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Surgery.(General 2).Vascular > Arterial.9.Aneurysm > Flashcards

Arterial.9.Aneurysm Flashcards

1
Q

Definition of aneurysm

A

It’s a sac that contains blood and communicates with the lumen of an artery

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2
Q

Classification of aneurysm

A

Aneurysms can be classified according to

  1. Etiology :
  2. Structure : True or false.
  3. Shape : Fusiform, saccular
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3
Q

Etiology in Classification of aneurysm

A
  • Pathological
  • Traumatic
  • Congenital
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4
Q

Pathological Etiology in Classification of aneurysm

A

1) Atherosclerosis.
2) Collagen diseases :
3) Syphilis.

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5
Q

Collagen diseases in Pathological Etiology in Classification of aneurysm

A
  • Behcet’s disease.
  • Marfan syndrome
  • Ehler’s Danlos syndrome.
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6
Q

Traumatic Etiology in Classification of aneurysm

A

A. Blunt trauma:

B. Penetrating injury

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7
Q

Pathogenesis of Blunt trauma in Traumatic Etiology in Classification of aneurysm

A
  • Blunt trauma to an artery may weaken part of its wall.

* Later this weak area progressively yields leading to aneurysmal dilatation.( True aneurysm)

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8
Q

Pathogenesis of Penetrating trauma in Traumatic Etiology in Classification of aneurysm

A
  • A penetrating injury to an artery may cause a small hole in the wall Leading to a haematoma surrounding the artery.
  • Later on, this clot is surrounded by a false capsule of organised fibrous tissue and the result will be a false aneurysm
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9
Q

Congenital Etiology in Classification of aneurysm

A
  • These may occur in the circle of Willis & causes subarachnoid haemorrhage.
  • Other sites include the splenic, renal or coeliac vessels.
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10
Q

Structure in Classification of aneurysm

A

True aneurysms

False aneurysms

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11
Q

True aneurysms in Structure in Classification of aneurysm

A

The wall of a true aneurysm is formed of the 3 layers of the dilated artery.

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12
Q

False aneurysms in Structure in Classification of aneurysm

A
  • a false aneurysm is actually a haematoma communicating with lumen of an artery through a partial tear in its wall.
  • Thus, the wall of the false aneurysm is formed by the fibrous wall of the haematoma
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13
Q

Clinical picture of aneurysms

A
  • Symptoms

* Examination

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14
Q

Symptoms in Clinical picture of aneurysms

A
  1. Silent aneurysms :
  2. Swelling
  3. Symptoms of complications or compression on adjacent structures.
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15
Q

Silent aneurysms in Symptoms in Clinical picture of aneurysms

A

Some aneurysms e.g. of the abdominal aorta are commonly silent & accidentally discovered on ultrasound examination that is done for another reason.

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16
Q

Examination in Clinical picture of aneurysms

A
  • Site
  • shape
  • Surface
  • Consistency
  • Compressibility
  • Special character
  • Special tests
  • Palpation and Auscultation
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17
Q

Site in Examination in Clinical picture of aneurysms

A

swelling lies along the line of an artery.

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18
Q

shape in Examination in Clinical picture of aneurysms

A

rounded swelling

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19
Q

Surface in Examination in Clinical picture of aneurysms

A

Smooth swelling

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20
Q

Consistency in Examination in Clinical picture of aneurysms

A

cystic swelling

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21
Q

Compressibility in Examination in Clinical picture of aneurysms

A

Compressible swelling

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22
Q

Special character in Examination in Clinical picture of aneurysms

A
  • The swelling gives expansile pulsations

* The most important sign

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23
Q

Special tests in Examination in Clinical picture of aneurysms

A

Proximal pressure on the main artery results in diminution or disappearance of pulsations

Distal compression on the main artery causes the aneurysm to increase in size and become more tense

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24
Q

Palpation and Auscultation in Examination in Clinical picture of aneurysms

A

A systolic thrill may be felt

A bruit may be heard

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25
Q

most important sign of aneurysm in Examination in Clinical picture of aneurysms

A

The swelling gives expansile pulsations

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26
Q

meaning of expansile pulsations

A

pulsations in all directions

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27
Q

Complications of aneurysm

A
  1. Rupture
  2. Distal ischaemia :
  3. Infection
  4. Compression on adjacent structures
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28
Q

