Arterial Aneurysms (1*)

Question 1

What is it defined as?

What are its 3 types?

Answer 1

➊ Dilatation > 50% of original diameter

➋ • True - Involving all layers of the arterial wall, and can be fusiform (e.g. AAA) or sac-like (e.g. berry aneurysms)
• False (pseudoaneurysms) - Collection of blood in the outer layer only
• Dissecting - Tear of t.intima, and blood enters between the layers to separate them

Question 2

What are its risk factors?

What can cause it?

What are the complications?

Answer 2

➊ DM, Obesity, HTN, Smoking, Alcohol, Dyslipidaemia

➋ Trauma, Atheroma, Infection

➌ • Rupture - presents as hypovolemic shock
• Thrombosis
• Embolism

Question 3

How does it present?

How is it managed in general?

How is an AAA managed?

When is surgery indicated?

Answer 3

➊ Depends on its location:
• Cerebral - may present with sensory/motor signs if pressing on structures, but will present as a SAH if it ruptures
• Abdominal Aorta - usually asymptomatic and found incidentally or once ruptured

➋ • Control of modifiable risk factors e.g. DM, HTN, Smoking
• Depending on its size, conservative or surgical management can be taken

➌ • Small (3-4.4cm) – Repeat USS yearly
• Medium AAA (4.5-5.4cm) – Repeat USS every 3 months
• Large AAA (>5.5cm) – Open repair or EVAR

➍ • Symptomatic
• Asymptomatic + >5.5cm
• Asymptomatic + > 4.0cm and has grown by >1cm in 1 yr