Diseases of the Aorta Flashcards
An anatomic remnant of right aortic aorta
Kommerell’s Diverticulum
Occurs near the insertion of the LIGAMENTUM ARTERIOSUM adjacent to the left subclavian artery
Coarctation of the Aorta
The more dominant factor in AAA or DESCENDING THORACIC ANEURYSM
Atherosclerosis
Associated with AAA
Hypertension
Usually a HARBINGER OF RUPTURE and represents a medical emergency
Aneurysmal pain
MC location of aortic aneurysm
Infrarenal aorta
Defined as a pathologic focal dilation of the aorta that > 30 mm or 1.5 times the adjacent diameter of the normal aorta
Abdominal Aortic Aneurysm
MC cause of AAA
degenerative process in the aortic wall
Risk factors associated with AAA ↑ in size
HPN
COPD
Smoking
SCREENING MODALITY OF CHOICE in AAA with high accuracy and sensitivity with a specificity of 100%
Abdominal Ultrasound
The GOLD STANDARD for determination of anatomic eligibility for endovascular repair
Abdominal CT
Indicated to ↓ the risk of cardiovascular events related to atherosclerosis
Statins
Anatomic criteria for endovascular AAA repair
INFRARENAL NECK: length 15 mm or greater, diameter 30 mm or less, and anterior angulation less than 60 degrees
LANDING ZONE: ability to fixate distally proximal to at least one internal iliac artery
COMMON FEMORAL AND EXTERNAL ILIAC ARTERY DIAMETERS—at least 7 mm
RELATIVE CONTRAINDICATIONS: severely calcified iliac arteries and severely tortuous iliac arteries
Indicated for abdominal aortic aneurysms of any size that are expanding rapidly or are associated with symptoms
Operative repair of the aneurysm with insertion of a prosthetic graft
OR
endovascular placement of an aortic stent graft
An alternative approach to treat ruptured aneurysms and may be associated with a lower mortality rate
Endovascular repair with stent placement
Represents a revolutionary and minimally invasive treatment for infrarenal AAA that only requires 1-2 days of hospitalization
Endovascular repair with stent placement
First step of medical therapy followed by surgical repair
smoking cessation
Anatomic eligibility for endovascular repair is mainly based on three areas:
proximal aortic neck
common iliac arteries
external iliac and common femoral arteries
Usual distal landing zone
Common Iliac Artery
Alternative site when the ipsilateral common iliac artery is aneurysmal or ectatic
External Iliac Artery
An extravasation of contrast OUTSIDE THE STENT GRAFT and WITHIN THE ANEURYSM SAC
Endoleak
Type I endoleak
attachment site leak
Type II endoleak
Side branch leak caused by lumbar or inferior mesenteric arteries
Type III endoleak
Junctional leak (of overlapping endograft components) and graft fabric defect
Type IV endoleak
Endograft fabric porosity (FOURosity) leak
Which endoleaks are treated aggressively and which are initially observed?
Type I and III endoleaks – aggressively treated by endovascular means (additional stent graft components and fixation site angioplasty/stent)
Type II endoleaks –most often will thrombose and are not reintervened on unless AAA sac growth is observed
4 major acute aortic syndrome
AORTIC RUPTURE
AORTIC DISSECTION
INTRAMURAL HEMATOMA
PENETRATING ATHEROSCLEROTIC ULCER
DeBakey Type I
An intimal tear occurs in the ASCENDING AORTA but involves the DESCENDING AORTA as well
DeBakey Type II
Dissection is limited to the ASCENDING AORTA
DeBakey Type III
Intimal tear is located in the DESCENDING AORTA with distal propagation of the dissection
Stanford Type A
Dissection involves the ASCENDING AORTA (proximal dissection)
Stanford Type B
Dissection limited to the ARCH and/or DESCENDING AORTA (distal dissection)
Criteria for surgical management of aortic dissection
type A dissections – treated with emergent operation including replacement or repair of the ascending aorta, aortic root, and aortic valve
type B dissections – treated with early surgical intervention if visceral or extremity arterial origins are compromised
*aneurysmal dilation of the aorta to 6 cm or intractable back pain
