Aneurysms

What is an aneurysm??An aneurysm is a localized, permanent

dilatation of an artery greater than 1.5 times

its normal diameter.

Aneurysms occur all over the body and in any

vessels, including the aorta, and the iliac,

femoral, popliteal, subclavian, axillary and

carotid arteries.

Aneurysms:Classification:

Wall True aneurysms False aneurysms

Morphology Fusiform Saccular Dissecting

Etiology Atherosclerosis Mycotic traumatic

Clinical presentation:Asymtomatic

Symptomatic

Pressure on nearby structures

Aneurysm thrombosis leading to ischemia

Aneurysm embolization

Aneurysm rupture.

O/E: palpable, expansile mass, with or

without thrill

Pseudoaneurysm of popletial

artery

Differential diagnosis:

1. Cyst or abscess overlying an artery

2. Mass overlying an artery

3. Tortuous artery

Investigatons:1. Ultrasonography

2. Duplex ultrasound

3. Angiography

4. CT and CT angiography

5. MRA

Ultrasound & Duplex Ultrasound:

Angiography:

CT angiography:

Treatment:1. Aneurysm excision with graft interposition

2. Aneurysm repair

3. Aneurysm excision with resection of

supplying tissue

4. Aneurysm excision without arterial

reconstruction

5. Endovascular aneurysm repair

Arterio-Venous Fistula

What is an AV fistula??Abnormal direct communication between the

arterial and venous system that bypasses the

capillary bed.

Etiology:Causes of AV fistulas:

1. Congenital (arteriovenous malformations or hemangiomas

2. Acquired which may beA. TraumaticB. Iatragenic.C. Neoplastic.D. SpontaneousE. Surgically created

Clinical Presentation:Congenital AV malformation:

1. Cosmetic effect

2. Pressure effect on nearby structures

3. Bleeding and ulceration

4. Thrombosis or thrombophlebitis

Benign AV malformations

Complex AV malformations

Acquired AV fistulas1. Distal limb ischemia leading to ischemic

ulcers and gangrene.2. Dilated tortuous veins in the area (varicose

veins)3. Limb edema with pain and discomfort due to

the chronic venous hypertension4. Increased venous return to the heart leading

to increase work load on the heart and eventually heart failure

5. Aneurismal dilatation leading to what is called an "aneurismal fistula"

6. A chronic fistula in a limb of a growing child may affect the growth of that limb.

Treatment:AV malformations

Staged operationsPercutaneous embolization, Multidisciplinary teams

Acquired AV fistulas:Percutaneous embolization of the fistula, Excision with or without vascular

reconstruction, or 4 limb ligation of the fistula

Thank You