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Sagittal Overview

Aortic Ectasia and Aneurysms

Localized dilatations of the vascular lumen are generally caused by atherosclerotic lesions and local weakening of the arterial wall. They are rarely posttraumatic. A dilatation of up to 3 cm is referred to as ectasia and can be found in addition to an aneurysm (Fig. 13.1).

The dilatation can be fusiform or saccular. It can be complicated by dissection of the arterial wall (dissecting aneurysm) or circumferential intraluminal clot formation (52) with possible peripheral emboli. Risk factors for rupture of an aortic aneurysm are a diameter of greater than 6 cm, an excentric lumen, and diverticulum-like bulging of the aortic wall. As general rule, the risk of a rupture increases with the size of the aneurysm and patients with an aortic aneurysm exceeding 5 cm in diameter should be assessed clinically for surgical repair.

If an aneurysm is detected, the sonographic examination should report its maximal length (Fig. 13.2) and diameter (Fig. 13.3) as well as any detected thrombi (52) and possible involvement of the renal and iliac arteries. Though most aortic aneurysms are infrarenal, their exact extent should be established before surgical intervention. Any aneurysmal bleeding primarily occurs into the retroperitoneum but can extend into the peritoneal cavity in the presence of high pressure.

Fig. 13.2b

Checklist Aortic Aneurysm:

Normal lumen:

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