Aneurysm ppt

Aneurysm is defined as an abnormal permanent dilatation of localized segment of arterial system

1. e n love da Homoeopathy ANEURYSM

2. ANEURYSM

3. ANEURYSM DEFINITION It is an abnormal permanent dilatation of localised segment of arterial system. Atherosclerosis which is the most common (90%) facilitating cause of aneurysm is due to destruction and loss of stability of tunica media.

4. TYPES True aneurysm contains all three layers of artery. False aneurysm contains single layer of fibrous tissue as wall of the sac and it usually occurs after trauma

5. Fusiform uniform dilatation of entire circumference of arterial wall ™ Saccular dilatation of part of circumference of the arterial wall Dissecting through a tear in the intima blood dissects between inner and outer part of tunica media of the artery

6. CAUSES Acquired: Degenerative : Atherosclerosis mucoid degeneration of intima and media Traumatic: Direct indirect like in post­stenotic dilatation by cervical rib traumatic AV aneurysmal sac aneurysm due to irradiation (due to dryness and destruction of vasa vasorum causing weakening ).

7. Infective: Syphilis Mycotic tuberculosis (in lung); Arteritis acute sepsis Collagen diseases like Marfan‘s syndrome polyarteritis nodosa Ehler­Danos syndrome. EhlerDanos syndrome

8. Congenital: Berry aneurysm cirsoid aneurysm congenital AV fistula. COMMON SITE Aorta. Femoral. Popliteal. Subclavian. Cerebral, mesenteric, renal, splenic arteries. The most common is true, fusiform, atherosclerotic, aortic aneurysms. Berry aneurysms are multiple aneurysms occurring in circle of Willis. Cirsoid aneurysm

9. CLINICAL FEATURES Swelling at the site which is pulsatile ( expansile ), smooth, soft, warm, compressible, with thrill on palpation and bruit on auscultation Swelling reduces in size when pressed proximally. Distal oedema due to venous compression. Altered sensation due to compression of nerves.

10. Erosion into bones, joints, trachea or oesophagus. Aneurysm with thrombosis can throw an embolus causing gangrene of toes, digits, extending often proximally also. INVESTIGATION Doppler study Duplex scan Angiogram DSA. Tests relevant for the cause, like blood sugar, lipid profile, echocardiography . Angiogram

11. TREATMENT Reconstruction of artery using arterial grafts. Arterial endoaneurysmorrhaphy Therapeutic embolisation . Clipping the vessel under guidance

12. MYCOTIC ANEURYSM CAUSES It is a misnomer. It is not due to fungus but due to bacterial infection Common bacteria are gram ­ positive organisms like Staphylococcus aureus (most common) and Streptococcus. Common aetiology is bacterial endocarditis but could be any infective site

13. COMMON SITE Common vessels involved are aorta, visceral, head and neck and intracranial. Commonly it is saccular, multilobed , with a narrow neck. CLINICAL FEATURES Fever Toxaemia tender pulsatile mass if it is in the periphery. Mycotic aneurysm

14. INVESTIGATION Investigations: Leucocytosis. Positive blood culture MRI or CT angiogram are relevant. TREATMENT Broad-spectrum antibiotics Resection of aneurysm; debridement and drainage of the infected aneurysm with adequate blood transfusions. Extra ­ anatomic bypass through uninfected tissue planes to avoid contamination of the graft. Long ­ term antibiotic therapy is necessary

15. DISSECTING ANEURYSM DEFINITION It is a misnomer. It is not an aneurysm, only an aortic dissection. It is the dissection of media of the aorta after splitting through intima creating a channel in the media of the vessel wall. DISSECTING ANEURYSM

16. CAUSES Hypertension (It is associated in 80% of dissecting aneurysms). Cystic medial necrosis. Marfan’s syndrome and collagen diseases. Trauma. Weakening of the elastic layers of the media due to shear forces.

17. SITES thoracic aorta - ascending aorta other parts of aorta or other vessels. aortic arch or thoracic descending aorta. PATHOLOGY This dissected aortic channel gets lined by endothelium, often reopens distally into the aorta causing double-barrelled aorta which, in fact, prevents complications

18. CLINICAL FEATURES Pain in the chest, back which is excruciating. Features of ischaemia due to blockage of different vessels INVESTIGATION Chest X-ray shows mediastinal widening Arterial Doppler Angiogram Doppler – dissecting aneurysm

19. COMPLICATION Acute: Rupture into the pericardium or pleura—dangerous type Chronic: Blockage of coronary vessels and major vessels like carotid and subclavian arteries with aortic insufficiency TREATMENT Antihypertensives . Surgery: Using Dacron graft reconstruction of aorta has to be done with cardiopulmonary bypass.

20. CIRSOID ANEURYSM DEFINITION It is actually a rare arteriovenous fistula / malformation of the scalp usually of congenital origin but occasionally can be traumatic. It is a rare variant of capillary haemangioma occurring in skin, beneath which abnormal artery communicates with the distended veins. CIRSOID ANEURYSM

21. 90% occur in relation to superficial temporal artery but few occur additionally also in relation to occipital arteries. It should be differentiated from the true aneurysm of the superficial temporal artery. Cirsoid means varix.

22. COMMON SITE Commonly seen in superficial temporal artery and its branches. Often the underlying bone gets thinned out due to pressure. Occasionally extends into the cranial cavity. Ulceration is the eventual problem which will lead to uncontrollable haemorrhage .

23. CLINICAL FEATURES Pulsatile swelling in relation to superficial temporal artery, which is warm, compressible, with arteria lisation of adjacent veins and with bone thinning (due to erosion). It feels like a ‘pulsating bag of worms ’ Bag of worms

24. INVESTIGATION Doppler study CT scan. Angiogram X-ray of the part. X-ray

25. TREATMENT Ligation of feeding artery and excision of lesion, often requires preliminary ligation of external carotid artery. Intracranial extension requires formal neuro surgical approach. Endovascular therapy is also useful

26. REFERENCE SRB's Manual of Surgery by Sriram Bhat M 2. A Manual on Clinical Surgery by Das 3. A C oncise textbook of Surgery by Das

27. A Special Thanks To A Very Special Doctor