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AASM > 1 - Aorta > Flashcards

1 - Aorta Flashcards

1
Q

What are the anterior branches of the abdominal aorta?

A

Coeliac artery
Superior mesenteric
Inferior mesenteric

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2
Q

What are the 3 lateral branches of the abdominal aorta?

A

Renal arteries
Infra-renal arteries
Gonadal arteries

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3
Q

What three branches come off the arch of the aorta?

A

Brachiocephalic
Left common carotid
Left subclavian

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4
Q

What are the first vessels to arise from the aorta?

A

Left + right coronary vessels

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5
Q

What level do the 3 main structures cross the diaphragm?

A

Vena cava = T8
Oesophagus = T10
Abdominal aorta = T12

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6
Q

How many embryological arches form the adult arch of the aorta?

A

6

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7
Q

What vessels does the 3rd aortic arch form?

A

Common carotid

Head and neck vessels

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8
Q

What vessels does the 4th aortic arch form?

A

Aortic arch

Subclavian

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9
Q

What major vessel does the 6th aortic arch form?

A

Pulmonary trunks

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10
Q

In the context of congenital abnormalities, which arches fuse together in a ‘bovine arch’?

A

3 and 4

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11
Q

Bovine arch results in fusion of which vessels?

A

Brachiocephalic

Left common carotid

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12
Q

What is the problem with ‘coarctation of the aorta’?

A

Narrowing of the aorta

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13
Q

Where does coarctation usually occur?

A

Just after the subclavian artery, at the site of the embryological ductus arterosius

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14
Q

What effect will coarctation have on the heart?

A

Pumping against increased resistance - LV hypertrophy which eventually leads to HF

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15
Q

What finding, in the context of BP, will also occur from coarctation?

A

Upper limbs = high BP

Lower limbs = low BP

Can also cause headaches, fluid imbalance.

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16
Q

What pathology occurs in the case of an ‘Aberrant subclavian’, specifically dysphagia lusoria ?

A

Right subclavian leaves arch in the wrong place, and obstructs the oesophagus

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17
Q

What kind of circulation occurs in a state of chronic obstruction?

A

Collateral circulation

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18
Q

Which 2 vessels can connect the coeliac artery to the SMA?

A

Gastroduodenal

Dorsal pancreatic

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19
Q

What vessel can connect the SMA to the IMA?

A

Marginal artery of drummond

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20
Q

Which 2 vessels can connect the IMA to the internal iliac artery?

A

Superior rectal

Middle rectal

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21
Q

What defines an abdominal aortic aneurysm?

A

Diameter greater than 50%

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22
Q

What is the normal diameter of the abdominal aorta?

A

2cm

23
Q

What are the 3 layers of the abdominal aorta?

A

Tunica intima
Tunica media
Tunica adventitia

24
Q

What cell forms the tunica intima?

A

Endothelium

25
Q

What 3 components make up the tunica media?

A

Smooth muscle
Collagen
Elastic fibres

26
Q

What 2 components make up the tunica adventitia?

A 
Connective tissue
Vasa vasorum (blood vessels - supplying the cells)
27
Q

Marfan’s syndrome results is genetic disease which results in what mutation?

A

Mutation in the gene that encodes fibrillin (part of the elastic fibres)

28
Q

What consequence is more likely to occur in Marfan’s as a result of this mutation?

A

AAA

And even rupture!

29
Q

Aneurysms occur through the action of what enzyme?

Where do they work?

A

Matrix metalloproteinases

Adventitia

30
Q

What are the two forms of surgical repair for aneurysms?

A 
Open
EVAR (endovascular aneurysm repair)
31
Q

How does EVAR work?

A

Femoral artery, into the aneurysm.

Depositing a mesh frame into the artery, restoring integrity.

32
Q

Where is the most common place along the abdominal aorta for aneurysms to occur?

What %?

A

Infra-renal position

90%

33
Q

What complications can arise from open surgery, as a result of aortic clamping (which is necessary)?

A

Heart = myocardial infarction - heart pumps FASTER and HARDER (less time for systole)

Legs = anaerobic conditions –> lactate + inflammatory mediators –> unclamping results in systemic vasodilation –> SIRS, can lead BP crashing –> death

34
Q

What checks do you have to do to the infra-renal neck to confirm EVAR is a suitable option?

A

> 1.5cm long

<60 degree angle

35
Q

What term is used if EVAR is unsuccessful and blood leaks?

A

Endoleak

36
Q

Despite the numerous benefits, what disadvantages occur with EVAR?

A

More likely will require a revisit due to an endoleak.

However, mortality rates are the same.

37
Q

What is the issue that occurs in an aortic dissection?

A

The tunica intima separates away from the media

38
Q

What two risk factors predispose dissection?

A

HTN = mechanical

Smoking = chemical

39
Q

What types of dissection are there, and which classification is used?

A

Type A and Type B

Stanford classification

40
Q

What is a Type A dissection?

A

A dissection that involves the ARCH OF AORTA as well as the thoracic

41
Q

what is a type B dissection?

A

One that doesn’t involve the arch

42
Q

Why is Type A surgically managed immediately?

A

Tunica intima can impede flow to coronary artery, thus requires surgery immediately.

43
Q

How is Type B dissection managed?

A

Medications and lifestyle options to reduce mechanical stress.

44
Q

Why do dissections always start at the edge of the left subclavian?

A

First 3 major vessels form a hold of the arch in place.

Point after it acts like a hinge and is subjected to a lot of force.

45
Q

What are the main blood supplies to the brain (and their branches)?

A

Internal carotid (from common carotid)

Vertebral (from subclavian arteries)

46
Q

What are the 4 complications of aortic dissection?

A

Rupture

Heart failure (aortic valve incompetence)

Stroke (branch compromisation)

Aneurysm

47
Q

What are the logistics / steps to a surgical treatment of Type A dissection?

A

Open surgery. Divert blood supply.

Stent the entire ascending arch + completely replace the aortic valve.

48
Q

Surgical treatment or aortic dissection depends on what staging system?

A

Ishimaru zones

49
Q

How are the zones separated?

A

0 - ascending + brachio

1 - left com carot

2 - left subclavian

3 - descending

4 - thoracic

50
Q

Treatment of zone 0 requires what kind surgery?

A

Open

51
Q

Treatment of zone 1 requires what type of surgery?

A

Hybrid (frozen elephant)

open + stent

52
Q

Treatment of zone 2 requires what type of surgery?

A

Stent with carotid revascularisation

53
Q

Treating zone 2 Ishimaru involves which artery?

Why is it not a problem?

A

Left subclavian

Collateralisation of bloodflow - blood from the brain can divert towards high–>low resistance into the arm.

AASM (8 decks)

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