Aorta Flashcards
What is the primary reason to have an aorta u/s performed?
It is to identify aneurysms and stenosis of the arteries.
What affects the aorta and its main branches?
- atheroma
- aneursym formation
- connective tissue disorders like cystic medial necrosis and marfan’s syndrome
- rupture
- thrombosis
- infection like syphilis
- displacement by and invasion from diseases in adjacent structures
This is a vascular wall disorder characterized by the presence of lipid deposits in the intima.
atheroma
What is atheroma?
A fatty deposit that builds up in the lining of the arteries throughout the body over a number of years. This deposit narrows the artery and eventually reduces the amount of blood that can get through.
What does plaque in the vessel cause?
Mural irregularity and frequently narrows the vessel lumen
A disease of the arteries in which fatty material and plaque are deposited in the wall of an artery, resulting in narrowing of the arterial lumen and eventual impairment of blood flow is called…
… atherosclerosis.
The condition of having plaque in the arteries is called…
…atherosclerosis.
___ is hardening of the arteries.
Arteriosclerosis
Which condition not only thickens the wall of the arteries but also causes stiffness and a loss of elasticity?
arteriosclerosis
When is arteriosclerosis disease a concern?
Arteriosclerosis may be present in any artery of the body but the disease is most concerning when it attacks the coronary arteries and threatens to cause a heart attack.
What is the most common type of ateriosclerosis?
atherosclerosis
A patient with arteriosclerosis may not have ___, but a patient with atherosclerosis does have ___.
atherosclerosis/arteriosclerosis
What disease most often occurs in the infrarenal portion of the aorta?
stenotic or occlusive disease
The incidence of atheromatous disease increases with ___ and effects more ___ than ___.
age/men/women
What vessels are involved with atheromatous?
aorta, iliac arteries and other aortic branches
Where in the vessel is atheroma commonly seen?
on the posterior wall of the vessel
What causes atheroma?
- cigarette smoking
- diabetes
- HTN (hypertension)
- increased cholesterol (LDL)
Any swelling or localized dilation in a blood vessel, either focal or diffuse, with at least a 50% increase over normal aortic diameter is called…
aneurysm.
What are the types of aneurysm?
- True aneurysm
- False aneurysm (pseudoaneurysm)
- Dissecting aneurysm
Who are 4 times more likely to have AAA?
Male
What are the symptoms of aneurysm?
*usually there are no obvious symptoms of the disease but if any symptoms are present they can be
*abdominal pain that may be constant or come and go
*pain in the lower back that may radiate to the buttocks, groin or legs
the feeling of a heartbeat or pulse in the abdomen
Ultrasound findings for aneurysm are…
- increased aorta diameter ( >3 cm AP dimension)
- focal dilation
- lack of normal tapering distally
- presence of thrombus - thick echogenic echoes, sometimes with shadowing
- occasional dissection
- rupture
How do you analyze AAA?
- maximum true length, width and transverse dimensions
- documentation of shape
- documentation of location, including suprarenal extension or involvement of common iliac vessels
- nature and type of wall thickening (calcified or soft plaque)
- patent channel found and flow pattern characterized with doppler
- examine both kidneys if AAA involves renal arteries
Types of true aneursym are…
- Berry aneurysm
- Saccular aneursym
- Fusiform aneursym
A minority of true aneurysms are due to which underlying disease?
Marfan’s syndrome
The size of a berry aneurysm is…
1 to 1.5 cm
What is the size and shape of a saccular aneursym?
spherical and larger 5-10 cm
Describe saccular aneurysm.
Saccular aneurysm is an aneursym connected to the vascular lumen by a neck and out pouches.from one side of the vessel wall.
Fusiform aneurysm can be ___, so one aspect of the vessel wall may be more severely affected.
eccentric
The common iliac arteries are considered enlarged once the diameter exceeds ___.
2 cm
The aorta that is found to be enlarged throughout and curving without an actual bulge but never measuring >3 cm is called?
ectatic aorta
When is surgery an emergency for an aneursym?
for a ruptured aneursym
What symptoms include when an aneurysm bursts?
