Aneurysms

Question 0

What is a saccular aneurysm?

Name one type of saccular aneurysm

Answer 0

Dilated portion of artery joins main lumen by narrow neck.

Mycotic aneurysms (seen in inf endocard) often of this sort.

Question 1

What is an aneurysm?

Answer 1

Permanent dilatation of an artery (?to 2x normal diameter)

Question 2

What is a fusiform aneurysm?

In which artery is it most commonly seen?

Answer 2

Generalised dilatation of artery

Commonest type to affect abdominal aorta leading to AAA

Question 3

What is a pseudo-aneurysm?

How does it differ from a ‘true’ aneurysm?

Answer 3

Blood leaks from artery and is contained by surrounding connective tissue lined with thrombus.
Connective tissue therefore forms wall of the pseudo-aneurysm, whereas a true aneurysm’s wall is the vessel wall.

Question 4

What are the symptoms of AAA?

Answer 4

• Usually asymptomatic - picked up on screening/routine inv
• Rapid expansion or rupture may cause severe pain (epigastric, radiating to back)
• Ruptured AAA may lead to hypotension, tachycardia and sudden death
• Gradual erosion of vertebral bodies may cause non-specific back pain

Question 5

What is the typical sign of AAA?

Answer 5

• Pulsatile, expansile mass in abdomen.

Question 6

Name 4 causes of AAA

Answer 6

• Atherosclerosis
• Infection (syphilis, E. Coli, salmonella)
• Trauma
• Genetic (eg connective tissue disorders, Marfan’s)

Question 7

What investigations are undertaken to assess AAA?

Answer 7

• Ultrasound

- CT - more accurate and relates anatomical relationship to renal and visceral vessels

Question 8

When is surgery of most benefit in AAA patients?

Answer 8

• If AAA > 5.5cm diameter
• If AAA growing at rate > 1cm/year
• If symptomatic

Question 9

What is the management strategy for AAA?

Answer 9

Medical:

• Control HTN & lipids and stop smoking
• If no indication for surgery, follow up with ultrasound surveillance

Surgical:

• Open surgical repair with insertion of graft
• Endovascular aneurysm repair (EVAR)

Question 10

What is the pathological process that occurs in aortic dissection?

Answer 10

A tear in the intimal later allows blood to penetrate diseased medial layer and cleaves intimal laminar plain, leading to dissection.

Question 12

What are the two types of aortic dissection?

Answer 12

• Type A: involves aortic arch and aortic valve proximal to left subclavian artery origin
• Type B: involves descending aorta distal to left subclavian artery origin

Question 13

What are the symptoms and signs of aortic dissection?

Answer 13

• Severe and central chest pain, often radiates to back and down arms.
• May be shocked
• Neuro symps secondary to loss of blood supply to spinal cord
• Absent peripheral pulses

Question 14

What are the different management approaches to aortic dissection?

Answer 14

• Type A = surgery - arch replacement
• Type B = treat medically unless complications arise

Manage hypertension.