
30 - 50%
49
What does emergency EVAR have a risk of?
Abdominal compartment syndrome
50
Branches of common carotid artery
Internal carotid artery | External carotid artery
51
Where does the internal carotid artery go?
Inside brain
52
Complications of carotid endarterectomy
Wound infection, Bleeding, Scar Nerve damage Perioperative stroke due to plaque rupture
53
What is an indication for urgent synchronised DC cardioversion in AF?
Signs of HF

CVS Pathology (19 decks)

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