Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BCC > TAAA > Flashcards

TAAA Flashcards

1
Q

What does it mean if the aorta has ectasia? What about aneurysm?

A

Ectasia: Dilation of the aorta <150% of normal diameter; Aneurysm: >150% of normal diameter (of all 3 layers of the aorta - intima, media, adventia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the difference between an aneurysm and a pseudoaneurysm?

A

A pseudoaneurysm does NOT involve all 3 layers of the aorta (an aneurysm involves all 3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the cause of dilation of the aorta?

A

Loss of elastic fibers and increased deposition of proteoglycans (i.e. due to atherosclerosis, fibroelastic diseases, or inflammation of the aorta)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the cause of Marfan’s syndrome?

A

Defect in the FBN1 gene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What system is used to classify aortic aneurysms?

A

Crawford Classification (different from DeBakey which is for dissections)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the various types in the Crawford Classification?

A

Type I = left subclavian to celiac axis (suprarenal); Type II = left subclavian to the aortic bifurcation (most extensive); Type III = 6th intercostal space to the iliac bifurcation; Type IV = Visceral abdomoinal aorta to the iliac bifurcation (no thoracic component); Type V = 6th intercostal space to above the renal arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How many landing zones are there of the aorta?

A

Eleven

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What size aneurysm should you consider surgical intervention?

A

TAA with diameters >/= 5.5cm OR <5.5cm but risk of rupture OR if there is increased risk for perioperative morbidity and mortality regardless of size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What constitutes increased risk of rupture for TAAs?

A

Rapid growth >/= 0.5 cm/year + symptomatic aneurysm + connective tissue disease + saccular aneurysm + female + infectious aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why is the spinal cord at risk of injury during TAA repairs?

A

Multifactorial: decreased blood flow due to restriction of segmental arterial inflow + increased tissue pressure from edema or increased ICP + increased venous pressure limiting outflow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What part of the spinal cord is more often damaged?

A

The anterior spinal cord (versus the posterior) because there is only one anterior spinal artery while there are two posterior spinal arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What do you see if you have anterior spinal cord injury?

A

Decreased motor function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the formula for spinal cord perfusion pressure?

A

SCPP = MAP - ICP; should be > 70mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How far after can you have delayed paraplegia?

A

Delayed paraplegia can occur any time in the first 2 weeks after open repair (accounts for 60% of spinal cord injuries encountered)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What should you do to optimize spinal cord and end-organ perfusion after open aneurysm repair?

A

CDV for tachyarrhythmias + increase lumbar drain + increased MAP + transfusion Hbg > 10 g/dL + volume resuscitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the leading cause of morbidity and mortality after TAAA repair?

A

Respiratory failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What Crawford classification types require lung isolation?

A

Type I, Type II, and Type III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What can be damaged during TAAA repair that would affect respiratory function?

A

The left recurrent laryngeal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the perioperative morbidity and mortality rate for an open TAAA repair?

A

10-15%

20
Q

What intervention helps reduce postop renal insufficiency?

A

Delivery of cold crystalloid perfusate into the renal arteries during repair

21
Q

In what situation are open repairs the recommended route over endovascular?

A

In patients with connective tissue disorders and aneurysms

22
Q

What are risk factors for perioperative morbidity and mortality for open surgical repair?

A

Age >/= 65yo (worse if >/= 75yo) + preoperative renal insufficiency or hemodialysis use + COPD and FEV1 </= 50% predicted + previous stroke

23
Q

What are risk factors for perioperative morbidity and mortality for TEVAR?

A

Functional dependence (frailty) + TAAA extent + pulmonary disease + need for iliac access + zone 1/2 landing for thoracic stent graft

24
Q

What are the different types of endoleaks?

A

Type I = proximal/distal graft attachment site leaks; Type II = retrograde flow into the aneurysm sac from aortic side branches; Type III = Defect in the graft (i.e. fabric tear or disconnection of modular overlap); Type IV = graft wall porosity; Type V = No identifiable cause

25
Q

What is left heart bypass?

