peripheral and visceral artery aneurysms Flashcards
what is an aneurysms?
a persistent, abnormal dilatation of an artery above 1.5 times its normal diameter.
what are the risk factors for aneurysms?
- smoking
- hypertension
- hyperlipidaemia
- family history
NB: The aetiology of most peripheral and visceral aneurysms is largely unknown
what investigations are done?
- CT angiography is best option
- MRI angiography is alternative due to reduced risk of kidney damage and radiation
- US duplex scan can be used for detection and follow up
how are peripheral and visceral artery aneurysms managed generally?
watchful waiting
medical therapy e.g statins and anti platelets
smoking cessation
surgical intervention (endovascular or open) depending on location, size and symptoms
where do the most common peripheral artery aneurysm occur?
popliteal and femoral artery
how do popliteal artery aneurysms present?
symptomatically as either acute limb ischaemia (from aneurysm thrombosis or distal emboli)
may also get intermittent claudication
may also be found incidentally, or from compression symptoms from popliteal vein or perineal nerve
how are popliteal artery aneurysms investigated?
ultrasound duplex sound initially to allow differentiation between other causes of popliteal fossa swelling e.g bakers cyst
further imaging will often be CT angiogram or MR angiogram for anatomical assesment
what are the criteria for popliteal artery aneurysms management?
symptomatic = should be treated regardless of size due to embolic risk
asymptomatic but >2.5cm, treat
thrombosis, if theres no patient tibial vessel then embolectomy of thrombosis can be attempted to improve run off prior to/ at the time of bypass surgery
how can popliteal artery aneurysms be managed surgically?
Endovascular repair involves stent insertion across the aneurysm and requires a normal calibre artery above and below the aneurysm for the stent to seal in
Surgical repair involves ligation of the aneurysm or resection of the aneurysm with a bypass graft (either a vein from the patient (preferred) or a graft)
what are the main causes of femoral artery aneurysms?
- percutaneous vascular interventions
- patient self injecting
NB: femoral artery aneurysms are typically pseudo aneurysms
how do patients with a femoral artery aneurysm present?
signs and symptoms are either from
- thrombosis
- rupture
- embolisation
of the aneurysm
if an IVDU, concurrent infection may also be present
as a result, will have varying degrees of claudication or acute limb ischaemia
how are patients with femoral artery aneurysms investigated and managed?
- US duplex scan is the initial management for aneurysms
- CT angiography for further imaging and operative planning
- mainstay treatment is open surgical repair
what visceral arteries are most commonly affected by aneurysms?
splenic artery, hepatic artery, and renal artery.
splenic is most common
how do splenic artery aneurysms present?
vague epigastric or LUQ pain
rupture = present with severe abdominal pain and haemodynamic compromise
how are splenic artery aneurysms investigated and managed?
investigation
- CT angiography
- USS can sometimes be used by only in thinner patients really
management
- endovascular repair
