Aneurysms Flashcards
What happens to the 3 layers of the aorta during an aneurysm?
All 3 layers dilate
What is a true aneurysm?
AAA that involved all 3 layers
A pseudo/false -aneurysm?
Collection of blood/rupture in outer adventitia layer or surrounding soft tissue
How does a false aneurysm present in an examination?
- Thrills
- Bruits
- Pulsatile mass
What can a false aneurysm result in?
- Ischaemia
- Rupture of full aorta
What is a false aneurysm caused by?
- Inflammation
- Trauma
- Iatrogenic
What does iatrogenic mean?
Caused by a medical examination or treatment
Back to true aneurysms - what are some common sites?
- Aorta
- Illiac
- Femoral
- Popliteal
Complications of aneurysms?
- Rupture
- Thrombosis
- Embolism
- Fistula’s
- Pressure on other structures
What causes aneurysms?
- Degenerative disease
- CT disease - marfans
- Infection - mycotic aneurysm
- Atheroma
- Trauma
- Inflammation
Risk factors?
- Males
- Age
- Smoking
- Hypertension
- Family history
How does it present?
Asymptomatically - will probably be found incidentally via screening
What screening is in place?
Abdo Aortic Aneurysm screening for all over 65 yr old males - ultrasound scan
How are aneurysms classed and managed?
- Normal - discharged
- Small - 3-4.4 cm - annual scans
- Medium - 4.5-5.5 cm - monthly scans
- Large >5.5 cm - consider surgical options
What are the unruptured symptoms?
None really - may have some abdo/back pain
Impending rupture symptoms?
- Increasing back pain
- Tender AAA
Symptoms and signs upon a rupture?
- Abdo/back/flank pain
- Painful pulsatile mass
- Hypo-perfusion
- Haemodynamic instability (unstable BP)
How is an unruptured small - medium aneurysm treated?
- Control risk factors - stop smoking control BP as if these high has higher chance of rupture
- Monitor closely
What types of imaging is used to assess the AAA?
- Ultrasound
- CT/MRI
Ultrasound pos and negs?
- Pos - cheap, no radiation or contrast
- Neg - operator dependent and inadequate for surgical planning
MRI pos and negs?
- Pos Quick Not op dependant Needed for surgical planning as it shows detailed anatomy
- Neg Uses contrast and radiation
When is surgery considered?
Size of 5.5 cm or more If it expands >1 cm in a year If patient has symptoms
What should be taken into account pre surgery?
- Size and risk of rupture
- Patient suitability
- Can aneurysm have an EVAR or open surgery?
Complications of open surgery?
- Infection
- Bleeding
- Pain
- Scar
- Damage to nearby structures
Complications of endovascular surgery?
- Wound infection
- Bleeding
- Pain
- Scar
- Contrast/Radiation reaction = kidney injury
- Endoleak
- Damage to arteries veins, nerves
What is endoleak?
Persistant blood flow within the aneurysm sac following an endovascular aneurysm repair (EVAR)
Steps for an emergency open repair?
- Straight to theatre
- Massive transfusion protocol
- Prep abdomen, rapid anaesthetic
- Laparotomy xiphisternum to pubic symphysis
- Occlude aorta proximally
Steps to consider about an emergency EVAR?
Is anatomy suitable
Local anesthetic should be given
Is there time to assess anatomy?
