Peripheral and Visceral aneurysm Flashcards
Presentation of aneurysms broadly
- Asymptomatic - incidental finding
- Symptomatic but not ruptured
- Symptomatic secondary to rupture
Causes of peripheral and visceral aneurysm
- Largerly unknown - trauma, infection, connective tissue disease, inflammatory disease of arteries
- RF - smoking, HTn, high cholesterol, FH
Imaging for peripheral and visceral aneurysm
- CT angiography
- MR angiography - reduced radiation exposure if younger pts who need long f/u
- USS duplex if detecting and f/u
Management options peripheral/visceral aneurysms
- Watchful waiting + optimising medical therapy (antiplatelet + statin)
- Surgical intervention - endovascular or open
- Dependent on size, location and symptoms
Most common site for peripheral aneurysms
- Popliteal
- High risk of embolisation and/or occlusion
Presentation of popliteal aneurysms
- Symptomatically - acute limb ischaemia (aneurysm thrombosis or emboli)
- Intermittent claudication - ocassionally
- OR compression symptoms on popliteal vein or tibial nerve
- Thrombosis has 50% risk of amputation due to damage tibial vessels
- Can be incidentally when AAA repair workup or knee replacement
Investigations for popliteal aneurysm
- US duplex scan - differentiate between other causes eg Bakers cyst or lymphadenopathy
- Also allows to check for thrombosis or embolisation
- Later - CT angiogram or MR angiogram - allow anatomical assessment and patency
Management popliteal aneurysm - when to treat
- Symptomatic - treat regardless of size
- Distal embolisation on imaging - treat early stage
- If asymptomatic but larger than 2.5cm - treat
If thrombosis and no patent tibial vessel, what can be attempted?
- Thrombolysis or embolectomy
- Improves supply prior to or at time of bypass surgery
osis
Surgical options popliteal aneurysm
- Endovascular repair - stent across aneurysm, need normal calibre below and above artery for stent to seal in
- Surgical repair - ligation of aneurym, or resection with bypass graft (vein or graft)
Endovascular repair for popliteal aneurysm risk
- Risk of continued aneurysm sac filling through collateral vessels
- Instent thrombosis
- Done under local anaesthetic though so preferred for unfit patients
How is surgical repair of popliteal aneurysm done
- Above and below knee popliteal bypass
- Or posterior approach to knee, open up aneurysm sac and inserting tube graft from top to bottom
Femoral artery aneurysm cause
- Typically pseudoaneurysms
- Due to trauma from percutaneous interventions
- Patient self injecting - IV drug users into groin
Presentation femoral artery aneurysm
- Thrombosis, rupture, or embolisation
- In IVDU can have infection
- = varying degrees claudication, acute limb ischaemia or can be asymptomatic with swelling in groin
Investigations and management femoral aneurysm
- USS duplex then CT angio/MR angio
- Open surgical repair
Most common arteries affected by visceral aneurysms
- Splenic
- Hepatic
- Renal
RF for splenic aneurysm development
- Female
- Multiple pregnancies
- Portal HTN
- Pancreatitis or pancreatic pseudocyst
Presentation of splenic aneurysm
- Epigastric or LUQ pain
- Rupture = severe abdo pain and haemodynamic compromise
Investigations splenic artery
- CT angio
- MR angio
- US can be used for monitoring
Management splenic aneurysm
- Endovascular repair
- Embolisation or covered stent grafts once stable
Hepatic artery aneurysm - how
- Percutaneous instrumentation
- Others can be trauma, degenerative disease, post transplant - false aneurysm around vessel anastomoses
Presentation of hepatic artery aneurysm
- Vague RUQ pain
- Or epigastric pain
- Jaundice can occur if biliary obstruction
Investigation and managament hepatic aneurysm
- CT angio or MR angio
- Endovascular repair - embolisation or covered stent grafts
Renal artery aneurysm
- Often found incidentally
- Asympotmatic
- If symptomatic - haematuria, resistant hypertension, loin pain
