Aneurysns and vasculitis stanley medical colleg3 chennai

1. ANEURYSMS AND
VASCULITIS
DR. S.P. GAYATHRE MS.,DGO.,
PROFESSOR AND HEAD
DEPARTMENT OF GENERAL SURGERY
STANLEY MEDICAL COLLEGE AND HOSPITAL

2. INTRODUCTION
Localised dilatation >50 % - Aneurysm
<50% - Ectasia
Most commons -
M/C site - Circle of willis
M/C Extracranial site - Infrarenal aorta
M/C peripheral aneurysm - Popliteal

3. • Based on layers involved : (a) All 3 - true
(b) 1 fibrous layer - Pseudoaneurysm
• Shape - Fusiform/ Saccular
• Etiology : Atheromatous
Traumatic
Mycotic - misnomer
Collagen disorder
TYPES

5. ABDOMINAL AORTA ANEURYSM
• M/C site : Infrarenal aorta
• M/C large vessel aneurysm
• M/C extracranial aneurysm
Risk factors :
Male sex, Increasing age, White race, Family history, smoking
Pathology -Atheromatous degenaration
Natural history of AAA - Continous expansion

6. CLINICAL PRESENTATIONS
• Asymptomatic - M/C
• Symtpomatic :
Chronic vague abdominal/back pain
• Ruptured AAA -
Triad (a) Hypotension
(b) Sudden abdominalpain/back pain
(c) Pulsatile abdominal mass

7. ASYMPTOMATIC AAA
• Prepared electively
• Indications for surgery :
Males - >55mm in size
Female and High risk : >45 mm
>1cm increase per year
Investigations :
Routines, CXR, ECHO, Cardiopulmonary testing
Pulmonary function tests
Dental hygiene asessment.

8. DIAGNOSTIC MODALITY OF CHOICE
• CT Scan
• MRA + MRI - AAA + renal failure
• Digital subtraction angiography -
false + due to thrombus

9. SURGERY
• Open surgical repair
Midline abdominal incision made and aorta
viualised.
Aorta opened and graft fixed proximodistally
More mortality
Better long term results
• Endovascular repair
Approached via femoral arteries
Graft placed endoluminally.
Lesser mortality
Lifelong followup

10. RUPTURED AAA
• M/C and lethal complication
• Sites : Retroperitoneal (M/C)
Intraperitoneal - dangerous
Into IVC, Iliac vessels, Duodenum
• 50% dont reach hospital.
• 50% operative mortality
• Total mortality - 80 - 90 %
• If unoperated - Certain death.

11. • Investigation - CT scan
• Rx :
Immediate resuscitation
SBP < or equal 100mmHg
Catheterisation
Cross matching
Surgery - Open or EVAR

12. COMPLICATIONS OF SURGERY
• Open :
MI
Atelectasis, consolidation
Colonic ischemia
AKI
Sexual dysfunction
Spinal cord ischemia

13. COMPLICATIONS CONTINUED
• EVAR :
Endoleak
Graf migration
Graft failure
Metal strut fracture
Graft limb occlusion

14. PERIPHERAL ANURYSMS
• Popliteal
• Femoral
• Iliac
M/C - popliteal aneurysm

15. POPLITEAL ANEURYSMS
• M/C Peripheral aneurysm - popliteal (70%)
• Risk Factors - Male sex, >70 years
• Bilateral - 50%
• 1/3rd associated with AAA
Clinical features :
• Rupture - rare
• M/C - Thrombus - distal emboli - gangrene
• Amputation rate 30%

16. Diagnosis :
Duplex scan
CT Angiogram
Rx :
Indications - Asymptomatic >2cm, symptomatic, Thromboembolism
Surgeries - Exclusion bypass, Posterior aproach inlay repair.

17. OTHER PERIPHERAL ANEURYSMS
Femoral Aneurysms :
• Rare
• Bilateral - 50%
False aneuryms > True aneurysms
True - rarely ruptures - Conservative approach
False - Due to Prior arterial surgery, puncture trauma

18. • Due to arterial surgery :
If not infected : reanastomosis of graft to femoral artery in groin
If infected - Distal bypass after old graft removal
• Due to trauma :
<3cm - USG guided Thrombin injection
>3cm - Open surgery.

19. VASCULITIS
Vasculitis of surgical importance
• Buerger’s disease
• Temporal arteritis
• Takayasu arteritis

20. BUERGER’S DISEASE
• Small and medium sized limb arteries
• Risk Factors : Male, Smokers
• Never ocurs in women, non smokers.
• Characteristic triad : Raynaud’s Syndrome
Intermittent claudication
superficial and deep vein throbophlebitis
Histology : Inflammatory changes - thrombosis.
Skip lesions characteristic

21. • Diagnosis ; Duplex of all 4 limbs
• Treatment
Total abstinence from smoking - arrests, not reverses disease
Bypasses - not possible
Amputations.

22. • Giant cell arteritis :
Temporal arteritis - Old age
associated with headache, throbbing pain - temporal
Blurring, vision loss - emergency
Tender palpable plseless temporal artery
Histology : Giant cells infiltration
Diagnosis : Temporal artery biopsy
Treatmet - Immediate steroid initiation - if late - blindness
OTHER VASCULITIS

23. • Takayasu Arteritis -
Large arteries - Aorta and branches
Risk Factors - Young women 10 - 40 years age.
Histology _ Inflammation - fibrosis
M/C vessel - Subclavian
Clinical features:
Hypertension - renal artery stenosis
claudication
retinopathy, angina, abdominal angina

24. • Investigations : CT Angiogram
• Labs : Raised ESR, CRP, WBC
• Treatment - Steroid therapy
• Bypass procedures - After inflammation settles.

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