13. Aneurysm.pptx

Aneurysm A V Fistula Aneurysm • An aneurysm is a bulging or ballooning of the wall of a blood vessel, usually an artery, due to weakening • A bulge is called an aneurysm when the dilation is at least 50% of the normally expected diameter of the vessel • Aneurysms - do not cause any symptoms / sudd...

Aneurysm A V Fistula Aneurysm • An aneurysm is a bulging or ballooning of the wall of a blood vessel, usually an artery, due to weakening • A bulge is called an aneurysm when the dilation is at least 50% of the normally expected diameter of the vessel • Aneurysms - do not cause any symptoms / sudden bursting of the aneurysm Types of aneurysms • Aneurysms are either classified by their location in the body or based on their shape. • Aortic aneurysm: This aneurysm is located in the aorta Abdominal aortic aneurysm (AAA): most common aneurysm of the aorta. Thoracic aortic aneurysm (TAA) • Cerebral aneurysm • Peripheral aneurysms Peripheral aneurysm • Carotid artery aneurysm • Femoral artery aneurysm • Mesenteric artery aneurysm • Popliteal aneurysm: most common peripheral aneurysm • Splenic artery aneurysm • Visceral aneurysm: bowel or kidneys Aneurysms based on shape • Fusiform aneurysms: all sides of a blood vessel • Saccular aneurysms: formed only on one side of the vessel • Berry aneurysm: looks like a berry on a narrow stem. It is the most common type of cerebral aneurysm • Pseudo aneurysm or false aneurysm: Breach in the layers of the vessel wall causes blood to leak. The leakage gets contained by the surrounding soft tissue or the perivascular tissue of the blood vessel thus creating a pseudo aneurysm. direct communication of blood flow between the lumen of the aneurysm and that of the vessel. Types of aneurysm Pseudoaneurysm Causes • Weakening of all three layers of the arterial walls Degradation of the elastic lamellae of the blood vessel Accumulation of a leukocytic infiltrate Enhanced proteolysis within the wall Smooth muscle cell loss within the wall Predisposing factors • Atherosclerosis • High blood pressure: damages and weakens the walls of blood vessels • Diseases of blood vessels: Systemic conditions may cause vasculitis or inflammation of the blood vessels • Mycotic or infected aneurysm: • Congenital : from birth as an arterial defect. Risk factors • Age: more often in people of age 65 and older • Family history: aneurysm in a first-degree relative • Gender: Men are likely to develop AAA more often than women Women are more likely to develop cerebral aneurysms • Hypertension • Obesity • Poor dietary habits • Sedentary lifestyle • Smoking tobacco Symptoms • clinically silent • symptoms usually depend on the location of the aneurysm. • Abdominal aortic aneurysms (AAA) asymptomatic and slow-growing. In some cases, the aneurysm may never rupture. An enlarging AAA may present with: Back pain Deep, constant pain in the abdomen or on the side abdomen Pulsation near the umbilicus TAA • effect on nearby nerves and other blood vessels cause symptoms like: Breathing difficulties Difficulty in swallowing Pain in the jaw, chest, and upper back Hoarseness of voice Persistent cough Shortness of breath Aortic aneurysm Cerebral aneurysm • In unruptured cerebral aneurysm, symptoms may include: • Blurred or double vision • Pain above and behind one eye and a dilated pupil • Numbness of one side of the face • A ruptured aneurysm may present with: • Blurred or double vision • Confusion • Drooping of eyelid • Loss of consciousness • Nausea and vomiting • Seizure • Sensitivity to light • Stiff neck • Sudden, extremely severe headache • Common Iliac Artery Aneurysm • Atherosclerosis • Pregnancy • Infection • Trauma after lumbar or hip surgery • Femoral and Popliteal Artery Aneurysm • Atherosclerosis • Trauma • Congenital disorders Complications • sudden rupture, obstruction to blood flow, and/or clot formation. • Thromboembolism: obstruction to the flow of blood to adjacent tissues and organs. Turbulence in blood flow leads to the formation of blood clots or thrombi that may get disseminated and obstruct smaller blood vessels A thrombus on reaching the brain may obstruct the blood flow to the brain and lead to ischemic stroke or other serious complications. Sudden rupture • Severe pain in the chest or back: Rupture of an aortic aneurysm may cause severe unbearable pain in the chest or back region. • Angina pectoris: Sometimes an aneurysm can cause angina pain or sudden pain in the chest that can lead to the obliteration of the blood flow to the heart, thereby causing myocardial ischemia or heart attack. • Subarachnoid hemorrhage (SAH) and stroke: Rupture of an aneurysm in the brain is life-threatening due to the chances of bleeding into the space surrounding the brain • Hydrocephalus • Coma Aortic aneurysm dissection Diagnosis • In majority cases, aneurysms remain undetected • Diagnose aneurysm based on medical history, physical examination, and medical investigations. Sometimes an aneurysm may be detected accidentally • Investigations: • Doppler ultrasound • CT Scan: A ruptured aneurysm with the presence of symptoms and the risk of bleeding in the brain is preferred to be evaluated with a CT scan. • MRI Scan: An aneurysm that has not yet ruptured can be evaluated with an MRI if symptoms are present. • Angiogram: requiring surgery, can be evaluated with an angiogram to identify the exact area that requires surgical repair. Calcified aneurysm Contrast CT Scan Magnetic resonance imaging Angiography • preoperative evaluation in patients with manifestations of atherosclerotic vascular disease, such as renal artery stenosis or peripheral vascular disease. Angiogram Management options • Routine ultrasound procedures. These procedures will monitor the size and rate of growth of the aneurysm every 6 months to 12 months as part of a "watchful waiting" approach for smaller aneurysms. • Controlling or modifying risk factors. Steps such as quitting smoking, controlling blood sugar if diabetic, losing weight if overweight or obese, and controlling dietary fat to