Makindo Medical Notes

An aneurysm is a localised, permanent dilatation of an artery due to weakening of the vessel wall. 👉 Peripheral aneurysms (e.g., femoral, popliteal) often present as pulsatile masses and carry risks of thrombosis or rupture. Arterial occlusion can be acute (embolus, thrombosis) or chronic (atherosclerosis, peripheral arterial disease).

⚠️ Complications of Aneurysms

• 💥 Rupture: Life-threatening haemorrhage → shock.
• 🩸 Thrombosis: Intraluminal clot → acute limb ischaemia.
• 🚨 Embolization: Thrombus fragments lodge distally → “blue toe syndrome”, gangrene risk.
• 🧩 Compression: Adjacent nerves/veins → neuropathy, DVT, oedema.

🧑‍⚕️ Clinical Features

• 🔍 Pulsatile mass (e.g., femoral triangle, popliteal fossa).
• Groin/leg discomfort or swelling.
• Signs of acute limb ischaemia (“6 Ps”): Pain, Pallor, Pulselessness, Paraesthesia, Paralysis, Perishingly cold.
• Claudication in chronic occlusion.

🔎 Investigations

• 🩺 Bedside: Palpate pulses, ankle–brachial pressure index (ABPI).
• 🖥️ Duplex Doppler US: First-line for aneurysm size and flow.
• 🧲 CT/MR angiography: For operative planning.
• 🧪 Bloods: FBC, U&Es, coagulation screen (esp. pre-op).

🛠️ Management of Aneurysms

• 🆘 Emergency: Ruptured or acutely thrombosed → urgent vascular referral.
• 🔪 Surgical repair: Open resection & grafting for symptomatic, large (>2.5 cm femoral, >2 cm popliteal) or ruptured aneurysms.
• 🩻 Endovascular repair: Stent-graft in selected cases.
• 💊 Medical: Antiplatelets, statins, BP control for atherosclerotic disease.

🚨 Acute Limb Ischaemia (ALI)

ALI = sudden decrease in limb perfusion (<14 days), causing a threat to limb viability. Causes: embolus (AF, mural thrombus), thrombosis in situ (PAD), dissection, trauma.

• 🔑 6 Ps: Pain, Pallor, Pulselessness, Paraesthesia, Paralysis, Perishingly cold.
• ❗ Paralysis and absent Doppler signals = late, poor prognosis.
• 💉 Immediate management: ABC, IV heparin bolus, urgent vascular surgery consult.
• 🔪 Definitive: Embolectomy, thrombectomy, bypass, or thrombolysis depending on cause.

🌙 Chronic Limb Ischaemia

• 🚶 Claudication: Pain on walking, relieved by rest.
• 🛌 Rest pain: Severe PAD, pain at night, relieved by hanging foot over bed.
• 🩻 Critical limb ischaemia: Rest pain + tissue loss/ulceration.
• 🛠️ Management: Risk factor modification (smoking cessation, statins, antiplatelets), supervised exercise, angioplasty, bypass if severe.

📌 Key Exam Pearls

• Always check bilateral femoral & popliteal pulses in suspected aneurysms.
• Acute limb ischaemia = surgical emergency → give heparin, call vascular urgently.
• Femoral aneurysms can mimic inguinal hernia or lymph nodes.
• Peripheral aneurysms are often multiple → check for popliteal/aortic aneurysm.
• Blue toe syndrome = cholesterol emboli from aneurysm or atheroma.

📚 References

• NICE CKS – Peripheral Arterial Disease
• Vascular Surgery Texts – Rutherford’s, Browse’s