Aortic aneurysm Flashcards
False aneurysms
Occur when inner two layers rupture and there is dilation of the vessel with blood only contained within outer layer
Typically after trauma
True aneurysm
Where the three layers are intact but dilated
Risk factors
Men
Increased age
Smoking
HTN
FH
Existing CVD
Marfans and Ehler’s Danlos
Presentation
Often asymptomatic
Symptoms due to taking up space:
- chest/ back pain
- trachea/ left bronchus compression- cough, SOB, stridor
- phrenic nerve compression- hiccups
- oesophageal compression- dysphagia
- recurrent laryngeal nerve compression- hoarse voice
Diagnosis
Echocardiogram
CT or MRI angiogram
Management options
Suveillance
Thoracic endovascular aortic repair
Open surgery
Complications of thoracic aortic aneurysm
Aortic dissection
Ruptured aneurysm
Aortic regurgitation
Ruptured thoracic aortic aneurysm features
Bleeding into oesophagus- haematemesis
Bleeding into airways- haemoptysis
Bleeding into pericardial cavity- cardiac tamponade
Ruptured thoracic aortic aneurysm presents with
A
Severe chest/ back pain
Haemodynamic instability
Collapse
Death
Ruptured thoracic aortic aneurysm management
Emergency open surgery
Replacement of affected section of aorta with synthetic graft
AAA screening
All men in England offered screening US scan at 65
Patients with aorta diameter >3cm referred to vascular team
Referred urgently in >5.5cm
AAA presentation
Most asymptomatic
Non-specific abdo pain
Pulsatile and expansile mass when palpated with both hands
AAA diagnosis
US the usual investigation to establish diagnosis
CT angiogram gives more detailed picture of aneurysm and helps guide elective surgery to repair
Classification of AAA
Normal <3cm
Small aneurysm 3-4.4cm
Medium aneurysm 4.5-5.4cm
Large aneurysm >5.5cm
AAA surveillance programme
Yearly scans for 3-4.4cm
3-monthly scans for 4.5-5.4cm
