AORTIC ANEURYSM Etiology Symptoms with Treatment

• Aneurysm is a pathological dilatation of a seg­ment of vessel.
• An aneurysm affecting any part of the aorta from the aortic valve to the iliac arteries.
• True aneurysm involves all 3 layers of an ar­tery or vein or heart.
• Pseudo aneurysm is a breakage of intima and media of the blood vessels, sometimes contain­ing a clot, and lined by adventitial layer.
• A fusiform aneurysm is a diffusely dilated aneu­rysm.
• A saccular aneurysm is a bulging of the vessel
• wall.

Aneurysm may be abdominal or thoracic.

Etiology :

• Atherosclerosis
• Cystic medial necrosis -as in Marfan syndrome, Ehlers-Danlos syndrome etc.
• Thoracic aneurysms occur most commonly in the sixth and seventh decade of life.
• Hypertension is an important risk factor, being present in over 60 percent of patients
• Syphilis
• Tuberculosis
• Mycotic aneurysm (An aneurysm dU~jo_staphy­lococcal,~treP-tococcal or salmonella infection qf the aorta gn a plaque~ .
• these are infected saccu­[ar aneurysl1Js).
• Takayasu disease Trauma Congenital Vasculitis.

Types —

• Thoracoabdominal aneurysms — 10 %
• Descending aortic aneurysms distal to the left subclavian artery — 40%
• Ascending aortic aneurysms arise anywhere from the aortic valve to the innominate artery — 60%
• Aortic arch aneurysms include any thoracic aneurysm that involves the brachiocephalic vessels — 10 %

THORACIC AORTIC ANEURYSM

Usually asymptomatic Symptoms

• Chest pain
• Dyspnoea
• Cough
• Dysphagia.
• -AR
• CHF
• Superior vena cava
• syndrome.

Investigations

• X-ray chest
• – 2D echocardiography
• – TEE – trans esophageal
• echocardiography
• – CT
• – MRI
• – Aortography .

Treatment

• Beta blockers
• Antihypertensives
• Prosthetic grafts
• Other surgeries.

ABDOMINAL AORTIC ANEURYSM

• aneurysm is a focal dilation of a blood vessel with respect to the original or adjacent artery
• More common in elderly males
• Abdominal aortic aneurysm occurs four to five times more commonly in men than women ,
• The aneurysm is usually below the level of renal arteries
• Peripheral embolization is common due to ath­erosclerosis
• Abdominal aortic aneurysm in more common in patients with atherosclerosis
• Usually asymptomatic.

Investigations: –

• X-ray abdomen –
• Ultrasound
• – CT, MRI
• – Aortography.

Treatment

• Operative repair if diameter of aneurysm more than 5.5 em.
• Prosthetic graft, endovascular stents.