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Saturday, February 26, 2011

AORTIC ANEURYSM

An aortic  aneurysm is an abnormal dilatation of the aortic wall. Aneurysm may be due to atheromatous disease, connective tissue disease, or syphilis, Dissecting aneurysm has a different pathology and is considered separately. Atheromatous aortic aneurysm is the commonest form.
Atheroma may weaken the aortic wall and lead to local aneurysm formation. The commonest site is abdominal aorta between renal and iliac arteries, but the thoracic aorta may also be affected.
Clinical features
Abdominal aneurysms usually occur in men over 60 they may be asymptomatic, may cause backache or be associated with claudication, or may present acutely with abdominal pain and hypotension as a consequence of rupture. Clinical diagnosis is by palpation- the 'expansile' pulsation of an aneurysm is different from ' transmitted' pulsation from a normal aorta. Confirmation is by ultrasound scanning, followed up by angiography. The natural history of an aneurysm is for it to expand and eventually rupture.
Management
Elective surgical repair has a much lower mortality than emergency surgery for rupture. The mortality repair of thoracic anuerysms is higher, and they are usually treated conservatively unless there are signs of progressive enlargement

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