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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
most important sign of aneurysm in Examination in Clinical picture of aneurysms
The swelling gives expansile pulsations
26
meaning of expansile pulsations
pulsations in all directions
27
Complications of aneurysm
1. Rupture 2. Distal ischaemia : 3. Infection 4. Compression on adjacent structures
28
Rupture in Complications of aneurysm
* the most serious complication )> fatal hge | * Pseudo aneurysm is more liable to rupture (its wall is fibrous tissue)
29
The most serious complication of aneurysm
Rupture
30
Etiology of distal ischemia in Complications of aneurysm
a) Acute ischaemia | b) Chronic ischaemia
31
Pathogenesis of Acute ischaemia in Etiology of distal ischemia in Complications of aneurysm
a mural thrombus within the aneurysm may be the source for athero-embolization.
32
Pathogenesis of Chronic ischaemia in Etiology of distal ischemia in Complications of aneurysm
gradual decrease of blood supply distal to the aneurysm.
33
Infection in Complications of aneurysm
Leads to : * Rupture * Secondary haemorrhage
34
Compression on adjacent structures in Complications of aneurysm
* 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.
35
Differential Diagnosis of aneurysms
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.
36
difference between aneurysms and a swelling overlying an artery
* Pressure on the proximal artery | * Moving the swelling away from the artery
37
Pressure on the proximal artery in aneurysms in difference between aneurysms and a swelling overlying an artery
Decrease its size
38
Pressure on the proximal artery in a swelling overlying an artery in difference between aneurysms and a swelling overlying an artery
does not change the size of the swelling.
39
Moving the swelling away from the artery in aneurysms in difference between aneurysms and a swelling overlying an artery
The pulsations Persists
40
Moving the swelling away from the artery in a swelling overlying an artery in difference between aneurysms and a swelling overlying an artery
The pulsations disappear
41
Treatment of aneurysms
1. The standard line of treatment is excision and graft. 2. Exclusion graft 3. Excision with arterial ligation
42
Indication of Excision with arterial ligation
can be done for aneurysms of small arteries as the radial and ulnar arteries
43
Incidence of Abdominal Aortic Aneurysm
* The most frequent type of aneurysms. | * It affects the aorta below the origin of the renal arteries in 95% of cases
44
ETIOLOGY of Abdominal Aortic Aneurysm
Atherosclerosis is most common cause and is responsible for 95% of AAAs.
45
Clinical picture of AAA
1. Asymptomatic aneurysms 2. Pain is the commonest symptom : 3. Swelling "Not Common":
46
Asymptomatic aneurysms in Clinical picture of AAA
In 75% of patients the AAA is discovered accidentally during a routine abdominal U.S examination.
47
Pain in Clinical picture of AAA
* Incidence | * Pathogenesis
48
Incidence of Pain in Clinical picture of AAA
The commonest symptom
49
Pathogenesis of Pain in Clinical picture of AAA
* 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
Swelling in Clinical picture of AAA
* Incidence | * Pathogenesis
51
Incidence of Swelling in Clinical picture of AAA
Not common
52
Pathogenesis of Swelling in Clinical picture of AAA
* Visible pulsating abdominal mass | * in cases of large AAA reaching the anterior abdominal wall.
53
Complications of AAA
1. Rupture "The most serious complication" | 2. Distal embolization
54
Rupture in Complications of AAA
* The classic triad | * Types of rupture
55
The classic triad of Rupture in Complications of AAA
* Sudden severe pain * Pulsatile abdominal mass. * Shock
56
Types of rupture of Rupture in Complications of AAA
Retroperitoneal rupture: Can be saved Intraperitoneal rupture is fatal & the patient usually does not reach the hospital.
57
Alternative name for Retroperitoneal rupture in Types of rupture of Rupture in Complications of AAA
Postero-lateral rupture
58
Alternative name for Intraperitoneal rupture in Types of rupture of Rupture in Complications of AAA
Anterior rupture
59
Distal embolization in Complications of AAA
* Definition | * Consequences
60
Definition of Distal embolization in Complications of AAA
A mural thrombus within the aneurysm may be the source for athero-embolization
61
Consequences of Distal embolization in Complications of AAA
a) Acute embolic ischemia | b) Blue toe syndrome
62
Acute embolic ischemia in Consequences of Distal embolization in Complications of AAA
if the embolus is lodged in a large artery
63
Blue toe syndrome in Consequences of Distal embolization in Complications of AAA
* 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
Investigation of AAA
1. Abdominal U.S "Best screening test". 2. CT scan : 3. Angiography or digital subtraction angiography :
65
Best screening test for AAA
Abdominal U.S
66
Advantages of CT scan in Investigation of AAA
* very accurate in determining the size of the aneurysm | * very accurate in the diagnosis of leaking or ruptured AAA
67
Angiography or digital subtraction angiography in the investigation of AAA
* Advantages | * Disadvantages
68
Advantages of Angiography or digital subtraction angiography in the investigation of AAA
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
Disadvantages of Angiography or digital subtraction angiography in the investigation of AAA
Angiography or digital subtraction angiography is Not reliable to determine the diameter of the aneurysm
70
the reason why Angiography or digital subtraction angiography is Not reliable to determine the diameter of the aneurysm
because of the mural thrombus which reduces the aneurysm lumen size.
