Aneurysm

Question 1

Aneurysm, what is it

Answer 1

• an abnormal dilations in the blood vessels
• occurs in any arteries: aorta, femoral, iliac, popliteal, cerebral, and sometimes veins, but way less common due to low pressure system

Question 2

List the Different categories of aneurysm

Answer 2

• True aneurysm: all layers of the blood vessels are dilated, subdivided into
  .Fusiform aneurysm -> true aneurysm balloting out symmetrically
  .Saccular (berry) aneurysm -> asymmetrical aneurysm: balloting only on one side (one side weaker)
• Pseudoaneurysms: false aneurysms
  Caused by a small whole in the vessel -> causing the blood to leak out and form something that looks like a berry or fusiform aneurysm

Question 3

Aortic aneurysm: locations

Answer 3

• Aorta most commonly
• Abdominal aorta (60%), below the renal artery and above the aortic bifurcation (due to less elastin -> weaker)
• Thoracic aorta (40%)

Question 4

Aortic aneurysm: C

Answer 4

• due to a weakness in the blood vessel wall

Question 5

Aortic aneurysm: E

Answer 5

1) HTN
If HTN occurs in the vasavasorum -> development of hyaline arteriosclerosis -> causing narrowing of their lumen -> causing ischemia to the aortic wall -> weakening of the aortic wall

2) Atherosclerosis
Mostly seen in the abdominal aorta

3) Tertiary syphilis
causes inflammation in the tunica intima of the vasa vasorum -> narrowed lumen -> restricted blood flow to the aortic aorta

4) Bacterial infections
Called mycotic aneurysms: emboli bacterias go to intracranial arteries, visceral arteries or arteries feeding arms and legs -> weakens vessel walls -> aneurysm

5) Genetic disorders
.Marfan syndrome
.Ehler’s danlos syndrome
.Cystic medial degeneration

Question 6

Aortic aneurysm: Complications

Answer 6

• intact aneurysms: no symptoms, unless in compresses organs/vessels around it -> Inf/Sup vena cava -> decreased venous return to the heart
• Rupture: causing ischemia to the downwards tissues
• aortic insufficiency: if the thoracic aneurysms is right above the aortic valve -> pulls aortic valves away -> preventing it from closing
• Subarachnoid bleeding: causing pressure in brain tissue -> causing irritation of the meninges -> intense headache + inability to flex the neck forward
• Blood clot formation

Question 7

Aortic aneurysm: signs and symptoms

Answer 7

• Abdominal aortic aneurysms: severe pain in the left flank, pulsatile mass, hypotension (classic sign of abdominal aortic aneurysms)
• thoracic aortic aneurysms: usually no symptoms, severe back and abdominal pain,

Question 8

Aortic aneurysm: diagnosis

Answer 8

• imaging
• US, CT, MRI
• aortography is the preferred diagnostic modality for the evaluation of thoracic aortic aneurysm, although tranesophageal echocardiography and computed tomography scanning are often used before this

Question 9

Aortic aneurysm: T

Answer 9

• surgery

Question 10

Charcot Bouchard micro aneurysms:

Answer 10

• type of central nervous system aneurysm associated with chronic HTN and commonly affects the small vessels of the deep brain