Cards: Aorta Flashcards
Who are the only people who should be screened for thoracic aorta disease?
Screening of asymptomatic patients for abnormalities of the thoracic aorta should be reserved for patients with underlying vascular pathology (such as Marfan or Ehlers-Danlos syndrome), a bicuspid aortic valve, or a family history of aortic disease.
Is invasive imaging needed for diagnosis of acute aortic disease?
Invasive imaging of the aorta by angiography is rarely necessary for the diagnosis of acute disease; it should be reserved for patients in whom a percutaneous intervention is planned.
What parts of the aorta are involved in a thoracic aortic aneurysm?
Thoracic aortic aneurysms may involve the aortic root, ascending aorta, aortic arch, or descending aorta.
What are the majority of aneurysms associated with the descending aorta associated with?
The vast majority of aneurysms affecting the descending thoracic aorta are associated with atherosclerosis.
In patients with a bicuspid aortic valve, how often should their thoracic aneurysm be evaluated? And when does that start?
Because patients with a bicuspid aortic valve have an increased risk of aortic aneurysm and dissection, these patients should undergo echocardiography of the aorta annually if the aortic root or ascending aorta dimension is greater than 4.5 cm. In those with an aortic diameter between 4.0 and 4.5 cm, the examination interval depends on the rate of progression of dilation and the family history.
In patients with Marfan syndrome, how often should their thoracic aneurysm be evaluated and when?
In patients with Marfan syndrome, follow-up imaging is recommended 6 months after diagnosis with annual surveillance thereafter if the aortic root is less than 4.5 cm in diameter and otherwise stable. If the aortic diameter is 4.5 cm or greater or shows significant growth over time, then more frequent surveillance is suggested (for example, twice yearly).
When is thoracic aneurysm repair recommended for:
- symptomatic
- Marfan/Ehlers Danlos
- bicuspid aortic valve
The repair of a thoracic aortic aneurysm is often recommended prophylactically to prevent the morbidity and mortality associated with aneurysm rupture. In asymptomatic patients, elective thoracic aortic repair is recommended if the aortic root or ascending aorta is greater than 5.5 cm (5.5–6.0 cm for the descending aorta) or has rapid growth (>0.5 cm/year). For genetically mediated disorders (such as Marfan syndrome), a lower threshold of 5.0 cm (4.0–5.0 cm in certain patients) may be used for repair. For patients with a bicuspid aortic valve, repair is indicated if the aortic diameter is greater than 5.5 cm and is reasonable if the diameter is greater than 5.0 cm and the patient has an increased risk of dissection (family history of dissection or rapid growth).
What are the acute aortic syndromes?
Acute aortic syndromes include aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, and trauma-induced aortic rupture
What are the risk factors for acute aortic syndromes?
Hypertension is the most important risk factor; other risk factors include smoking and atherosclerosis.
What findings on physical exam increase suspicion for dissection?
Other findings on physical examination that may increase the index of suspicion include pulsus paradoxus, asymmetric blood pressure in the upper extremities, and an asymmetric pulse examination.
Once diagnosed, if someone has an acute aortic syndrome, how is it immediately managed (if they don’t have cardiogenic shock)
Patients with a suspected acute aortic syndrome who are not in cardiogenic shock should receive medical therapy to control heart rate and blood pressure. Intravenous β-blockers should be used to target a heart rate of below 70/min. In patients requiring additional blood pressure control, a rapidly titratable antihypertensive medication, such as sodium nitroprusside, labetalol, enalaprilat, hydralazine, or nicardipine, should be given intravenously, with a goal of decreasing the mean arterial pressure to the lowest level that still allows visceral and cerebral perfusion.
How is a Type A Dissection managed?
Emergency surgery is recommended for all patients with type A aortic dissection as well as for type A intramural hematoma.
Any delays to surgery should be avoided or addressed, as type A dissection has a very high short-term mortality rate. Concomitant aortic arch reconstruction, coronary artery reimplantation, aortic valve repair or replacement, or branch vessel repair may be required depending on the anatomy and pathology of the lesion.
How is an uncomplicated Type B dissection managed?
Uncomplicated type B aortic syndromes may be treated medically. The INSTEAD trial, which enrolled subjects with uncomplicated chronic type B dissection, showed no difference in clinical or aortic outcomes at 2 years for patients treated with TEVAR versus medical therapy alone. Among patients who survived at 2 years, additional long-term follow-up of the INSTEAD trial demonstrated that TEVAR in addition to optimal medical treatment was associated with improved long-term aorta-specific survival and delayed disease progression
How is a complicated type B aortic dissection defined?
Surgery is indicated for complicated type B aortic dissection defined by refractory pain or hypertension, rapid aneurysmal expansion, rupture, or malperfusion syndrome.
What is the definition of a AAA?
An abdominal aortic aneurysm (AAA) is considered to be present when the minimum anteroposterior diameter of the aorta reaches 3.0 cm.
