Aneurysms Flashcards
Defin
Perm localised dilat of A over 50% normal diam.
Over 3cm fr aorta
Ectasia- loc enlargem under 1.5 x
Arteriomegaly- gen enlargement of arterial tree.
Loss elastin and sm
Types
True- pathol degen inv all or part vess wall. Wall layers NOT breached.
False pseudoaneurysms- leak blood to cav surr by CT, expansile and pulsatile, pseudowall format.
causes
Congenital eg berry Degen eg atheroma dam due to smoking, HTN, chol, age Familial Male 4 to 1 More in caucasian CT dis- marfans, ehlers Infec- mycotic anaer eg syphillis Trauma, inflamm Dissection- blood btw endoth and emdia, forms 2 lumens
sites
Aorta- infra renal most comm Poplit A- 2nd most comm Comm femoral Intra abdo splanchnic Subclavian Carotids
AAA px
Maj asymp Occas distal embolisat, limb isch Pain- abdo, back, loin Malaise Wl Rupture- pain, pulsing mass above umbillicus, hypov. Rarely retroperit haemorr signs. Shock, syncope. Most rupt post into retroperit sp. Mild abdo symps and pain over aneur can indicate contained retroperit rupt
ix
Hx Exam US initially CT with contrast if large ECG Amylase
indics for repair
AAA over 5.5cm
Symptomatic
Rapid expanding or ruptured
AAA mx
US monit if small
Stop smok, BP control, statin, asp, wl
Rupt mx- O2, bloods incl x match, fluids, transfus O neg init, CT angio if stable, then surg
Surg if over 5.5 or expanding over 1cm per yr or symps-
Open or laparo repair, prosthetic tube
Endovasc repair, stent graft via femoral A with X-ray guidance. Deps on whether inv kidn and bowel, and if stent can fit. Lifelong surv.
Complics of repair-haemorrhage, cardiac event, resp, renl fail, embol or thrombu, colon isch, death. Graft migration or fracture, endoleak, endotension.
Poplit aneur px
Asymp Claudication Embolisation Occlusion Rupture
poplit aneur mx
Hunterian igat and bypass
Endovac stent
AAA screening
Abdo US at 65
3-5 yr surveillance if pos
AAA diffs
Renal colic Diverticulitis IBD IBS GI haemorr Appedicitis Ovarian torsion or rupt Splenic infarction
AAA rupture complics
Retroperit leak
Embolisation
Aortoduodenal fistula
