aneurysms Flashcards
what is thee difference between true and false aneurysm ?
true - all 3 layers ooff the wall are involved
false - hematoma communicating with the lumen of the artery through a partial tear
what is the clinical picture of aneurysms ?
most of them are discovered incidentally
pulsatile swelling
back pain
compressing the surrounding structures
complicated
what is the most common cause of aneurysms ?
atherosclerosis
what is the most serious complication of AAA ?
rupture
what are the types of pseudo aneurysms ?
traumatic
post surgical
what artery is associated with traumatic pseudo aneurysms ?
femoral artery
how should a diagnosis of pseudo aneurysms be made ?
duplex
what is the management of pseudo aneurysms ?
1- small and asymptomatic can be treated conservatively
2- false aneurysms larger than 2.5 cm are treated by thrombin injection under U/S
3- open surgical repair
what risk factor is associated with rupture off the AAA ?
smoking
what is the most common site of aneurysm in the aorta ?
infra renal
what are the differential diagnosis of AAA rupture ?
pancreatitis
peritonitis
duodenal perforation
myocardial infarction
what are the methods of screening and surveillance in AAA ?
ultrasonography
what methods of investigations are used for planning in AAA ?
CTA and MRA
at what age should screening start in men ?
above 65
above 55 if there is a positive family history
at what age should screening start in women ?
above 65 if positive family history or a personal smoking history
what are the different approaches to elective management ?
1- aneurysms under 5.5 without risk factors
close surveillance sing USGG or CT scan yearly
2- cessation of smoking, control of hypertension
3- doxycycline
what are the indications of elective repair in AAA ?
1- symptomatic aneurysms
2- 5.5 in men 4.5 in women
3- saccular aneurysm ( due to increased risk of infection)
4- smaller in size, but associated with COPD and poorly controlled hypertension
what are the different options for repair
open repair - transperitoneal approach , retroperitoneal approach
endovascular aortic repair - EVAR
when should EVAR be used ?
1- older higher risk patients
2- patient with hostile abdomen
3- patient with such clinical conditions where open repair is risky
what are thee indications for retroperitoneal repair ?
hostile abdomen with multiple operations
extension of aneurysm to suprarenal segment
horseshoe kidney
ascites
what are thee complications associated with repair ?
renal injury
paraplegia
ischemic colitis
prosthetic graft infection
aorto enteric fistula
what can a ruptured AAA be easily mistaken for ?
renal or ureteri colic
what is the management of ruptured AAA ?
resuscitation and allow for permissive hypotension
urgent CTA followed by surgical intervention
most common visceral artery aneurysm ?
splenic artery aneurysm
what are the indications for treatment of splenic artery aneurysm ?
1- presence of symptoms
2- documented enlargement
3- diameter of greater than 2.5
4- preegnancy or anticipated pregnancy
what must happen pre operatively for patients undergoing repair for splenic artery aneurysm ?
must give vaccinations as if going in for a splenectomy
what is the most common shape associated with renal artery aneurysm ?
saccular
what is the most common cause of a true renal artery aneurysm ?
medial fibroplasia
what are the indications for surgery in renal artery aneurysms ?
difficult to control hypertension
size greater than 2 cm
where are peripheral aneurysms usually found ?
in the femoral and popliteal
what is the most common cause off peripheral aneurysms ?
atherosclerosis and are more common in men
prominent popliteal pulsation ?
most likely an aneurysm
what are the indications for intervention in femoral and popliteal aneurysms ?
surgical intervention in femoral larger than 2.5 and larger than 2 in popliteal
