Aneursym pathology

1. Definition
   • Abnormal localised dilation of an arterial blood vessel (cf varix of a vein)
2. Causes
   • Traumatic
   • Inatrogenic
3. Shape Classification
   • Fusiform
   • Saccular
   • False: cavity in a haematoma which connects with the lumen of the artery
4. Pathological classification
   • True: all layers of arterial wall
   • False: partial laceration of vessel wall causing blood to leak out of the vessel into the surrounding tissues (same as a pulsating haematoma) - fibrous tissue forms around haematoma which then contracts, producing a false sac which contains thrombus but remains connected to the lumen of the damaged vessel: pulsation transmitted from the artery tends to increase the size of the cavity with time

Approach

• Expose abdomen

1. Inspection
   • Presence of surgical scars over the abdomen
2. Palpation
   • Think about incisional herniaes over scar
   • Describe pulsatile swelling
   • Define anatomy of swelling: midline, lateral - ascertain artery involved
   • Continue to palpate femoral pulses
3. Percussion
4. Auscultation
   • May be bruit over swelling

Treatment options

1. Observe and review
2. USS compression of false aneurysm
3. Thrombin injection
4. Surgical repair