Aneurysms and carotid artery surgery-Presentation investigation and therapy

Question 1

What is aneurysm disease of aorta?

Answer 1

• Dilation of all layers of aorta
• increase diameter of >50%
• Abdominal aorta >3cm

Question 2

What is the causes of aneurysm disease?

Answer 2

• Degenerative disease
• Connective tissue (Marfans)
• Infection (mycotic aneurysm)

Question 3

What are the risk factors for degenerative AAA disease?

Answer 3

• Male
• Age
• Smoking
• Hypertension
• Family history

Question 4

When are men invited for AAA screening in the uk?

Answer 4

65

Question 5

What are the outcomes of screening?

Answer 5

• A) Normal aorta, discharged
• B)Small AAA
• C) Medium AAA
• D)Large AAA

Question 6

What is the size of a small AAA?

Answer 6

(3.0-4.4 cm) - annunal scans

Question 7

What is the size of a medium AAA?

Answer 7

(4.5-5.5cm) monthly scans

Question 8

What is the large AAA size?

Answer 8

5.5cm

Question 9

When is AAA symptomatic?

Answer 9

impending rupture

Increasing back pain

Question 10

What are the symptoms of AAA rupture?

Answer 10

• Abdo/back/flank
• Painful pulsatile mass
• Haemodynamic instability
• Hypoperfusion

Question 11

What are the unusual presentations of AAA?

Answer 11

• Distal embolism
• Aortocaval fistula (Aotra and VC)
• Aortoenteric fistula (Aorta and oesophagus)
• Ureteric occulsion
• Duodenal obstruction

Question 12

How do you measure patient fitness?

Answer 12

• Full history
• Bloods
• ECG
• ECHO
• PFTs
• MPS
• CPEX (Exercise test)

Question 13

What does PFTs for?

Answer 13

Pulmonary function tests (PFTs)

Question 14

What does MPS stand for?

Answer 14

Myofascial pain syndrome (MPS), a, is a syndrome characterized by chronic pain in multiple myofascial trigger points (“knots”) and fascial (connective tissue) constrictions. It can appear in any body part.

Question 15

When is treatment conservative for AAA?

Answer 15

• If pateint/aneurysm not fit for repair

- Consider event of rupture

Question 16

What are the general complications of an open repair?

Answer 16

• Wound infection
• Bleeding
• Pain
• Scar

Question 17

What are the technical complications of an open repair?

Answer 17

• Damage to bowel, ureters,veins,nerves
• Incisional hernia
• Graft infection
• Distal embolism
• Renal failure
• Colonic ischaemia

Question 18

What are the patient factors which can complicate open repair?

Answer 18

• DVT/PE
• MI
• Stroke
• Death

Question 19

What are the general complications of an endovascular repair?

Answer 19

Wound infection
bleeding/Haematoma
Pain
scar
Contrast
radiation

Question 20

What are the technical complications of endovasculature repair?

Answer 20

• Endoleak
• Femoral artery dissection/pseudoaneurysm
• Rupture
• Distal emboli/ischaemia/colonic ischaemia
• Damage to femoral vein/ nerve

Question 21

What are the patient factors of endovasculature repair?

Answer 21

• DVT/PE
• MI
• Stroke
• Death

Question 22

What is type 1 endoleak?

Answer 22

blood flow from above or below

Question 23

What is type 2 endoleak?

Answer 23

Blood flow from side branches

Question 24

Type 3 endoleak?

Answer 24

Between the joint of the two stents

Question 25

Type 4 endoleak?

Answer 25

General bleeding through stent

Question 26

What is a TIA?

Answer 26

Transient ischaemic attack

Question 27

Describe a TIA?

Answer 27

Focal CNS disturbance caused by vasculature events such as microemboli and occulsion leading to cerebral ischaemia?'

Question 28

What is the definition of a stroke?

Answer 28

Clinical syndrome consisiting of rapidlt developing clinical signs of focal or global disturbance of cerebral function, lasting more than 24hrs or leading to death. with vascular origin

Question 29

What are the causes of a stroke?

Answer 29

-AF -Carotid atheroscelrosis plaque rupture/thrombus -Endocarditis -MI -Carotid artery trauma/dissection -Drug abuse -Haemaatological disorder (sickle cell)

Question 30

What are the three components of Virchow`s triad?

Answer 30

- Coaguability - Flow - Vessel wall

Question 31

What would you find on examination of carotid

Answer 31

Contralateral symptoms of paralysis/paresis/visuospatial neglect, dysphasia, and ipsilateral amaurosis fugax symptoms

Question 32

What is amaurosis fugax symptoms?

Answer 32

Amaurosis fugax (transient monocular blindness) is a symptom of retinal ischemia just as contralateral hemiparesis and sensory loss are symptoms of cerebral ischemia

Question 33

What is paresis?

Answer 33

a condition of muscular weakness

Question 34

What is poiseuille`s law?

Answer 34

As radius of a vessel decreases (i.e. stenosis) velocity increases

Question 35

What is the best management to prevent aneurysms or carotid atheromas?

Answer 35

- Smoking cessation - Control of hypertension - Antiplatelet - Statin - Diabetic control

Question 36

What is carotid doppler?

Answer 36

Ultra sound of carotid

Question 37

What are complications of carotid endarterectomy?

Answer 37

- Wound infection - Bleeding - Scar - Anaesthetic risks - Nerve

Question 38

What can happen during the period before surgery?

Answer 38

Plaque rupture Hypoperfusion Virchows triad (raw intiamal surface and thrombus)

Question 39

When is the most risky time after stroke?

Answer 39

Within first 2 weeks for further

Question 40

When should carotid surgery by offered?

Answer 40

For all patients with >70% stenosis (except occluded)