Aneurysms Flashcards
(26 cards)
What is the definition of an abnormal bulge in a vessel and what is the specific size threshold for an abdominal aortic aneurysm (AAA)?
An abnormal bulge in a vessel, also known as an aneurysm, is characterized by an enlargement of more than 50% of the normal diameter of the vessel. For an abdominal aortic aneurysm (AAA), it is considered when the diameter exceeds 3 cm
What are the characteristics of true and false aneurysms?
True aneurysms have an intact vessel wall, whereas false aneurysms occur due to a hole in the vessel wall, leading to a pool of blood formation that mimics an aneurysm
What are the risk factors and etiological factors associated with aneurysm formation?
Older age, male gender, family history, atherosclerosis, hypertension, and smoking.
Atherosclerosis, infections (e.g., syphilis, Escherichia coli, Salmonella), trauma, and genetic conditions (e.g., Marfan’s or Ehlers–Danlos syndrome)
Describe the pathophysiology of aneurysm formation, particularly focusing on the role of elastin and collagen proteins.
The weakening of the vessel wall is due to the loss of elastin and collagen proteins in the tunica media.
During atherosclerosis, macrophages release enzymes that break down collagen and elastin, leading to the expansion of the tunica media.
This weakening of the vessel wall causes it to bulge, with the most common location being below the renal arteries
Clinical presentation of Asymptomatic aneurysms
75% asymptomatic (incidental finding) until rupture
How to know if its a symptomatic aneurysm?
Sudden onset pain
Describe Proximal AAA symptomatic aneurysm.
upper abdomen radiating to back pain
Describe distal AAA symptomatic aneurysm.
lower abdomen radiating to back pain
Describe Unruptured aneurysm symptomatic aneurysm
vague, nonspecific pain
Describe ruptured aneurysm symptomatic aneurysm
sudden onset severe pain, pulsating mass with heartbeat, hypotension
What are the other signs of an abdominal aortic aneursym other that sympomatic and symptomatic causes?
5.5cm AP diameter
Rapid expansion of >1cm per year
Trashy foot - embolisms moving from the aorta to the peripheral
Collapse (due to hypotension)
Tachycardia
Investigations for monitoring abdominal aortic aneurysm
Monitoring - Ultrasound
= - Shows AAA presence, AP diameter, iliac involvement
- Monitoring program for all men >65 in the UK
Ruptured AAA investigation is what?
CT Angiography
Surgical management for an unruptured abdominal aortic aneurysm
Elective Aneurysm repair
= is a prophylactic operation to reduce the risk of rupture balanced against the risk of the procedure.
> 5.5 cm in diameter or rapid expansion
Surgical management for an ruptured abdominal aortic aneurysm
Emergency Aneurysm repair
= is a therapeutic procedure balancing the expectation of death against the risk of the procedure
> EVAR - Stent to open lumen
Open Lap - Opening of the chest cavity, clamping either side of the aneurysm, stitching graft to the aorta
Scanning regime for an aneurysm <3cm in size
Discharge
Scanning regime for an aneurysm 3-4.4 in size
Annual surveillance
Scanning regime for an aneurysm 4.5-5.4cm in size
3 monthly surveillance
Scanning regime for an aneurysm >5.5cm in size
urgent referral for surgery
What is a thoracoabdominal Aortic Aneurysm?
aneurysms that coexist in both segments of the aorta (thoracic and abdominal)
How does aneurysm formation occur in the aorta according to the provided information?
Aneurysm formation begins when blood enters through the intima and splits the media of the aorta
What are the two types of aortic aneurysms mentioned in the context of their location and prevalence?
Type A aneurysms
= comprising about 2/3 of cases, involve the ascending aorta and may extend to the descending aorta. They are commonly associated with Marfan syndrome.
Type B aneurysms
= representing the remaining 1/3 of cases, affect only the descending aorta. They are typically secondary to atherosclerosis and, less commonly now, syphilis.
What clinical feature distinguishes aneurysms involving both segments of the aorta? (abdominal and Thoracoabdominal)
Presents as sudden tearing chest pain radiating to the back
Investigations for thoracoabdominal aortic aneurysm
Imaging - CT or MRI
