What is Aneurysm PowerPoint Presentation

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Aneurysm, Dissection

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Aneurysm Aneurysm: localized dilation of the vessels or the heart May occur at any site, most important is aorta and ventricles. True aneurysm is bounded by vessel wall False aneurysm: extravascular hematoma with communication to vascular space (Pulsating hematoma)

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Aneurysm Congenital or acquired Aortic aneurysm: Causes: Atherosclerosis Cystic medial degeneration Others: trauma, congenital (berry aneurysm), infections (mycotic aneurysm, syphilis), Vasculitis

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Aneurysm Mycotic aneurysm (infection) Route of infections Embolization of infections Extension of adjacent infection Circulating organisms

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Aneurysm Saccular aneurysm: localized bulging of vessel Fusiform aneurysm: long segment of the vessel is involved.

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Aortic Aneurysm Atherosclerosis is the most common cause Common in abdominal aorta: Abdominal Aortic Aneurysm (AAA) May occur at other sites: thoracic aorta, common iliac artery…. AAA is usually below the level of renal arteries and above aortic bifurcation

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Aortic Aneurysm AAA can be saccular or fusiform Atherosclerosis – weak media – aneurysm – thrombosis. Mycotic AAA: atherosclerosis with infection, bacteria: Salmonella

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Aortic Aneurysm Pathogenesis: Genetic Predisposition >50 years M>F Marfan syndrome Genetic defects in structural proteins Atherosclerosis

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Aortic Aneurysm Complications: Rupture with massive hemorrhage 2% in <4 cm aneurysm 5-10% in >5 cm aneurysm Occlusion of vessels: renal artery, mesenteric, iliac Embolism Compression of other structures: eg. ureters

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Aortic Aneurysm Presentation of AAA: Abdominal mass: pulsating Any of the complications

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Aortic Aneurysm Presentation of Thoracic aneurysm Respiratory difficulties Difficulty in swallowing Cough Chest pain Heart disease: valvular disease, Ischemic heart disease Syphilitic aneurysm

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Aortic Dissection

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Aortic Dissection Dissection is hematoma within the vessel wall with dissection of blood between layers of the media (muscle layer) Can rupture resulting in massive hemorrhage

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Aortic Dissection Two groups of patients: Men 40-60 years with hypertension Young with connective tissue disorder eg. Marfan syndrome Others: iatrogenic, Pregnancy Dissection is unusual in severe atherosclerosis

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Aortic Dissection How does is happen? Intimal tear usually within 10 cm of the aortic valve Dissection of blood into aortic wall Dissection can extend proximally or distally usually between the middle and outer third of the muscle layer Dissection can rupture outside the vessel Or can open inside to the vascular space resulting in Chronic dissection

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Aortic Dissection Pathology: Cystic medial degeneration Degeneration of the muscle Deposition of plasma proteins and collagen Fragmentation of elastic fibers

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Aortic Dissection Types: Type A: Common, dangerous Proximal Ascending aorta: DeBakey type I Ascending and Descending thoracic aorta: DeBakey type II Type B: Distal to subclavian artery DeBakey type III

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Aortic Dissection Presentation: Sudden Severe pain: anterior chest radiating to the back then moving downward Complications: Rupture Cardiac tamponade Occlusion of vessels: coronary, mesenteric, renal….

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Berry Aneurysm

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Arteriovenous Fistula Communication between arterial and venous circulation Causes: Developmental Trauma/repair Rupture of vessels Aneurysm Inflammatory process surgical

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Arteriovenous Fistula If small: not significant If large can cause heart failure May rupture resulting in hemorrhage

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Varicose Veins

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Varicose Veins Abnormal dilated, tortuous veins Due to prolonged increase in pressure Common in superficial veins of legs Occupational relation: Long stand, long automobile and airplane rides Common: 15-20% of general population More in >50 years, obese women Familial tendency

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Varicose Veins Valve deformity, thrombosis Pathology: Thickening and thinning of the vessel walls, degeneration, calcification, muscle hypertrophy (Phlebosclerosis)

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Varicose Veins Presentation: Venous stasis, congestion, edema, pain, thrombosis Skin atrophy, ulcers, poor healing Esophageal varices Hemorrhoides

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Thrombophlebitis and Phlebothrombosis Thrombophlebitis is venous thrombosis Phebothrombosis is inflammation of veins Predisposing factors for thrombosis: Heart failure, neoplasia, obesity, post operative, prolonged bed rest, genetic hypercoagulability

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Thrombophlebitis and Phlebothrombosis Presentation: DVT: edema, cyanosis, dilated superficial veins, tenderness, swelling, pain (Homan sign) Others: veins in skull, dura, pelvic veins Trousseau sign

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Vascular Neoplasm

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Vascular Neoplasm Benign Borderline Malignant

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Hemangioma Common in infants, children Skin, mucosa, subcutaneous tissue Capillary hemangioma Cavernous hemangioma

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Vascular Ectasia Nevous Flammeus: birth mark Spider Telangiectasia: in cirrhosis, pregnancy

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Kaposi Sarcoma Chronic: classic Old men, multiple red-purple skin plaques in lower extremities Slow growing Endemic (African) KS Children in Africa Localized/generalized lymphadenopathy Transplant-Associated KS AIDS-Associated KS ¼ of AIDS patients, male, Homosexual

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Kaposi Sarcoma Pathology Patch Plaque Nodular Cause: associated with Human Herpes Virus type 8 (HHV8)

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Angiosarcoma Malignant vascular neoplasm Sporadic Secondary: radiation, lymphedema Arise in any site: common in skin, soft tissue, breast, liver

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Coarctation of Aorta

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