Thoracoabdominal Disease

Question 1

What are the 4 types of TAAA?

Answer 1

1 above 6th intercostal to celiac

2 above 6th intercostal to below renals

3 at/below 6th space to below renals

4 above celiac to below renals

5 at/below 6th space to celiac.

Question 2

How large in French is the delivery system for an advanced EVAR (zenith)

Answer 2

22F

Question 3

What diameter is considered an appropriate threshold for elective treatment of TAAA

Answer 3

6-6.5mm

Question 4

What are the contraindications to advanced EVAR

Answer 4

Proximal landing zone diameter >38mm

Supraceliac angulation over 90 deg

Paravisceral patent lumen < 26mm

Occluded subclavians

Lateral or upgoing renal

Short (<15 mm) main visceral trunk prox to vital branch

Question 5

Approximately how many patients are suitable for an off the shelf advanced EVAR.

Answer 5

> 80% (??)

Question 6

What are typical blood pressure targets after tevar

Answer 6

MAP above 90

SBP above 140

Question 7

What settings are appropriate for spinal drain?

Answer 7

10 cm above right atrium

Then adjust drain level so that the drain is < 15 mm/hour.

Question 8

What is the rate of spinal cord ischemia after open and endo TAAA repair?

Answer 8

15% open 7-10% endo

Question 9

What is the risk of stroke following TAAA EVAR?

Answer 9

< 5%

Question 10

What is the rate of renal failure/dialysis following TAAA endo repair?

Answer 10

20%, 10% req dialysis

Question 11

What vessels/structures are at risk if the proximal landing zone covers the left subclavian?

Answer 11

Posterior brain, spinal cord, internal mammary, upper extremity

Question 12

Where are the incisions for a carotid subclavian transposition vs bypass?

Answer 12

Supraclavicular

Transposition - between SCM heads

Bypass - lateral to SCM heads

Question 13

What are 4 categories and 8 causes of TAA?

Answer 13

1) degenerative
2) inherited - ehlers Danilo’s, Loeys dietz, marfans
3) Vasculitis: ankylosing spondilitis, lupus, giant cell arteritis, takayasu
4) other: trauma, mycotic

Question 14

When using extracorporeal circulation in open TAAA repairs, where are the cannulas placed?

Answer 14

Left heart (atrium or inferior pulmonary vein) and femoral artery

Question 15

When performing circ arrest, where are the cannulas?

Answer 15

Arterial: femoral artery or ascending aorta

Venous: femoral vein extending to right atrium - TEE to confirm placement

Question 16

What temperature is the body cooled to during circ arrest?

Answer 16

16-18 degrees