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Multiple Aneurysms

Multiple Aneurysms. 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%

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Multiple Aneurysms

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  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, cont’d • 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 octagenarianKudaka et alJapanese 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 POD#25

  6. Genetics and aneurysm • Familial clustering in 10-20% first degree relatives • Marfan’s (fibrillin ) • Ehler’s 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 Rutherford

  8. Aneurysm Classification by Etiology cont’d

  9. Thoracoabdominal Aneurysms • Principle goal – prevent rupture and death • Most Surgeons choose to intervene when > 6cm • Smaller aneurysm followed by CT scan every 6 months • If expands > 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% F:M 4:1 , rupture during pregnancy • Hepatic – 20% M:F 2:1, 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% • M:F 30:1 • >50% bilateral • 33% has AAA • Most common manifestation - thrombosis ( 40% ) - embolization ( 25% ) • 25% with distal thromboembolism come to amputation • Rupture – rare - < 5% Indication for treatment Acute lower limb ischemia from acute occlusion Transverse diameter > 2cm Sabiston

  13. Diameter of normal arteries ( cm )

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