02.19 Diseases of the Aorta and its Branches Flashcards by Karla Guntayon

Abnormal weakening and dilatation of the artery

Aortic aneurysm

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Aneurysm is most located in the ______

Abdominal aorta

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RF of AA

Older age
Male sex
Fam Hx
Smoking
HPN
Hypercholesterolemia
Connective tissue disorders
DM
Inflammation

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Two most common complications of AAA

Rupture

Thromboembolism

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Frequently asymptomatic
Abdominal mass or fullness
Low back pain
Abdominal rigidity
Fainting or lightheadedness
Excessive thirst
Vomiting

AAA

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PE of AAA

Pulsatile mass

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Best screening tool for the definitive diagnosis of AAA in the ER setting

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What are the information that you can gather through US

Absolute diameter
Relationship of aneurysm with the renal artery
Involvement of the iliac arteries
Detects presence of thrombus

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Gives more accurate size of the aortic aneurysm
For the evaluation for endovascular repair
Most sensitive test for detecting a rupture

CT Scan

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Signs of rupture in CT

Contrast extravasation
Stranding of blood in ventral peritoneum
Break in calcification ring

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Do repair for AAA if

Symptomatic
Rapidly growing aneurysms (>0.5 cm in 6 months)
With RF (strong fam hx, irregular shape, uncontrolled HPN, COPD)

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Threshold size of AAA for repair

5.5 cm

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Treatment options for AAA

Open surgery
Endovascular repair
Grafts

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Midline laparotomy
Retroperitoneal
Resect the aneurysm with restoration of distal flow

Open surgery

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Extrude the aneurysmal sac from the aortic circulation
Uses fluoroscopic guidance
Proximal neck fixation to prevent migration
Adequate seal to ensure aneurysmal sac exclusion
Sac shrinkage

Endovascular repair

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Endoleak related to graft device itself; endo leak that happens at the attachment site
Must be repaired

Type 1 endoleak type

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Endoleak due to retrograde flow from collateral branches

Must only be observed

Type II

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Endoleak due to fabric tears, graft disconnection, or disintegration
Must be repaired

Type III

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Flow through the graft presumed to be associated with graft wall “porosity”

Type Iv

Persistent or recurrent pressurization of the sac with no evidence or endoleak

Endotension

Eligibility criteria for EVAR

Access
Iliac vessels
Aberrant Vessels
Neck

Critical features that limit eligibility for EVAR

Alterations in neck composition (presence of thrombus, calcification)
Neck angulation
Undesirable neck length and diameter

Neck: Angulation ___, Length at least _____, Diameter _____, Reversed ____ shape neck, no thrombus, atheroma, calcification

< 60 deg C
1.5 cm
< 32 mm
Cone

Clinical syndromes of carotid artery disease

Asymptomatic
Transient ischemic attacks
Reversible ischemic neurologic deficit
Crescendo TIAs
Amaerosis fugax

A temporary loss of vision in one eye due to a lack of blood flow Stroke

Amaeurosis fugax

Mechanism of CAD that causes stroke

Embolization/thrombosis | Hypoperfusion

Risk of stroke is related to:

Degree of stenosis Symptom status Plaque morphology

Types of plaque

Calcified Dense Soft

PE for CAD

Bruits Absence of carotid pulse Embolic material in retinal artery branches

Embolic material in retinal artery branches

Hollenhorst plaque

Diagnostic tools for CAD

Carotid duplex US Magnetic resonance angiography CT angiography Contrast angiography

Data obtained in CDUs

Degree of stenosis | Plaque morphology

Less susceptible to overestimating carotid stenosis and provides good quality images that can be viewed in multiple planes Limited use in patients with calcified vessels because of possible overestimation

CT angiography

Gold standard | Anatomic measurement is done to measure the degree of stenosis

Contrast angiography

Patient is under general anesthesia The carotid vessels are exposed, do vascular control open up the vessel, take out the plaque and close it using a commercially available patch

Carotid endarterectomy

Done in catheterization lab under laparoscopic guidance The gold standard is that you have to have embolic protection device because if the plaque is soft, or ulcerated, any manipulation can cause the plaque to dislodge and travel to the brain and cause a stroke

Carotid artery stenting

Complications of CAD

Stroke Surgical Endovascular

Syndrome of elevated arterial blood pressure due to reduced kidney perfusion

Renovascular hypertension

Most common form of surgically correctable hypertension

Renal artery occlusive disease

Onset before age 30 without risk factors Presence of abdominal bruit Accelerated hypertension or resistant hypertension Renal failure of uncertain etiology Recurrent flash edema Acute renal failure precipitated by ACE I or ARBs

Renal hyperternsion

Anatomic studies for renal hypertension

Renal duplex ultrasonography MRI/MRA CT angiography Contrast angiography

Best screening method

Renal duplex ultrasonography

Gold standard Determines imporatnce of suggestive lesions Concurrently perform endovascular therapy

Contrast angiography

Functional studies

Captopril renography | Renal vein rein assay

Goals of treatment for renal hypertension

Control hypertension | Preservation of renal function

Treatment of renal hypertension

Medical Percutaneous transluminal renal angioplasty with or without stenting Bypass surgery