Aneurysm PDF

INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION WORK UP INTRODUCTION  CLINICAL PRESENTATION According the size and location of aneurysm. Asymptomatic Rupture Pulsating mass CVA Embolization of distal Sepsis Compression of adjacent structure Fistula ...

INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION INTRODUCTION WORK UP INTRODUCTION  CLINICAL PRESENTATION According the size and location of aneurysm. Asymptomatic Rupture Pulsating mass CVA Embolization of distal Sepsis Compression of adjacent structure Fistula  COMPLICATIONS According the size and location of aneurysm. Rupture CVA Embolization of distal Sepsis Compression of adjacent structure Fistula  AORTIC ANEURISM {AA} Classification : 1) Infrarenal Aortic Aneurysms 2) Thoracoabdominal Aortic Aneurysms Type I : Most of descending thoracic and upper abdominal aorta. Type II : Most of descending thorasic aorta and most or all of abdominal aorta. Type III : Distal descending thoracic aorta and most of the abdominal aorta. Type IV : Most or all of abdominal aorta, including visceral vessl segment.  AORTIC ANEURISM {AA} 3) Aortic dissecting Aneurysms : - DeBakey type I (Stanford A) : Involvement of ascending aorta and extend beyond the left subclavian artery. - DeBakey type II (Stanford A) : Involvements of ascending aorta till only the left subclavian artery. - DeBakey type III (Stanford B) : Involvement the descending thoracic aorta without involvement ascending aorta.  INFERARINAL AORTIC ANEURYSMS It is the most common site of arterial aneurysms. About 5% extend above renal artery. Mostly fusiform. The common iliac and hypogastric vessels are frequently involved. Men : Women 4 : 1 Most commonly diagnosed in the 7th decade.  INFERARINAL AORTIC ANEURYS ¾ of all patients are asymptomatic. Elderly patient with abdominal, back or flank pain, tenderness, AAA be considered. Vague abdominal pain (most common). Symptoms and signs by encroachment on adjacent structures :- - Severe back pain(by vertebral body erosion) - Early satiety, Nausea and loss of weight (by intestinal compression). - Signs and symptoms of complete GI obstruction. - Hydronephrosis, flank pain may radiate to groin. Bouts of pyelonephritis(by urethral obstruction).  INFERARINAL AORTIC ANEURYS Acute lower extrimity ischemia(by embolization of acute aortic acclusion) Ruptured aneurysm (as an acute abdomin) - The triad of : Shock, pulsatile abdominal mass and severe abdominal or backpain ( in contained rupture ). - Death before arriving the hospital ( intraperitoneal rupture ). Rare manifestations :- - Primary aortoenteric fistulea :-. Abdominal or backpain.. Hematemesis or melena.. Catastrophic hemorrhage and death ( intraintistinal rupture) Inferarinal Aortic WORK UP Aneurysms  DIAGNOSIS Complete and accurate history and physical examination. Screening for AAA, by ultrasonography. Indications :- - Those with family history of aneurysms. - Patients between 55 and 80 years with peripheral vascular disease and/or CAD. - Those with known extremity artery aneurysm such as popliteal femoral aneurysms. INTRODUCTION WORK UP  MANAGEMENT I) Conservative ttt : - Treatment of risk factor, or any associated disease. - Follow up the condition of the patient. II) Operative ttt : - Admession of patient in the hospital. - Full history and physical examination. - Treatment of risk factors if present. - Prepare the patient for operation.  MANAGEMENT III) Management of high risk patients : - Defer surgery indefinitely until symptoms develop or signs of rupture become evident. - Or perform aneurysm exclusion and bypass ( ex. Extra-anatomic ). - Or undertake conventional aneurysm repair with intensive perioperative and postoperative suport. IV) TTT patient, associated with cardiac disease : 1) Asymptomatic cardiac status need AAA repair. 2) Mild, stable cardiac symptoms need noninvasive cardiac study :- - If +ve need coronary angiography. - If –ve need AAA repair.  MANAGEMENT 3) Significant cardiac symptome need coronary angiography:- - Significant CAD need CABG then staged AAA repair. - Insignificant CAD need AAA repair. 4) Very elderly, or LVEF < 30% or nonreconstractable CAD : - If AAA < 6 cm need carfull AAA surveillance - If AAA > 6 cm need AAA repair with cardia support. COMPLICATIONS OF AAA SURGERY I) Early :- -Intraoperative hemorrhage. - Renal failure. - GI complication :-. Paralytic ileus.. Diarrhea, periodic constipation and anorexia.. Ischemic colitis and perforation. - Ureteral injury. - Embolization or thrombosis of the distal arterial tree. COMPLICATIONS OF AAA SURGERY 2) Late :- - Anastomotic aneurysm. - Aortoenteric fistula. - Graft limb occlusion. - Chronic graft dilatation. - Graft disruption CLINICAL PRESENTATION WORK UP THANK YOU Thank you