Aneurysmal Disease

Arterial aneurysms are abnormal, focally dilated blood vessels that are usually without symptoms. Although the pathology may involve any artery in the body, the most commonly affected locations are the abdominal aorta and popliteal arteries. The exact cause of aneurysmal disease remains unclear but risk factors include male sex, advancing age, smoking and a positive family history. All management strategies should target the prevention of any aneurysmal-related complications that can be devastating.

Aneurysmal Disease Aneurysmal Disease

CT Angiogram showing large AAA (arrowed).

Abdominal aortic aneurysms (AAA) are normally discovered on medical investigation for other symptoms. The major risk of an AAA is a typically-fatal rupture. Size is the prime determinant of this rupture risk and current evidence suggests that if AAA diameter > 5.5cm (normal aortic diameter ~2cm), then repair should be considered. Below this threshold, in the continued absence of symptoms and rapid AAA expansion, regular out-patient surveillance should be instituted. Supportive measures include risk factor modification and medical therapy. Definitive AAA repair may be endovascular (EVAR) or by open surgery.

Aneurysmal DiseasePopliteal aneurysms affect the artery behind the knee. The prime risk of an untreated popliteal aneurysm is not rupture but thrombo-embolism (‘clotting off’) to the lower limb arteries. This scenario can be rapid and is associated with a significant risk of leg amputation. Definitive treatment may be either surgical or endovascular and depends on aneurysmal size, integrity of arteries above & below disease, general health and the presence of clot.

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