Aortic Surgery

Question 0

Location of descending and thoracoabdominal aorta

Answer 0

Just below the subclavian to the aortoiliac bifurcation

Question 1

Location of ascending aorta

Answer 1

AV annulus to the proximal innominate artery

Question 2

Aortic dissection

Answer 2

Blood penetrates the intima of the aorta

Creates expanding hematoma btwn medial layers it does not affect true lumen or branching vessels

Question 3

Aortic aneurysm

Answer 3

Dilation of all three layers of the aorta

Question 4

Risk factors for aortic dissection

Answer 4

HTN, advanced age, male, Marfans syndrome, coarctation, bicuspid AV, pregnancy

Question 5

Causes of aortic dissection

Answer 5

Increased physical exercise
Emotional stress
Blunt trauma
Cannulation

Question 6

Aortic dissection type 1

Answer 6

Intima tear in ascending aorta

Dissection occurs throughout all thoracic aorta

Question 7

Aortic dissection type 2

Answer 7

Intima tear in ascending aorta

Dissection is in ascending aorta only, stops before innominate artery

Question 8

Aortic dissection type 3a

Answer 8

Intima tear in descending aorta

Dissection is in the descending aorta only distal to left subclavian, ends above diaphragm

Question 9

Aortic dissection type 3b

Answer 9

Intima tear in descending aorta

Dissection below diaphragm

Question 10

Aortic dissection type A

Answer 10

Any dissection involving the ascending aorta no matter where the tear is or how trait propagates
Usually emergent cases because much more virulent

Question 11

Aortic dissection type B

Answer 11

Any dissection in the distal aorta distal to the left subclavian

Question 12

Causes of death with aortic dissections

Answer 12

Rupture of false lumen into pleural space or pericardium *most commmon* 
Progressive heart failure
MI
Stroke
Bowel gangrene

Question 13

3 shapes of aneurysms

Answer 13

Fusiform: entire circumference of aortic wall
Saccular: only part of circumference of aortic wall

Question 14

Aneurysm Crawford extent 1

Answer 14

Most or all of descending aorta or upper abdominal

Question 15

Aneurysm Crawford extent 2

Answer 15

Most or all of descending aorta into infra renal abdominal aorta

Question 16

Aneurysm Crawford extent 3

Answer 16

Half or less of distal descending aorta with varying portion of abdominal

Question 17

Aneurysm Crawford extent 4

Answer 17

Most or all abdominal aorta

Question 18

2 most common sits for thoracic injury rupture

Answer 18

Distal to origin of left subclavian

Ascending aorta just distal to aortic valve

Question 19

Indication for surgery in ascending aorta

Answer 19

Dissection: acute type A
Aneurysm: persistent pain, AV involvement creating MI, angina, rapidly expanding, greater than5-5.5cm

Question 20

Indication for surgery in aortic arch

Answer 20

Dissection: acute, limited to arch
Aneurysm: persistent symptoms, progressive expansion, 5.5-6cm diameter

Question 21

Indication for surgery in descending aorta

Answer 21

Dissection: failure to control HTN, continued pain, enlargement on CXR, CT, angio, neurologic deficit, renal/GI ischemia
Aneurysm: greater than 5-6cm, expanding, leaking, chronic