Pathology of the Aorta (Part 1)

What is an aneurysm?

a permanent localized dilation of an artery, with an increase in diameter > 1.5 times the normal diameter​

AAA is

> 3 cm or greater than 1.5 times the superior aorta​

Primary risk factors for a patient with AAA:

Dissection and rupture

What puts a patient at risk fro AAA

• Smoking

• HTN

• Cardiovascular disease

• COPD

• Family history of AAA

• Genetic conditions

Men that are ________ have a 5-10% increase risk of AAA

> 65

How does an US determine AAA

Measures diameter, length and looks at extent of involvement of branches

Once they compare diameter of abnormal area vs the normal vessel (Sup and Inf) they can…

make a diagnosis

What is the most common cause of AAA

Arteriosclerosis

Where is it most common to see AAA

infrarenal

Who is it more common to see AAA in

men

AAA ____ extend into iliac arteries

may

AAA may involve

ascending and descending aorta

a PA will do a physical exam where they check

• Pulsatile abdominal mass​

• Slightly to left of midline​

• Between xyphoid & umbilicus​

• Will listen for a bruit

Clinical Symptoms and Indications of AAA not at rupture:

• May vary​

• Most are asymptomatic​

• Pulsatile abdominal mass​

• Abdominal pain​

• Impinge on adjacent structures​

• Occlusion of vessel by direct pressure or thrombus​

• Abdominal bruit

Clinical symptoms and indication of AAA at rupture:

• intense back pain and drop in hematocrit

• Grey Turner’s syndrome

AAA treatment for < 4cm

follow up in 6 months

AAA treatments when size is 4-5 cm

surgery or endovascular repair; if in good health

AAA treatments when size is 5-6cm

surgery or endovascular repair

AAA treatments when size is >6cm

surgery

AAA size that has the highest risk of rupture

> 6cm

What needs to be measured to AAA

• Exact location of AAA​

• Measurements​

  • AP of AAA​

  • Width of AAA​

  • Length of AAA​

  • AP of lumen​

  • Width of lumen​

  • Relationship to Renal Arteries (infrarenal neck)​

• Extent (Branches &/or Iliac arteries)

What doppler do we use for AAA

color and spectral

What does this image show

Pseudoaneurysm

What does this image show

True aneurysm

In a true aneurysm ______________ of the vessel wall are intact but STRETCHED

all 3 layers

In a true aneurysm there is ____________ and localized dilation of the arterial wall

focal weakening

Over time a true aneurysm may

enlarge or even tear

Fusiform and Saccular aneurysm are:

true aneurysms

What aneurysm is this

Fusiform

What aneurysm is this

Saccular

Grey Turner’s Syndrome

when aneurysm ruptures they will have bruising at flanks bc blood is pooling at abdomen