Aneurysm, Aortic dissection Flashcards
Aneurysm definition
Dilatation of a blood vessel > 50%
True aneurysm definition
Involves all layers of vessel wall
Types of true aneurysm
Fusiform
Saccular
Example of fusiform
AAA
Example of saccular
Berry
False aneurysm definition
Collection of blood around vessel wall which communicates with vessel lumen
Causes of false aneurysm
Usually iatrogenic - eg. cannulation, puncture
Risks with aneurysms
Rupture
Thrombosis
Popliteal aneurysm Sx
Easily palpable popliteal pulse
50% bilateral
Risks with popliteal aneurysm
Rarely ruptures
Thrombosis and distal embolism
Acute mx of popliteal aneurysm
embolectomy
fem-distal bypass
Chronic mx of popliteal aneurysm
elective grafting + tie off vessels
Normal size of abdominal aorta
<3 cm
Most common place for aortic aneurysm
90% infrarenal
30% involve iliac arteries
AAA sx?
Usually asymptomatic
Back pain radiating to groin
Acute limb ischaemia
Blue toe syndrome - distal embolus
Acute rupture
AAA O/E
Expansile mass
Bruits
Ix for AAA
AXR - calcifications
Abdo US
CT/MRI - gold standard
Angiography
RFs for AAA rupture
HTN
Smoker
F (M get it more, F ruptures more easily)
FH
AAA screening
U/S 65 yo men
General mx of chronic AAA
> 3cm - yearly monitoring
> 4.5 cm - 6 monthly monitoring
> 5.5 cm - consider surgery
Indications for surgical management of AAA
Symptomatic/complications
Diameter > 5.5 cm
Rapidly expanding > 1 cm/yr
Surgical options for AAA
EVAR
Open repair
EVAR of AAA
Endovascular aneurysm repair
“Stent” placed within aorta - reduces strain upon vessel wall
Open repair of AAA
Clamp aorta + bypass
AAA rupture presentation
Pain (Sudden onset abdo pain, radiates to back or flanks)
Collapse / shock
Cullen’s sign
Grey-Turner’s sign
Cullen’s sign
bruise around umbilicus
also a sign of pancreatitis
Grey-turners sign
bruise across flanks
also a sign of pancreatitis
Management of AAA rupture
O2 Fluids (keep SBP<100)
Cross-match 10 u
Major haemorrhage protocol
Analgesia
Cef + Met
Surgery
Congenital causes of anaeurysm
AD polycistic kidneys -> Berry aneurysm
Marfans
Ehler-Danlos syndrome
Dissection definition
Dilatation by blood forming a lumen within the separated vessel wall
Different types of aortic dissection
Type A 70%
Type B 30%
Type A aortic dissection
if it includes ascending aorta
Type B aortic dissection
Any dissection excluding ascending aortic
Mx of type A dissection
consider urgent surgery
Mx of type B
may be managed medically, case dependent
Emergency mx of dissection
Xmatch 10u
CXR/ echo TOE
Keep BP below 100, labetolol/esmolol/CCB
