Chapter 69 - Arterial aneurysms etiology epidemiology and natural history Flashcards
Factors associated with degenerative aneurysms environmental
1) duration of smoking 2) intensity of smoking
% of CFA aneurysm with another aneurysm elsewhere
88%
Isolated internal iliac aneurysm rupture mortality
31% difficult to repair
Matas 1923 on aortic aneurysm
Ligated aorta, pt lived 18 months until TB killed
Juan Parodi in 1991
Used balloon-expandable stent and polyester graft to devise EVAR using femoral access only
Factors associated with degenerative aneurysms microscopically
1) Increase metalloproteinase 2) decrease tissue inhibitor of metalloproteinase 1 (antiproteolytic enzymes)
Increase in incidence of aortic aneurysm with every decade after 65
6%
Arteriomegaly
Diffuse continuous enlargement with multiple arterial segments > 50% increase Associated with family history of siblings getting aneurysms
Dysphagia lusoria
Caused by aberrant right subclavian
Developmental/congenital aneurysms: persistent sciatic artery association
40% have aneurysms
Renal artery aneurysm in 3rd trimester of pregnancy mortality if rupture
70% maternal 100% fetal
Antyllus on aneurysm
Proximal and distal ligation of extremity aneurysms and pack the sac
Popliteal aneurysm rate
Most common peripheral 1% in men 65-80
Definition of aneurysm
Localized dilation with more than 50% increase compared to expected size Developed by Ad Hoc Committee Reporting Standard of SVS 1991
Aortic aneurysm incidence in siblings
20-30%
Splenic aneurysm rate and association
most common visceral, 60% of all 1) female 2) portal HTN
Most prevalent type of aneurysm
Infrarenal AAA
Matas 1888 on aneurysm
Endo-aneurysmorrhaphy for brachial artery aneurysm
Polyester graft developed by
DeBakey
Normal diameter of peripheral vessels
Celiac 0.5 SMA 0.6 CFA 0.8 pop 0.9 tib 0.3
Average aneurysm size aorta men and women
Specific inflammatory aneurysm cases
1) Takayasu 2) Giant Cell 3) Polyarteritis Nodosa 4) Behcet disease 5) Cogon Syndrome 6) Cystic medial necrosis
Galland found popliteal aneurysm association
59% have contralateral popliteal aneurysm 49% had AAA
John Hunter 1785 on aneurysm
Ligated SFA to treat popliteal aneurysm
Femoral artery when to treat
1) 3.5 cm or 2) thrombus
Connective tissue disorder associated with aneurysm
1) Ehlers-Danlos 2) Marfan 3) Loey-Dietz Syndrome 4) Cystic medial degeneration (bicuspid valve, biopsy + 75%) 5) familial thoracic aortic aneurysm syndrome 6) Turner syndrome
Dubost 1951 on aneurysm
Replace aorta with homograft suggested
Type of aneurysm etiology
1) Degenerative/atherosclerotic 2) inflammatory 3) secondary to dissection 4) developmental/congenital 5) infectious
Radiographic finding of inflammatory aneurysm
1) inflammatory rind 2) ureteral obstruction
Kommerell diverticulum
Aneurysm degeneration at origin of aberrant right subclavian
Vinyon N cloth developed by
1) Voorhees 2) Jaretski 3) Blakemore
Crawford found association % TAA with AAA and vice versa
50% TAA have AAA 12% AAA have TAA
Isolated internal iliac artery rupture on presentation %
40% difficult to diagnose asymptomatically
Repair renal artery aneurysm when
1) > 2-3 cm 2) women of child bearing age 3) refractory HTN 4) flank pain 5) hematuria
Normal aortic size at 70 yo men and women
Definition of ectasia
Intermediate enlargement not yet 50% Associated with family history of siblings getting aneurysms
Ebers Papyrus in 2000 BC on aneurysms
“Treat it with a knife and burn it with fire so that it bleeds not too much”
Aneurysm shapes
1) Fusiform 2) Concentric saccular 3) Eccentric saccular
Typical location for eccentric true sac aneurysm
1) Renal 2) Intracranial 3) Cerebral
Percent of CFA with bilateral aneurysm
26%
Percent of iliac aneurysms without AAA
11!
Aortic aneurysm incidence at 65 years of age
female: 1.7% male 5%
Danger in open repair of inflammatory aneurysms
1) duodenal injury 2) ureteral injury
