Aneurysm

Question 1

What is the pathology of an aneurysm?

Answer 1

TRUE

• Abnormal dilation of an artery or heart >50% of original diameter
• Involves all layers of vessel wall
• Saccular = Protrudes form one side of vessel
• Fusiform = Generalised dilation of vessel (most AAA)

FALSE

• Collection of blood in adventitia (outer layer)
• Mainly due to trauma e.g. iatrogenic

Question 2

AETIOLOGY: Aneurysms

Answer 2

• Arethoma
• Trauma
• Infection eg endocarditis
• Connective Tissue Disorders: Marfan’s Ehlers-Danlos
• Inflammatory: Kawasaki

Question 3

COMPLICATIONS: Aneurysms

Answer 3

• Rupture
• Thomboembolism
• Fistulae
• Pressure on other structures

Question 4

AETIOLOGY: AAA

Answer 4

• M > F
• > 60 yrs
• FHx
• Either atheroscleortic causes or inflammatory

NB: 95% infra-renal

Question 5

CLINICAL FEATURES: AAA

Answer 5

Unruptured

• Asymptomatic
• Back, abdomen, loin pain
• Pulatile mass

Ruptured

Loin pain radiating to groin in >50yrs is AAA until proven otherwise

• Severe pain radiating to back
• Collapse
• Hypovolaemia

Question 6

INVESTIGATIONS: AAA

Answer 6

Bloods

• ESR/CRP = high
• FBC = leucocytosis, anaemia
• Imaging*
• Abdominal US/CT = aortic dilation x 0.5

Question 7

MANAGEMENT: AAA

Answer 7

1. Small diameter (<5cm)

• Regular USS survelliance
• Modify risk factors (diabetes/HTN)
• 2. Diameter >5.5cm*
• Surgical repair: open/endovascular stent graft

Question 8

COMPLICATIONS: AAA

Answer 8

• Death
• Renal failure
• Ischaemic bowel
• Limb loss
• Paralysis
• MI/Stroke
• Graft infection