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Questions and Answers
What is the primary goal of surgery in patients with dissecting aneurysms?
Which of the following medications is used to reduce pulsatile flow in patients with dissecting aneurysm?
What is the most common cause of abdominal aortic aneurysm?
What is the typical location of infrarenal aneurysms?
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What is the eventual outcome of untreated abdominal aortic aneurysm?
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What is the damaged layer of the vessel in aneurysm development?
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What is the percentage of patients with abdominal aortic aneurysms who have symptoms?
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Which of the following is a risk factor for aneurysm development?
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What is the term for a localized sac or dilation formed at a weak point in the wall of the aorta?
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What percentage of thoracic aortic aneurysm cases are caused by atherosclerosis?
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What is the most common symptom of a thoracic aortic aneurysm?
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What is the term for a very small aneurysm due to localized infection?
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What is the most common site for a dissecting aneurysm?
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What is the primary method of diagnosis for a thoracic aortic aneurysm?
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What is the most common age range for men to develop thoracic aortic aneurysm?
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What is the percentage of patients with thoracic aneurysms who die of rupture of the aneurysm?
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Study Notes
Aortic Aneurysm
- An aneurysm is a localized sac or dilation formed at a weak point in the wall of the aorta.
- Classified by its shape or form, common forms are saccular or fusiform.
- Saccular aneurysm projects from one side of the vessel only, while fusiform aneurysm develops when an entire arterial segment becomes dilated.
Types of Aneurysms
- Mycotic aneurysms: small aneurysms due to localized infection.
- Atherosclerosis: historically attributed to the cause of abdominal aortic aneurysm.
- Other causes of aneurysm formation are listed in Chart 31-5.
Thoracic Aortic Aneurysm
- Approximately 85% of cases are caused by atherosclerosis.
- Occur most frequently in men between 40 and 70 years old.
- The thoracic area is the most common site for a dissecting aneurysm.
- About one third of patients with thoracic aneurysms die of rupture of the aneurysm.
Clinical Manifestations
- Symptoms are variable and depend on how rapidly the aneurysm dilates and how the pulsating mass affects surrounding intrathoracic structures.
- Pain is the most prominent symptom, usually constant and boring, but may occur only when the person is supine.
Assessment and Diagnostic Findings
- Compression of large veins in the chest can cause dilated superficial veins of the chest, neck, or arms.
- Edematous areas on the chest wall and cyanosis are often evident.
- Pressure against the cervical sympathetic chain can result in unequal pupils.
- Diagnosis is made by chest x-ray, transesophageal echocardiography, and CT.
Medical Management
- Treatment is usually surgical repair.
- General measures: controlling blood pressure and correcting risk factors may be helpful.
- Controlling blood pressure is important in patients with dissecting aneurysms.
- Medications: antihypertensive (e.g., hydralazine, esmolol, or beta-blockers), and medications that reduce cardiac contractility (e.g., propranolol).
Surgical Repair
- Goal: to repair the aneurysm and restore vascular continuity with a vascular graft.
- Intensive monitoring is usually required after surgery, and the patient is cared for in the critical care unit.
- Endovascular grafts may decrease postoperative recovery time and complications compared with traditional surgical techniques.
Abdominal Aortic Aneurysm
- Most common cause: atherosclerosis.
- Condition is more common among Caucasians, affects men four times more often than women, and is most prevalent in elderly patients.
- Most aneurysms occur below the renal arteries (infrarenal aneurysms).
- Untreated, the eventual outcome may be rupture.
Pathophysiology
- Aneurysms involve a damaged media layer of the vessel.
- Caused by congenital weakness, trauma, or disease.
- Risk factors: genetic predisposition, smoking, and hypertension.
- More than one half of patients with aneurysms have hypertension.
Clinical Manifestations (Abdominal Aortic Aneurysm)
- About two fifths of patients have symptoms, while the remainder do not.
- Symptoms: feeling their heart beating in their abdomen, feeling an abdominal mass or abdominal throbbing.
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Description
Learn about the different types of aortic aneurysms, including their shapes, forms, and causes. Understand the characteristics of saccular, fusiform, mycotic, and atherosclerosis aneurysms.
