Aortic Aneurysms

Question 1

define aneurysm

Answer 1

focal
1.5x increase in normal diameter

Question 2

define ectasia

Answer 2

diffuse dilatation of an artery
increase in diameter >50%

Question 3

define arteriomegaly

Answer 3

diffuse enlargement of an artery

Question 4

define pseudo aneurysm

Answer 4

frequently due to trauma

Question 5

define true aneurysm

Answer 5

incorporates all three layers of the vessel

Question 6

associates aneurysms that aortic aneurysms may hev

Answer 6

aortoiliac - 41%
femoro-popliteal - 15%

Question 7

associated medical conditions with aortic aneurysms

Answer 7

carotid artery stenosis
smoker
male
HTN

Question 8

reasons aortic aneurysm develops (aetiology)

Answer 8

• atherosclerosis
• cystic medial necrosis
• dissection
• Ehlers-danlos syndrome
• syphilis
• familial associated (Lysol oxidase syndrome)
• degenerative
• mycotic
• inflammatory

Question 9

how can aortic aneurysm be degenerative

Answer 9

decrease in elastic and collagen in arterial wall
elastic becomes fragmented - arterial elongation and dilatation
increase in the collagenase and elastase activity

Question 10

how can aortic aneurysm be mycotic

Answer 10

degradation of media and intimal layers by S. cocci and E. coli

Question 11

Laplace’s law

Answer 11

tension = pressure x radius

Question 12

clinical presentation of aortic aneurysm

Answer 12

asymptomatic: 70-75%
symptoms: early satiety, abdominal flank or back pain
abrupt onset of pain = rupture or expansion of aneurysm
frequently incidental discovery

Question 13

ruptured aneurysms locations

Answer 13

usually occurs postero-laterally
can rupture in vena cava creating aorta-caval fistula

Question 14

ruptured aneurysms locations

Answer 14

usually occurs postero-laterally
can rupture in vena cava creating aorta-caval fistula
occasionally can rupture anterior which is rally fatal

Question 15

limitation of arteriography for aortic aneurysm diagnosis

Answer 15

cannot determine aneurysm size because of mural thrombus

Question 16

indications for obatining an ateriogrpahy

Answer 16

suspicion of visceral ischaemia
occlusive disease of iliac and femoral arteries
severe HTN, or impair renal function
horseshoe kidney
suprarenal of TAAA component
femora-popliteal aneurysms

Question 17

ways that ultrasound for aortic aneurysm is helpful

Answer 17

establishes diagnosis easily
accurately measures infrarenal diameter
widely available, quick, no rick, cheap

Question 18

ways that US for AA is not helpful

Answer 18

difficult to visualise thoracic or suprarenal aneurysms
difficult to establish relationship to renal arteries
technician dependant

Question 19

ways that CT scan for AA is helpful

Answer 19

reliable and reproducible
can image entire aorta
can visualise relationship to visceral vessels
most useful

Question 20

ways that CT scan for AA is not helpful

Answer 20

longer to obtain and more expensive
requires contract agent which can cause renal toxicity

Question 21

MRA (magnetic resonance angiography) for AA

Answer 21

now widely available
more expensive than CT and US
no contract agent needed
spacial resolution less than CT

Question 22

complications for AAs

Answer 22

thrombosis
distal embolisation
rupture

Question 23

how high is risk of rupture in AA

Answer 23

23.4% of aneurysms 4-5cm will rupture

Question 24

what increases likelihood of rupture

Answer 24

patients with COPD and HTN have increased risk

Question 25

likelihood of survival of rupture

Answer 25

half die before reaching hospital an additional quarter die before repair

Question 26

how to reduce mortality associated with surgical repair

Answer 26

endovascular techniques are reducing surgical mortality

Question 27

indications for treatment of AA

Answer 27

infrarenal aneurysm >5cm without comorbid medical conditions repair smaller aneurysms f rate of enlargement is larger than expected repair all symptomatic aneurysms

Question 28

indications for treatment in patients with AA and comorbid conditions

Answer 28

wait until risk of repair and rupture are equal (usually about 6cm)

Question 29

standard surgical repair for AA

Answer 29

replace diseased aorta with synthetic material requires 7 day hospital stay

Question 30

potential complications in standard repair of AA

Answer 30

cardiac renal respiratory bowel ischameia spinal ischaemia (rare)

Question 31

EVAR stands for

Answer 31

endovascular aneurysm repair

Question 32

what is EVAR

Answer 32

percutaneous access through groin with expandable prosthesis under fluoroscopic guidance

Question 33

why do EVAR

Answer 33

significantly reduced m&m long term result good in selected patients life long surveillance recommended hospital stay 2 days