Thoracoabdominal Disease Flashcards

1
Q

What are the 4 types of TAAA?

A

1 above 6th intercostal to celiac

2 above 6th intercostal to below renals

3 at/below 6th space to below renals

4 above celiac to below renals

5 at/below 6th space to celiac.

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2
Q

How large in French is the delivery system for an advanced EVAR (zenith)

A

22F

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3
Q

What diameter is considered an appropriate threshold for elective treatment of TAAA

A

6-6.5mm

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4
Q

What are the contraindications to advanced EVAR

A

Proximal landing zone diameter >38mm

Supraceliac angulation over 90 deg

Paravisceral patent lumen < 26mm

Occluded subclavians

Lateral or upgoing renal

Short (<15 mm) main visceral trunk prox to vital branch

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5
Q

Approximately how many patients are suitable for an off the shelf advanced EVAR.

A

> 80% (??)

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6
Q

What are typical blood pressure targets after tevar

A

MAP above 90

SBP above 140

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7
Q

What settings are appropriate for spinal drain?

A

10 cm above right atrium

Then adjust drain level so that the drain is < 15 mm/hour.

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8
Q

What is the rate of spinal cord ischemia after open and endo TAAA repair?

A

15% open 7-10% endo

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9
Q

What is the risk of stroke following TAAA EVAR?

A

< 5%

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10
Q

What is the rate of renal failure/dialysis following TAAA endo repair?

A

20%, 10% req dialysis

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11
Q

What vessels/structures are at risk if the proximal landing zone covers the left subclavian?

A

Posterior brain, spinal cord, internal mammary, upper extremity

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12
Q

Where are the incisions for a carotid subclavian transposition vs bypass?

A

Supraclavicular

Transposition - between SCM heads

Bypass - lateral to SCM heads

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13
Q

What are 4 categories and 8 causes of TAA?

A

1) degenerative
2) inherited - ehlers Danilo’s, Loeys dietz, marfans
3) Vasculitis: ankylosing spondilitis, lupus, giant cell arteritis, takayasu
4) other: trauma, mycotic

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14
Q

When using extracorporeal circulation in open TAAA repairs, where are the cannulas placed?

A

Left heart (atrium or inferior pulmonary vein) and femoral artery

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15
Q

When performing circ arrest, where are the cannulas?

A

Arterial: femoral artery or ascending aorta

Venous: femoral vein extending to right atrium - TEE to confirm placement

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16
Q

What temperature is the body cooled to during circ arrest?

A

16-18 degrees