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Multiple Aneurysms

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In 1990 Gloviczki et al reviewed 102 patients with multiple aneurysm ... Two stage operation for multiple aneurysms of the thoracic aorta,abdominal aorta and ... – PowerPoint PPT presentation

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Title: Multiple Aneurysms


1
Multiple Aneurysms
2
Multiple Aneurysms
  • In 1982 Cohen et al reviewed 1500 patients with
    AAA
  • 13 had multiple aneurysms
  • 72 synchronously/28 metachronously
  • Cause 62 - nonspecific , 23 dissection
  • Location Abdominal 63
  • Thoracoabdominal - 14
  • Descending aorta 13
  • Aortic arch 5
  • Ascending aorta - 5

Rutherford
3
Multiple Aneurysms
  • In 1990 Gloviczki et al reviewed 102 patients
    with multiple aneurysm over two decades
  • Age range 20 81 yrs
  • Total 201 aortic reconstructions 3.4 of all
    aortic aneurysm performed during that time
  • Location
  • Infrarenal 30.9
  • Descending aorta 26.7
  • Thoracoabdominal 23.0
  • Aortic arch 19.3

JVS , 1990
4
Gloviczki et al, contd
  • 53.9 had Multiple aneurysm at first repair
  • 21 pts underwent simultaneous repair of at least
    2 aortic aneuysm
  • 7 of the 21 pts (33.3) died
  • 27 emergency procedures
  • 15 - rupture
  • 11 - pain
  • 1 distal embolization with leg ischemia
  • 3 ruptured descending thoracic aneurysn
  • ( 4cm , 4 cm, 3.8 cm )
  • One ruptured 2 days after AAA repair

5
Two stage operation for multiple aneurysms of the
thoracic aorta,abdominal aorta and left common
iliac artery in octagenarian Kudaka et
al Japanese Annal of Thoracic and
Cardiovascular Surgery
  • AAA and iliac aneurysm resected first due to
    risk of thromboembolism 52 days later Repair of
    descending aorta
  • Discharged home POD25

6
Genetics and aneurysm
  • Familial clustering in 10-20 first degree
    relatives
  • Marfans (fibrillin )
  • Ehlers Danlos type 4 ( procollagen III)
  • Aneurysms at an early age in these patients
  • Less type III collagen in aortic media
  • Abnormality on long arm of chromosome 16

7
Aneurysm Classification by Etiology
Type Example
Congenital Idiopathic Turners
Connective tissue disorder Marfans Ehlers Danlos Cystic medial necrosis Berry
Degenerative Atherosclerotic Fibromuscular dysplasia
Infectious Bacterial Fungal Syphilis
Rutherford
8
Aneurysm Classification by Etiology contd
Inflammatory Takayasus Behcets Kawasaki Giant cell arteritis SLE
Post Dissection Idiopathic Trauma
Post stenotic Thoracic Outlet Syndrome Coarctation
Pseudoaneurysm Trauma Anastamotic disruption
Miscellaneous Pregnancy associated
9
Thoracoabdominal Aneurysms
  • Principle goal prevent rupture and death
  • Most Surgeons choose to intervene when gt 6cm
  • Smaller aneurysm followed by CT scan every 6
    months
  • If expands gt 5mm in 6 months intervene
  • Patient with family history of AA
  • Women of small stature with 5cm aneurysm

Cameron
10
Spinal cord perfusion , minimize visceral organ
ischemia and renal dysfunction
11
Visceral Aneurysms
  • Relatively uncommon
  • 25 present as emergency
  • 8.5 result in death
  • Frequency
  • Splenic 60 FM 41 , rupture during
    pregnancy
  • Hepatic 20 MF 21, trauma, IVD, inflammation
  • SMA 5.5
  • Aggressive approach in management because of high
    mortality associated with rupture

12
Popliteal Aneurysm
  • Most frequent peripheral aneurysm 70
  • MF 301
  • gt50 bilateral
  • 33 has AAA
  • Most common manifestation
  • - thrombosis ( 40 )
  • - embolization ( 25 )
  • 25 with distal thromboembolism come to
    amputation
  • Rupture rare - lt 5

Indication for treatment Acute lower limb
ischemia from acute occlusion Transverse diameter
gt 2cm
Sabiston
13
Diameter of normal arteries ( cm )
Female Male
Aorta -Descending -Supraceliac -Suprarenal -Infrarenal 2.4 2.6 2.1 2.3 1.9 1.2 2.1 2.4 3.0 2.5 2.7 2.0 2.3 1.4 2.4
Iliac -Common -Internal 0.9 1.0 0.5 1.1 1.2 0.5
Popliteal 0.9 0.9
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