Arterial Diseases Flashcards
Aorta
three layers of the aorta
- tunica intima (thin, innermost)
- tunica media (thick, middle)
- tunica adventitia (thin, outermost)
Aorta
3 conditions of the aorta
- aneurysm
- dissection
- rupture
Aorta
describe aortic aneurysm
general, 2 statements
- dilatation of the aorta (> 3 cm(
- involves all 3 layers of the vessel wall
Aorta
describe aortic dissection
general
tear of the tunica intima which creates a false lumen
Aorta
describe aortic rupture
full-thickness tear of aorta
Aortic Aneurysm
3 types?
- thoracic aortic aneurysm (TAA)
- thoracoabdominal aortic aneurysm
- abdominal aortic aneurysm (AAA)
Aortic Aneurysm
what does TAA involve?
- thoracic aortic aneurysm
- involves aortic root, ascending aorta, arch, and descending aorta above diaphragm
Aortic Aneurysm
what does thoracoabdominal aortic aneurysm involve?
involves descending thoracic aorta and abdominal aorta
Aortic Aneurysm
what does AAA involve?
- abdominal aortic aneurysm
- involves descending aorta below diaphragm
Abdominal Aortic Aneurysm
90% of AAA most commonly occur where?
in the segment of aorta between the renal arteries and the bifurcation of the aorta
Abdominal Aortic Aneurysm
more common in who?
occurs in what % of them over 55 y/o?
- male > female
- 2% of men over 55 y/o
Abdominal Aortic Aneurysm
risk factors
7 things
- advanced age
- male
- tobacco use
- alcohol use
- white
- family hx
- atherosclerotic disorders (HTN, hyperlipidemia)
Abdominal Aortic Aneurysm
protective factors
4
- female
- not white
- diabetes
- moderate alcohol consumption
Abdominal Aortic Aneurysm
how large does an AAA need to be to be consistently found on PE?
> 5 cm
Abdominal Aortic Aneurysm
how are asx AAA found?
incidental findings on abd ultrasound or CT imaging
Abdominal Aortic Aneurysm
clinical findings when symptomatic?
- mild to severe deep abd pain
- flank pain that is constant or intermittent
- pain exacerbated on palpation
- pain radiates to back
Abdominal Aortic Aneurysm
complication
RUPTURE
has poor prognosis
Abdominal Aortic Aneurysm
risk of rupture drastically increases when diameter is > than?
5.5 cm
Abdominal Aortic Aneurysm
what are 2 imaging options? (which is preferred?)
- abdominal ultrasound (DO THIS ONE)
- abdominal CT w/ contrast
Abdominal Aortic Aneurysm
what will abd CT w/ contrast allow you to do?
- assess the diameter
- visualize arteries above/below to help plan surgical repair
Indications for surgical repair?
- diameter > 5.5cm
- rapid expansion in diameter ( > 0.5 cm in 6 mo)
- symptomatic (indicates impending rupture)
which of the following is not an indication for referal for surgical intervention?
1. increase in size > 0.8cm in 1 yr
2. active back/abd pain
3. hx of marfan’s syndrome
4. HTN
HTN
Abdominal Aortic Aneurysm
2 repairs that can be done
- open surgical repair
- endovascular repair
Abdominal Aortic Aneurysm
describe open surgical repair
graft sutured into the superior and inferior non-dilated aorta
Abdominal Aortic Aneurysm
what are the considerations for open surgical repair
3
- cardiopulmonary risk assessment
- abdominal adiposity
- abdominal incision
Abdominal Aortic Aneurysm
complications of open surgical repair
- myocardial infarction
Abdominal Aortic Aneurysm
mortality rate of open surgical repair
1-5%
Abdominal Aortic Aneurysm
describe endovascular repair
- stent graft introduced through femoral arteries
- placed via fluoroscopic guidance
Abdominal Aortic Aneurysm
considerations of endovascular repair
2
- reduced intraoperative morbidity and mortality
- shorter recovery period
Abdominal Aortic Aneurysm
mortality rate of endovascular repair?
0.5-2%
Abdominal Aortic Aneurysm
Long term survival for either surgical repair option?
- equivalent for both procedures
- 60% of pts are alive after 5 years
- MI is leading cause of death
Abdominal Aortic Aneurysm
which surgical repair carries more intraoperative risk? which carriers more post-op risk?
- open repair more risk intraoperatively
- endovascular repair more post-operative complications
Abdominal Aortic Aneurysm
one time screening
how, who, why, outcome?
- abd US
- men 65-75 y/o
- family hx, smoking hx
- decreased risk of AAA-related mortality
Abdominal Aortic Aneurysm
management & disposition of asx w/ diameter of:
* < 5.5 cm
* > 4.5 cm
* > 5.5 cm
- periodic clinical surveillance, risk reduction strategies
- refer to vascular surgery
- elective open vs endoscopic repair
Abdominal Aortic Aneurysm
management & disposition of symptomatic AAA
- admit for observation and surgical risk assessment
- determine if pt is a candidate for surgical repair
Thoracic Aortic Aneurysm
Risk Factors
5 groups: 3, 2, 2, 1, 1
- idiopathic/degenerative (atherosclerosis, HTN, smoking)
- aortitis (takayasu arteritis, giant cell arteritis)
- connective tissue disorders (Marfan’s, Ehlers-Danlos)
- Bicuspid aortic valve
- family hx of TAA
Thoracic Aortic Aneurysm
what do sx depend on?
size, position, and rate of growth of aneurysm
Thoracic Aortic Aneurysm
clinical presentation
6 components
- can be asx
1. dysphagia
2. stridor, dyspnea
3. SVC: upper extremity edema, jugular venous distension
4. Aortic root: aortic regurgitation
5. substernal chest pain
6. pain radiating to back/neck
Thoracic Aortic Aneurysm
complication of being symptomatic
rupture