Peripheral and Visceral Artery Aneurysms Flashcards
Risk factors
Smoking
HTN
Hyperlipidaemia
FH
Possible causes
Trauma
Infection
Marfan’s/EDS
Takayasu’s
Broadly speaking how will they present?
Asymptomatic and found incidentally
Symptomatic but not rupture
Symptomatic secondary to a rupture
Investigation
Best is CT angiography
MR angiography is a good alternative due to less risk of kidney damage from radiation
US duplex scans can be useful for detection and follow up.
General management
Watchful waiting with antiplatelets and statin therapy and smoking cessation
Surgical intervention that is endovascular or open depending on location and size
What are the most common peripheral artery aneurysms?
Popliteal artery (70-80%) and femoral artery aneurysms.
Why are popliteal aneurysms dangerous?
High risk of embolisation and/or occlusion
Clinical features of PopAA
Usually present symptomatically with either ALI or less commonly with intermittent claudication
Thrombosis of a popliteal aneurysm has a 50% amputation rate due to trash to the tibial vessels.
They can however also be found incidentally, from e.g. compression symptoms on the poplitea vein or peroneal nerve.
Investigations of PopAA
Ultrasound duplex scan to dx from popliteal fossa swelling like Baker’s cyst or lymphadenopathy.
Further imaging will often be via CT angiogram or MR angiogram.
When should symptomatic popliteal aneurysms be treated?
Always regardless of size due to risk of embolic events.
When should asymptomatic popAA be treated?
>2.5cm should be considered for treatment
If there is a large thrombus load a lower threshold should be considered
Surgical approaches of popAA
Endovascular repair
Surgical repair
Explain endovascular repair
Stent insertion across the aneurysm
This requires the artery above and below aneurysm to be well.
Risks of endovascular repair
Incur risks of continued aneurysm sac filling through collateral vessels and in-stent thrombosis can occur.
This is however the preferred choice in unfit patients
Explain surgical repair of popAA
Ligation of the aneurysm or resection of it with a bypass graft
The graft can be from a vein of the patient or a synthetic graft.
Femoral artery aneurysms are typically pseudoaneurysms.
Two major causes of FeAA
Percutaneous vascular interventions
Patient self-injecting into femoral artery.
Clinical features of FeAA
The symptoms and signs are from either thrombosis, rupture or embolisation of the anuerysm
In IVDU infection might also be concurrent
There will be varying degrees of claudication or ALI
But often no symptoms more than swelling in the groin
Investigations of FeAA
US duplex scan first
Then CT angiography or MR angiography for anatomical mapping and operative planning
Mainstay treatment for FeAA
Open surgical repair
Endovascular repair is very rarely performed
Visceral arteries most commonly affected in aneurysm formation
Splenic artery
Hepatic artery
Renal artery
Main risk factors of splenic artery aneurysm
Female
Multiple pregnancies
Portal HTN
Pancreatitis
Pancreatic pseudocyst formation
Clinical features of SpAA
Vague epigastric or LUQ pain
Those that rupture will present with severe abdo pain and haemodynamic compromise
Investigations of SpAA
CT angiography or MR angiography
First line management of SpAA
Endovascular repair with embolisation or covered stent grafts.
Open repair might be advised if the patient is unstable
