By Dr Mustafa Awadelkareem

Learning Objectives What is an aneurysm? How may it occur? What is a

dissecting aneurysm?

List possible manifestations of an aneurysm. How can an aneurysm be treated?

Compare and contrast Raynaud’s disease and Raynaud’s phenomenon.

Aneurysm

An aneurysm is a localized, balloon-like swelling in the wall of an artery.

caused by weakening of the arterial wall. Aneurysm may occur in any artery, but the aorta is most susceptible to aneurysm due to the constantly high pressure on the walls of that vessel.

Cerebral aneurysms may also occur. They are most frequently located in the circle of Willis

of the cerebral circulation.

causes of aneurysm A leading is cause isatherosclerosis,

The formation of lipid plaques can erode arterial walls and compromise their integrity.

Aneurysms may also be associated with

hypertension,

vascular infections

the normal aging process.

Types of Aneurysms True aneurysms:

Are Aneurysms that involve all three layers of the blood vessel wall.

There are other types of arterial distention that may occur from external injury or trauma.

A dissecting aneurysm :

is a very severe condition in which there is a tear in the inner layers of the blood vessel (tunica intimaand tunica media) and as a result bleeding occurs in the space below the adventitia( Walls) of the vessel.

Clinical manifestations of aneurysm

Depending upon size and location, aneurysms may be completely asymptomatic or may be associated with severe pain.

• Aneurysms in the thoracic aorta most commonly present with back or neck pain, cough, difficulty swallowing or compression of the trachea.

Clinical manifestations of aneurysm

Aneurysms in the abdominal aorta are often asymptomatic until they cause pain from compression on spinal nerves or abdominal organs.

Clinical manifestations of aneurysm Aneurysms of the cerebral arteries often present

with symptoms that are characteristic of increased intracranial pressure. Stroke can result if the abnormal blood vessel ruptures and bleeding occurs into the brain tissue.

Treatment of aneurysms

Reduction of blood pressure and blood volume with appropriate drugs.

Surgical grafting to strengthen arterial walls.

Dissecting aneurysms are acutely life- threatening and require immediate surgical repair.

Vasospastic conditions

Two common vasospastic disorders are

1. Raynaud’s disease.

2. Raynaud’s phenomenon.

These disorders are characterized by vasospasm of small cutaneous blood vessels in the fingers and toes

Raynaud’s disease is a primary vasospastic disorder whose etiology is

uncertain.

It occurs most frequently in otherwise healthy young women.

It is often precipitated by strong emotions or exposure to cold.

Raynaud’s phenomenon 1

in contrast, it is a vasospastic condition that occurs secondarily to other underlying diseases such as:

scleroderma.

Malignancy.

Blood vessel injury due to vibrations (jackhammers)

Prolonged cold exposure (of butchers to low temperatures, frostbite).

Raynaud’s phenomenon 2 Localized vasospasm of arterial walls can acutely

block blood flow to a particular region of tissue leading to numbness and discoloration.

Clinical Manifestations Severe or prolonged attacks of Raynaud’s disease or

syndrome may result in

cyanosis

ulceration and gangrene of fingers or toes.

Treatment of Raynaud’s disease and Phenomenon Avoidance of precipitating factors such as cold and

strong emotions.

Vasodilator drugs or calcium channel blockers may be used to prevent vasoconstriction in Raynaud’sphenomenon. In severe cases the sympathetic nerves that innervate the local vasculature may be surgically severed.

Arterial inflammation

Thromboangiitis obliterans (Buerger’s disease)

is an inflammatory disorder that can affect the aorta or peripheral arteries.

It occurs most often in young heavy cigarette smoker men. The exact etiology of this disorder is uncertain but it manifests with inflammatory lesions of the arteries that may result in vasospasm, occlusion and thrombus formation.

Treatment of Burger’s Disease

cessation of smoking

Improve blood flow and reduce vasospasm through the use of vasodilator drugs.