Aneurysms Flashcards
define aneurysm
permanent, localised dilatation of an artery more than 50% its normal diameter
normal aortic diameter
1.2-2cm
classification of aneurysms
- true
2. false
what is a true aneurysm?
all 3 layers of the artery are involved
what is a false aneurysm?
there is a defect in the wall of the artery and it is the surrounding structures (skin, fat, fascia) that keep the aneurysm restrained
what causes true aneurysms?
medial degeneration due to metallo-proteinases causing wall stress and abnormal regulation of elastin and collagen proteins
causes of false aneurysms
iatrogenic (post catheter angiogram, orthopaedic surgery, arterial anastomosis)
IV drug use
trauma
risk factors for AAA
age sex (male) genetic (male family members) smoking hypertension
presentation of AAA
most asymptomatic until rupture can have pain (renal colic) trashing malaise weight loss
presentation of ruptured AAA
sudden epigastric/ central abdo pain radiating to the back
collapse
hypotension
pulsatile expansile mass
criteria for intervention in AAA
diameter >5.5cm
size increasing by >1cm/year
symptomatic
rupture
two types of surgical options for AAA
open repair
endovascular aneurysm repair (EVAR)
open repair of AAA
general anaesthetic
laparotomy
aortic cross clamp and iliac vessel clamping
prosthetic graft (Dacron or PTFE)
follow up in open repair of AAA
lifelong follow up not required
complications of open repair of AAA
death MI CVA DVT/PE pneumonia UTI graft infection renal failure mesenteric ischaemia lower limb ischaemia ED
endovascular aneurysm repair (EVAR)
local/regional anaesthetic, groin incisions, iliac arteries need to be disease free
follow up post EVAR?
lifelong follow up to prevent complications
complications of EVAR
stent misplacement
endoleaks
stent migration/ dislocation
where does ruptured AAA tend to occur?
retroperitoneal
screening of AAA
all males >65 years
