Vascular 2 Flashcards
An arterial aneurysm is defined by a > ___% increase in normal diameter.
> 50%
What aneurysm morphology type is at a higher risk for rupture?
Saccular
What aneurysm type is the most commonly seen?
fusiform
An arterial aneurysm is involves full-thickness dilation of ___ layers of the artery.
3 layers
Which is the most common aortic aneurysm location?
abdominal (AAA)
Where is the most common site of a THORACIC aortic aneurysm?
ascending aortic aneurysm
Where is the most common site of a ABDOMINAL aortic aneurysm?
infrarenal
What is the only type of abdominal aortic aneurysm that you CAN stent?
a. suprarenal
b. pararenal
c. juxtarenal
d. infrarenal
d. infrarenal
* MOST COMMON LOCATION OF AAA AS WELL*
Cystic medial necrosis is commonly associated with these 3 inherited or developmental collagen vascular disorders.
cystic medial necrosis is term for degenerative disease for artery
- Marfan syndrome
- Ehlers-Danlos syndrome
- Biscupid aortic valve
Hoarseness, chest pain, dyspnea are symptoms more consistent with what type of aortic aneurysm?
thoracic
deep abdominal pain or discomfort, pulsating feeling near navel are symptoms more consistent with what type of aneurysm?
abdominal
What is the diagnostic criteria for AAA?
diameter > 3cm or > 50% expected
Cystic medial necrosis is most common in what type of thoracic aortic aneurysm?
ascending aortic aneurysms
Atherosclerosis is most common in what type of thoracic aortic aneurysms?
aneurysms of the aortic arch and descending thoracic aorta
What are the 3 classic signs and symptoms of an AAA rupture?
- hypotension
- flank/back pain
- pulsatile mass
what is the imaging test of choice for SCREENING for AAA?
abdominal ultrasound (AAA)
what imaging test is required for a patient going to the OR for an AAA rupture?
CT with contrast
she said angiogram is better choice
What are the 4 indications for AAA screening?
- men 65-75 yo with smoking Hx
- anyone with 1st degree relative with an aneurysm
- anyone with another aneurysm (e.g. popliteal)
- patients with hyper-mobility syndromes
What is the treatment for ASYMPTOMATIC aneurysms?
- serial imaging with ultrasound
Based on the following ultrasound findings what is the recommended surveillance/treatment protocol?
a. aneurysm of 3.0-3.9
b. aneurysm 4.0-4.9
c. 5-5.4
d. >5.5
a. aneurysm of 3.0-3.9 = screening every 3 years
b. aneurysm 4.0-4.9 = screening every 12 months
c. 5-5.4 = screening every 6 months
d. >5.5 = FIX
What is the most important determinant of aneurysm rupture and complication?
aneurysm size (diameter)
What are the size indication for repair of an asymptomatic aneurysm in the following locations:
a. ascending TAA
b. descending TAA
c. AAA
d. femoral artery aneurysm
e. popliteal artery aneurysm
a. ascending TAA = >5.5cm
b. descending TAA = >5.5cm
c. AAA = >5.5cm
d. femoral artery aneurysm = >3cm
e. popliteal artery aneurysm = > 3cm
Which of the following aneurysm locations are most at risk for thrombosis?
a. ascending TAA
b. descending TAA
c. AAA
d. femoral artery aneurysm
e. popliteal artery aneurysm
e. popliteal artery aneurysm
What are the 3 surgical indications for aortic aneurysm treatment?
(this includes both TAA and AAA)
- AAA growth > 0.5 cm in 6 months
- TAA growth > 0.5 cm in a year
- symptomatic aneurysms
What is an aortic dissection?
tear in the aortic INTIMA that leaves to the creation of a false lumen
The major modifiable risk factor for aortic dissection is what?
systemic hypertension
Sudden onset of severe sharp or “tearing” chest pain in posterior chest or back and a wide pulse pressure is a common presentation of this diagnosis.
aortic dissection
The classic clinical triad for presentation of aortic dissection includes:
- sudden onset thoracic or abdominal pain
- widened mediastinum on chest radiograph
- variations in pulse or BP
D-Dimer is a great test to rule ____ aortic dissection.
rule out
What is the diagnostic study of choice for aortic dissection?
CT scan
Acute aortic regurgitation may develop in this arterial condition.
aortic dissection
Based on the Stanford classification for aortic dissection, what is the difference between Type A and B? How does treatment differ based on the Type?
- Type A = arises in the ascending aorta SURGICAL EMERGENCY
- Type B = arises distal (below) the left subclavian MANAGE MEDICALLY
What does the long term management of an aortic dissection consist of?
- lifelong beta blocker + avoid strenuous activity
- serial imaging 3, 6, 12 months, then every 1-2 years
- reoperation when indicated
