Vascular Surgery Lecture Powerpoint Flashcards
Aortic aneurysms are present when vessel (not the lumen) exceeds ___ x normal diameter. Most common area to see development?
1.5x, abdominal infrarenal most often
Risk factors for aortic aneurysm (5)
- smoking***
- hypertension
- age most important**
- diabetes
- dyslipidemia
Prognosis of ruptured AAA
Majority never make it to hospital, 40-80% do not survive so rather variable, only 10-15% overall survive, best results is to repair before rupture
Median rate of expansion of an aneurysm approx ___cm per year but highly variable
.5cm
Screening for AAA (3)
- physical exam (feeling for pulsatile mass)
- age appropriate noninvasive screening >65 or younger if family hx of aneurysm
- ultrasound is continuing screening test of choice
AAA clinical presentation (4)
- many asymptomatic
- gnawing steady discomfort lower back or hypogastrium unaffected by movement
- severe lower abdomen or back pain with radiation to groin and legs
- evidence of other peripheral vascular disease or coronary artery disease
- embolization and thrombosis
- GI hemorrhage (duodenum and aorta fistula)
Ruptured AAA clinical presentation (6)
- abrupt onset back and abdominal pain
- abdominal tenderness
- palpable pulsatile mass
- hypotension
- shock
- often mimics GI bleed
- flank hematoma (grey turners sign) if retroperitoneal rupture
Diagnostic studies for ruptured AAA (3)
- ultrasound
- CT if hemodynamically stable
- angiography if planning on operating
Most common site of embolism in a patient with “blue toe syndrome”
the heart - 2nd most common is the aorta!
Repair of AAA options (3)
- percutaneous placement of implantable endovascular stent (has to be infrarenal)
- insertion of synthetic graft
- resection of aneurysm (not common)
Surgical mortality of repair of AAA
Increases greatly if rupture impending or has ruptured
What cutaneous level to the iliacs bifurcate from the aorta?
Just below the umbilicus
Rare complication of AAA repair that results in permanent lower extremity paralysis
Having to suture off the lumbar vessels that exit the posterior abdominal aorta due to backflow bleeding after removal of the aneurysm
Pathogenesis of stroke
- ischemic due to plaque development, most often at bifurcations, platelet aggregation and thrombus formation that potentially embolizes occluding a vessel, majority are these
- hemorrhagic often due to injury or rupture
Thrombosis vs embolism
Thrombosis is narrowing due to blood clot formation vs embolism is when piece of clot comes loose and lodges at a downstream location
