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Flashcards in Arterial Aneurysms Deck (31)
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1

What are the two types of aneurysms

- true
- false

2

What is the definition of the aneurysm

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

3

What happens in true aneurysms

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

4

what are arteries that are most frequently involved in true aneurysms

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

5

What happens in false aneurysms

- the surrounding tissues form the wall of the aneurysm

6

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

7

where do abdominal aortic aneurysms commonly occur

- these most commonly occur below the renal arteries

8

What can cause an abdominal aortic aneurysm

- atherosclerosis
- infection
- trauma
- genetic

9

What are risk factors for abdominal aortic aneurysms

- age
- male
- gender
- strong family history

Modifiable
- smoking
- hypertension
- hypercholestrolaemia

10

Who should screening be given to

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

11

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

12

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

13

What is the signs of an aortic abdominal aneurysm

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

14

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

15

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

16

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

- Endovascular stent

17

How does an endovascular stent work

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

18

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

19

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

20

Who do thoracic abdominal aneurysms occur with

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

21

What investigations are used in an thoracic abdominal aneurysm

- CT or MRI
- aortography
- transoesophageal echocardiography

22

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

23

What do acute aortic syndromes include

- aortic dissection
- intramural haematoma
- penetrating aortic ulcers

24

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

25

What is intramural haematoma considered a precursor of

- aortic dissection

26

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

27

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

28

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

29

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

30

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