URR Abdominal Aorta

Question 1

what are the three branches of the heart in order?

Answer 1

innominate, left common carotid, left subclavian

Question 2

what is the most common anatomic variation of the aorta?

Answer 2

bovine arch

Question 3

what is the bovine arch?

Answer 3

innominate and left CCA origin are combined and the left subclavian artery is the 2nd branch

Question 4

where is the aorta in relation to the IVC until the level of the umbilicus?

Answer 4

posterior

Question 5

where are arteries in relation to veins?

Answer 5

-above umbilicus, arteries are posterior to veins
-below the umbilicus, arteries are anterior to veins

Question 6

what is auscultation?

Answer 6

stethoscope placed in multiple locations on the abdomen
-patient holds breath while listening to flow sounds

Question 7

LUQ bruit can be associated with what?

Answer 7

splenic artery stenosis or lt renal artery stenosis

Question 8

RUQ bruit can be associated with what?

Answer 8

right renal artery stenosis

Question 9

measurements for the prox ao?

Answer 9

2-2.6 cm

Question 10

measurements for mid ao?

Answer 10

1.6-2.4 cm

Question 11

measurements for dist ao?

Answer 11

1.1-2.0 cm

Question 12

measurements for iliacs?

Answer 12

.6-1.4 cm

Question 13

what kind of resistance flow does the ao have?

Answer 13

highly resistive, plug flow

Question 14

what is the average velocity of the ao?

Answer 14

70-100 cm/sec

Question 15

what does the waveform look like of the ao?

Answer 15

biphasic above renal arteries
-resistance increases as flow moves distally
-triphasic below renal arteries

Question 16

what is coarctation?

Answer 16

-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

Question 17

what is takayasu arteritis?

Answer 17

-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

Question 18

what is the cause of a AAA?

Answer 18

breakdown of the media and adventitial layer

Question 19

where is a AAA most commonly found?

Answer 19

distal ao

Question 20

what is the most common type of AAA?

Answer 20

fusiform

Question 21

what is a fusiform AAA?

Answer 21

vessel wall stretches, all 3 walls intact

Question 22

what is a saccular AAA?

Answer 22

formed with stalk connecting distal wall portion to vessel

Question 23

what is a berry AAA?

Answer 23

tiny outpouching

Question 24

what is a mycotic AAA?

Answer 24

due to infection in the ao

Question 25

what is vasculitis?

Answer 25

due to inflammatory process of vasa vasorum and adventitia

Question 26

what is blue toe syndrome?

Answer 26

-thromboembolic disease -embolic material lodges in dist artery -causes acute ischemia distal to embolism, blue color changes in distal tissue

Question 27

what is EVAR?

Answer 27

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

Question 28

what is IVUS?

Answer 28

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

Question 29

what is an endoleak?

Answer 29

-blood leakage outside the graft but inside the aneurysm being treated by graft -increase aneurysm size after the graft placement indicates possible endoleak

Question 30

what is endoleak 1?

Answer 30

1=leak at site of attachment A: prox to attachment B: leak dist to attachment

Question 31

what is endoleak 2?

Answer 31

leak at branch vessels

Question 32

what is endoleak 3?

Answer 32

caused by tear in the graft or separation of the main graft from iliac limbs

Question 33

what is endoleak 4?

Answer 33

transgraft leak through porous material of the graft (no tear)

Question 34

what is the most dangerous endoleak, requires surgery?

Answer 34

1

Question 35

what is the most common endoleak?

Answer 35

2w

Question 36

what are the measurements that indicate a possible endoleak?

Answer 36

7.5cm increase in diameter

Question 37

intimal layer tears and allows flow between the intima and media, bidirectional flow seen in false lumen?

Answer 37

dissection

Question 38

where are dissections most commonly found?

Answer 38

ascending Ao -2nd is left subclavian

Question 39

what is the stanford classification for dissections?

Answer 39

A: involves ascending Ao and arch B: involves Ao from left subclavian A to the iliacs

Question 40

what is the Debakey Classification for dissections?

Answer 40

1: involves ascending Ao and descending 2: involves only ascending Ao 3: descending Ao only

Question 41

what happens during Ao stenosis?

Answer 41

-resistance will increase prox to stenosis -causes increased velocities a site of stenosis -distal to stenosis, flow will be dampened and possible tardus parvus

Question 42

what is Leriche Syndrome?

Answer 42

(Aoroiliac occlusive disease) -due to occlusion of the abdominal Ao just above the bifurcation -fatigue of the bilat limbs, absent or diminished femoral pulses

Question 43

What is Retroperitoneal Fibrosis (Ormond Disease)?

Answer 43

-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