1. الجامعة السورية الخاصة كلية الطب البشري قسم الجـراحـة الدكــتـور عاصم قبطان MD – FRCS www.surgi-guide.com 4th lecture 1M.A.Kubtan

2. 2  Aneurysm is a dilatation of localized segments of an artery.  It can be true containing three layers of arterial wall ( intima, media,adventitia ) ‘ or false aneurysm having a single layer of fibrous tissue.  According to its shape it can be grouped as ( fusiform, saccular, dissecting ).  According to their etiology ( atheromatous, traumatic, syphilitic, mycotic )

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4. Clinical features  All aneurysms can cause symptoms as a result of :  Expantion.  Thrombosis.  Rupture.  Release of emboli.  It can be palpable.  Expansile pulsation. M.A.Kubtan4

5. Abdominal aortic aneurysm ( AAA )  Found in 2% of the population at autopsy.  95% are caused by atherosclerosis.  95% occur below the renal arteries. M.A.Kubtan5

6. Symptoms of AAA  Asymptomatic ( incidental finding during clinical examination, radiography, ultrasound scan or CT scan ).  Moderate symptoms : back and abdominal discomfort  Sever symptoms as an emergency when ruptures. M.A.Kubtan6

7. Ruptured AAA  Anterior rupture into the peritoneal cavity 20% very few patients reach hospital alive.  Posterior rupture to retroperitoneal space 80%, will produce retroperitoneal hematoma.  Less than 50% of patient with rupture AAA survive to reach hospital.  Patient may remain conscious but in sever pain.  If not treated surgically death is inevitable.  Surgical mortality 50%. M.A.Kubtan7

8. Clinical features of ruptured AAA  Tender pulsatile mass palpable in the abdomen.  Hypotesion.  Ultrasound or CT.  Most diagnosis are made on clinical ground alone. M.A.Kubtan8

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14. M.A.Kubtan14 Endoluminal treatment Is minimally invasive treatment,

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16. A ortic Dacron graft M.A.Kubtan16

17. Peripheral aneurysm  APopliteal aneurysm.  Femral aneurysm.  Iliac aneurysm.  Arteriovenous fistula ( congenital, acquired ). M.A.Kubtan17