Rupture in Complications of aneurysm

A
  • the most serious complication )> fatal hge

* Pseudo aneurysm is more liable to rupture (its wall is fibrous tissue)

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29
Q

The most serious complication of aneurysm

A

Rupture

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30
Q

Etiology of distal ischemia in Complications of aneurysm

A

a) Acute ischaemia

b) Chronic ischaemia

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31
Q

Pathogenesis of Acute ischaemia in Etiology of distal ischemia in Complications of aneurysm

A

a mural thrombus within the aneurysm may be the source for athero-embolization.

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32
Q

Pathogenesis of Chronic ischaemia in Etiology of distal ischemia in Complications of aneurysm

A

gradual decrease of blood supply distal to the aneurysm.

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33
Q

Infection in Complications of aneurysm

A

Leads to :

  • Rupture
  • Secondary haemorrhage
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34
Q

Compression on adjacent structures in Complications of aneurysm

A
  • Compression of an adjacent vein may cause DVT.
  • Compression of a nerve may cause motor or sensory affection.
  • The adjacent bone may also be eroded.
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35
Q

Differential Diagnosis of aneurysms

A
  1. An arterio-venous fistula “Varicose aneurysm”.
  2. A swelling overlying an artery may elicit transmitted arterial pulsations :
  3. A very vascular tumour as an osteosarcoma or metastases.
  4. An abscess.
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36
Q

difference between aneurysms and a swelling overlying an artery

A
  • Pressure on the proximal artery

* Moving the swelling away from the artery

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37
Q

Pressure on the proximal artery in aneurysms in difference between aneurysms and a swelling overlying an artery

A

Decrease its size

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38
Q

Pressure on the proximal artery in a swelling overlying an artery in difference between aneurysms and a swelling overlying an artery

A

does not change the size of the swelling.

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39
Q

Moving the swelling away from the artery in aneurysms in difference between aneurysms and a swelling overlying an artery

A

The pulsations Persists

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40
Q

Moving the swelling away from the artery in a swelling overlying an artery in difference between aneurysms and a swelling overlying an artery

A

The pulsations disappear

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41
Q

Treatment of aneurysms

A
  1. The standard line of treatment is excision and graft.
  2. Exclusion graft
  3. Excision with arterial ligation
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42
Q

Indication of Excision with arterial ligation

A

can be done for aneurysms of small arteries as the radial and ulnar arteries

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43
Q

Incidence of Abdominal Aortic Aneurysm

A
  • The most frequent type of aneurysms.

* It affects the aorta below the origin of the renal arteries in 95% of cases

44
Q

ETIOLOGY of Abdominal Aortic Aneurysm

A

Atherosclerosis is most common cause

and is responsible for 95% of AAAs.

45
Q

Clinical picture of AAA

A
  1. Asymptomatic aneurysms
  2. Pain is the commonest symptom :
  3. Swelling “Not Common”:
46
Q

Asymptomatic aneurysms in Clinical picture of AAA

A

In 75% of patients the AAA is discovered accidentally during a routine abdominal U.S examination.

47
Q

Pain in Clinical picture of AAA

A
  • Incidence

* Pathogenesis

48
Q

Incidence of Pain in Clinical picture of AAA

A

The commonest symptom

49
Q

Pathogenesis of Pain in Clinical picture of AAA

A
  • An A.A.A. gradually enlarges and compresses on surrounding structures causing vague abdominal pain & dyspepsia.
  • Back and flank pain result from vertebral compression.
50
Q

Swelling in Clinical picture of AAA

A
  • Incidence

* Pathogenesis

51
Q

Incidence of Swelling in Clinical picture of AAA

A

Not common

52
Q

Pathogenesis of Swelling in Clinical picture of AAA

A
  • Visible pulsating abdominal mass

* in cases of large AAA reaching the anterior abdominal wall.

