Aortic Disease

Question 1

What are the 2 types of aneurysm? Describe them.

Answer 1

Fusiform = affects the entire circumference of the vessel
Saccular = involves a portion of the circumference out-pouching of the vessel

Question 2

What is the MC sx of a thoracic aortic aneurysm?

Answer 2

Asymptomatic

Question 3

What is the MC pathological cause of a thoracic aortic aneurysm in the ascending aorta? In the aortic arch? In the descending aorta?

Answer 3

Ascending = cystic medial fibrosis
Arch = atherosclerosis
Descending = atherosclerosis

Question 4

A pt presents with sx of CHF and aortic regurgitation. He complains of steady, deep chest pain that sometimes radiates to his back. After R/O’ing MI, what is the next most likely diagnosis? What should you do to confirm your diagnosis?

Answer 4

TAA of the aortic root
CT (gold standard)
CXR, MRA

Question 5

A pt presents with cough, left tracheal deviation, and hoarseness. He has a history of Marfan’s syndrome, and CT confirms your diagnosis. What treatment do you recommend?

Answer 5

TAA of the aortic arch
Surgery (open surgery) b/c Marfan’s pt
Perform surgery if TAA is symptomatic and large (> 5.5-6 cm)

Question 6

A pt presents with dysphagia and steady, deep chest pain that radiates to her back. CXR shows mediastinum widening, a large aortic knob, and calcifications outlining a 5.2cm bulge in the aorta. What is the diagnosis? What treatment do you recommend? If the pt had no sx?

Answer 6

TAA of the descending aorta
Surgery (endovascular stent grafting) b/c pt is symptomatic
If asymptomatic medical Tx - B-blockers!

Question 7

A 58 yo male presents with constant abdominal pain that occasionally affects his lower back as well. He has a history of atherosclerosis, HTN, T2DM, and a 25 yr pack Hx. Exam reveals a palpable, pulsatile, non-tender mass. What is the diagnosis? What complication are you most worried about in this pt?

Answer 7

AAA

Rupture (pain indicates impending rupture)

Question 8

Who should you screen for a AAA? Where are AAAs most commonly found?

Answer 8

All male smokers > 65yo
Anyone with a Hx of aneurysm
Infrarenal (90%)

Question 9

A pt presents with a palpable, pulsatile, non-tender mass in his lower abdomen. What diagnostic test should you perform? How will you treat?

Answer 9

Abdominal U/S
Surgery (sx, > 5.5 cm)
Meds (B-blockers, U/S q 6 mo, stop smoking, control HTN)

Question 10

A 55 yo male presents with severe tearing pain in his chest. He says that over the past few hours it has been migrating towards his shoulders. Exam reveals HTN, an aortic regurg murmur, and asymmetric pulses. What do you suspect? Which 3 diagnostic tests could you perform?

Answer 10

Aortic dissection

CT, Echo, MRI

Question 11

A pt presents with severe sharp chest pain and neck pain. Exam shows hypotension, pulmonary edema, and altered mental status. CT confirms an aortic dissection. What is the goal of treatment? What do you recommend?

Answer 11

Goal = stop progression
B-blocker to control BP
Surgery

Question 12

Define an aortic dissection

Answer 12

A tear of the intima that allows a false channel to form within the media

Question 13

What are the DeBakey Classifications for aortic dissection? Stanford Classficiations?

Answer 13

DeBakey I = originates in ascending aorta & continues into descending aorta
DeBakey II = ascending aorta
DeBakey III = descending aorta
Stanford A = involves ascending aorta
Stanford B = doesn’t involve ascending aorta

Question 14

Give 2 indications for surgery in a pt w/ an aortic dissection

Answer 14

Acute distal dissection w/ vital organ compromise
Marfan’s syndrome
Continued pain