Aneurysms

Question 1

what is a localized dilation of a blood vessel or chamber of the heart?

Answer 1

aneurysm or dissection

Question 2

what are the most common sites of aneurysms in order from greatest to least common?

Answer 2

1. aorta
2. iliac
3. splenic
4. renal
5. vertebral

Question 3

what are the two categories of aneurysms?

Answer 3

true and false

Question 4

what is a true aneurysm?

Answer 4

where the aneurysm is bounded by arterial wall components (all 3 layers dilate)

Question 5

what is a false aneurysm?

Answer 5

where a breach in the wall leads to a vascular hematoma (through internal layers -> bleed into tunica media/adventitia)

Question 6

what is the most common etiology of TRUE aneurysms?

Answer 6

atherosclerotic

Question 7

what are 4 common etiologies of true aneurysms

Answer 7

atherosclerotic (MC)
syphilitic (Treponema pallidum)
congenital
left ventricular (dilative cardiomyopathy)

Question 8

where do syphilitic aneurysms tend to localize?

Answer 8

around ascending aorta

Question 9

what is the most common cause of FALSE aneurysms?

Answer 9

post myocardial infarctive

Question 10

what are the 3 causes of FALSE aneurysms?

Answer 10

• (MC) post myocardial infarctive
• junctional leak at vascular graft
• genetic

Question 11

what does junctional leak at a vascular graft mean?

Answer 11

tearing of stitches or bleeding within new vessel during or after cardiac bypass surgery

Question 12

what are the 2 genetic collagen vascular disease that can lead to genetic FALSE aneurysms?

Answer 12

Marfan’s syndrome
Ehler’s Danlos syndrome

Question 13

what is Marfan’s syndrome?

Answer 13

it is a defect in fibrillin in which causes a person to be long, tall, and thin

Question 14

what is Ehler’s Danlos syndrome?

Answer 14

very compliant collagen = very stretchy/flexible people

Question 15

what kind of aneurysm is very small spherical dilations (blueberry size)?

Answer 15

Berry aneurysm
(Rarely greater than 1-1.5 cm)

Question 16

where do berry aneurysms most frequently occur at?

Answer 16

at the brain base (circle of Willis)

Question 17

is a berry aneurysm TRUE OR FALSE?

Answer 17

TRUE

Question 18

what kind of aneurysm is large spherical dilations (5-10 cm)?

Answer 18

saccular
(same as berry but bigger)

Question 19

are saccular aneurysms true or false?

Answer 19

TRUE

Question 20

what kind of aneurysm is gradual and progressive dilation of a blood vessel producing a spindle shaped expansion?

Answer 20

fusiform

Question 21

T/F: fusiform aneurysms may be eccentric (dilation may occur unilaterally)

Answer 21

T

Question 22

are fusiform aneurysms true or false?

Answer 22

TRUE

Question 23

what kind of aneurysm refers to escape of blood into the tunica media?

Answer 23

dissecting aneurysm

Question 24

what is the presentation of the lumen of a dissecting aneurysm?

Answer 24

double barrel presentation

Question 25

T/F: you need dilation of the blood vessels for a dissecting aneurysm to occur

Answer 25

F

Question 26

what are the 2 different types of dissecting aneurysms and how are they different?

Answer 26

Type A- includes the ascending aorta Type B- does not include the ascending aorta

Question 27

is a dissecting aneurysm TRUE or FALSE?

Answer 27

false

Question 28

what kind of aneurysm is caused by traumatic injury to muscle layer producing a focal dilation?

Answer 28

pseudoaneurysm (traumatic aneurysm)

Question 29

you can classify an aneurysm by which two ways?

Answer 29

etiology or location

Question 30

name 5 classifications of aneurysms based on etiology or location

Answer 30

- atherosclerosis - infection - syphilis - arteritis (kawasaki disease) - miscellaneous

Question 31

what is the most common area for a atherosclerotic aneurysm?

Answer 31

in the abdominal aorta

Question 32

atherosclerotic aneurysms are most common in what population?

Answer 32

males around 60-80 years old

Question 33

when is an atherosclerotic aneurysm usually diagnosed?

Answer 33

when it is greater than 50% dilation of normal diameter of vessel has occurred

Question 34

what 2 things are atherosclerotic aneurysms usually associated with?

Answer 34

hypertension (40%) and heart disease (30%)

Question 35

where does pain manifest when you have an atherosclerotic aneurysm?

Answer 35

intermittent back and abdominal pain

Question 36

what are some other symptoms of atherosclerotic aneurysms?

Answer 36

claudication and lower limb ischemia

Question 37

what is the difference between neurogenic and vascular claudication?

Answer 37

- neurogenic claudication: limb doesn't work well all the time - vascular claudication: can walk a bit, then it is hard

Question 38

how are atherosclerotic aneurysms commonly found?

Answer 38

accidental discovery is extremely common when plain film, MRI, CT is taken for back pain evaluation

Question 39

aneurysms less than 5cm have __________ chance of rupture

Answer 39

5%

Question 40

aneurysms greater than 6cm have _____ chance of rupture

Answer 40

15%

Question 41

aneurysms greater than 7 cm have _____ chance of rupture

Answer 41

75%

Question 42

T/F: treatment must take into account the risk/benefit of surgical intervention

Answer 42

T

Question 43

what does treatment for atherosclerotic aneurysms consist of?

Answer 43

removal of dilation and replacement with graft