How are aneurysms diagnosed and what screening can be involved?

How are aneurysms diagnosed and what kind of screening is involved? Yeah, so, I mean, classic, there are different routes by which patients with aneurysm are referred into the, into the clinic. You know, in the United Kingdom, where I've worked previously, you know, we have a very robust screening programme which picks up a large number of aneurysms. in Australia where I'm currently, there is no real screening program in the state that I'm in, but given the prevalence of imaging, a large number of patients are actually referred in with incidentally found aneurysms, which haven't been causing the patient any pain, but they're promptly referred to a vascular surgeon and a decision on treatment is usually made using the data that I've mentioned previously. But in terms of acquiring that data, you know, the initial screening or the initial tool that is frequently used to detect an aortic aneurysm is ultrasound, which is essentially uses high frequency sound waves to pick up on structures within the abdomen. It's not quite as as detailed or as reliable in terms of mapping out the exact anatomy as a CT scan is but it's a very useful tool for detecting you know the presence of aneurysm which is often frequently the only thing that is needed to start off with and then most often the surgeon will arrange for a very rapid CT angiogram just to map out the aortic anatomy or the patient's anatomy in detail And CT angiogram, I'm sure most people are familiar with what a CT is. The angiogram part simply refers to timing the acquisition of the CT images during the arterial phase, so when most of the contrast is in the arterial system of the body. So that's one aspect, and then once we have those images, we can render them in three dimensions and actually reconstruct the images in 3D and look at the aorta and the anatomy in more detail. Then in terms of the physiological assessment or the assessment of the patient's fitness, depending on the unit that the patient is referred to, these can be a mixture of echocardiography to look at the left ventricular function and to assess the valves. ourselves. Sometimes we undertake stress echo, which artificially creates strain on the patient's heart to see if it can withstand strain. Another mode of investigation for fitness is cardiopulmonary exercise assessments, which are run by anaesthetists and essentially the patient is put on a treadmill a number of parameters are recorded, you know the ECG is recorded, gas exchange is recorded, and the patient's metabolic state is recorded. So that's another means of assessing someone's fitness and again it depends on which unit the patient is referred to they might get that. Usually in combination with the echocardiogram we'd arrange a pulmonary or lung function testing because, as mentioned before, a lot of the patients that come through do have a smoking history or other reasons to have lung disease, so we need to make sure that their lungs are going to be able to firstly not only withstand a general anaesthetic, but also potentially a period on intensive care units afterwards where they're ventilated. So those kind of physiological aspects are really, really, really important to get right and to evaluate before putting a patient forward for surgery.