Aneurysms

Question 1

What is the definition of an abnormal bulge in a vessel and what is the specific size threshold for an abdominal aortic aneurysm (AAA)?

Answer 1

An abnormal bulge in a vessel, also known as an aneurysm, is characterized by an enlargement of more than 50% of the normal diameter of the vessel. For an abdominal aortic aneurysm (AAA), it is considered when the diameter exceeds 3 cm

Question 2

What are the characteristics of true and false aneurysms?

Answer 2

True aneurysms have an intact vessel wall, whereas false aneurysms occur due to a hole in the vessel wall, leading to a pool of blood formation that mimics an aneurysm

Question 3

What are the risk factors and etiological factors associated with aneurysm formation?

Answer 3

Older age, male gender, family history, atherosclerosis, hypertension, and smoking.

Atherosclerosis, infections (e.g., syphilis, Escherichia coli, Salmonella), trauma, and genetic conditions (e.g., Marfan’s or Ehlers–Danlos syndrome)

Question 4

Describe the pathophysiology of aneurysm formation, particularly focusing on the role of elastin and collagen proteins.

Answer 4

The weakening of the vessel wall is due to the loss of elastin and collagen proteins in the tunica media.

During atherosclerosis, macrophages release enzymes that break down collagen and elastin, leading to the expansion of the tunica media.

This weakening of the vessel wall causes it to bulge, with the most common location being below the renal arteries

Question 5

Clinical presentation of Asymptomatic aneurysms

Answer 5

75% asymptomatic (incidental finding) until rupture

Question 6

How to know if its a symptomatic aneurysm?

Answer 6

Sudden onset pain

Question 7

Describe Proximal AAA symptomatic aneurysm.

Answer 7

upper abdomen radiating to back pain

Question 8

Describe distal AAA symptomatic aneurysm.

Answer 8

lower abdomen radiating to back pain

Question 9

Describe Unruptured aneurysm symptomatic aneurysm

Answer 9

vague, nonspecific pain

Question 10

Describe ruptured aneurysm symptomatic aneurysm

Answer 10

sudden onset severe pain, pulsating mass with heartbeat, hypotension

Question 11

What are the other signs of an abdominal aortic aneursym other that sympomatic and symptomatic causes?

Answer 11

5.5cm AP diameter
Rapid expansion of >1cm per year
Trashy foot - embolisms moving from the aorta to the peripheral

Collapse (due to hypotension)
Tachycardia

Question 12

Investigations for monitoring abdominal aortic aneurysm

Answer 12

Monitoring - Ultrasound

= - Shows AAA presence, AP diameter, iliac involvement
- Monitoring program for all men >65 in the UK

Question 13

Ruptured AAA investigation is what?

Answer 13

CT Angiography

Question 14

Surgical management for an unruptured abdominal aortic aneurysm

Answer 14

Elective Aneurysm repair
= is a prophylactic operation to reduce the risk of rupture balanced against the risk of the procedure.

> 5.5 cm in diameter or rapid expansion

Question 15

Surgical management for an ruptured abdominal aortic aneurysm

Answer 15

Emergency Aneurysm repair
= is a therapeutic procedure balancing the expectation of death against the risk of the procedure

> EVAR - Stent to open lumen
Open Lap - Opening of the chest cavity, clamping either side of the aneurysm, stitching graft to the aorta

Question 16

Scanning regime for an aneurysm <3cm in size

Answer 16

Discharge

Question 17

Scanning regime for an aneurysm 3-4.4 in size

Answer 17

Annual surveillance

Question 18

Scanning regime for an aneurysm 4.5-5.4cm in size

Answer 18

3 monthly surveillance

Question 19

Scanning regime for an aneurysm >5.5cm in size

Answer 19

urgent referral for surgery

Question 20

What is a thoracoabdominal Aortic Aneurysm?

Answer 20

aneurysms that coexist in both segments of the aorta (thoracic and abdominal)

Question 21

How does aneurysm formation occur in the aorta according to the provided information?

Answer 21

Aneurysm formation begins when blood enters through the intima and splits the media of the aorta

Question 22

What are the two types of aortic aneurysms mentioned in the context of their location and prevalence?

Answer 22

Type A aneurysms
= comprising about 2/3 of cases, involve the ascending aorta and may extend to the descending aorta. They are commonly associated with Marfan syndrome.

Type B aneurysms
= representing the remaining 1/3 of cases, affect only the descending aorta. They are typically secondary to atherosclerosis and, less commonly now, syphilis.

Question 23

What clinical feature distinguishes aneurysms involving both segments of the aorta? (abdominal and Thoracoabdominal)

Answer 23

Presents as sudden tearing chest pain radiating to the back

Question 24

Investigations for thoracoabdominal aortic aneurysm

Answer 24

Imaging - CT or MRI

Question 25

Management for thoracoabdominal aortic aneurysm

Answer 25

Surgical management - operative repair, stenting, EVAR

Question 26

An aneurysm is found in the superior mediastinum of a 64-year-old male during radiographic imaging. The surgeon opts to remove the aneurysm. In which of vessel is the aneurysm most likely located?

Answer 26

Arch of the aorta