02.19 Diseases of the Aorta and its Branches Flashcards Preview

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Flashcards in 02.19 Diseases of the Aorta and its Branches Deck (46):
1

Abnormal weakening and dilatation of the artery

Aortic aneurysm

2

Aneurysm is most located in the ______

Abdominal aorta

3

RF of AA

Older age
Male sex
Fam Hx
Smoking
HPN
Hypercholesterolemia
Connective tissue disorders
DM
Inflammation

4

Two most common complications of AAA

Rupture
Thromboembolism

5

Frequently asymptomatic
Abdominal mass or fullness
Low back pain
Abdominal rigidity
Fainting or lightheadedness
Excessive thirst
Vomiting

AAA

6

PE of AAA

Pulsatile mass

7

Best screening tool for the definitive diagnosis of AAA in the ER setting

US

8

What are the information that you can gather through US

Absolute diameter
Relationship of aneurysm with the renal artery
Involvement of the iliac arteries
Detects presence of thrombus

9

Gives more accurate size of the aortic aneurysm
For the evaluation for endovascular repair
Most sensitive test for detecting a rupture

CT Scan

10

Signs of rupture in CT

Contrast extravasation
Stranding of blood in ventral peritoneum
Break in calcification ring

11

Do repair for AAA if

Symptomatic
Rapidly growing aneurysms (>0.5 cm in 6 months)
With RF (strong fam hx, irregular shape, uncontrolled HPN, COPD)

12

Threshold size of AAA for repair

5.5 cm

13

Treatment options for AAA

Open surgery
Endovascular repair
Grafts

14

Midline laparotomy
Retroperitoneal
Resect the aneurysm with restoration of distal flow

Open surgery

15

Extrude the aneurysmal sac from the aortic circulation
Uses fluoroscopic guidance
Proximal neck fixation to prevent migration
Adequate seal to ensure aneurysmal sac exclusion
Sac shrinkage

Endovascular repair

16

Endoleak related to graft device itself; endo leak that happens at the attachment site
Must be repaired

Type 1 endoleak type

17

Endoleak due to retrograde flow from collateral branches
Must only be observed

Type II

18

Endoleak due to fabric tears, graft disconnection, or disintegration
Must be repaired

Type III

19

Flow through the graft presumed to be associated with graft wall "porosity"

Type Iv

20

Persistent or recurrent pressurization of the sac with no evidence or endoleak

Endotension

21

Eligibility criteria for EVAR

Access
Iliac vessels
Aberrant Vessels
Neck

22

Critical features that limit eligibility for EVAR

Alterations in neck composition (presence of thrombus, calcification)
Neck angulation
Undesirable neck length and diameter

23

Neck: Angulation ___, Length at least _____, Diameter _____, Reversed ____ shape neck, no thrombus, atheroma, calcification

< 60 deg C
1.5 cm
< 32 mm
Cone

24

Clinical syndromes of carotid artery disease

Asymptomatic
Transient ischemic attacks
Reversible ischemic neurologic deficit
Crescendo TIAs
Amaerosis fugax

25

A temporary loss of vision in one eye due to a lack of blood flow
Stroke

Amaeurosis fugax

26

Mechanism of CAD that causes stroke

Embolization/thrombosis
Hypoperfusion

27

Risk of stroke is related to:

Degree of stenosis
Symptom status
Plaque morphology

28

Types of plaque

Calcified
Dense
Soft

29

PE for CAD

Bruits
Absence of carotid pulse
Embolic material in retinal artery branches

30

Embolic material in retinal artery branches

Hollenhorst plaque

31

Diagnostic tools for CAD

Carotid duplex US
Magnetic resonance angiography
CT angiography
Contrast angiography

32

Data obtained in CDUs

Degree of stenosis
Plaque morphology

33

Less susceptible to overestimating carotid stenosis and provides good quality images that can be viewed in multiple planes
Limited use in patients with calcified vessels because of possible overestimation

CT angiography

34

Gold standard
Anatomic measurement is done to measure the degree of stenosis

Contrast angiography

35

Patient is under general anesthesia
The carotid vessels are exposed, do vascular control open up the vessel, take out the plaque and close it using a commercially available patch

Carotid endarterectomy

36

Done in catheterization lab under laparoscopic guidance
The gold standard is that you have to have embolic protection device because if the plaque is soft, or ulcerated, any manipulation can cause the plaque to dislodge and travel to the brain and cause a stroke

Carotid artery stenting

37

Complications of CAD

Stroke
Surgical
Endovascular

38

Syndrome of elevated arterial blood pressure due to reduced kidney perfusion

Renovascular hypertension

39

Most common form of surgically correctable hypertension

Renal artery occlusive disease

40

Onset before age 30 without risk factors
Presence of abdominal bruit
Accelerated hypertension or resistant hypertension
Renal failure of uncertain etiology
Recurrent flash edema
Acute renal failure precipitated by ACE I or ARBs

Renal hyperternsion

41

Anatomic studies for renal hypertension

Renal duplex ultrasonography
MRI/MRA
CT angiography
Contrast angiography

42

Best screening method

Renal duplex ultrasonography

43

Gold standard
Determines imporatnce of suggestive lesions
Concurrently perform endovascular therapy

Contrast angiography

44

Functional studies

Captopril renography
Renal vein rein assay

45

Goals of treatment for renal hypertension

Control hypertension
Preservation of renal function

46

Treatment of renal hypertension

Medical
Percutaneous transluminal renal angioplasty with or without stenting
Bypass surgery