Aortic Dissection and Aneurysms

Posted by e-Medical PPT Thursday, December 15, 2011
Abdominal Aortic Aneurysms (AAA)
Risk factors
Elderly (>60)
Familial trend (18% with 1° relative)
Connective Tissue D/O (Marfan’s)
Other aneurysms
Atherosclerosis (HTN, Lipids, smoking, DM)

Pathogenesis
Intima infiltrated by atherosclerosis and thinned media.
Possible intraluminal thrombus and adventitia infiltrated by inflammatory cells

Clinical Features
Syncope (10-12%)
Back and/or Abdominal Pain –severe and abrupt, ripping or tearing sensation (50%)
Shock –intraperitoneal rupture, massive blood loss
Sudden death

Physical Exam
Pain on palpation or not
Retroperitoneal hematoma
Cullen sign (periumbilical ecchymosis)
Grey-Turner sign (flank ecchymosis)
Scrotal hematoma or inguinal mass (blood dissecting to these areas)
Iliopsoas sign
Femoral nerve neuropathy

Found aneurysms refer to follow up
>5cm diameter –increased chance of rupture
<5cm –decreased chance of rupture
Symptomatic aneurysms of any size = Emergency!!

Aortic Dissection
Pathogenesis
Prominent cause of sudden death
Presents with severe abd., chest, and back pain
Violation of intima that allows blood to enter media and dissect b/w intimal and adventitial layers
Common site is ascending aorta at ligamentum arteriosum

Stanford Classification
Type A -involves ascending aorta
Type B –involves descending aorta
DeBakey Classification
Type I –ascending, arch & descending aorta
Type II –ascending only
Type III –descending only

Clinical Features
>85% abrupt, severe pain in chest or b/w scapula
50% ripping or tearing
Pain in anterior chest –ascending aorta (70%)
Back pain (less common) –descending aorta (63%)
If dissection into carotid classic neuro symptoms
40% with neurologic sequelae (ex. paraplegia)
Nausea, vomiting, diaphoresis

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