Abstract: . . .  Aneurysmal Vascular Disease Chapter 64 Townsend: Sabiston Textbook of Surgery, 17 th ed. Introduction Arterial aneurysm permanent localized enlargement of an artery to more than 1.5 times its expected diameter Arterial ectasia localized enlargement < 50% Arterial megaly generalized arterial enlargement . . .
. . .  & fever May have peripheral evidence of septic emboli such as petechial skin lesions and splinter hemorrhages in digits Treatment debride infected tissue, excise, reconstruct Pseudoaneurysms Contained arterial disruptions Two types Perforation of artery from traumatic or iatrogenic injury Dehiscence of a surgical vascular anastomosis Management Infection must be ruled out Direct surgical repair Exclude pseudoaneurysm with stent graft Ligation, compression, or coil embolization Large, expanding, painful pseudoaneurysms likely to rupture US is choice of study If size < 2 cm then likely thrombose with compression US-guided thrombin . . .
. . .  for evaluating renal/visceral/iliac/fem arteries. Important in evaluating dissection Preop Evaluation Severe coronary artery disease present in more than 50% of patients with aneurysm Pulmonary function test Repair when Maximal diameter > 5.5cm Expansion rate > 0.5cm over 6 months Back or abdominal pain not accounted by other disease processes Peripheral embolization originating at aneurysm Ruptured Abdominal Aortic Aneurysm Into peritoneum or retroperitoneum back, abdominal pain, hypovolemic shock, chest pain When into the retroperitoneum May occur without significant blood loss initially and may be hemodynamically stable If unstable with previously . . .
--2237,3,373,2121,11187