Aneurysms: Presentation, Investigation and Therapy Flashcards
What is the clinical perspective defintion of aneurysms?
Aneurysm is the dilation of an artery more than 1.5 times it’s normal diameter and involving all layers of the arterial wall.
What are true anuerysms?
Involves all the layers of the arterial wall. Has different names such as fosiform and saccular for different shapes
What are false anuersms?(pseudoaneurysms)
This is when there is a hole in the wall of the artery which blood escapes and is then contained by surrounding tissue. Sometimes can be bounded by adventitia, more often a thin wall is developed from fibrin/platelet cross links which forms as part of the clotting cascade
Which arteries are most affected by true anuerysms?
- Aorta (ascending, descending and abdominal)
- Iliac arteries
- popliteal arteries
What are the risk factors for aneurysms?
- Increasing age
- Male
- Genetics
- Connective tissue disorders such as Marfans
- Smoking
- Hypertension
What is ruptured AAA?
As aneurysm gets larger the aorta wall gets thinner. On cellular level there is usually evidence of inflammation, smooth muscle cell death and degradation of the extracellular matrix. If wall is streched too much it becomes to weak to contain the pressure. A hole therefore may form in the arterial wall allowing blood to follow into the surrounding tissue, this is called a rupture.
What is the presentation of rupture AAA?
Most are Asymptomatic, patients will not know they have one.
What is the investigations of rupture AAA?
Can be picked up through screening
If not picked up in screening may be picked up through incidental findings on imaging for something else
Cna be found on clinical examination.
What is abdominal aortic aneurysms treated?
Threshold for treatment of aortic aneurysms if 5.5 cm. This is the size at which risks of serious harm from the rupture are higher than that of repair
How is a standard inferenal abdominal aortic aneurysm repaired?
- Open repair
- Endovascular repair
