Chapter 106 - Aortoiliac disease direct reconstruction

Question 1

John Hunter 1700 on AIOD

Answer 1

First to describe aortic bifurcation disease

Question 2

Leriche on AIOD

Answer 2

first characterized AIOD symptoms

Question 3

dos Santos 1947 on peripheral arterial disease

Answer 3

First FEA Portuguese surgeon

Question 4

Wylie 1951 on AIOD

Answer 4

First Aortic endarterectomy in San Francisco

Question 5

AIOD associated disease in anatomical branches

Answer 5

1) 1/3 in profunda 2) 40% SFA 3) rare visceral and not enough to repair concomitently

Question 6

Collaterals around AIOD

Answer 6

1) lumbar and hypogastric to circumflex iliac, femoral, profunda 2) internal mammary to inferior epigastric (Winslow pathway) 3) SMA to IMA + hemorrhoidal (Arc of Riolan)

Question 7

Small aortic syndrome risk factors

Answer 7

hypoplastic aortic syndrome 1) smoking 2) young females

Question 8

I.C. from AIOD compared to I.C. from infrainguinal disease

Answer 8

10 years younger in AIOD disease

Question 9

AIOD rate of ED

Answer 9

30% cannot achieve or maintain erection due to decreased internal pudendal flow

Question 10

Leriche syndrome

Answer 10

terminal aortic occlusion 1) claudication to thigh/hip/butt 2) leg muscle atrophy 3) decrease femoral pulses 4) impotence

Question 11

Non invasive diagnosis with duplex cut off to indicate disease

Answer 11

20 mmHg drop indicate disease at level above

Question 12

Reasons to choose direct reconstruction over hybrid

Answer 12

1) failure of stent 2) renal failure 3) complication of stent

Question 13

Heparin discovered by

Answer 13

Best in 1930

Question 14

Arteriography developed in this yaer

Answer 14

1927

Question 15

Gross 1948 on AIOD

Answer 15

arterial homograft

Question 16

Vorhees 1952 on AIOD

Answer 16

first prosthetic graft

Question 17

Gruntzig 1974 on AIOD

Answer 17

POBA

Question 18

Puel/Sigwart 1986 on AIOD

Answer 18

stent

Question 19

Aortic endarterectomy candidate

Answer 19

1) focal disease 2) distal aorta and proximal CIA 3) impotence as symptom

Question 20

Harrison on AIOD

Answer 20

eversion endarterectomy

Question 21

Inahara 1970 on AIOD

Answer 21

modified eversion endarterectomy

Question 22

Heparon dose and ACT

Answer 22

70-100 Units/kg ACT 250-350s

Question 23

Knitted vs Woven polyester

Answer 23

Knitted: higher durability Woven: less dilatation

Question 24

End to end vs end to side

Answer 24

End to end perceived benefit: 1) more comprehensive thromboendarterectomy 2) less turbulent flow 3) decrease pseudoaneurysm 4) better patency 5) less risk of clamp induced emboli 6) easier position to close retroperitoneal 7) technically easier if calcified 8) concomitant aneurysmal disease End to side benefit 1) occluded EIA patent CIA and IIA 2) preserve large IMA or accessory low renal artery

Question 25

Protamine dose

Answer 25

1 mg/100 Units of circulating heparin

Question 26

Name of the vein in front of proximal profunda

Answer 26

Lateral femoral circumflex vein

Question 27

Reasons to do aortoiliac bypass instead of ABF

Answer 27

1) hostile groin 2) redo groin 3) infected groin 4) obesity 5) diabetes

Question 28

Perioperative mortality for aorta, renal or combined recon

Answer 28

Aortic recon: 0.7% Renal recon: 1.7% Combined recon: 5-6%

Question 29

Improvement in HTN and renal function in combined recon

Answer 29

HTN improve in 60-70% renal function improve in 33%

Question 30

Minilaparotomy or laparoscopic AIOD treatment chance of conversion to full open

Answer 30

20%

Question 31

Patency of endarterectomy of aorta

Answer 31

5 year 95% 10 years 85-90%

Question 32

ABF mortality in 30 days

Answer 32

4-4.4% more recently closer to 1%

Question 33

Patency of ABF

Answer 33

5 year: 85-90% 10 year: 75-85%

Question 34

Effect of age on patency of ABF at 5 year

Answer 34

Age > 60: 95% AGe < 50: 66% more aggressive atherosclerosis causes younger patients

Question 35

Patency of ABF over last few years

Answer 35

Worse due to more complex disease and worse technicians due to less exposure in training

Question 36

Renal protection best practice

Answer 36

1) avoid repetitive clamping 2) avoid perioperative hypotension

Question 37

Spinal ischemia risk in ABF

Answer 37

0.3%

Question 38

ABF entire graft and single limb thrombosis causes

Answer 38

Entire graft: proximal disease in remaining aorta Single limb: distal anastomosis intimal hyperplasia

Question 39

False aneurysm after ABF rate

Answer 39

1-5%

Question 40

Reasons to repair false aneurysm after ABF size

Answer 40

>2cm in femoral >50% diameter of graft in aorta

Question 41

Most common Aortoenteric fistula location

Answer 41

Proximal aortic suture with 3rd/4th duodenum

Question 42

Isolated profundoplasty results in CLI and IC

Answer 42

75% limb salvage at 3 year in CLI 88% 5 year patency in I.C.

Question 43

Complications and rates in ABF

Answer 43