Aneurysms

Question 1

What is the definition of an aneurysm?

Answer 1

Abnormal dilatation of a blood vessel more than 50% of its normal diameter

Question 2

What is the definition of a true aneurysm?

Answer 2

Dilatation of a blood vessel involving all layers of the wall and is more than 50% of its normal diameter

Question 3

What are the types of true aneurysm?

Answer 3

Fusiform e.g. AAA

Saccular e.g. Berry aneurysm

Question 4

What is the definition of a false aneurysm?

Answer 4

A collection of blood around the vessel wall that communicates with the vessel lumen

Question 5

What is the aetiology of a false aneurysm?

Answer 5

Usually iatrogenic e.g. puncture, cannulation

Question 6

What is the definition of aortic dissection?

Answer 6

Vessel dilatation caused by blood splaying apart the media to form a channel within the vessel wall

Question 7

What are some causes of aneurysms?

Answer 7

Congenital:

• AD PKD: Berry aneurysms
• Connective tissue disorders: e.g. Marfans, Ehlers-Danlos

Acquired:

• Atherosclerosis
• Trauma e.g. penetrating trauma
• Inflammatory: Takayasu’s aortitis, HSP
• Infection: Tertiary syphilis, salmonella typhi

Question 8

What are complications of aneurysms?

Answer 8

• Rupture
• Thrombosis
• Distal embolisation
• Pressure: DVT, oesophagus, nutcracker syndrome
• Fistula: IVC, intestine

Question 9

What aneurysms require monitoring?

Answer 9

Those 4-5.5cm (over 5.5 require repair)

Question 10

Which aneurysms should be repaired?

Answer 10

Symptomatic: Back pain, tenderness to palpation, distal embolic events, ruptured/leaking

Asymptomatic: 5.5cm+ or those increasing in diameter by 1cm or more

Question 11

Why is it recommended to repair aneurysms 5.5cm+?

Answer 11

At this size the risk of rupture increases exponentially- 10% at 5.5cm, increasing with increasing size

Question 12

What is a false aneurysm?

Answer 12

A collection of blood around a vessel wall that communicates with the lumen (i.e. a pulsating haematoma)

Formation of fibrous tissue around the haematoma forms a false sac which communicates with the vessel lumen

Question 13

What is the difference between a true and false aneurysm?

Answer 13

A true aneurysm involves all layers of the arterial wall

Question 14

What is the aetiology of a false aneurysm?

Answer 14

Following a laceration/puncture to vessel wall

Usually iatrogenic or traumatic e.g. common femoral following puncture for radiological procedure

Question 15

How do you manage a false aneurysm?

Answer 15

Non-surgical:

• US compression
• Thrombin injection

Surgical repair