Vascular Disease and Aortic Disease

Question 1

List the three main

types of aneurysms?

Answer 1

Fusiform, Saccular, Pseudoaneurysm

Question 2

Describe fusiform aneurysm

Answer 2

affects entire circumference of segment of vessel

Question 3

Describe saccular aneurysm

Answer 3

involves only a portion of the circumference resulting in outpouching of wall

Question 4

Describe a pseudoaneurysm

Answer 4

intimal and medial layers are disrupted. Dilated segment is lined by adventitia only (occasionally clot)

Question 5

List three causes of Aortic Aneurysm?

Answer 5

-Degenerative diseases (cystic medial necrosis)
-Atherosclerosis
-Inherited or developmental diseases (Marfan syndrome,
Ehlers-Danlos syndrome,
Family history)
-Infections (syphilis)
-Vasculitis (Takayasu’s arteritis)
-Trauma

Question 6

Which part of the aorta is most often affected if it’s caused by atherosclerosis?

Answer 6

Thoracic aortic aneurysm

Question 7

What is the best imaging option for diagnosing proximal ascending aortic aneurysms?

Answer 7

-Echocardiography

Question 8

Definition of Abdominal Aortic Aneurysm?

Answer 8

-Definition = >3cm

Question 9

At what size are you concerned for AAA rupture?

Answer 9

-Concern for rupture when >5cm-5.5cm

Question 10

Name 3 risk factors of Abdominal Aortic Aneurysm?

Answer 10

• Advancing age (>60)
• Male gender
• Cigarette smoking
• HTN
• Hyperdyslipidemia
• Caucasian
• Family history
• Presence of other large aneurysms
• Atherosclerosis

Question 11

Who should be screened for Abdominal Aortic Aneurysm? (Name 3)

Answer 11

• Men 65-74 with history cigarette smoking
• Siblings or offspring of persons with AAA (close family history)
• Individuals with thoracic aortic or peripheral arterial aneurysms.
• Patients with hypermobility syndromes ie Marfan’s syndrome & Ehlers-Danlos Syndrome

Question 12

Name the two approaches to surgical correct Abdominal Aortic Aneurysm

Answer 12

1. Open surgical repair
2. Endovascular Repair

(decision based on anatomy and comorbidities)
-Endovascular repair has lower short-term morbidity, comparable long
term mortality
-Long-term surveillance with CTA or MRA after endovascular repair
-After acute rupture, mortality rate of emergent operation is 45-50%

Question 13

Describe Aortic Dissection?

Answer 13

• Tear in the aortic intima
• Blood dissects into the media
• Intima separates from the surrounding media
• False lumen created
• Circulation in affected area can be disrupted

Question 14

What are the risk factors for Aortic Dissection? (Name 3)

Answer 14

• Turner syndrome
• Coronary artery bypass graft surgery (CABG)
• Previous aortic valve replacement
• Trauma
• Cardiac catheterization
• High intensity weight lifting or strenuous resistance training
• Crack, cocaine

Question 15

What are the signs & symptoms of Aortic Dissection? (name at least one symptom and at least one sign)

Answer 15

• Severe sharp or *”tearing” chest pain in ant/posterior chest or back sudden onset, radiating into anterior chest or neck
• Hypertension
• Wide pulse pressure
• Ascending Aorta
• Descending Aorta

Question 16

What is the main diagnostic tests for Aortic Dissection?

Answer 16

-CTA widely available (commonly used)

Question 17

What is Type A Aortic dissection?

Answer 17

Arises in the ascending aorta

Question 18

What is Type B aortic dissection?

Answer 18

Arises distal to the left subclavian

Question 19

What is Type I DeBakey Aortic Dissection?

Answer 19

ascending aorta, aortic arch, and the descending aorta

Question 20

What is DeBakey Aortic Dissection Type II?

Answer 20

only ascending aorta

Question 21

What is DeBakey Aortic Dissection Type III?

Answer 21

only descending aorta

Question 22

What is the treatment of Aortic Dissection? (name two items)

Answer 22

Control blood pressure, heart rate, and surgical repair