PERPHERAL ARTERY ANEURYSM. By Pooja Sharma and Susanna Sebastianpillai

Transcription

1 PERPHERAL ARTERY ANEURYSM By Pooja Sharma and Susanna Sebastianpillai

2 Defintions True Aneurysm Involves all three layers of the vessel. Have two basic shapes; Fusiform = symmetric widening of the vessels Saccular = bulge asymmetrical False Aneurysm Does not involve all three layers of the vessel. (Pseudoaneurysm) Injury to a vessel results in a rupture that is contained by surrounding conncetive tissue.

3 Types A mesenteric (splenic, hepatic, or celiac) aneurysm occurs in an artery located in the abdomen, but not in the aorta. Other types of peripheral aneurysms can affect the: Renal arteries that supply blood to your kidneys. Femoral arteries in your groin. Popliteal arteries that run behind your knees. Carotid arteries in your neck.

4 Extra Cranial Carotid Aneurysms Defined as 1.5 times the diameter of the normal common carotid artery. Rare They most often involve the common carotid artery, followed by middle and distal internal carotid artery. The main risk is thromboembolism Causes: Atherosclerosis 50%. Usually fusiform aneurysm at the bifurcation Trauma usually saccular Intimal dissection Congenital/familial Mycotic ( 0 2.8%) e.g. Tuberculousis. In IV drug addicts but also tooth and jaw infections. Secondary to previous surgery Cystic medial necrosis associated with other peripheral aneurysms Fibromuscular dysplasia Marfans syndrome Polyarteritis nodosa Irradiation Neurofibromatosis Bechets syndrome Takayasu s commonest cause in young patients

5 Signs and Symptoms Usually present with a mass in the neck, tonsillar fossa or oropharynx (dysphagia). Distal ICA aneurysm may cause facial pain, 5th or 6th nerve palsy, deafness or Horner s syndrome. Some present with a TIA or stroke. Raeders paratrigeminal syndrome intermittent facial pain and oculosympathetic paresis.

6 Diagnosis and Treatment CT & MRI Ligation (25% risk of stroke and 20% mortality). Interposition grafting (vein or prosthetic) is possible in most. Stent grafting may be possible.

7 Renal Artery Aneurysm True aneurysms 0.1% of general population. F>M due to the association with fibromuscular dysplasia. Right more than left. Dysplastic disease is more common and severe on right. Mostly saccular Can be associated with polyarteritis nodosa. Symproms: hypertension, high BP, abdominal pain. Rupture mortality 10%. Rupture during pregnancy > 85% fetal mortality and 45% maternal mortality. Dissecting renal artery aneurysms usually due to blunt trauma or iatrogenic.

8 Diagnosis Treatment Gadolinium-enhanced magnetic resonance angiography (MRA) computed tomography (CT) angiography (CTA) with threedimensional (3D) reconstruction Indications - Back pain hematuria HTN - Renal dysfunction thrmoboembolism - Size of aneurysm - Pregnancy Methods - Surgical resection - Percutaneous intervention: Expandable stent-graft for fusiform aneurysm

9 Femoral Artery Aneurysm Mostly asymptomatic, but pain may occur. Causes: Atherosclerosis, in which case 70% have bilateral disease and 85% will have an aneurysm, at another site. Can burst, which may cause lifethreatening, uncontrolled bleeding. The aneurysm may also cause a blood clot, potentially resulting in leg amputation.

10 Risk Factors: high cholesterol high blood pressure Smoke Have a bacterial infection Have had blood-vessel reconstruction in one or both legs Diagnosis: - Ultrasound - Computed tomography (CT) scan - Magnetic resonance imaging (MRI) scan - Angiography

11 Treatment: Femoral artery aneurysms that are symptomatic or larger than 2.5 cm should be repaired. - Open repair (prosthesis?) - Endovascualar grafting

12 Popliteal Artery Aneurysm The commonest peripheral artery aneurysm. Prevalence of approximately 1% of men aged Found almost exclusively in men. Bilateral in 50%, 75% have an aneurysm at another site. 10% of patients with an AAA have a popliteal artery aneurysm. Causes: - Atherosclerosis. - Trauma e.g. knee dislocation, knee replacement - Inflammation Behcet s, Kawasaki disease - Infection staph, salmonella - Popliteal entrapment syndrome - Marfans

13 Clinical Findings: 70% are symptomatic at presentation. Thrombosis, causing an acutely ischaemic leg (40% amputation rate) Embolization Popliteal nerve compression sciatic nerve Popliteal vein compression Rupture very rare. Can present as acutley ischaemic leg due to arterial compression or cause AV fistula. Indications for intervention: - Acute ischaemia - Embolisation - Size greater than 2cm diameter - Intraluminal thrombus - rupture

14 Diagnosis - US - CT Angiography - MR Angiography - Conventional angiography Treatment Endovascular insertion of covered stent: Open surgical repair (usually aneurysmorrhaphy and bypass surgery).