Chapter 70 - Aortoiliac aneurysms - evaluation, decision and medical management

Question 1

Egypt 1550BC on aneurysms

Answer 1

First described

Question 2

Galen on aneurysms

Answer 2

First anatomical description

Question 3

Antyllus on aneurysm

Answer 3

attempted ligation

Question 4

Versalius in 14th century on aneurysms

Answer 4

Cadaveric dissections to fully describe anatomy

Question 5

Pare/Morgagni 14th century on aneurysms

Answer 5

associated it with syphilis

Question 6

Cooper 1817 and Matas 1888 on aneurysms

Answer 6

Described ligation and obliteration of aneurysms

Question 7

Pappe 1946 on aneurysms

Answer 7

Wrapping the aneurysm

Question 8

Carnel/Dubost 1950’s on aneurysms

Answer 8

Autologous reconstruction

Question 9

Vorhees 1952, Debakey and cooley on aneurysms

Answer 9

synthetic reconstruction

Question 10

Parodi 1990 on aneurysms

Answer 10

first EVAR

Question 11

When did FDA approve EVAR

Answer 11

1999

Question 12

Aneurysm Dissection and Management (ADAM) Veterans Affair Cooperative Study Groupstated this

Answer 12

Variations in age, sex, race, BMI/BSA not enough to deviate from standard of AAA definition and indications for repair

Question 13

How much of aortic aneurysms are infrarenal

Answer 13

30%

Question 14

Incidence of aneurysms > 4cm in men 55-64 and rate of increase

Answer 14

1% in 55-64 men 2-4% increase every 10 years

Question 15

Risk factors for aneurysm formation

Answer 15

1) Smoking (proportional to duration) 2) Family history 3) Atherosclerosis 4) MI 5) PAD 6) HTN

Question 16

Factors associated with less aneurysms

Answer 16

1) smoking cessation duration 2) female 3) African 4) diabetes

Question 17

Rate of adjacent aneurysms with AAA

Answer 17

juxta/suprarenal 5-15% iliac 10-25% thoracic 12% fem/pop 14%

Question 18

Popliteal aneurysms prevalence in general population

Answer 18

1%

Question 19

Rate of finding AAA when there are aneurysms in other locations

Answer 19

Popliteal 62% Femoral 85% CIA/IIA 86%

Question 20

Most common iliac artery in iliac aneurysms

Answer 20

CIA

Question 21

Rate of isolated CIA aneurysm

Answer 21

6.4%

Question 22

Rate of IIAA with AAA

Answer 22

2%

Question 23

Causes of IIAA

Answer 23

1) degenerative 2) trauma 3) Vasculitis (Behcet, FMD, Takayasu, Connective tissue) 4) mycotic (rare)

Question 24

Mayo Clinic Group on CIAA

Answer 24

1) growth 0.29 cm/yr 2) no ruptures seen < 3.8 cm 3) average asymptomatic 5.1 cm; symptomatic 7.6cm, rupture 8.3cm

Question 25

Rupture risk of AAA as per UK small aneurysm trial

Answer 25

2.2% most in 5-5.5 cm

Question 26

Risk factors for rupture of AAA (patient factors)

Answer 26

1) female 2) size 3) smk 4) decreased FEV1 5) increased MAP No association with 1) age 2) BMI 3) cholesterol 4) ABI

Question 27

Risk of rupture at different sizes

Answer 27

3-3.9 cm = 0.3%/yr 4-4.9 cm = 0.5-1.5%/yr 5-5.9 cm = 1-11%/yr 6-6.9 cm = 11-22%/yr \>7 cm = \>30%/yr

Question 28

Risk factors for rupture of AAA (aneurysm factors)

Answer 28

1) saccular 2) mural thrombus 3) dissection 4) disruption of peripheral calcification

Question 29

Rate of growth that warrants repair

Answer 29

\> 1cm in 12 months

Question 30

Thoracic Aorta vs abdominal aorta in embryological histology

Answer 30

1) Thoracic media from neura crest cells; abdominal media from mesoderm 2) thoracic media has 55-60 lamellar units for vasa vasorum to penetrate; abdominal only has 28-32

Question 31

Intraluminal thrombus (ILT) mechanism of thinning walls

Answer 31

Plasmin (MMP) and TGF beta cause degradation and thins wall; loss of SMC; elastin degradation and adventitia inflammation

Question 32

Problem with using U/S in assessing AAA

Answer 32

fail to identify ruptures in 50% of the time

Question 33

Screening recommendations by different societies

Answer 33

ESVS 2010 and NSC (UK) 2007: men \> 65 SVS 2009: men \> 65 and 1st degree relative; men 60-85 and female 60-85 with FMHX CSVS 2007: men 65-75, men \< 65 with FMHX; female \> 65 with smk, CVD, FMHX American college of cardiology/AHA: men \> 65; female 65-85 with FMHX; every 6-12 months to detect expansion

Question 34

Medical management that showed promise in animals to reduce aneurysm growth or reduce rupture risk

Answer 34

1) Statin 2) ACEi 3) beta blocker 4) tetracycline 5) doxycycline 6) antiplatelets none work in humans

Question 35

Vascular study group of new england (VSGNE) risk index uses

Answer 35

CEA Bypass EVAR OAAA

Question 36

VSGNE OAAA factors

Answer 36

1) creatinine 2) distal anastamosis location 3) BMI 4) proximal clamp location 5) race 6) CAD 7) COPD 8) recent stress test 9) CHF 10) age

Question 37

Connective Tissue Syndromes Associated With Abdominal Aortic Aneurysms

Answer 37