Surgery - Aortic and Peripheral Vascular Disease Flashcards
1
Q
AORTIC & PERIPHERAL VASCULAR DISEASE
A
Aortic Disease:
- Aortic Aneurysm
- Aortic Dissection
Arterial Disorders:
- Peripheral Arterial Disease (PAD)
- Acute Arterial Occlusion
- Atheroembolism
- Reynaud’s Disease & Phenomenon
Venous & Lymphatic Disorders:
- Deep Venous Thrombosis
- Chronic Venous Insufficiency (CVI)
- Varicose Veins
- Lymphedema
2
Q
Aortic Disease
Aortic Aneurysm:
- Pathologic dilatation of a segment of a artery; true aneurysm vs. pseudo aneurysm
Aneurysm Type:
- Fusiform affects entire circumference of a segment of vessel
- Saccular involves only a portion of the circumference, resulting in an outpouching of the vessel wall
- Dissecting false aneurysm resulting from tear in the intima of the vessel allowing blood to enter vessel wall
A
Aortic Disease
- *Aortic Aneurysm**
- *Etiology** commonly associated w/ atherosclerosis
- *Can be thoracic or abdominal**
- *75% of atherosclerotic aneurysms** are infrarenal
- *Cystic medial necrosis (CMN)** is the term used to describe the degeneration of collagen & elastic fibers in the tunica media
- *Syphilis,** TB, vasculitis & trauma are less common causes
3
Q
Aortic Disease
Thoracic Aortic Aneurysm (TAA)
- Caused by either cystic medial necrosis or atherosclerosis
- Growth rate is 0.1-0.4 cm per yr. & risk of rupture is related to the size
- Clinical manifestations most are asymptomatic!! compression or erosion into adjacent tissue can cause sxs CP, SOB, cough, hoarseness, dysphagia, CHF sxs, venous congestion of head, neck or upper extremities
A
4
Q
Aortic Disease
Thoracic Aortic Aneurysm (TAA)
Diagnosis
- CXR widening of mediastinal shadow
- 2D Echo or TEE assesses both the ascending & descending thoracic aorta
- Computed Tomography (CT) w/ contrast
- MRI w/ contrast
- Contrast aortography
Treatment
- Medical long-term B-Blocker therapy & further control of HTN as indicated
- Surgical graft placement in pts who are symptomatic or aortic diameter >6 cm
A
5
Q
Thoracic Aneurysm Repair: Open and Intravascular
A
Aortic Disease
Abdominal Aortic Aneurysm (AAA)
- More common in males than females
- 90% are affected by atherosclerosis & located below level of renal arteries
- Prognosis is related to size of aneurysm & the risk of rupture with the size
- The formation of mural thrombi within the aneurysm may predispose to peripheral embolization
6
Q
Aortic Disease
Abdominal Aortic Aneurysm (AAA)
- Clinical Manifestations commonly asymptomatic; pain indicates aneurysm expansion, some pts c/o strong abdominal pulsations, others c/o pain in chest, lower back, or scrotum; on PE a palpable, pulsatile, non-tender mass may be present
- More often acute rupture presents w/o any warning resulting in acute pain & hypotension
A
Aortic Disease
Abdominal Aortic Aneurysm (AAA)
Diagnosis
- Abdominal X-Ray calcified outline of the mass may be present
- Abdominal U/S delineates transverse & longitudinal dimensions of aneurysm & detect thrombus
- CT-scan w/ contrast location & size0
- MRI w/ contrast similar value as CT-scan, however more expensive
- Contrast Aortography used to evaluate pts prior to surgery; procedure carries potential risks
