Aortic Pathology Flashcards
(34 cards)
What is an aneurysm?
It is defined if there is permanent dilation of the artery to twice its normal diameter.
What is the normal diameter of the aorta?
2cm
What are the two classifications of an aneurym?
True or false
What is a true aneurysm?
It is an abnormal dilation that involves all layers of the arterial wall
What arteries are most commonly involved in a true aneurysm?
- Abdominal aorta (most common)
- Iliac
- Popliteal and femoral arteries
- Thoracic aorta
What is a false aneurysm?
Involves the collection of blood in the outer layer only (adventia) which communicates with the lumen
What is the commonest site for a false aneurysm?
Infrarenal abdominal artery
What causes an abdominal aortic aneurysm?
Degradation of the elastic lamellae resulting in leukocyte infiltrate causing enhanced proteolysis and smooth muscle cell loss.
Where do abdominal aortic aneurysms most commonly occur?
In the renal arteries
What are the risk factors for abdominal aortic aneurysms?
- Severe atherosclerotic damage - most common
- Family history
- Smoking
- Male
- Increasing age
- Hypertension
- COPD
- Trauma
- Hyperlipidaemia
What is the presentation of an unruptured aortic aneurysm?
Often asymptomatic. Pain in loin, groin and back, pulsatile abdominal swelling
What would make an aortic aneurysm more likely?
If the patient has increased blood pressure, if they’re a smoker, if they’re female or if they have a family history.
How would a ruptured abdominal aortic aneurysm present?
- Intermittent or continuous abdominal pain (radiates to the back, iliac fossa’s or groin)
- Pulsatile abdominal swelling (more pronounced)
- Collapse
- Hypotension
- Tachycardia
- Profound anaemia
- Sudden death
What investigations would you do if you suspected an aortic aneurysm?
Abdominal ultrasound, CT and MRI
What is the non pharmacological management for abdominal aortic aneurysm?
- Small ones are just monitored
- Treat the underlying cause
- Modify risk factors
What is the pharmacological treatment for an abdominal aortic aneurysm?
Rigorous BP control
When would surgical treatment be used in an abdominal aortic aneurysm?
When the aneurysm is symptomatic, more than 5.5cm and expandly yearly
What are the two surgical options for aneurysm?
- Open surgical repair - replace segment of artery with plastic tube
- Endovascular repair - stent inserted via femoral or iliac arteries
What is the pathology of a thoracic aortic aneurysm?
Involves inflammation, proteolysis and reduced survival of the smooth muscle cells in the aortic wall. Once the aorta reaches a crucial diameter it loses all distensibility so that a rise in BP to around 200mmHg can exceed the arterial wall strength and may trigger dissection or rupture
What are some causes of thoracic aortic aneurysms?
- Strong genetic link
- Connective tissue disorders e.g Marfans
- Aortic dissection in some cases
- Weight lifting, cocaine and amphetamine use ( prehaps sure to large rise in BP when doing these activities)
What are the risk factors of thoracic aortic aneursyms?
- Hypertension
- Increasing age
- Smoking
- Bicuspid or unicuspid aortic valves
- Atherosclerosis
- COPD
- Renal failure
- Previous aortic aneurysm repair
What is the usual presentation of TAA’s?
Usually asymptomatic and found by accident
What are the symptoms of TAA if not asymptomatic and what are these due to?
Chest pain and hemoptysis - due to the compression of local structures
What are the signs of TAA?
- Aortic regurgitation
- Fever if there is infective cause
- Collapse, shock and sudden death
- Cardiac tamponade
