URR Abdominal Aorta Flashcards
what are the three branches of the heart in order?
innominate, left common carotid, left subclavian
what is the most common anatomic variation of the aorta?
bovine arch
what is the bovine arch?
innominate and left CCA origin are combined and the left subclavian artery is the 2nd branch
where is the aorta in relation to the IVC until the level of the umbilicus?
posterior
where are arteries in relation to veins?
-above umbilicus, arteries are posterior to veins
-below the umbilicus, arteries are anterior to veins
what is auscultation?
stethoscope placed in multiple locations on the abdomen
-patient holds breath while listening to flow sounds
LUQ bruit can be associated with what?
splenic artery stenosis or lt renal artery stenosis
RUQ bruit can be associated with what?
right renal artery stenosis
measurements for the prox ao?
2-2.6 cm
measurements for mid ao?
1.6-2.4 cm
measurements for dist ao?
1.1-2.0 cm
measurements for iliacs?
.6-1.4 cm
what kind of resistance flow does the ao have?
highly resistive, plug flow
what is the average velocity of the ao?
70-100 cm/sec
what does the waveform look like of the ao?
biphasic above renal arteries
-resistance increases as flow moves distally
-triphasic below renal arteries
what is coarctation?
-congenital narrowing of the ao
-most commonly occurs distally to the origin of the left subclavian
-causes lower extrem ischemia
-monophasic flow with continuous flow in diastole
what is takayasu arteritis?
-most commonly seen in young females
-presents as hypertrophic areas of inflamed tissue usually found in the ao and branches
-commonly affects the subclavian and carotids
what is the cause of a AAA?
breakdown of the media and adventitial layer
where is a AAA most commonly found?
distal ao
what is the most common type of AAA?
fusiform
what is a fusiform AAA?
vessel wall stretches, all 3 walls intact
what is a saccular AAA?
formed with stalk connecting distal wall portion to vessel
what is a berry AAA?
tiny outpouching
what is a mycotic AAA?
due to infection in the ao
what is vasculitis?
due to inflammatory process of vasa vasorum and adventitia
what is blue toe syndrome?
-thromboembolic disease
-embolic material lodges in dist artery
-causes acute ischemia distal to embolism, blue color changes in distal tissue
what is EVAR?
endovascular aortic repair
-used to improve the streamline flow through a stenosis or AAA
-easier and better than using external graft
-kissing stents used for stenosis at the origin of common iliacs
what is IVUS?
intravascular US
-can be used to guide the graft during placement
-doc uses an US catheter to vis the lumen prior to procedure and eval best location
what is an endoleak?
-blood leakage outside the graft but inside the aneurysm being treated by graft
-increase aneurysm size after the graft placement indicates possible endoleak
what is endoleak 1?
1=leak at site of attachment
A: prox to attachment
B: leak dist to attachment
what is endoleak 2?
leak at branch vessels
what is endoleak 3?
caused by tear in the graft or separation of the main graft from iliac limbs
what is endoleak 4?
transgraft leak through porous material of the graft (no tear)
what is the most dangerous endoleak, requires surgery?
1
what is the most common endoleak?
2w
what are the measurements that indicate a possible endoleak?
7.5cm increase in diameter
intimal layer tears and allows flow between the intima and media, bidirectional flow seen in false lumen?
dissection
where are dissections most commonly found?
ascending Ao
-2nd is left subclavian
what is the stanford classification for dissections?
A: involves ascending Ao and arch
B: involves Ao from left subclavian A to the iliacs
what is the Debakey Classification for dissections?
1: involves ascending Ao and descending
2: involves only ascending Ao
3: descending Ao only
what happens during Ao stenosis?
-resistance will increase prox to stenosis
-causes increased velocities a site of stenosis
-distal to stenosis, flow will be dampened and possible tardus parvus
what is Leriche Syndrome?
(Aoroiliac occlusive disease)
-due to occlusion of the abdominal Ao just above the bifurcation
-fatigue of the bilat limbs, absent or diminished femoral pulses
What is Retroperitoneal Fibrosis (Ormond Disease)?
-commonly occurs at the level of the Ao bif and inf in pelvis
-idiopathic usually, overgrowth of fibrous tissue around atherosclerotic Ao
-can be related to drugs, cancer, infection, cancer therapy
-may cause hydro due to ureteral obstruction
-may compress IVC
-may compress gonadal veins
-soft tissue mass surrounding great vessels
