Ch 83 - Lower Extremity Aneurysms

Question 1

What is the men to women ratio of true lower extremity aneurysms (all types)?

Answer 1

30:1

Question 2

What are the main types of aneurysms and their definition?

Answer 2

• True aneurysm - focal, fusiform dilation of the artery to 1.5 times the normal diameter of the adjacent segment of artery.
• Pseudoaneurysm - a rim of fibrous tissue containing thrombus and arterial flow in continuity with a defect in the artery.

Question 3

What is the appeoximated normal size of CFA in men and women?

Answer 3

• 1 cm in men

- 0.8 cm in women

Question 4

What are the indication for aneurysmatic Femoral artery intervantion?

Answer 4

• All symptomatic aneurysms should be treated.
• Asymptomatic aneurysms of more than 2.5cm in good risk patients can be concidered for treatment.
• Recent study (by Lawrence et al. 2014) acute complications such as ischemia or rupture did not occur in patients with asymptomatic femoral artery aneurysms less than or equal to 3.5 cm.
• Size threashold can be reduced in the presence of intraluminal thrombuse.

Question 5

What is the most common etiology of true aneurysms in lower extremities?

Answer 5

Degenerative aneurysems.

Question 6

What is the major risk of lower limb aneurysms?

Answer 6

They can cause limb-threaening ischemia due to thrombose or emboly.
Rapture is a rear presentation!

Question 7

What is the rate of association between femoral aneurysms and aortic aneurysms?

Answer 7

50-90% chance of concurrent aortic aneurysm

Question 8

What is the rate of association between popliteal aneurysms and aortic aneurysms?

Answer 8

30-50% chance of concurrent aortic aneurysm

70% chances for aortic aneurysm if there is a bilateral popliteal aneurysms.

Question 9

What is the rate of bilateral femoral aneurysms?

Answer 9

25-50%

Question 10

What is the rate of bilateral popliteal aneurysms?

Answer 10

50-70%

Question 11

What is the rate of femoral or popliteal aneurysems in men with aortic aneurysms?

Answer 11

14%

Question 12

What is the rate of femoral or popliteal aneurysems in women with aortic aneurysms?

Answer 12

Rare

Question 13

what is tne major etiology of Pseudoaneurysm?

Answer 13

iatrogenic injury due to instrumentation

Question 14

What is the rate of the specific femoral arteries aneurysms (CFA, SFA, PFA)?

Answer 14

CFA 57%
SFA 27%
PFA 17%
Bilateral 26%
Associated with additional aneurysms 48%

Recent study showed higher percentage (81%) in the CFA, and lower percentage (14%, 5%) in the SFA and PFA, respectively.

Question 15

At which age group are femoral artery aneurysms predominantly found?

Answer 15

70 year or older

Question 16

What is the possible clinical presentaion of symptomatic femoral artery aneuryems and their rate (most common to less common)?

Answer 16

Lower extremity ischemia is the most common presentation in up to 65%.
30-40% locolized pain from compression.
Rupture (rear) 4%

Question 17

What is the rate of asymptomatic femoral artery aneurysms?

Answer 17

30-40% are asymptomatic and found on physical examination or Duplex US.

Question 18

What is the imaging modality of chioce for the diagnosis and assessment of lower extremities aneurysms?

Answer 18

Duplex ultrasound.

Question 19

What is the role of CTA and MRA in the assessment of lower extremities aneurysms?

Answer 19

Although the modality of chioce is Duplex US, CTA and MRA has a role in:

• Planning intervantion
• Measurment
• identify normal proximal and distal segments.

Question 20

What is the recommended treatment approch to femoral aneurysms?

Answer 20

Open surgery with exclusion and interposition graft is the prefarred approch.
In both emergency and elective repair there is a minimal morbidity and mortality.

Question 21

What type of graft is preffered for interposition in open surgical repair of the femoral artery?

Answer 21

Syntetic PTFE or Dacron graft are better size matches and have equivalent or better patency rates than vein grafts in the femoral artery.

Question 22

מה שיעור החדירות (patency) של ניתוח endarterectomy במחלה אאורטו-איליאקלית?

Answer 22

5 שנים 95%

10 שנים בין 85-90%.

Question 23

מה שיעור התמותה בניתוחי endarterectomy במחלה אאורטו-איליאקלית?

Answer 23

1% תמותה פריאופרטיבית

Question 24

מה שיעור החדירות (patency) של ניתוח aortobifemoral grafting?

Answer 24

5-years primery patency rate 85-90%

10 year primery patency rate 75-85%

Question 25

מה ההשפעה של גיל על שיעור החדירות (patency) של ניתוח aortobifemoral grafting?

Answer 25

מתחת לגיל 50 יש שיעור חדירות ל-5 שנים נמוך של 66% לעומת שיעור חדירות של 95% מעל לעיל 60.
אבל ה-long term patency בצעירים הוא טוב יותר.

Question 26

מה האינדיקציה להתערבות לתיקון pseudoaneurysms פמורליות או אאורטליות לאחר ניתוח aortobifemoral graft?

Answer 26

גודל מעל 2 ס”מ או מעל 50% מקוטר הגראפט