Aortic Aneurysms and Carotid Artery Disease

Question 1

Aneurysm disease

Answer 1

Dilation of all layers of the aorta leading to an increase in diameter of >50%

Question 2

Causes of aneurysm disease

Answer 2

Degenerative disease
Connective tissue disease
Infection (mycotic aneurysm)

Question 3

Risk factors for degenerative abdominal aortic aneurysms

Answer 3

Male
Age
Smoking
Hypertension
Family history

Question 4

Prevalence of aortic aneurysm disease in the UK

Answer 4

3%

Question 5

Symptoms of abdominal aortic aneurysm

Answer 5

Asymptomatic

Question 6

Abdominal aortic aneurysm can only be detected by

Answer 6

Screening

Question 7

Type of screening used for abdominal aortic aneurysm

Answer 7

Ultrasound scan

Question 8

A good screening is one which

Answer 8

Minimises false positives and negatives, maximises true positives and negatives

Question 9

Presentation of impending rupture of abdominal aortic aneurysm

Answer 9

Increasing back pain

Tender abdominal aortic aneurysm

Question 10

Presentation of ruptured abdominal aortic aneurysm

Answer 10

Abdominal and back pain
Painful pulsatile mass
Haemodynamic instability
Hypoperfusion

Question 11

Usual presentations of abdominal aortic aneurysms in scan

Answer 11

Distal embolisation
Aortocaval fistula
Aortoenteric fistula
Ureteric occlusion
Duodenal obstruction

Question 12

Treatment options for abdominal aortic aneurysm

Answer 12

Conservative
Endovascular repair
Open repair

Question 13

Endovascular repair

Answer 13

Insertion of stent graft into aneurysm

Question 14

Open repair general complications

Answer 14

Wound infection or separation
Bleeding
Pain
Scar

Question 15

Open repair technical complications

Answer 15

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

Question 16

Open repair and endovascular repair patient factor complications

Answer 16

Deep vein thrombosis/pulmonary embolism
MI
Stroke
Death

Question 17

Endovascular repair general complications

Answer 17

Wound infection
Bleeding/haematoma
Pain
Scar
Radiation
Contrast - kidney injury

Question 18

Endovascular repair technical complications

Answer 18

Endoleak
Femoral artery dissection/pseudo-aneurysm
Rupture
Distal emboli/ischaemia/colonic ischaemia
Damage to femoral vein/nerve

Question 19

Emergency open repair of abdominal aortic aneurysm

Answer 19

Laparotomy xiphisternum to public symphysis to occlude aortic proximally

Question 20

Surveillance of abdominal aortic aneurysm until it reaches a diameter of

Answer 20

5.5cm

Question 21

Atherosclerosis of carotid arteries can result in

Answer 21

Ischaemic attacks and stroke

Question 22

Transient ischaemic attack

Answer 22

Focal CNS disturbance caused by vascular events leading to cerebral ischaemia, lasts less than 24 hours

Question 23

Stroke

Answer 23

Clinical syndrome consisting of rapidly developing clinical signs of focal or global disturbance of cerebral function due to vascular event, lasts more than 24 hours

Question 24

Causes of stroke/TIA

Answer 24

Cerebral infarction
Primary intracerebal haemorrhage
Subarachnoid haemorrhage

Question 25

Causes of cerebral infarction

Answer 25

``` Atrial fibrillation Carotid atherosclerosis - rupture/thrombus Endocarditis MI Carotid artery trauma/dissection Drug abuse Haematological disorder ```

Question 26

Risk factors for carotid artery atherosclerosis

Answer 26

``` Smoking Dibetes Family history Male Hypertension Hyperlipidaemia/hypercholesterolaemia Obesity Age ```

Question 27

Imaging for carotid artery atherosclerosis

Answer 27

CT and carotid ultrasound

Question 28

Effect of decrease in vessel radius on velocity

Answer 28

Increases

Question 29

Degree of stenosis can be measured via

Answer 29

Measuring velocity

Question 30

Best medical therapy for carotid artery atherosclerosis

Answer 30

``` Smoking cessation Control of hypertension Anti-platelet Statin Diabetic control ```

Question 31

Statin

Answer 31

Drug that lowers cholesterol levels in the blood

Question 32

The brain is still perfused despite carotid artery atherosclerosis due to

Answer 32

Circle of Willis

Question 33

Carotid endarterectomy

Answer 33

Removal of plaque from artery

Question 34

Complications of carotid endarterectomy

Answer 34

``` Wound infection Bleeding Scar Anaesthetic risks Nerve damage - vagus and hypoglossal Preoperative stroke ```

Question 35

Management of carotid artery atherosclerosis

Answer 35

Best medical therapy Carotid endarterectomy Stenting

Question 36

Timing of management

Answer 36

Longer carotid is left alone the more stable the plaque becomes

Question 37

The NNT to prevent one stroke for men and women

Answer 37

Men - 9 | Women - 36

Question 38

Most risky period for further event is within

Answer 38

The first 2 weeks

Question 39

Prophylactic

Answer 39

Doesn't reverse effects of stroke, just prevents further events

Question 40

Surgery is described as being

Answer 40

Prophylactic

Question 41

Carotid surgery should be offered to

Answer 41

Symptomatic patients with >70% stenosis

Question 42

Surgery in men considered if stenosis percentage is between

Answer 42

50-69%

Question 43

Surgery in asymptomatic patients considered if stenosis percentage is >

Answer 43

70%