Vascular Flashcards
Three most common organisms in Mycotic aortic aneurysms?
1) Salmonella 2) E. coli 3) Enterococcus
Most common location for traumatic aortic injury?
immediately distal to the ligamentum arteriosum
Most common location for syphilitic aneurysm?
ascending aorta
Classification and treatment of thoracic aortic dissection?
Type A: proximal to the ligamentum arteriosus
Type B: distal to the ligamentum
Rx for dissections • Alpha blockade followed by beta blockade
Type A Must treat surgically - Replace with graft or insert stent.
- Type B Surgery only if medical management complicated by failure of BP control, continued pain, size increase, development of CNS problems or visceral or extremity ischemia
What size is aortic root surgery indicated in in Marfans?
6 cm
Most life-threatening/acute complication of aortic dissection?
proximal extension into pericardium causing tamponade
Most common major complication of thoracoabdominal aneurysm repair?
How do you minimize it?
Thoracoabdominal aortic aneurysm repair carries risk of paraplegia.
Short cross-clamp times are helpful, but not 100% preventative.
What is genetic pattern of Marfans?
Autosomal Dominant
What size do you repair a AAA?
5 cm
How do you get initial control in a ruptured AAA?
Control above celiac initially, then infrarenal after better exposure
What is the best test for aortic dissection?
The best test for aortic dissection is the quickest one available once dissection is suspected. It can be a contrast CT, MRI, aortogram, or transesophageal echo.
CXR findings for traumatic aortic transection? (6)
- widening of the mediastinum
- blunting of the aortic knob
- pleural capping of the left apex
- depression of the left bronchus
- esophageal deviation to the right as seen by NGT displacement
- fractures of left 1st and 2nd ribs.
Most common cause of death after AAA surgery?
MI
Most common non-lethal complication of AAA surgery?
Impotence
Best test for AAA active surveillance?
yearly ultrasound for all aneurysms >3.5 cm
Post-op AAA follow-up?
SVS reccomendations
Open: noncontrast CT q 5years
EVAR: contrast imaging at 1 and 12 months
q6 months ultrasound to follow an endoleak
Endoleak classification:
Type Iendoleakoccurswhen there is a gap between thegraftand the vessel wallat “seal zones.” This type ofendoleaktypically requires urgent attention due to high risk of sac enlargement and rupture.
AType IIendoleakresultswhenincreased pressure within the sidebranches oftheaortaforce blood to leakback into the lower-pressure aneurysm sac.Thisis the MOST COMMON type ofendoleak, andis generally considered benign.
AType IIIendoleakresults from a defector misalignment between the components ofendografts. Type IIIendoleakalso requires urgent attention.
AType IVendoleakoccurs soon after some EVAR procedures due to theporosity of certain graft materials.
AType Vendoleak, sometimes calledendotension,is apoorly understood phenomenon.It is thought to occur when increased graft permeabilityallowspressureto betransmittedthroughtheaneurysm sac, affectingthenative aortic wall, butthisis only atheory.
Groin mass after vascular access?
usually hematomas. 2% may be lymphoceles or lymph fistulae. Proximal lymphatic injury is likely
Fistulization is best treated by re-exploration and ligation of the lymph source. 20. Lymphoceles may respond to aspiration and pressure dressings.
define Primary varicosities
disease of superficial veins and their valves
define secondary varicosities
disease of superficial veins and valves secondary to deep venous insufficiency