Aorta Flashcards
What is the Crawford Classification?
Type I LSCA to diaphragm Type II LSCA to bifurcation Type III T6 to to bifurcation Type IV T6 to renals Type V T6 to above renals
Things to ask when imaging aorta?
Location of abnormal Max diameter If genetic syndrome, av sinus, STJ, asc aorta diam Filling defects Presence if IMH, PAU, calcification Extension into branches end organ injury Presence of rupture hematoma Previous imaging
What are the indications for surgical treatment for ascending aorta?
Class I
Asympto aneurysm, asc, root, IMH, PAU, mycoric pseudo >5.5 cm
Asympto growth rate >o.5 cm per year
Asympto plus cv sx >4.5 cm
Sympto
Modified David if possible for marfans LD, EHD
What is risk for asc/thoracic repair?
MI 1-5% Infection 1-5% Stroke. 1-2% Reop 1-6% Resp failure 5-15% Paralysis 2-4% increase in extent II
What are causes of TAAA?
Degenerative 82%
Dissection 17%
CTD
What are the Indications for desc aneurysm/TAAA?
Class I
If chronic dissection >5.5cm
If defen/traumatic >5.5cm or saccular or pseudo EVAR recommend
If EVAR not commended and TAAA then 6.0 cm
What inflamm dz are associated with TAA and dissection?
Takayasau. T cell mediated para arteritis
Giant cell arteritis- elastic vessel vasculitis
Behcet
Ank spon
Infective
What bacteria are common in infected aorta?
S. Aureus, salmonella most common
Pneumococcus and E. coli most common gram negative
Treponema pallidum
Candida/aspergillus
Before stenting defending what do you need to confirm before covering LSCA?
What conditions increas risk of paraplegia when stenting?
Contra r subclavian and verts are patent
Verts communicate via basilar artery
Previous AAA 10% vs 2%
What is the endoderm classification?
Type I leak at attachment site
Ia proximal, Ib distal, Ic iliac occluder
Type II branch vessel, IIa single vessel, IIb 2 or more
Type III defect in great
IIIa junction of component, IIIb wint graft defect
Type IV. Graft porosity
Type V
Continued expansion without demonstrating leak endotension
Which endoleak is most common?
Which endoleak considered unresolved? What percentage are these?
How to deal with type II?
Does type IV require tx?
II 80%
I 10%
Can resolve spon or add occluder
NO
What are indications for definitive management for acute aortic disease?
Asc urgent repair
Desc
Medical management unless complicated
What is medical management of acute aortic disease?
Class I
IV BB HR 60 SBP<120
If BB CI then CCB
If SBP >120 with adequate HR use second vasod or ACEi
In what condition should BB and AoD be administered cautiously?
AI with AoD
Will block compensatory tachy
What is natural he of type A dissection?
Surgical mortality?
Survival?
50% die immediately then 1% per hour
10%
50-70% alive at 5years