Endovascular approaches (TBL)

Question 1

Aortic aneurysm incidence in the US

Answer 1

60/1000

Question 2

Deaths per year from ruptured aneurysms

Answer 2

15,000

Question 3

Aortic aneurysm are the __ leading cause of death

Answer 3

12th

Question 4

Aortic aneurysms occur mostly in what demographic

Answer 4

Elderly men

Question 5

Aortic aneurysms occur mostly in what location

Answer 5

Infrarenal

Question 6

Aortic aneurysm treatments for small size

Answer 6

(<5.0 cm)

Serial CT scans

Question 7

Aortic aneurysm treatments for large size

Answer 7

(>5.0 cm)

Surgical repair

Question 8

Aortic aneurysm treatment for ruptured aneurysms

Answer 8

Emergent repair

Question 9

Surgical options

Answer 9

Trans peritoneal
Retroperitoneal
Laparoscopic
Endoluminal stent grafting (EVAR)

Question 10

Open repair

Answer 10

Physically cut open patient to reach vessel area

Question 11

Laparoscopic

Answer 11

Using a tool outside the body to be fed to vessel area without majorly cutting open patient

Question 12

Endovascular stent grafting (EVAR) limitations

Answer 12

Prox neck angulation.
Delivery limited by tortuous, calcified, small iliacs.
concurring aneurysms limit use.

Question 13

EVAR complications

Answer 13

Movement of prosthesis.
Continued/recurrent circulation of blood in aneurysm but outside stent.
Pseudoaneurysm formation.
Thrombus within stent leading to stenosis/occlusion.
Arterial dissection.

Question 14

EVAR follow-up

Answer 14

Life-long surveillance.
Physical exam.
CT scan.
Duplex scan.
Interventions.

Question 15

EVAR main goal

Answer 15

Aneurysm sac shrinkage

Question 16

Endografts on Duplex (B mode)

Answer 16

Begin trans.
Document patency of renal arteries.
Measure aneurysm sac in trans, AP, lateral
Measure area.

Question 17

Endografts on duplex (color/dopp)

Answer 17

Low color scale.
Examine prox attachment site.
Patency of graft.
Evaluate each limb of graft (Bifur not in normal place).
Scroll though graft with Doppler.

Question 18

Doppler of endografts

Answer 18

Document signals in both common iliac, and both external iliac arteries.
Asses both iliac attachment sites.

Question 19

Endoleak types

Answer 19

Type 1
Type 2
Type 3
Type 4

Question 20

Type 1 endoleak

Answer 20

Occurs at attachment site. Inadequate seal.
1A=Proximal
1B=Distal

Question 21

Type 2 endoleak

Answer 21

Occurs from back bleeding from branch vessels.
Lumbars
IMA

Question 22

Type 3 endoleaks

Answer 22

Occurs from leak in fabric or modular disconnection

Question 23

Type 4 endoleaks

Answer 23

Occurs from fabric porosity.

Leak through fabric

Question 24

Result after endograft placement

Answer 24

Aneurysm should shrink over time.
Failure to shrink or begins to enlarge indicates leak.
Unrepaired leaks causing expansion leads to aneurysm rupture.

Question 25

Assessing Endografts on Duplex

Answer 25

Assess the configuration of stent for bulges, kinking or fractures.
Evaluate lumen of stent for thrombus/stenosis.

Question 26

Aneurysm size changes

Answer 26

AAA size reduction predicts successful exclusion.
Continuing endoleak and AAA enlargement are linked.
Aneurysms enlarge with no leak=poor imaging.

Question 27

EVAR pros

Answer 27

AAA size not a limitation.

Delivered by bilateral trans-femoral route