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Flashcards in Arterial Aneurysms Deck (31)
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What are the two types of aneurysms

- true
- false


What is the definition of the aneurysm

- Aneurysm is defined if there is permanent dilatation of the artery to twice the normal diameter


What happens in true aneurysms

- this is when the arterial wall forms the wall of the aneurysm


what are arteries that are most frequently involved in true aneurysms

- abdominal aorta
- iliac
- popliteal
- femoral arteries
- thoracic aorta


What happens in false aneurysms

- the surrounding tissues form the wall of the aneurysm


When do false aneurysms occur

- false aneurysms occur following a femoral artery puncture
- a haematoma is formed because of inadequate compression of the entry site and continued bleeding into the surrounding compressed soft tissue forms the wall of this aneurysm


where do abdominal aortic aneurysms commonly occur

- these most commonly occur below the renal arteries


What can cause an abdominal aortic aneurysm

- atherosclerosis
- infection
- trauma
- genetic


What are risk factors for abdominal aortic aneurysms

- age
- male
- gender
- strong family history

- smoking
- hypertension
- hypercholestrolaemia


Who should screening be given to

- be offered to men aged 65-74 years who will receive an abdominal ultrasound


What are the sizes of abdominal aortic aneurysms seen on abdominal ultrasound and what does this mean

- Normal or less than 3cm - will not require treatment or further scans
- Small - 3-4.4 cm - aorta will require annual ultrasound surveillance and GP review to optimise lifestyle
- Medium - 4.5-5.4cm - aorta requires quarterly ultrasound surveillance and cardiovascular secondary prevention therapy
- large greater than 5.5cm - aorta will be referred for assessment and possible elective repair


What are the symptoms of aortic abdominal aneurysm

- asymptomatic mostly

Rapid expansion
- serve pain - epigastric pain that radiates to the back

Ruptured AAA
- hypotension
- tachycardia
- profound anaemia
- sudden death


What is the signs of an aortic abdominal aneurysm

- aneurysm is suspected if a pulsatile, expansile, abdominal mass is felt


What is the medical management of an abdominal aortic aneurysm

- control of hypertension
- smoking cessation
- lipid lowering medication
- patients with an AAA greater than 5.5cm are followed up by regular ultrasound surveillance


What happens in surgical repair to an abdominal aortic aneurysm

- standard therapy is open surgical repair with insertion of a macron or gore-tex graft


What is a non surgical repair method of an abdominal aortic aneurysm

- Endovascular stent


How does an endovascular stent work

- endovascular stent insertion is a non surgical approach to AAA repair
- happens via the femoral or iliac arteries


What is the difference between an open surgical repair and an endovascular stent

- 30 day mortality rate was 1.7% with stenting and 4.7% with surgery
- but the long term mortality rate is similar in both groups at 4 years
- also reductions in intensive treatment unit care and in hospital stays with a stent


What are the symptoms of a thoracic abdominal aneurysm

- Asymptomatic

Rapid expansion
- severe pain (chest radiating to the upper back) and rupture is associated with hypotension, tachycardia and death

Chest symptoms
- stridor
- haemoptysis
- hoarseness
- aorta-oesophageal fistula


Who do thoracic abdominal aneurysms occur with

- they occur with patients with Marfan syndrome or hypertension
- atherosclerosis
- rarely due to syphilis


What investigations are used in an thoracic abdominal aneurysm

- CT or MRI
- aortography
- transoesophageal echocardiography


How do you manage a thoracic abdominal aneurysm

- if the aneurysm is greater than 6cm then operatively repair or stent may be appropriate
- these carry a high risk of mortality and paraplegia
- EVAR is usually used at present


What do acute aortic syndromes include

- aortic dissection
- intramural haematoma
- penetrating aortic ulcers


When does aortic dissection happen

- usually begins with a tear in the intima
- blood penetrates the diseased medical layer and then cleaves the intimal laminal plain leading to dissection


What is intramural haematoma considered a precursor of

- aortic dissection


How is aortic dissection classified

Timing of diagnosis form the origin of symptoms
- Acute is less than 2 weeks
- Subacute - 2-8 weeks
- Chronic - longer than 8 weeks


How is aortic dissection diagnosed anatomically

Type A
- involves the aortic arch and aortic valve proximal to the left subclavian artery origin
- De bakey type 1 - extends to the abdominal aorta
- de bakey type II - localised to the ascending aorta

Type B
- involves the descending thoracic aorta distal to the left subclavian artery origin
- this category includes de bakey type III


What are the symptoms of aortic dissection

- sudden onset of severe and central chest pain
- radiates to the back and down the arms
- pain described as tearing in nature


What are the signs of aortic dissection

- shocked
- neurological symptoms secondary to loss of blood supply to the spinal cord
- develop aortic regurgitation, coronary ischaemia, cardiac tamponade
- Distal extension may produce acute kidney failure, acute lower limb ischaemia or visceral ischaemia
- peripheral pulses may be absent


What is management of aortic dissection

- at least 50% of patients require antihypertensive medication to reduce blood pressure - IV beta blockers and GTN used
- type A dissections should undergo surgery
- Type B should be managed conservatively unless they develop complications
- long term follow up with CT or MRI