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304- Vascular surgery > Aneurysms > Flashcards

Aneurysms Flashcards

1
Q

Aneurysm definition

A

Permanent and irreversible localised dilation of a blood vessel
- At least 50% more than expected diameter.

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2
Q

Ectasia

A

Permanent, irreversible localised dilation of less than 50% of normal diameter

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3
Q

Arteriomegaly

A

Diffuse arterial enlargement without discrete aneurysm.

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4
Q

Most common locations of aneurysm

A

> 90% infra-renal abdominal

Aortic arch

Thoracic arch

Supra-renal abdominal aorta

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5
Q

Aetiology of aneurysms

A

Degenerative

Familial

Vasculitic

Connective tissue abnormality

Infective (mycotic)

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6
Q

Epidemiology of aneurysms
- Age
- Ethnicity
- Sex

A

M:F= 4:1

Familial, M:F= 2:1

Afro-Carribean= 0.53

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7
Q

Aneurysm classifications

A

True
- Dilation involves all layers
- Fusiform (AAA), saccular (berry)

False (Pseudo)
- Collection of blood that communicates with lumen. Between tunica media and the tunica adventitia.
- Cause: puncture, cannulation.

Dissection
- Dilation caused by blood separating apart the media
- Forms a channel with vessel wall.

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8
Q

Congenital causes of aneurysms

A

Autosomal dominant polycystic kidney disease (ADPKD)
- Berry aneurysms

Connective tissue abnormalities:
- Marfan’s
- Ehler’s danlos

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9
Q

Complications of aneurysms

A

Rupture

Thrombosis

Distal emoboli

Pressure
- DVT
- Oesophagus
- Nutcracker syndrome

Fistula

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10
Q

Nutcracker syndrome

A

Pressure complication of aneurysms

Compression of the left renal vein between the aorta and the superior mesenteric artery.

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11
Q

AAA presentation

A

Asymptomatic

Back/ umbilical pain radiating to groin

Acute limb ischaemia

Distal emboli: blue toe syndrome

Acute rupture:
- Expansile adominal mass
- Shock
- Severe abdo pain, radiating to back/ flank

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12
Q

Investigations for AAA

A

Imaging
- USS: monitors growth, identifies aneurysms

CR/MRI= gold standard

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13
Q

Management of AAA

A
  1. Conservative
  2. Open repair
  3. Endovascular (EVAR)
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14
Q

Screening for AAA

A

Screening occurs as it’s fairly common (5% males >65) with very high mortality rate if it ruptures (90%)

Men screen at 65

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15
Q

Conservative management of AAA

A
  1. Manage cardiovascular risk factors
    - BP, cholesterol

Can be monitored if diameter <5cm.
- 3-4.4cm= yearly monitoring
- 4.5-5.4= 3 monthly

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16
Q

Endovascular repair of AAA
- Incision
- Anaesthesia
- Complications
- Post-op
- Mortality

A

Small groin incisions made
- Under local or regional anaesthetics

Stent graft, complications
- Migration of graft
- Endoleak
- Graft limb occlusion

Post-op
- Surveillance
- Re-interventions risk
- Risk of rupture higher than open

Mortality= 1-2%

17
Q

Reasons for open> EVAR

A

Unusual anatomy

Cost (cheaper)

Large/ symptomatic juxa-renal aneurysm

Emergency

Patient preference

18
Q

Pathology of AAA
- Dize of dilation
- Location

A

Dilation >3cm

Location
- >90% infrarenal
- 30% iliac arteries.

19
Q

Surgical emergency management of AAA rupture

A
  1. High flow O2
  2. Large bore cannulae in each ACF
    - Keep BP <100
    - Give fluid if shocked
    - Blood taken: FBC, U+E, clotting, amylase, Crossmatch.
  3. Haemorrhage protocol + call vascular surgeon, anaesthesia
  4. Analgesia
  5. Antiobiotic prophylaxis
  6. Urinary catheter, CVP line
  7. Stable= CT/US
20
Q

Thoracic aortic dissection
- Aetiology

A

90%–> Atherosclerosis, HTN

21
Q

Thoracic aortic dissection
- Aetiology

A

90%–> Atherosclerosis, HTN

Rarer
- Connective tissue disorders: Marfan’s, Ehler’s danlos
- Vit C def

22
Q

Thoracic aortic dissection
- Presentation
- Include distal and proximal propagation.

A

Sudden onset of tearing chest pain
- Radiates to back

Tachycardiac, HTN

Distal propagation (occlusion of sequential branches)
- Left hemiplegia
- Unequal arm pulses and BP
- Paraplegia (anterior spinal art.)
- Anuria

Proximal propagation
- Arotic regurg
- Tamponade

23
Q

Classifications of thoracic aneurysms

A

Stanford classifications

Type A: Proximal (70%)
- Ascending aorta with/ without might involved descending
- Higher mortality due to cardiac complications.

Type B: Distal (30%)
- Descending aorta only
- Usually managed conservatively

24
Q

Investigations of thoracic aneurysm

A

Bloods
- Xmatch
- FBC, U+E
- Clotting
- Amylase

ECG
- Excludes MI
- May show ischaemia if coronary ostia involved.

Imaging
- CXR
- CT/MRI: if HD stable
- TTE/ TOE: if HD unstable

25
Q

Management of Thoracic anuerysm

A
  1. Analgesia
  2. BP management
    - Beta-blocker: Labetalol/ Esmolol
    - BP ket at 100-110
  3. Type A: Open repair
    Type B: Conservative . Surgery if pain persistent/ complications.
26
Q

Indications for elective repair of AAA

A
  • Symptomatic aneurysm
  • Aneurysm growing >1cm/ year
  • Diameter >5.5cm

304- Vascular surgery (7 decks)

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