control the progression of the aneurysm. • Medication. Medication can control factors such as hyperlipidemia and/or high blood pressure. • Surgery: Goal of treatment • size of the aortic aneurysm and how fast it’s growing. • Medical monitoring • manage other medical conditions, such as high blood pressure, that could worsen aneurysm. • abdominal ultrasound at least six months after your aneurysm is diagnosed and at regular follow-up exams. • smoking cessation and blood pressure control Treatment • Surgery • Repair is generally recommended if your aneurysm is 1.9 to 2.2 inches (4.8 to 5.6 centimeters) or larger or if it’s growing quickly • Open abdominal surgery for AAA: - area damaged by the aneurysm is then separated surgically from the main part of the aorta and replaced with an aortic graft Treatment • Endovascular repair: A less invasive alternative to open surgical repair is endovascular aneurysm repair (EVAR) using a special device called an endovascular stent graft Repair popliteal artery aneurysm Arteriovenous (AV) fistula • Irregular connection between an artery and a vein • Blood flows directly from an artery into a vein bypassing capillaries • Tissues below the avoided capillaries receive less blood • AVFs can be found in any area of the body. However, some locations may be more common, depending on the type of AVF. • There are two general types of AVF: • Congenital: Congenital AVFs are present from birth. • Acquired: Acquired AVFs are those that develop over the course of your lifetime. Congenital • Congenital AVFs are present from birth - occur due to irregularities during fetal development • Genetic condition. Some genetic conditions cause AVF • Some general areas where congenital AVFs may be found in: heart lungs brain liver • Congenital AVFs usually aren’t treated unless they become symptomatic, often later in adulthood. Acquired • Trauma from surgery or an injury - develop at or near the site of trauma Stab / Gunshot wounds / Head injuries • Certain types of procedures that are more likely to be associated with AVF formation. Cardiac catheterisation Needle biopsy • Surgically created – hemodialysis • Risk factors • Certain genetic or congenital conditions increase the risk of arteriovenous fistulas. Other potential risk factors for arteriovenous fistulas include: • Older age • Female sex • Cardiac catheterization, especially if the procedure involves blood vessels in the groin • Certain medications, including some blood thinners (anticoagulants) and medications used to control bleeding (antifibrinolytics) • High blood pressure • Increased body mass index (BMI) Symptoms • Small arteriovenous fistulas in the legs, arms, lungs, kidneys or brain often won't have any signs or symptoms. Large arteriovenous fistulas may cause signs and symptoms. • Purplish, bulging veins seen through the skin, similar to varicose veins • Swelling in the arms or legs • Decreased blood pressure • Fatigue • Heart failure Signs and symptoms • A significant arteriovenous fistula in the lungs (pulmonary arteriovenous fistula) can cause: Pale gray or blue lips or fingernails due to lack of blood flow (cyanosis) Fingertips to spread out and become rounder than normal (clubbing) Coughing up blood • An arteriovenous fistula in the digestive tract can cause gastrointestinal (GI) bleeding. Symptoms • Brain: AVFs in or around the brain can lead to: • severe headache • nausea or vomiting • Liver: An AVF in the liver can cause symptoms like: • abdominal pain • blood in the stool • Kidney: When an AVF is around the kidneys Symptoms • Asymptomatic • Limbs: Pain and swelling of the affected area Affected limb can appear larger and have varicose veins • Heart: Heart failure • Lung: If an AVF affects the lung, it may lead to symptoms like: • shortness of breath • coughing up blood • Cyanosis Complications •Heart failure. •Blood clots. An arteriovenous fistula in the legs can cause blood clots to form. Leg blood clots may lead to a condition called deep vein thrombosis (DVT). DVT can be life-threatening if the clot travels to the lungs (pulmonary embolism). Depending on where the fistula is, it may lead to a stroke. •Leg pain due to lack of blood flow (claudication) •Internal bleeding. Arteriovenous fistulas may cause bleeding in the stomach and intestines. • stethoscope to listen to the blood flow in the arms and legs. The blood flow through an arteriovenous fistula makes a sound like humming. •Duplex ultrasound. •Computerized tomography (CT) angiogram. •Magnetic resonance angiography (MRA) Complications • Venous hypertension: Venous hypertension is when the blood pressure in the veins is higher than normal. • Bleeding: Veins have very thin walls. In some cases, the wall of a vein in an AVF may rupture, leading to potentially serious bleeding in the body. • Steal syndrome: This is when oxygen levels are reduced in the affected area, due to large amounts of blood passing through the AVF. It can lead to tissue death and damage. • Heart failure: An AVF can cause the heart to work harder to pump blood throughout the body. Treatment • Ultrasound-guided compression. This may be an option for an arteriovenous fistula in the legs that's easily seen on ultrasound. In this treatment, an ultrasound probe is push down on the fistula for about 10 minutes. The compression destroys blood flow to the damaged blood vessels. • Catheter embolization. In this procedure, a thin, flexible tube (catheter) is inserted in an artery near the arteriovenous fistula. Then, a small coil or stent is placed at the site of the fistula to reroute blood flow. Many people who have catheter embolization stay in the hospital for less than a day and can resume daily activities within a week. • Surgery • How is an arteriovenous fistula treated? • conservative management. • Endovascular repair involves the insertion of a catheter into the affected blood vessel. This is then used to aid in the placement of a stent, coil, or foam that closes the AVF and helps to direct blood flow. • An open surgery can also be used to repair AVFs.