53
Q

Complications of AAA

A
  1. Rupture “The most serious complication”

2. Distal embolization

54
Q

Rupture in Complications of AAA

A
  • The classic triad

* Types of rupture

55
Q

The classic triad of Rupture in Complications of AAA

A
  • Sudden severe pain
  • Pulsatile abdominal mass.
  • Shock
56
Q

Types of rupture of Rupture in Complications of AAA

A

Retroperitoneal rupture: Can be saved

Intraperitoneal rupture is fatal & the patient usually does not reach the hospital.

57
Q

Alternative name for Retroperitoneal rupture in Types of rupture of Rupture in Complications of AAA

A

Postero-lateral rupture

58
Q

Alternative name for Intraperitoneal rupture in Types of rupture of Rupture in Complications of AAA

A

Anterior rupture

59
Q

Distal embolization in Complications of AAA

A
  • Definition

* Consequences

60
Q

Definition of Distal embolization in Complications of AAA

A

A mural thrombus within the aneurysm may be the source for athero-embolization

61
Q

Consequences of Distal embolization in Complications of AAA

A

a) Acute embolic ischemia

b) Blue toe syndrome

62
Q

Acute embolic ischemia in Consequences of Distal embolization in Complications of AAA

A

if the embolus is lodged in a large artery

63
Q

Blue toe syndrome in Consequences of Distal embolization in Complications of AAA

A
  • if a small embolus is lodged in one of the digital arteries of the toes.
  • The toes are cold blue & ischemic while the patient is having intact pedal pulse.
64
Q

Investigation of AAA

A
  1. Abdominal U.S “Best screening test”.
  2. CT scan :
  3. Angiography or digital subtraction angiography :
65
Q

Best screening test for AAA

A

Abdominal U.S

66
Q

Advantages of CT scan in Investigation of AAA

A
  • very accurate in determining the size of the aneurysm

* very accurate in the diagnosis of leaking or ruptured AAA

67
Q

Angiography or digital subtraction angiography in the investigation of AAA

A
  • Advantages

* Disadvantages

68
Q

Advantages of Angiography or digital subtraction angiography in the investigation of AAA

A

lt allows identification of iliac artery involvement as well as suprarenal extension

lt provides precise assessment of associated occlusive disease of the peripheral arteries as well as the renal and mesenteric arteries.

69
Q

Disadvantages of Angiography or digital subtraction angiography in the investigation of AAA

A

Angiography or digital subtraction angiography is Not reliable to determine the diameter of the aneurysm

70
Q

the reason why Angiography or digital subtraction angiography is Not reliable to determine the diameter of the aneurysm

A

because of the mural thrombus which reduces the aneurysm lumen size.

71
Q

Treatment of AAA

A
  • Plan of management

* Type of surgery for aneurysm repair

72
Q

Plan of management in Treatment of AAA

A
  1. Immediate surgery
  2. Urgent surgery
  3. Elective surgery
  4. Regular follow up
73
Q

Indication of Immediate surgery in Plan of management in Treatment of AAA

A

patients with the diagnosis of rupture

74
Q

Indication of Urgent surgery in Plan of management in Treatment of AAA

A
  • patients with symptoms of acute expansion
75
Q

symptoms of acute expansion in Indication of Urgent surgery in Plan of management in Treatment of AAA

A

severe pain of acute onset but with no leak on C.T. scan

76
Q

Indication of Elective surgery in Plan of management in Treatment of AAA

A

a) Symptomatic aneurysms regardless of the size

b) Asymptomatic aneurysms 5 cm or more in diameter

77
Q

Regular follow up in Plan of management in Treatment of AAA

A
  • Indication
  • Modalities
  • Time of intervention
78
Q

Indication of Regular follow up in Plan of management in Treatment of AAA

A

Asymptomatic aneurysms less than 5 cm in diameter

79
Q

Modalities of Regular follow up in Plan of management in Treatment of AAA

A

Ultrasound is done every 6 months.

