Aneurysm/aortic aneurysm Flashcards
Abdominal aortic aneurysm: aetiology
failure of elastic proteins within the extracellular matrix.
- dilation of all layers of the arterial wall.
loss of the intima with loss of elastic fibres from the media
After the age of 50 years the normal diameter of the infrarenal aorta is 1.5cm in females and 1.7cm in males. Diameters of 3cm and greater, are considered aneurysmal
AAA: risk factors
smoking and hypertension
Other causes (rare)
- Syphilis
- CT disorders e.g. Ehler Danlos 1 or Marfan’s
AAA: management (unruptured)
Low risk
- <5.5cm, asymptomatic –> abdo US surveillance + optimise RFs
High risk (symptomatic, >5.5cm, rapidly enlarging >1cm/year)
- 2w referral for vasc surgery
- Surgical open repair
- EVAR - stent in abdominal aorta via femoral artery
AAA screening
Single adbominal ultrasound for males >65yo
<3cm: no rescan
3-4.4cm: rescan every 12 months (small aneurysm)
4.4-5.4cm: rescan every 3 months (medium aneurysm)
=/>5.5cm - 2w referral for vascular surgery
Complication of EVAR
Endoleak - stent fails to exclude blood from aneurysm
Ruptured AAA presentation
Catastrophic
Subacute
What is the mortality associated with ruptured AAA
Almost 80%
Features of ruptured AAA
severe, central abdominal pain radiating to the back
pulsatile, expansile mass in the abdomen
patients may be shocked (hypotension, tachycardic) or may have collapsed
AAA management
Vascular review
If haem stable –> CT
If unstable –> diagnosis can be made clinically
- open surgical repair
What other pathologies are associated with aneurysms?
SAH (intracranial “berry” aneurysm bursts in 85% of cases)
Polyarteritis nodosa (leads to formation of aneurysm in medium-sized vessels)
Kawasaki disease (complication)
GIANT CELL ARTERITIS
What other vessel will be affected 40-50% of times in AAA
Popliteal artery aneurysm
