Arterial Aneurysms

Question 1

What is an aneurysm?

Answer 1

An artery with a dilation > 50% of its original diameter

Question 2

What are the different types of aneurysms?

Answer 2

• True aneurysm
• False aneurysm
• Dissecting aneurysm

Question 3

What are true aneurysms?

Answer 3

• Aneurysms that involve all the layers of the vessels wall
  => There are 2 types:
• Fusiform aneurysms (bulges on both sides)
• Saccular aneurysms (bulges on one side)

Question 4

What are false aneurysms?

Answer 4

• When there is a collection of blood in the outer layer only

Question 5

What is an Aortic Dissecting Aneurysm?

Answer 5

• Vessel dilatation caused by blood splaying apart the media to form a false lumen
• Occurs when there is a tear in the intima

Question 6

What are the 2 types of dissecting aneurysms?

Answer 6

=> Stanford Classification

• Type A: Involve the ascending aorta
• Type B: Do not involve the ascending aorta

Type A is more serious than Type B

=> DeBakey Classification:

• Type I: Originated in ascending aorta and propagates distally
• Type II: Originates and stays in ascending aorta
• Type III: Originates in descending aorta and projects distally

Question 7

What are the risk factors of dissecting aneurysms?

Answer 7

• Hypertension
• Abnormal media (Marfans Syndrome, Ehlers-Danlos Syndrome)
• Pregnancy

Question 8

What is the clinical presentation of Aortic Dissecting Aneurysms?

Answer 8

• Hypertension and asymmetrical pain

- Tearing pain between shoulder blades

Question 9

What are the complications of Type A Aneurysms?

Answer 9

• MI
• Stroke
• Cardiac Tamponade
• Aortic Regurgitation
• Exsanguination

Question 10

What are the complications of Type B Aneurysms?

Answer 10

• Rupture
• Renal ischaemia
• Gut ischaemia
• Lower limb ischaemia

Question 11

What is the management of Aortic Dissecting Aneurysms?

Answer 11

=> Type A:
- Managed via immediate surgical repair, target systolic BP between 100-120 mmHg whilst waiting for intervention

=> Type B:

• Conservative management
• Bed rest
• Reduce BP using IV Labetelol
• Surgery reserved for complications

Question 12

What is an Abdominal Aortic Aneurysm?

Answer 12

• An aneurysm below the level of the renal artery

Question 13

What is the diameter of the aorta past the age of 50?

Answer 13

Males => 1.7cm
Females => 1.5cm

A diameter > 3cm is AAA
A large AAA > 5.5cm

Question 14

What are the risk factors of an AAA?

Answer 14

• Smoking
• Hypertension
• Atherosclerosis
• Age (elderly)
• Gender (Male)
• Family History

Question 15

What are the causes of AAA?

Answer 15

• Atheroma
• Trauma
• Connective tissue disorders
• Infection (Syphillis)

Question 16

What are the 2 main connective tissue disorders?

Answer 16

• Marfans syndrome

- Ehlers Danlos syndrome

Question 17

What is the clinical presentation of AAA?

Answer 17

• Intermittent or continuous abdominal pain
• Collapse
• Expansile abdominal mass
• Sweating

=> only presents clinically when ruptured

Question 18

What are the investigations in suspected AAA?

Answer 18

• Ultrasound

- CT

Question 19

What is the emergency management of a ruptured AAA?

Answer 19

1. Summon vascular surgeon and anaesthetist
2. Do ECG, take blood for amylase, Hb and crossmatch. Catheterise bladder.
3. Gain IV access and transfuse O Rh -ve blood for shock
4. Take straight to theatre. NO TIME WASTING WITH INVESTIGATIONS
5. Give prophylactic antibiotics
6. Surgery: clamp aorta above leak

Question 20

What is the management of an unruptured AAA?

Answer 20

Insert endovascular stent via femoral artery

Question 21

What is the management of an unruptured AAA based on size?

Answer 21

< 3 cm - Discharge from screening
3 - 4.4 cm - Annual surveillance
4.5 - 5.4 cm - 3 monthly surveillance
> 5.5 cm - Consider surgery