A

Left atrium to left femoral bypass; cannulation for the LA done via pulmonary vein which is then sent to the FA (or other distal site)

26
Q

What is usually done with left heart bypass in surgery to help reduce cardiac injury?

A

Sequential clamping of the aneurysm to allow for reimplantation of arteries

27
Q

If you are on left heart bypass, where do you need to measure BPs?

A

Right radial artery = measures perfusion to the upper body + Femoral artery = measures perfusion to the lower body

28
Q

When do you go on partial CPB for TAAA repairs?

A

When one-lung ventilation will not be tolerated with left heart bypass; allows for oxygenation

29
Q

How do you go on partial CPB for TAAA repairs?

A

Usually via the left femoral vein + aorta (distal to the aortic clamp)

30
Q

Why do you not go on full bypass for TAAA repairs? What if you do go on full CPB?

A

The heart still needs to eject in order for blood to go to the upper body since there is an aortic cross-clamp that prevents blood from going back up to the head vessels; if you go on full CPB, you need to perform deep hypothermic circulatory arrest

31
Q

What are the risk factors for spinal cord injury during aortic surgery?

A

Extent of aorta replacement/coverage (extent II aneurysms and >20 cm endovascular coverage are highest risk) + replacement or coverage of aortic zone 5 (T9-T12 artery of Adamkiewicz) + urgent/emergent repairs + patient factors that predispose to atherosclerosis or poor O2 delivery

32
Q

What is the blood supply to the spinal cord?

A

One anterior spinal artery + two posterior spinal arteries + collaterals from thoracic, lumbar, and pelvic intercostal arteries

33
Q

What is the recommendation for neuromonitoring during aortic surgery?

A

Class IIb + level of evidence C; no large-scale studies demonstrate superiority

34
Q

How do SSEPs work?

A

Stimulus in peripheral nerve -> dorsal column (posterior cord) -> somatosensory cortex

35
Q

How do MEPs work?

A

Stimulus in motor cortex -> corticospinal tract (anterior cord) -> motor function

36
Q

What are causes of false positives during neuromonitoring?

A

Peripheral nerve ischemia, extremity malperfusion, or acute intraoperative stroke

37
Q

What are the interventions that one can do for spinal cord perfusion?

A

CSF drainage (best evidence and principal intervention) + MAP augmentation (>90mmHg) + increased Hg (10 g/dL) + hypothermia + steroids/mannitol/naloxone + neuromonitoring

38
Q

Should you put in a spinal drain for TEVARs?

A

Smaller benefits when compared to open repairs and there may be a higher risk of morbidity due to CSF drain complications; only in high-risk TEVARs (extensive length + previous aortic coverage + compromised pelvic perfusion + occluded vertebral arteries + planned left-subclavian coverage)

39
Q

What is the overall complication rates for lumbar drains?

A

~6.5%

40
Q

What are minor complications for lumbar drains?

A

Puncture site bleeding + hypotension + CSF leak (not requiring intervention) + drain fracture left in place + occluded or dislodged catheter + bloody CSF

41
Q

What are moderate complications for lumbar drains?

A

Spinal headache + CSF leak requiring intervention + drain fracture requiring surgical removal

42
Q

What are severe complications for lumbar drains?

A

Epidural hematoma + intracranial hemorrhage (from over-drainage of CSF) + SAH + meningitis + catheter-related neurologic deficits

43
Q

What do you do if you have a blood lumbar drain insertion for a patient who needs full CPB for TAAA repair?

A

Postpone surgery for 24 hours

44
Q

What is bloody CSF associated with when doing a lumbar drain?

A

Intracranial hemorrhage

45
Q

How much CSF can you remove at a time for lumbar drains?

A

Maximum of 15 cc/hour to minimize risk of intracranial hemorrhage

BCC (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions