Aneurysms Flashcards
define an aneurysm
permanent, localised dilatation in an artery of 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 involved
what is a false/ pseudoaneurysm?
defect in the wall of the artery and it is the surrounding structures (skin, fat, fascia) that keep the aneurysm restrained
morphology of aneurysms
- fusiform
2. saccular
causes of aneurysms
- congenital e.g. Berry in Circle of Willis, Marfan’s
- degeneration e.g. atherosclerosis
- trauma
- infection= bacterial arteritis
- inflammatory e.g. Kawasaki disease
what causes true aneurysms?
abnormal regulation of elastin and collagen proteins in aortic wall by enzymatic agents such as metallo-proteinases which leads to dilatation from wall stress
causes of false aneurysms
iatrogenic (post-catheter angiogram, orthopaedic surgery, arterial anastomosis)
IV drug use
trauma
risk factors for AAA
age sex (male) FH smoking hypertension
presentation of AAA
most asymptomatic until rupture sudden onset epigastric/ central abdominal pain radiating to the back collapse, hypotension renal colic expansile pulsatile mass trashing
why should prevention surgery be done in AAA
there is often continual expansion until rupture occurs
criteria for AAA intervention
5.5cm AP diameter
rapid expansion of >1cm/ year
symptomatic
rupture
two surgical options in AAA repair?
open
endovascular aneurysm repair (EVAR)
open repair of AAA
GA
laparotomy
aortic and iliac vessels clamped
graft hand sewn
graft options in AAA
Dacron
PTFE
is lifelong follow up required in open AAA repair?
not if successful
complications of AAA repair
death MI CVA DVT/ PE pneumonia infection UTI graft infection renal failure mesenteric ischaemia trash foot erectile dysfunction
presentation of mesenteric ischaemia
abdominal pain after eating
fear of eating, weight loss
management of mesenteric ischaemia
bypass graft
resection of bowel if infarction
EVAR procedure
radiological imaging
local/ regional anaesthesia
groin incision with stent going up common femoral > iliac
what must there be in EVAR?
disease-free iliacs
does EVAR require lifelong follow-up?
yes
complications of EVAR
stent misplacement
endoleak
migration, dislocation
where do most AAA rupture?
retroperitoneal (contained)
intraperitoneal fatal
who is screening offered to for AAA?
all males>65 with USS
complication of aortic surgery
aortoenteric fistula
what is an aortoenteric fistula?
connection between aorta and usually the duodenum/jejunum
presentation of aortoenteric fistula
brisk GI bleeding
hypotension
diagnosis of aortoenteric fistula
upper GI endoscopy
CT
management of aortoenteric fistula
emergency surgery with graft placement
poor prognosis
which conditions are mycotic aneurysms present in?
endocarditis
tertiary syphilis
what should systolic BP be kept below in AAA rupture?
<100mmHg to prevent further rupture
use labetalol?
how large must AAA be to inform DVLA?
> 6cm
when in AAA must you stop driving?
> 6.5cm