80
Q

Time of intervention in Regular follow up in Plan of management in Treatment of AAA

A
  • Surgery is required if the serial studies show an enlarging aneurysm > 5 mm in 6 months

or

  • The patient becomes symptomatic
81
Q

Type of surgery for aneurysm repair in Treatment of AAA

A

A. Open exclusion graft

B. Endovascular repair

82
Q

Open exclusion graft in Type of surgery for aneurysm repair in Treatment of AAA

A
  • Principle

* Complications

83
Q

Principle of Open exclusion graft in Type of surgery for aneurysm repair in Treatment of AAA

A
  • Opening the aneurysm and excluding it by implanting a synthetic graft
  • The anterior wall of the aneurysm should be closed over the synthetic graft
84
Q

The reason why The anterior wall of the aneurysm should be closed over the synthetic graft in Principle of Open exclusion graft in Type of surgery for aneurysm repair in Treatment of AAA

A
  • To separate it from the bowel

* To avoid pressure necrosis And aortoenteric fistula

85
Q

Complications of Open exclusion graft in Type of surgery for aneurysm repair in Treatment of AAA

تنطيط

A
  1. Declamping hypotension
  2. Trash foot
  3. Left colon ischemia
  4. Paraplegia
  5. Renal failure.
86
Q

Declamping hypotension in Complications of Open exclusion graft in Type of surgery for aneurysm repair in Treatment of AAA

A

Due to accumulation of V.D metabolites in ischaemic limbs

87
Q

Trash foot in Complications of Open exclusion graft in Type of surgery for aneurysm repair in Treatment of AAA

A
  • Microembolization to the digital arteries of the feet

* occurs with aortic aneurysm repair

88
Q

Left colon ischemia in Complications of Open exclusion graft in Type of surgery for aneurysm repair in Treatment of AAA

A

due to Affection of inferior mesenteric arteries

89
Q

Paraplegia in Complications of Open exclusion graft in Type of surgery for aneurysm repair in Treatment of AAA

A

due to Affection of Lumbar arteries

90
Q

Endovascular repair in Type of surgery for aneurysm repair in Treatment of AAA

A

Principle:

Indications

91
Q

Principle of Endovascular repair in Type of surgery for aneurysm repair in Treatment of AAA

A

insertion of an endoluminal stented graft through bilateral femoral arteriotomies.

92
Q

Indications of Endovascular repair in Type of surgery for aneurysm repair in Treatment of AAA

A

This technique is expensive & recurrence of the aneurysm may occur.

It is therefore indicated for :
* High risk patients who can not tolerate anesthesia and open surgery

93
Q

Pathogenesis of recurrence in Indications of Endovascular repair in Type of surgery for aneurysm repair in Treatment of AAA

A

failure of Fixation of graft

94
Q

Incidence of Popliteal aneurysm

A

the commonest peripheral aneurysm.

95
Q

Etiology of Popliteal aneurysm

A

1) Traumatic

2) Pathological

96
Q

Morphology of Traumatic Etiology of Popliteal aneurysm

97
Q

Main complication of Traumatic Etiology of Popliteal aneurysm

98
Q

Morphology of Pathological Etiology of Popliteal aneurysm

99
Q

Main complication of Pathological Etiology of Popliteal aneurysm

A
  • Thrombosis and

* Distal embolization

100
Q

Clinical picture of Popliteal aneurysm

A

Usually small size swelling (3-4 cm)

but ischaemia is common.

101
Q

Treatment of Popliteal aneurysm

A

Exclusion & bypass using autogenous saphenous vein graft

No attempt to excise the aneurysm as damage to the popliteal vein will occur.

102
Q

problem about Treatment of Popliteal aneurysm

A

No attempt to excise the aneurysm as damage to the popliteal vein will occur.

103
Q

Cause of pseudo aneurysm

A

Penetrating trauma

104
Q

Treatment of pseudo aneurysm

A
  • Evacuation (not excision)

* Arterial repair by suture or vein patch graft

105
Q

Recent trends in management of pseudo-aneurysm

A
  1. U.S guided compression.
  2. U.S guided thrombin injection.
  3. Embolization.
  4. Endovascular stent graft

Surgery.(General 2).Vascular (16 decks)

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