Vascular Surgery Flashcards
(37 cards)
What is the definition of an abdominal aneurysm?
Dilatation of the aorta greater than 3cm
What are some risk factors for AAA?
Smoking, hypertension, hyperlipidaemia, family history, male gender, increasing age
How do patients present with an abdominal aortic aneurysm?
Often asymptomatic and found as incidental finding or through screening.
Can present with non-specific abdo/back pain, pulsation and expansile mass.
What screening are patient offered for AAA and from what age?
At 65 men are offered a screening ultrasound scan
What imaging can be used to diagnose AAA?
Ultrasound- usually initial imaging
CT angiogram can be used to guide elective surgery as gives more detailed picture
How big would an AAA be to fit into the different categories of small, medium and large aneurysms?
Small: 3-4.4cm
Medium: 4.5-5.4cm
Large: >5.5cm
How would you manage a patient with an AAA less than 5.5cm?
3-4.4cm ultrasound yearly
4.5-5.4cm ultrasound every 3 months
Reduce cardiovascular risk factors
How would you manage a large AAA (>5.5cm)?
Consider surgery- either open or endovascular repair
How might a ruptured abdominal aortic aneurysm present?
Symptoms: Severe abdo pain radiating to back or groin, collapse, LOC
Signs: tender, pulsation and expansile abdo mass, haemodynamic instability
What does permissive hypotension refer to in ruptured AAA management?
Aiming for lower than normal BP when fluid resuscitating to not increase blood loss
How will you manage suspected AAA rupture if the patient is unstable?
Transferred to theatre right away
High flow O2, IV access, urgent bloods with group and save 6units
How will you manage suspected AAA rupture in stable patient?
CT angiogram
High flow O2, IV access, urgent bloods with group and save 6units
What is an aortic dissection?
Tear in the intimal layer of aortic wall, causing blood to flow between tunica intima and media
Which of anterograde or retrograde aortic dissections can result in cardiac tamponade?
Retrograde dissections
Which 2 classifications systems are used for aortic dissections?
Stanford classification
DeBakey classification
What are some risk factors for aortic dissection?
Hypertension, atherosclerosis, connective disorders, bicuspid aortic valve
What is a characteristic presentation of a patient with aortic dissection?
Symptoms: Tearing chest pain radiating to the back
Signs: tachycardia, hypotension, new aortic regurgitation murmur
Which imaging is recommended for diagnosis of aortic dissection?
CT angiogram
If a 60 year old man with a background of hypertension presents with sudden onset tearing chest pain, what would be your top differential?
Aortic dissection
How does the location of an aortic dissection affect where the patient feels the pain?
Pain more likely in anterior chest when ascending aorta affected
Pain more likely to be felt in the back when descending aorta affected
What is peripheral arterial disease?
Narrowing of the peripheral arteries, reducing blood supply to the limb/peripheries
What is intermittent claudication?
A crampy/achy pain in the calf or thigh occurring during exertion and relieved by rest
What is the end stage of peripheral arterial disease?
Critical limb ischaemia
What are some feature of critical limb ischaemia? (6P’s)
Burning pain at rest (worse at night)
Pallor, pulseless, paralysis, perishing cold, parasthesia
