7. Aortic Aneurysm

What are the three types of aortic aneurysm?

1. An aortic root aneurysm, or aneurysm of the sinus of Valsalva 2. Thoracic Aortic aneurysm (further classified: ascending, arch, descending) 3. Abdominal Aortic Aneurysm - most common

What is the Tx of a ruptured aortic aneurysm?

1. Summon vascular surgeon and anaesthetist 2. ECG 3. Blood - amylase, Hb, crossmatch 4. Catheter 5. 2 Large bore cannulas for IV access 6. Blood transfusion (ORh- if desperate) 7. Keep SBP <100 8. Take pt straight to theatre 9. Prophylactic ABx 10. Surgery - clamp above leak and insert a dacron graft (tube/trouser graft)

What is the prognosis of a ruptured aortic aneurysm?

10% survive

When can you opt for elective surgery for an aortic aneurysm? What do they do?

>5.5cm or expanding at more than 1cm/year or symptomatic Stenting - EVAR (endovascular treatment of aortic aneurysms - stenting via femoral artery)

What is a true aneurysm? What is a false aneurysm?

A true aneurysm is one that involves all three layers of the wall of an artery (intima, media and adventitia) A false aneurysm, or pseudo-aneurysm, is a collection of blood leaking completely out of an artery or vein, but confined next to the vessel by the surrounding tissue. This blood-filled cavity will eventually either thrombose (clot) enough to seal the leak, or rupture out of the surrounding tissue - can be caused by trauma e.g. knife wounds

Who is screened for AAA?

All men >65yo

What is an aortic aneurysm defined as?

An aortic aneurysm is enlargement (dilation) of the aorta to greater than 1.5 times normal size. They usually cause no symptoms except when ruptured.

What are the RFs for developing an aneurysm?

Coronary artery disease Hypertension Hypercholesterolemia Hyperhomocysteinemia Elevated C-reactive protein Tobacco use Peripheral vascular disease Marfan syndrome Ehlers-Danlos type IV Bicuspid Aortic Valve Syphilis

Why are AAA's the most common aortic aneurysm?

Elastin is reduced in the abdominal aorta compared to the thoracic aorta. It also doesn't have a vasa vasorum, the nutrient-supplying blood vessels within the wall of the aorta.

What are the RF's for rupture?

Female BP Smoker FHx

What is a fusiform aneurysm?

Fusiform aneurysms ("spindle-shaped" aneurysms) are variable in both their diameter and length.

What are the S&S of a ruptures aneurysm?

Intermittent/continuous back pain Expansile abdo mass Shock

What are the symptoms associated with an aortic aneurysm?

Most intact aortic aneurysms do not produce symptoms. As they enlarge, symptoms such as abdominal pain and back pain may develop. Compression of nerve roots may cause leg pain or numbness. In patients presenting with aneurysm of the arch of the aorta, a common sign is a hoarse voice from stretching of the left recurrent laryngeal nerve

What are the complications of an aortic aneurysm?

Rupture Thrombosis Embolism Fistulae Pressure on other structures

What is a saccular aneurysm?

Saccular aneurysms are spherical in shape and involve only a portion of the vessel wall, they often contain thrombus

What are the two ways of describing an aneurysm in terms of morphology?

Saccular or Fusiform

What is the medical therapy of an aortic aneurysm?

Statins and B blockers (also stop smoking)

What usually causes an AAA?

They can occur as a result of trauma, infection, or, most commonly, from an intrinsic abnormality in the elastin and collagen components of the aortic wall. Both thoracic and abdominal aortic aneurysms demonstrate a strong genetic component in their aetiology

Are most AAA's true or false aneurysms?

True

What are the two types of thoracic aortic dissection?

Type A: Ascending aorta (70%) Type B: Descending aorta (30%)