- severe back or abdominal pain that begins suddenly
- paleness
- dry mouth/skin and excessive thirst
- nausea and vomitting
- signs of shock, such as shaking, dizziness, fainting, sweating, rapid heartbeat and sudden weakness
The biggest risk factor for an aneursym to rupture is its ___.
size
A pulsatile hematoma where blood escapes through a hole in the intima but is contained in the deeper layers of the aorta or by the adjacent tissue is a…
pseudoaneurysm.
What are round or oval protuberances from the artery?
Pseudoaneurysms
In pseudoaneursyms blood circulates into them in ___ and out of them in___.
systole/diastole
What are the causes of pseudoaneurysms?
- Mycotic infection (bacterial)
- Trauma
- Surgery
- Interventional procedures (cardiac cath, etc)
What is the intervention for pseudoaneursyms?
- Compression
- Thrombin injection
- Surgical repair
Describe compression pseudoaneursyms.
Compression of the hematoma with a linear transducer at 20 min intervals may allow the lesion to close if the neck is small. Those that do not close with compression require surgical intervention as they become a source of emboli, infection or cause local pressure effects. They may also rupture which may result in exsanguinations (to lose blood to the point at which life can no longer be sustained).
What is the downfall of thrombin injection?
The only pitfalls are inadvertent injection of the thrombin in the wrong location and possible allergic reactions. The inadvertent injections are unlikely when u/s guidance is used to place the needle tip in the pseudoaneursym cavity and not in either the neck or the native artery.
What is a dissecting aneurysm?
A serious condition in which a tear develops in the inner layer of the aorta. Blood surges throughout the tear into the middle layer of the aorta, causing the inner and middle layers to separate (dissect). If the blood-filled channel ruptures through the outside aortic wall, aortic dissection is usually fatal.
Why does most aortic dissection occur?
Because the artery’s wall deteriorates. Most commonly such deterioration is associated with high blood pressure, which is present in more than 2/3rds of people who have an aortic dissection.
What causes aortic dissection?
Aortic dissection may be caused by hereditary connective tissue disorders, especially Marfan syndrome and Ehlers-Danlos syndrome. It may also be caused by birth defects of the heart and blood vessels, trauma, pregnancy or dissection of the thoracic aorta.
Which kind of person is likely to get dissecting aortic aneurysm?
- 40-70 years old.
- HTN
- Predominately males (Specifically African-Americans)
- Have a known aneurysm
- Those who have sudden excruciating chest and back pain
How can a dissecting aneurysm be diagnosed?
CT scan
MRA
TEE-Transesophageal echocardiography
What does the doctor recommend for dissections?
surgery
Where are people with an aortic dissection admitted?
They are admitted to intensive care units where their vital signs (pulse, blood pressure, and rate of breathing) are closely monitored. Death can occur a few hours after an aortic dissections begins.
Other aortic abnormalities are?
aortic grafts
AV fistulas
Explain aortic grafts
Flexible material inserted into the groin and deployed within the aorta - used for access of blood into lower extremities or repairing of AAA weakenend walls
What are the types of prosthetic aortic grafts?
- aorta end-end
- aorta-iliac
- aorta-bifemoral
- fem-fem
What must the sonographer ask when a patient comes in who has a graft?
- Ask the patient when the graft was placed (they have a card they carry with them at all times with the info on it).
- Assess the upper and lower anastomoses
- Check for stenoses, aneursyms & pseudoaneurysms with doppler
- Identify and measure fluid collections around the graft or anywhere in the abdomen
- Check the blood flow distally
Define arteriovenous fistula.
An abnormal communication between an artery and vein.
What are the 2 types of arteriovenous fistulas?
congenital and acquired
What is congenital AV fistula?
An uncommon birth defect. Lower extremities are more frequently involved than other areas of the body.
What is an acquired AV fistula?
One which develops after a person is born usually occurs when an artery and vein that are side by side are damaged and the healing process results in the 2 becoming linked.
What causes AV fistula?
May be due to trauma, inflammation or neoplasm
What are the symptoms of AV fistula?
- Present with low back and abdominal pain
- A pulsatile mass with bruit
- Massive swelling of the lower trunk and extremities
- Progressive cardiac decompensation
Berry aneurysm is mostly seen in ___ in the ___.
cerebral arteries / brain
