Cardiovascular and Respiratory Flashcards
Etiology of late hemorrhage of vascular grafts
Graft infection/anastamotic disruption. Infection by virulent bacteria usually results in graft infections within 4 months of surgery, usually due to Staph aureus, proteus, klebsiella, enterobacter, and pseudomonas, all of which produce proteases and break down arterial wall adjacent to the anastoomosis. This results in separation of the graft from host artery creating a pseudo aneurysm. These may rupture, thrombus, or embolize. Less virulent bacteria, such as Staph epidermis may cause delayed graft infections. May originate from septic emboli, like from mitral or aortic valves, or direct contamination during initial surgery. Successful tx includes systemic abx and frequently graft removal and revision.
Endoleak Type I - A,B
Ineffective seal at fixation zones
A: prox end
B: distal end
Urgent intervention with balloon angioplasty or balloon expandable stent placed proximally to complete the seal. Alternatively, an extension aortic cuff (IA) or iliac extension limb (type IB) may be deployed.
Endoleak Type II - A,B
Persistent flow through aneurysm sac via branch vessels most commonly from IMA or lumbar arteries.
A: single vessel (simple)
B: two or more vessels creating a circuit (complex)
Endoleak Type III - A,B
Structural endograft failure (separation between stent graft components that permits blood flow into aneurysm sac)
A: junctional separation of modular components
B: endograft fracture or holes
Repaired by deploying a stent within the current stent or utilizing a cuff if endoleak is in distal aspect of stent graft.
Endoleak Type IV
Through the stent grafts caused by porosity (
Endoleak Type V
Endotension (growth of aneurysm sac despite no identifiable source). Tx with either open surgical repair or deploying another stent graft into current one.
What is an endoleak
Persistent pressurization of aneurysm