71
Treatment of AAA
* Plan of management | * Type of surgery for aneurysm repair
72
Plan of management in Treatment of AAA
1. Immediate surgery 2. Urgent surgery 3. Elective surgery 4. Regular follow up
73
Indication of Immediate surgery in Plan of management in Treatment of AAA
patients with the diagnosis of rupture
74
Indication of Urgent surgery in Plan of management in Treatment of AAA
* patients with symptoms of acute expansion
75
symptoms of acute expansion in Indication of Urgent surgery in Plan of management in Treatment of AAA
severe pain of acute onset but with no leak on C.T. scan
76
Indication of Elective surgery in Plan of management in Treatment of AAA
a) Symptomatic aneurysms regardless of the size | b) Asymptomatic aneurysms 5 cm or more in diameter
77
Regular follow up in Plan of management in Treatment of AAA
* Indication * Modalities * Time of intervention
78
Indication of Regular follow up in Plan of management in Treatment of AAA
Asymptomatic aneurysms less than 5 cm in diameter
79
Modalities of Regular follow up in Plan of management in Treatment of AAA
Ultrasound is done every 6 months.
80
Time of intervention in Regular follow up in Plan of management in Treatment of AAA
* Surgery is required if the serial studies show an enlarging aneurysm > 5 mm in 6 months or * The patient becomes symptomatic
81
Type of surgery for aneurysm repair in Treatment of AAA
A. Open exclusion graft B. Endovascular repair
82
Open exclusion graft in Type of surgery for aneurysm repair in Treatment of AAA
* Principle | * Complications
83
Principle of Open exclusion graft in Type of surgery for aneurysm repair in Treatment of AAA
* 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
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
* To separate it from the bowel | * To avoid pressure necrosis And aortoenteric fistula
85
Complications of Open exclusion graft in Type of surgery for aneurysm repair in Treatment of AAA تنطيط
1. Declamping hypotension 2. Trash foot 3. Left colon ischemia 4. Paraplegia 5. Renal failure.
86
Declamping hypotension in Complications of Open exclusion graft in Type of surgery for aneurysm repair in Treatment of AAA
Due to accumulation of V.D metabolites in ischaemic limbs
87
Trash foot in Complications of Open exclusion graft in Type of surgery for aneurysm repair in Treatment of AAA
* Microembolization to the digital arteries of the feet | * occurs with aortic aneurysm repair
88
Left colon ischemia in Complications of Open exclusion graft in Type of surgery for aneurysm repair in Treatment of AAA
due to Affection of inferior mesenteric arteries
89
Paraplegia in Complications of Open exclusion graft in Type of surgery for aneurysm repair in Treatment of AAA
due to Affection of Lumbar arteries
90
Endovascular repair in Type of surgery for aneurysm repair in Treatment of AAA
Principle: Indications
91
Principle of Endovascular repair in Type of surgery for aneurysm repair in Treatment of AAA
insertion of an endoluminal stented graft through bilateral femoral arteriotomies.
92
Indications of Endovascular repair in Type of surgery for aneurysm repair in Treatment of AAA
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
Pathogenesis of recurrence in Indications of Endovascular repair in Type of surgery for aneurysm repair in Treatment of AAA
failure of Fixation of graft
94
Incidence of Popliteal aneurysm
the commonest peripheral aneurysm.
95
Etiology of Popliteal aneurysm
1) Traumatic | 2) Pathological
96
Morphology of Traumatic Etiology of Popliteal aneurysm
Saccular
97
Main complication of Traumatic Etiology of Popliteal aneurysm
rupture
98
Morphology of Pathological Etiology of Popliteal aneurysm
Fusiform
99
Main complication of Pathological Etiology of Popliteal aneurysm
* Thrombosis and | * Distal embolization
100
Clinical picture of Popliteal aneurysm
Usually small size swelling (3-4 cm) but ischaemia is common.
101
Treatment of Popliteal aneurysm
Exclusion & bypass using autogenous saphenous vein graft No attempt to excise the aneurysm as damage to the popliteal vein will occur.
102
problem about Treatment of Popliteal aneurysm
No attempt to excise the aneurysm as damage to the popliteal vein will occur.
103
Cause of pseudo aneurysm
Penetrating trauma
104
Treatment of pseudo aneurysm
* Evacuation (not excision) | * Arterial repair by suture or vein patch graft
105
Recent trends in management of pseudo-aneurysm
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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