02.19 Diseases of the Aorta and its Branches Flashcards
Abnormal weakening and dilatation of the artery
Aortic aneurysm
Aneurysm is most located in the ______
Abdominal aorta
RF of AA
Older age Male sex Fam Hx Smoking HPN Hypercholesterolemia Connective tissue disorders DM Inflammation
Two most common complications of AAA
Rupture
Thromboembolism
Frequently asymptomatic Abdominal mass or fullness Low back pain Abdominal rigidity Fainting or lightheadedness Excessive thirst Vomiting
AAA
PE of AAA
Pulsatile mass
Best screening tool for the definitive diagnosis of AAA in the ER setting
US
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
Gives more accurate size of the aortic aneurysm
For the evaluation for endovascular repair
Most sensitive test for detecting a rupture
CT Scan
Signs of rupture in CT
Contrast extravasation
Stranding of blood in ventral peritoneum
Break in calcification ring
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)
Threshold size of AAA for repair
5.5 cm
Treatment options for AAA
Open surgery
Endovascular repair
Grafts
Midline laparotomy
Retroperitoneal
Resect the aneurysm with restoration of distal flow
Open surgery
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
Endoleak related to graft device itself; endo leak that happens at the attachment site
Must be repaired
Type 1 endoleak type
Endoleak due to retrograde flow from collateral branches
Must only be observed
Type II
Endoleak due to fabric tears, graft disconnection, or disintegration
Must be repaired
Type III
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
