What is an aneurysm?? An aneurysm is a localized, permanent dilatation of an artery greater than 1.5 times its normal diameter. Aneurysms occur all over the body and in any vessels, including the aorta, and the iliac, femoral, popliteal, subclavian, axillary and carotid arteries.

Aneurysms: Classification: Wall True aneurysms False aneurysms Morphology Fusiform Saccular Dissecting Etiology Atherosclerosis Mycotic traumatic

Clinical presentation: Asymtomatic Symptomatic Pressure on nearby structures Aneurysm thrombosis leading to ischemia Aneurysm embolization Aneurysm rupture. O/E: palpable, expansile mass, with or without thrill

Pseudoaneurysm of popletial artery

Differential diagnosis: 1. Cyst or abscess overlying an artery 2. Mass overlying an artery 3. Tortuous artery

Investigatons: 1. Ultrasonography 2. Duplex ultrasound 3. Angiography 4. CT and CT angiography 5. MRA

Ultrasound & Duplex Ultrasound:

Angiography:

CT angiography:

Treatment: 1. Aneurysm excision with graft interposition 2. Aneurysm repair 3. Aneurysm excision with resection of supplying tissue 4. Aneurysm excision without arterial reconstruction 5. Endovascular aneurysm repair

What is an AV fistula?? Abnormal direct communication between the arterial and venous system that bypasses the capillary bed.

Etiology: Causes of AV fistulas: 1. Congenital (arteriovenous malformations or hemangiomas 2. Acquired which may be A. Traumatic B. Iatragenic. C. Neoplastic. D. Spontaneous E. Surgically created

Clinical Presentation: Congenital AV malformation: 1. Cosmetic effect 2. Pressure effect on nearby structures 3. Bleeding and ulceration 4. Thrombosis or thrombophlebitis

Benign AV malformations

Complex AV malformations

Acquired AV fistulas 1. Distal limb ischemia leading to ischemic ulcers and gangrene. 2. Dilated tortuous veins in the area (varicose veins) 3. Limb edema with pain and discomfort due to the chronic venous hypertension 4. Increased venous return to the heart leading to increase work load on the heart and eventually heart failure 5. Aneurismal dilatation leading to what is called an "aneurismal fistula" 6. A chronic fistula in a limb of a growing child may affect the growth of that limb.

Treatment: AV malformations Staged operations Percutaneous embolization, Multidisciplinary teams Acquired AV fistulas: Percutaneous embolization of the fistula, Excision with or without vascular reconstruction, or 4 limb ligation of the fistula