Vascular surgery notes detailing vascular pathologies and conditions. Notes made from multiple resources such as oxford handbook, question banks, university lectures and UK guidelines.
Look at specialty section and content list for the summary contents of this file.
Description
Aneurysms of the aorta can be thoracic or abdominal (AAA) refer to the increased size of the vessel due to either a
tear in the tunica intima or a loss of elastin, resulting to poor compliance of the vessel and bulging. Aneurysms can
later lead to dissections (in thoracic) or rupture (AAA). Due to this aneurysms are routinely monitored for growth to
evaluate risk of rupture.
Thoracic Aortic Dissection
Classifications Investigations
- Stanford Type A (Ascending Aorta) - ECG: ST elevation may be seen in minority
o DeBakey TI: Extends past ascending aorta - CT: Diagnostic and classifies tear
o DeBakey TII: Confined to the ascending aorta Management
- Stanford Type B (Descending Aorta) - Stanford Type A / DeBakey Type I-II
o DeBakey TIII: Extends from descending aorta o Surgery: Repair tear in vessel
Presentation o BP: Maintain systolic 100-120 mmHg
- Pain: Severe chest pain radiating to back - Stanford Type B / DeBakey Type III
- Features: Aortic regurgitation; HTN; Absent pulses o Conservative: Monitor and lower BP
- BP: >20 mmHg difference between either arms o Medical: IV Labetalol (↓ BP)
Causes Complications
- CVS: HTN (↑↑ Risk); Bicuspid aortic valve - CVS: Aortic incompetence; MI; Stroke; RF
- Genetic: CT Disease; Turner’s; Noonan’s - Findings: Unequal arm pulses
- Other: Pregnancy; Trauma; Syphilis
Abdominal Aortic Aneurysm
Description Types
- Path: Reduction in elastin in the vessel - True AAA: Affects all three layers of the vessel
- Incidence: 6:100,000; Commonest in males >65 YO - False AAA: Affects only one to two layers
Presentation Management
- Asymptomatic: May be Asx until rupture - Small AAA: Annual scans 3.0-4.4 cm
- Pain: Abdominal; Side; Back pain - Medium AAA: Quarterly scans 4.5-5.4 cm
- Exam: Abdominal pulsations - Large AAA: 2 wk red flag Vasc. Surg. >5.5 cm
Causes - Rupture: Emergency surgical repair
- Common: HTN; Smoking; DM - Rapid enlargement: Surgery if enlarging >1 cm/yr
- Uncommon: CT diseases; Syphilis - Large: Surgery if aneurysm >5.5 cm in size
Investigations - CTCAP: Use to plan in elective surgery
- Abdominal Ultrasound (single scan at 65 YO) Prognosis
o Normal: <3 cm normal - Symptomatic: 80 % annual mortality if untreated
o Small AAA: 3-4.4 cm - Immediate Post rupture: ⅓ Die immediately
o Medium AAA: 4.5-5.4 cm - En-Route Post-rupture: ⅓ Die on route
o Large AAA: >5.5 cm - Surgical Repair: ⅓ Die during surgery
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