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Vascular YR3 > Peripheral and Visceral aneurysm > Flashcards

Peripheral and Visceral aneurysm Flashcards

1
Q

Presentation of aneurysms broadly

A
  • Asymptomatic - incidental finding
  • Symptomatic but not ruptured
  • Symptomatic secondary to rupture
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2
Q

Causes of peripheral and visceral aneurysm

A
  • Largerly unknown - trauma, infection, connective tissue disease, inflammatory disease of arteries
  • RF - smoking, HTn, high cholesterol, FH
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3
Q

Imaging for peripheral and visceral aneurysm

A
  • CT angiography
  • MR angiography - reduced radiation exposure if younger pts who need long f/u
  • USS duplex if detecting and f/u
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4
Q

Management options peripheral/visceral aneurysms

A
  • Watchful waiting + optimising medical therapy (antiplatelet + statin)
  • Surgical intervention - endovascular or open
  • Dependent on size, location and symptoms
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5
Q

Most common site for peripheral aneurysms

A
  • Popliteal
  • High risk of embolisation and/or occlusion
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6
Q

Presentation of popliteal aneurysms

A
  • 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
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7
Q

Investigations for popliteal aneurysm

A
  • 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
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8
Q

Management popliteal aneurysm - when to treat

A
  • Symptomatic - treat regardless of size
  • Distal embolisation on imaging - treat early stage
  • If asymptomatic but larger than 2.5cm - treat
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9
Q

If thrombosis and no patent tibial vessel, what can be attempted?

A
  • Thrombolysis or embolectomy
  • Improves supply prior to or at time of bypass surgery
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10
Q

osis

Surgical options popliteal aneurysm

A
  • 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)
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11
Q

Endovascular repair for popliteal aneurysm risk

A
  • Risk of continued aneurysm sac filling through collateral vessels
  • Instent thrombosis
  • Done under local anaesthetic though so preferred for unfit patients
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12
Q

How is surgical repair of popliteal aneurysm done

A
  • Above and below knee popliteal bypass
  • Or posterior approach to knee, open up aneurysm sac and inserting tube graft from top to bottom
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13
Q

Femoral artery aneurysm cause

A
  • Typically pseudoaneurysms
  • Due to trauma from percutaneous interventions
  • Patient self injecting - IV drug users into groin
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14
Q

Presentation femoral artery aneurysm

A
  • Thrombosis, rupture, or embolisation
  • In IVDU can have infection
  • = varying degrees claudication, acute limb ischaemia or can be asymptomatic with swelling in groin
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15
Q

Investigations and management femoral aneurysm

A
  • USS duplex then CT angio/MR angio
  • Open surgical repair
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16
Q

Most common arteries affected by visceral aneurysms

A
  • Splenic
  • Hepatic
  • Renal
17
Q

RF for splenic aneurysm development

A
  • Female
  • Multiple pregnancies
  • Portal HTN
  • Pancreatitis or pancreatic pseudocyst
18
Q

Presentation of splenic aneurysm

A
  • Epigastric or LUQ pain
  • Rupture = severe abdo pain and haemodynamic compromise
19
Q

Investigations splenic artery

A
  • CT angio
  • MR angio
  • US can be used for monitoring
20
Q

Management splenic aneurysm

A
  • Endovascular repair
  • Embolisation or covered stent grafts once stable
21
Q

Hepatic artery aneurysm - how

A
  • Percutaneous instrumentation
  • Others can be trauma, degenerative disease, post transplant - false aneurysm around vessel anastomoses
22
Q

Presentation of hepatic artery aneurysm

A
  • Vague RUQ pain
  • Or epigastric pain
  • Jaundice can occur if biliary obstruction
23
Q

Investigation and managament hepatic aneurysm

A
  • CT angio or MR angio
  • Endovascular repair - embolisation or covered stent grafts
24
Q

Renal artery aneurysm

A
  • Often found incidentally
  • Asympotmatic
  • If symptomatic - haematuria, resistant hypertension, loin pain
25
Q

Investigation and management renal artery aneurysm

A
  • CT angio
  • MR angio
  • Endovascular repair - if affecting main artery can use stent, if affecting hilum, may need coils and covered stent graft
26
Q

Embolisation wiht coils and stent placement explained

A

Coil aneurysm
Place stent in main vessel, blocking aneurysm off

27
Q
A

Vascular YR3 (16 decks)

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