Aneurysmal Disease Flashcards
What is the incidence of aneurysmal disease?
60/1000
What is the 12th leading cause of death in the U.S
AAA
Approximately how many ruptured AAA are there annually?
15,000
Where do AAA typically occur?
Below the level of the renal arteries
What are the causes of aneurysmal disease?
- Family Hx
- Infection
- Trauma
- Connective tissue disorder
- Inflammation
What are 5 types of aneurysms?
- Fusiform
- Saccular
- Mycotic
- Dissecting
- Pseudo
What is the most common type of aneurysm?
Fusiform
What are fusiforms typically caused by?
Athersclerosis
Who is usually affected by fusiform aneurysm?
It typically affects more men than women.
Where do fusiform aneurysms typically occur?
Infrarenal
What makes a fusiform aneurysm a true aneurysm?
All layers of the arterial wall are intacted but stretched.
What is a saccular aneurysm?
It is a localized protusion or outpouching.
Involves all 3 layers.
In the brain, what is the most common aneurysm?
Saccular aneurysm.
Why are aneurysmal dissections called arterial dissections instead?
BECAUSE NOT ALL ARTERIAL DISSECTIONS RESULT IN ANEURYSMAL DILATION.
When do arterial dissections occur?
THIS OCCURS WHEN BLOOD ENTERS THE MEDIA OF A VESSEL THROUGH A TEAR IN THE INTIMA AND THEN DISSECTS ALONG A LENGTH OF THE ARTERY.
How does blood flow change due to a aneursym dissection?
BLOOD MAY FLOW FREELY THROUGH BOTH THE FALSE AND TRUE LUMENS.
WHAT TWO THINGS DOES AN ARTERIAL DISSECTION REQUIRE?
- A WEAKENING OF THE MEDIA OF THE VESSEL
- THE DEVELOPMENT OF THE RENT OR TEAR IN THE INTIMA
:
WHAT IS AN UNCOMMON CONDITION THAT CAN CAUSE AN ARTERIAL DISSECTION?
MARFANS SYNDROME
WHY IS MARFANS SYNDROME A RISK FACTOR FOR AN ARTERIAL DISSECTION?
BECAUSE IT WEAKENS THE MEDIA AND PREDISPOSE INDIVIDUALS TO ARTERIAL DISSECTION.
WHERE DO AROTIC DISSECTIONS OCCUR?
AORTIC DISSECTION USUALLY BEGINS IN THE CHEST AND EXTENDS INTO THE ABDOMEN
WHAT HAPPENS IF THE DISSECTION BEGINS IN THE ASCENDING AORTA?
THE BRACHIOCEPHALIC VESSELS MAY BE INVOLVED.
HOW DOES AN ARTERIAL DISSECTION LOOK ON DUPLEX?
- Bright line on ultrasound image demonstrates tear in vessel wall
- Looks like a second lumen
What is Marfan’s syndrome?
It is a connective tissue disorder
What are the clinical manifestations of Marfan’s syndrome?
- Long bone overgrowth
- Aneurysm near or at aortic root (ascending aorta), possible subsequent aortic dissection
- Ocular lens dislocation
What is a pseudoaneurysm?
It is a false aneurysm that occurs when a hole in the arterial wall permits the escape of blood, which the surrounding tissue confines.
Why is a pseudoaneurysm considered a fake aneurysm?
Because it is not confined by an arterial wall.
What are most false aneurysm caused by?
MOST FALSE ANEURYSMS ARE DUE FROM IATROGENIC INJURY WHERE THERE IS AN ARTERIAL PUNCTURE FOLLOWED BY INADEQUATE HEMOSTASIS.
WHAT ARE THE TREATMENTS FOR A PSA?
- WAIT AND SEE IF IT CLOSES SPONTANEOUSLY
- COMPRESSION
- SURGERY
- THROMBIN INJECTION
WHAT ARE MYCOTIC ANEURYSMS?
THESE ARE FALSE ANEURYSMS WHERE THE ARTERIAL WALL IS DESTROYED BY AN INFECTIOUS AGENT (COMMONLY STAPHYLOCOCCUS AUREUS AND SALMONELLA)
WHAT ARE THE RISK FACTORS FOR A MYCOTIC ANEURYSMS?
- IV DRUG USE
- IATROGENIC ARTERIAL INJURY OR TRAUMA
- IMMUNOSUPPRESSION
- Hx AAA
What is the most common pathology that is encountered during a carotid ultrasound examination?
Athersclerosis.
Patients reffered to the vascular lab are more likely to have which of the following conditions?
a. arteritis
b. carotid body tumor
c. tortuosity
d. dissection
c. tortuosity
A moving structure in the carotid lumen may be caused by any of the following conditions except:
a. arteritis
b. dissection
c. thrombus
d. intimal flap
a. arteritis
Which of the following conditions is described on imaging studies as a “string of beads”?
a. fibromuscular dysplasia
b. dissection
c. intimal flap
d. radiation induced arterial injury
a. fibromuscular dysplasia.
Which of the following conditions is most likely to be caused by blunt trauma?
a. carotid body tumor
b. carotid aneurysm
c, dissection
d. FMD
c. dissection
An 80 year old patient who presents to the vascular lab with a pulsating lump just above the clavicle on the right side is most likely to have which of the following conditions?
a. tortuous prox CCA
b. carotid aneurym
c. carotid body tumor
a,. tortuous prox CCA
Where is fibromuscular dysplasia most likely seen in the carotid arteries?
Mid/distal ICA
Which of the following conditions results in a “false lumen”?
a. pseudoaneurysm
b. FMD
c. carotid body tumor
d. dissection
d. dissection
Which of the following conditions is the most rarely encountered in the carotid arteries?
a. aneurysm
b. carotid body tumor
c. tortuosity
d. dissection
a. Aneurysm
A to and fro (pendulum) doppler signal in its “neck” is the most important diagnostic feature of this pathology.
a. aneurysm
b. pseudoaneurysm
c. carotid body tumor.
d. arteritis
b. pseudoaneurysm
