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
Investigation and management renal artery aneurysm
- CT angio
- MR angio
- Endovascular repair - if affecting main artery can use stent, if affecting hilum, may need coils and covered stent graft
Embolisation wiht coils and stent placement explained
Coil aneurysm
Place stent in main vessel, blocking aneurysm off
