less common arterial aneurysms

Question 1

aetiology of sublcavian artery aneurysms

Answer 1

-Post-stenotic. This is related to the thoracic outlet -syndrome –arterial type (a- TOS)
· Non-specific degenerative type 
· HIV-related
· Intimo-medial mucoid degeneration
· Tuberculous aneurysms 
· Trauma
· Fibromuscular dysplasia (FMD)

Question 2

clinical features of subclavian artery aneurysms

Answer 2

· Upper limb ischaemia
· Brachial plexus compression
· Limb swelling (venous compression)
· Stroke (rare complication)
· Hoarseness
· Stridor
· Pulsatile mass

Question 3

treatment of subclavian artery aneurysms

Answer 3

symptomatic = needs treatment
asymptomatic and < 2.5cm = observation
- open surgical repair
- endovascular repair with covered stent

Question 4

aetiology of extracranial carotid aneurysms

Answer 4

· Non-specific degerative
· HIV-related
· Tuberculous
· Trauma
· Anastomotic - following carotid surgery

Question 5

clinical features of extracranial carotid aneurysms

Answer 5

· Pulsatile mass
· Stroke
· Transient ischaemic attacks(TIAs)
· Hoarseness
· Stridor
· Dysphagia
· Odynophagia
· Nerve compression (e.g.hypoglossal n, facial n)
· Horner’s syndrome

Question 6

treatment of extracranial carotid aneurysms

Answer 6

open surgical repair

endovascular repair - trauma patients or to avoid sternotomy - not advised for infected aneurysms

Question 7

which vessels are involved in mesenteric aneurysms

Answer 7

Splenic artery aneurysms (60%)
hepatic artery aneurysms (20%)
superior mesenteric artery aneurysms (6%).

Question 8

aetiology of mesenteric artery aneurysms

Answer 8

· Non-specific degerative aneurysms
· HIV-related
· Initimo-medial mucoid degeneration
· Connective tissue disorders=Ehlers-Danlos syndrome
· Polyarteritis nodosa
· Pregnancy-related

Question 9

clinical features of mesenteric artery aneurysms

Answer 9

asymptomatic
symptomatic
rupture

Question 10

treatment of mesenteric artery aneurysms

Answer 10

open surgical repair
endovascular treatment
transcatheter coil embolisation

Question 11

morphology of renal artery aneurysms and where they are found

Answer 11

90% of true renal artery aneurysms are extrarenal

75% of these are sacular

Question 12

aetiology of renal artery aneurysms

Answer 12

· Non-specific degenerative
· Fibromuscular dysplasia (FMD) 
· Ehlers-Danlos syndrome
· Polyarteritis nodosa
· Trauma
· Dissection

Question 13

clinical features of renal artery aneurysms

Answer 13

· Most are asymtomatic and detected on routine angio- imaging
· Pain
· Haematuria
· Renovascular hypertension
· Rupture =most feared complication.

Question 14

tretment of renal artery aneurysm

Answer 14

open surgical repair
transcatheter coil embolisation
endovascular treatment using covered stents