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ARTERIAL DISORDERS : PART - 2

Complications following amputation

• Early complications :
Haemorrhage.
Infection.
Flap necrosis : If the flap is not raised properly and
blood supply is poor.
DVT.
• Late complications :
Pain.
Phantom limb : It occurs when neuroma is formed.
When the nerves are not sharply cut leading to the
perception of the limb still being there.
Aneurysm :
It is the dilation of the vessel.
The most common form of aneurysm is a fusiform
aneurysm (Uniform dilatation of the vessel).
The common vessels involved are vessels of circle of Willis.
Most common extracranial vessel involved is the infrarenal
abdominal aorta.
Most common peripheral vessel involved is the popliteal
vessel.
Most common visceral vessel is splenic artery.
Most common vessel in involved in mycotic aneurysm is also
the aorta.
The term mycotic is a misnomer as it is not a fungal but a
bacterial aneurysm. The organism involved is staph aureus.
Pseudo aneurysm formation is commonly seen in the
femoral artery and this is secondary to the cannulation or
any trauma.
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Abdominal aortic aneurysms/AAA

Infrarenal abdominal aorta is the most common extracranial

vessel to be involved in an aneurysm formation.
Most important risk factor for aneurysm formation is
atherosclerosis.
Screening in the UK starts from 65 years of age and is
done using an USG abdomen.
The screening is done because :
It is very common in that population.
There is a critical diameter in the aneurysm, where once
it is reached the risk of rupture goes up exponentially.
Critical diameters of aneurysm :
1. Abdominal aortic aneurysms : 5.5 cm.
That means if an AAA go above 5.5 cm, then chances of
rupture increases exponentially.
Even if the patient is asymptomatic they should be
surgically managed.

Critical diameter

5.5 cm

Chances of rupture are higher in females.

Critical diameter in female is 5 cm.
2. Ascending thoracic aortic aneurysms : 5.5 cm.
If there is more than 0.5 cm increase in size per year it
is considered significant.
In such patients surgery is recommended.
3. The descending thoracic aortic aneurysms : The value is
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6 cm.
If there is more than 1 cm increase in size it is a
significant finding.
Patients with Marfans syndrome are also predisposed to
thoracic aortic aneurysms and the critical diameter is
4.5-5 cm.
Clinical features of abdominal aortic aneurysm :
• Asymptomatic and can be picked up in routine
screening.
• Abdominal pain.
• Pulsatile mass.
• Aneurysm can also act as a source of embolus can
rise to Blue toe syndrome (gangrene).
• Rupture of the aneurysm (high mortality and usually
in the retroperitoneal region.
Investigation :
Investigation of choice is CT.
Screening modality is USG abdomen.

Diameter of the aneurysm

CT angio

Management :
1. Indication for intervention :
In all symptomatic patients and in asymptomatic
patients where it is more than 5.5 cm in size
2. Intervention in AAA :
EVAR (endovascular aneurysm repair) and open surgery.