aneurysms Flashcards
what is an aneurysm
an aneurysm is an increase in diameter in an artery greater than 1.5 times of normal and involves all layers
pathophysiology of an aneurysm
aneurysmal diameter of the intrarenal aorta
greater than 3 cm
what is the diameter of an aneurysmal common iliac
greater than 1.5 cm
what is the diameter of an aneurysmal popliteal artery
greater than 1.1 cm
what is a true aneurysm
there is enlargement on both or one side of the artery ,the enlargement is uniform on all the layers of the artery.
false aneurysm
an aneurysm that there is no uniform enlargement
what are the risk factors for aneurysms
males
increased age
positive family history
connective tissue disorder
smoking and hypertension
why does RAA have a higher mortality ?
patients can rapidly lose their entire circulating volume in the peritoneal cavity
size of the aneurysm and the risk of rupture
AAA size Annual rupture risk
<4cm <0.5%
4 – 4.9cm 0.5% - 5%
5 – 5.9cm 3% - 15%
6 – 6.9cm 10 – 20%
7 – 7.9cm 20 – 40%
> 8cm 30 – 50%
how can aneurysms be prevented
all men above 65 are eligible for screening
what are the outcomes for aneurysm screening
less than 3 discharged
between 3 and 5,5 surveillance
above 5.5 vascular surgery
how is the diameter of the of the aneurysm measured
from anterior to posterior
results of clinical examination
palpation of a mass just above the umbilicus
presence of a popliteal aneurysm on palpation have a chance of AAA.
past medical history that may be suggestive of IHD myoc
treatment options for aneurysms
Laparotomy
Cross-clamp abdominal aorta
Open aneurysm sac
Sew graft proximally and distally
Close abdomen
EVAR
acces through the femoral artery with wires and catheters and they are ballooned to give a good seal with special closure devices
what are the advantages of open surgery
higher upfront
with good long term outcomes
no long term surveillance
what are the considerations before surgery for an aneurysm
whether the patient is fit for an open surgery if there would be any recovery
assessment of pre operative fitness
blood tests
ECG
cardiopulmonary exercise
anaesthetic review
car or motorcycle license in the case of an AAA
you must tell DVLA if there is an aneurysms
you must not drive if the aneurysm is greater than 5.5
symptoms of an aneurysm
pain in the abdomen
hypotension
management of ruptured AAA
CT angiogram
haemorrhage protocol
analgesia
full blood count
lactate in ABG
no IV fluids permissive hypotension
what are complications that come with aneurysms
rupture of the aneurysms
thrombosis
embolus dislodging
compression on the sites and the size
thrombosis and aneurysms
there would be clotting of the blood that is pooled / stagnated on the blood
management of trash from popliteal artery aneurysm
ct angiogram
anticoagulation
analgesia of course so much pain
