Dr.

Gunawan Tohir SpB, M

Figure 19.1a

Permanent localized dilatation of the affected artery over the normal diameter
~ 50% ~ 100% Arteriomegaly Aneurysms

As the age increases, arteries become stiffer, wider (aneurysm) and longer (tortousity)

 Aneurysm:

localized dilation of the vessels or the heart May occur at any site, most important is aorta and ventricles.
True

aneurysm is bounded by vessel wall False aneurysm: extravascular hematoma with communication to vascular space (Pulsating hematoma)

 Most

aneurysms are caused by degenerative disease affecting the vessel (atherosclerosis) Structural weakness & Haemodynamic forces

Damage to, and loss of intima Reduction in the elastin and collagen content of the media Collagen; tensile strength, adventitia Elastin; recoil capacity, media

Risk

factors

smoking, hypertension, hypercholesterolaemia

 Laplaces

low

(Tension varies directly with radius when pressure is constant)

For every increase in the radius there is a large increase in tension, leading to further enlargement of the aneurysm

 Congenital

Marfans syndrome, Berry aneurysms Coarctation of the aorta, Cervical rib, Popliteal artery entrapment syndrome Gunshot, stab wounds, arterial punctures Takayasos disease, Behcets disease

Post-stenotic

Traumatic

Inflammatory

 Mycotic

Bacterial endocarditis, syphilis

Pregnancy

associated

Splenic, cerebral, aortic, renal, iliac & coronary

 False

Due to traumatic breach in the wall The sac made up from the compressed surrounding tissue
Dilatation involving all layers of the wall

Fusiform

Spindle-shaped involving whole circumference Small segment of wall ballooning due to localized weakness

Saccular

True

 >90%

affecting abdominal aorta Infra-renal segment in ~95% Male : Female ratio 4:1 More common in western countries 5% over 50s, 15% over 80s Associated with iliac aneurysms in 30% Associated with popliteal aneurysms in 10%

 Asymptomatic

in 75%

Incidentally discovered during clinical exam.or radiographic investigation Central abdominal radiating to the back Chronic due to stretching the vessel wall or compression/erosion of surrounding structures Acute pain due to rupture

Pain

 Rupture

Risk of rupture correlate with aneurysm size Retroperitoneal, back pain, stable Intraperitoneal, abdo/back/falnk pain, shock 5-year rupture rate 0% in AAA <5cm 5-year rupture rate 25% in AAA >5cm

Risk

of rupture can be predicted by

High diastolic BP, COAD

 Fistulation,

rare
rare

Gut, IVC, left renal vein Acute lower limb ischaemia

Thrombosis,

Distal
Distal

embolism
obliteration

Acute ischaemia to small distal areas (trash foot)

Claudication, rest pain, gangrene

 MEKANISME

YANG DIDUGA 1.DEGRADASI PROTEOLITIK DARI JAR IKAT 2.INFLAMASI DAN RESPONS IMUN 3.STRESS BIOKIMIA DARI DINDING 4.MOLEKULER GENETIK