Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Rosalynn's ABSITE > Vascular aneurysms > Flashcards

Vascular aneurysms Flashcards

1
Q

At what diameter does an abdominal aneurysm occur?

A

> 1.5 times normal

>3 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

where do most AAA occur?

A

infra renal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

true or false

most AAA are true aneurysms

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what layers are usually involved in pseudo aneurysms?

A

adventitia

connective tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the 4 main etiologies of AAAs?

A

Degenerative
Inflammatory
Traumatic
Infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how do degenerative AAA form?

A

atherosclerotic AAA

associated w/matrix metalloproteinases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

where are matrix metalloproteinases in the vessel of degenerative aneurysm?

A

the media

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how to inflammatory AAA form?

A

exaggerated inflammation leading to fibrotic reaction around the aneurysm the can encase the surrounding structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are inflammatory AAAs associated with?

A

ureteral obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how are infectious AAAs formed?

A

may be caused by primary infection of arterial wall or foreign bodies (prior vascular repair)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what bacteria are associated w/infectious AAAs

A 
Salmonella
Staph
Candida
Aspergillus
Mycobacterium tuberculosis
Treponema pallidum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the biggest RFs for AAA development?

A 
smoking
increased age (over 70)
male
family hx
concurrent aneurysms
HTN
HLD
CAD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are 2 protective factors for AAA

A

diabetes

DVT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are risk factors for rupture?

A 
female
decreased FEV1
large initial aortic diameter
current smoker
uncontrolled HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

at what diameter does risk for rupture exponentially increase?

A

5.0 cm (1-11%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the screening recommendation for AAA

A

U/S screening in men or women 65-75 years w/hx of tobacco use

or

U/S screening in first degree relative of Pts w/AAA, do at age 65-75 or 75 and older and in good health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

is there a higher incidence of peripheral aneurysms in those with AAA?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How can AAAs cause distal ischemic symptoms

A

atheroembolism

acute thrombosis of AAA can cause acute lower body ischemia (very rare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the best imaging test for AAA?

A

U/S
almost 100% sensitivity and specificity
not good for detecting rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what SBP is the goal for a ruptured AAA?

A

70-90 mmHg

permissive hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

when do you repair a AAA besides rupture?

A

diameter > 5.5 cm
> 5 mm growth in 6 months or >1 cm growth in 1 year
symptomatic abdominal pain (emergent repair)
signs of embolism
mycotic aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is a relative indication for repair?

A

saccular AAA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the disadvantages of endovascular repair?

A 
higher rate of reintervention
need long term follow up and imaging
no difference in mortality rate 2-3 years after intervention
high cose
not for everyone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what do you need to do an EVAR?

A

10-15 mm “landing zone in normal infra renal aorta and iliac artery
less than 25% circumferential thrombus in “landing zone”
no significant tortuosity in infrarenal landing zone
large enough iliac arteries for delivery sheaths

25
Q

how big do the iliac arteries have to be to do an EVAR

A

6-7 mm w/o significant plaque burden

26
Q

what are the warning signs of colon ischemia?

A

early post op diarrhea, melena, hematochezia, leukocytosis, metabolic acidosis/lactate, hypotension

27
Q

treatment for colon ischemia includes

A 
sigmoidoscopy
aggressive IVF
broad spec abx
bowel rest
ex-lap if full thickness bowel ischemia
28
Q

how does a graft infection present?

A

“herald bleed”
inflammation or bleeding into bowel on CT
direct visualization of graft material on EGD

29
Q

how to treat graft infection?

A

removal of entire graft
wide debridement of affected tissues
in situ recon or extra anatomical bypass (staged)

30
Q

what are options for in-situ reconstruction of graft infection?

A

rifampin soaked or silver coated polyester grafts
cryopreserved arterial allograft
saphenofemoral vein allograft

31
Q

how to treat a stable patient with graft infection?

A

staged axillary bifemoral bypass then 24-48 hrs laters RTOR to explant infected graft

32
Q

if doing a bypass for graft infection what must you make sure to do?

A

oversew aortic stump in 2 layers and cover with mental patch to prevent stump break down and blow out

33
Q

what is a type I endoleak?

A

failure to achieve satisfactory seal at proximal (type Ia) or distal zone (1B)
aneurysmal sac is not excluded

34
Q

what is a type II endoleak?

A

continued retrograde filling of aneurysmal sac by lumbar branches or IMA

35
Q

what is a type III endoleak?

A

failure of individual component or of seal between components of graft system
aneurysmal sac not excluded

36
Q

what is a type IV endoleak?

A

leakage through the porous material of the graft (rare)

37
Q

what is a type V endoleak?

A

persistent growth of aneurysmal sac without detectable leak (endotension)

38
Q

which types of endoleaks do you have to repair?

A

Types I and III because the sac is not excluded

39
Q

how do you repair a type II endoleak?

A

requires repair if there is continued aneurysm sac expansion

embolization of back bleeding branches or direct aneurysm sac puncture w/injection of thrombotic agents

40
Q

what is the most common endoleak type?

A

type II

41
Q

when do you follow up with someone with 2.5-2.9 cm AAA

A

10 years

42
Q

when do you follow up with someone with 3.0-3.9 cm AAA

A

3 years

43
Q

when do you follow up with someone with 4.0-4.9 cm AAA

A

1 year

44
Q

when do you follow up with someone with 5.0-5.4 cm AAA

A

6 months

45
Q

what is the follow up after an EVAR?

A

baseline imaging at 1 month post-op with contrast enhanced CT and duplex U/S

46
Q

if no leak after 1 month of EVAR when is the next follow up?

A

repeat imaging at 12 months

47
Q

if there is an endoleak 1 month after EVAR when is the next follow up?

A

repeat imaging at 6 months

48
Q

should accessory renal arteries be preserved when possible?

A

yes

49
Q

what approach is helpful with a horse shoe kidney?

A

retroperitoneal
allows mobilization of the kidney anteriorly
do not divide the isthmus of the horseshoe kidney

50
Q

during an open AAA repair, if an asymptomatic colon mass or cholelithiasis is found should it be taken out?

A

no

51
Q

if during an open AAA repair you injure the bowel how do you manage it?

A

repair the enterotomy

consider aborting case and closing abdomen, return at later date to repair aneurysm

52
Q

management of bowel injury after graft implantation

A

repair enterotomy
copious irrigation
consider IV abx

53
Q

how to manage a ureteral injury during open AAA

A

IV methylene blue can help ID injury

intra op urology repair

54
Q

how to manage a venous injury during open AAA

A

can be from clamp injury or dissection
manual compression proximal and distal
division of ipsilateral iliac artery may be needed to visualize and repair injury

55
Q

how to manage distal embolization after open AAA

A

can be from clamping disease vessels or failure to adequately flush prior to completion of an anastomosis

56
Q

how to manage femoral artery injury during EVAR

A

get open exposure of artery
primary repair if possible
complete femoral endarterectomy w/patch angioplasty if needed

57
Q

how to manage iliac artery injury during EVAR

A

covered stent placement for perforation if needed

consider balloon occlusion and open repair if needed

58
Q

how to manage groin hematoma after EVAR

A

localized pressure
reverse coagulopathy
arterial duplex to assess for active flow or pseudoaneurysm

59
Q

how to manage a femoral pseudoaneurysm

A

localized pressure
reverse coagulopathy
arterial duplex to assess neck, if narrow can do thrombin injection, if short/wide or clinically unstable or skin necrosis needs open repair

Rosalynn's ABSITE (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions