Aortic Reconstruction Flashcards
Open approach is still commonly used for aneurysms with __________, __________, and __________ locations.
JuxtarenalSuprarenalThoracoabdominal
The risk of aortic rupture is related to the __________ of the aortic aneurysm sac. The risk of rupture increases once the aneurysm is ____________________.
Absolute diameterGreater than 4.5 to 5 cm
The 6-year cumulative incidence of rupture was _____ among patients with aneurysms >5 cm in diameter
20%
What three trials showed improvements in mortality with EVAR compared to OAR?
EVAR-1DREAMOVER
Does EVAR confer greater renal protection than OAR?
No, probably because the risk of CIN is increased despite the fact that IRI is decreased.
Name at least 5 risk factors of increased postoperative mortality after EVAR?
In order of decreasing importance:Renal failure with dialysisLower extremity ischemiaAge ≥85 yearsLiver diseaseCHFRenal failure without dialysisAge 80 to 84 yearsFemale genderNeurologic conditionChronic pulmonary conditionSurgeon EVAR experience
What is the most common complication of EVAR and what is its incidence?
Endoleak, 30%
Define the 5 types of endoleak.
Type I—high flow leak adjacent to a stent that is not sealing the sac from the systemic circulation (requires immediate intervention).Type II—low flow leak due to arterial branches that have been excluded by the stent (can be treated with embolization).Type III—failure with the stent itself or at its junction with another stent (requires immediate recognition and treatment).Type IV—porosity in the stent (often resolves with reversal of anticoagulation).Type V (endotension)—persistent or recurrent pressurization of the aneurysm sac despite no detectable endoleak.
Type ___ endoleak can usually be managed conservatively.
II
Types ___ and ___ endoleak are high-pressure leaks and generally require urgent management because of their relatively high short-term risk of sac rupture
Types I and III
What is post-implantation syndrome and how common is it?
Occurring after EVAR, post-implantation syndrome is a transient condition characterized by fever, leukocytosis, elevated C-reactive protein level, and coagulopathy. The incidence is estimated at 35% to 60%.
The incidence of spinal cord ischemia after EVAR is higher in patients receiving endovascular repair for a _______ aneurysm.
Thoracic
What two approaches can be used for exposure in OAR surgery?
Transperitoneal - a thoracoabdominal midline incision is performed and the aorta is accessed through the peritoneumRetroperitoneal - incision is made over the lateral border of the left rectus muscle, 2 cm below the umbilicus to the 12th rib. This allows access to the aorta from the crux of the diaphragm to its bifurcation.**The retroperitoneal technique allows a surgical exposure as good as the transperitoneal approach and is associated with less fluid shift, faster return of bowel function, lower pulmonary complications, shorter ICU stay, and lower overall hospital cost.
What physiologic changes are associated with immediate period after aortic cross clamping?
Passive recoil distal to clamp - increased preloadCatecholamine response - venoconstriction, increased resistance, increased cardiac contractilityImpedance to flow - increased afterloadOverall, increase or decrease in Co possible
What mediators are released with cross clamp removal? What strategies can be used to mitigate HD effects?
Hydrogen/LactatePotassiumPro-inflammatory cytokinesStrategies:Staged releaseBicarbonatePressors
