Aneurysmal Disease

Question 1

What are some common areas for aneurysm?

Answer 1

Brain
Carotids
Thoracoabdominal Aorta
Peripheral vessels
splanchnic vessel

Question 2

T or F: aneurysm have all layers intact

Answer 2

T

Question 3

Which aneurysm looks like a football or balloon?

Answer 3

fusiform shape

Question 4

What presents with a Popliteal and femoral aneurysms?

Answer 4

Popliteal and femoral aneurysms usually present with emboli or thrombosis rather than ruptured.

Question 5

Which aneurysm can be a complication of aortic dissection?

Answer 5

Thoracoabdominal Aneurysm

Question 6

How does aortic dissection occurs?

Answer 6

Shear forces on the arch leads to tears through the intima and into the media.

Question 7

T or F: false aneurysm are pulsatile and have no true layer

Answer 7

T

Question 8

What is the most common cause of aneurysm?

Answer 8

Genetic disposition to degenerative forces

Question 9

What are some infectious causes of aneurysm?

Answer 9

Chronic mycotic aneurysms (eg. Syphyllitic) or acutely supprative (Staph.)

Question 10

What are some congenital causes of aneurysm?

Answer 10

Marfan’s, Ehlers-Danlos

Question 11

Where do mechanical aneurysm occur?

Answer 11

subclavian

Question 12

T or F: Marfan syndrome is autosomal recessive?

Answer 12

F: autosomal dominant

Question 13

What happens in Marfan syndrome?

Answer 13

Defect in the cross-linking of collagen due to mutations of type I procollagen.

Question 14

Which type of Ehlers-Danlos Syndrome have increased risk for aneurysm?

Answer 14

E-D Type IV is the “arterial-ecchymotic” type (collagen type III)

Question 15

What are the majority of aneurysm?

Answer 15

cerebral and infrarenal aortic

Question 16

What is the classical triad in abdominal aortic aneurysm (AAA)?

Answer 16

1) acute abdominal or back pain
2) hypotension
3) pulsatile abdominal mass

(usually presentation does not have all three)

Question 17

T or F: AAA affects more so in males

Answer 17

T

Question 18

Non-ruptured AAA presentation:

Answer 18

Inflammatory
Symptomatic or tender AAA
Contained rupture (false aneurysm)

Question 19

T or F: most patients have calcium deposit at the wall of their aneurysm

Answer 19

T

Question 20

What is mural thrombosis?

Answer 20

Very stable mass of debris, dead cells, fibrin, few red cells.

Question 21

T or F: anticoagulation is needed for mural thrombosis

Answer 21

F:

It does not usually embolize, will occasionally liquefy and shift. You do not anticoagulate.

Question 22

T or F: angiogram is usually important for imaging aneurysm

Answer 22

F:

CT, Xray, ultrasound

Question 23

What is the Szilagi Curve?

Answer 23

Describe the 5 year risk of rupture in relation to the diameter of the aneurysm (greater than 4 cm…80% at 6cm)

Question 24

T or F: the aneurysm grows each year

Answer 24

T: .4 TO .5 CM/YEAR

Question 25

What are the indications for surgery for AAA?

Answer 25

> 6 cm diameter
Painful or tender on palpation
Documented to be enlarging, especially if greater than .5 cm/year
Distal emboli
Thrombosis
Obstruction/compression of adjacent viscera
Rupture

Question 26

What are contraindications to AAA surgery?

Answer 26

Recent Myocardial Infarction
Congestive Heart Failure
Severe Angina
Renal Failure
Life Threatening Disease
Decreased Mental Acuity
Patient doesn’t want it (age related)

Question 27

What are some complications of AAA surgery?

Answer 27

Hemorrhage
Acute Renal Failure
Ureteral Injury
Embolization/Trash Foot
Ischemic Colitis
Paraplegia
Infected Graft
Aorto-enteric Fistula

Question 28

What is an endovascular graft?

Answer 28

Endovascular surgery is performed inside your aorta using thin, long tubes called catheters to place a stent surrounded with a fabric liner to reinforce the weak spots.