Flashcards in Aortic Surgery- Exam 2 Deck (115)
What is the goal of aortic surgery?
Enable aortic repair while limiting ischemic injury to the CNS
We utilize different perfusion strategies depending on what?
What portion of the aorta is affected
What are the 4 portions of the aorta?
What are the two different types of aortic conditions?
Begins at the AV annulus and extends to the proximal innominate artery
Where 3 brachiocephalic branches arise
How does the treatment for ascending and transverse arch compare?
Descending Thoracic and Thoracoabdominal Aorta
Lies just beyond the subclavian to the aortoiliac bifurcation
Occurs when blood penetrates the intima of the aorta; creates an expanding hematoma between medial layers; true lumen is not usually dilated/compressed by dissection
Are the branching vessels affected in a dissection?
May not be
Dilation of all 3 layers
Incidence of Aortic Dissections
According to European Autopsy Study
Occurs in 3.2 dissections per 100,000 autopsies
What occurs in more deaths: Aortic Dissection or Aneurysm rupture?
Aortic Dissection risk factors
Hypertension (90% pts), advanced age (>60), male sex, Marfan's Syndrome, Coarctation, bicuspid AV, pregnancy, toxins and diet
Connective Tissue disorder
Aortic Dissection Causes (Inciting Events)
Increased Physical Activity
Can occur w/o any physical activity (i.e. cannulation for bypass)
Aortic Dissection Mechanism
Intimal Tear; presence of a weakened aortic wall; areas experiencing greatest mechanism shear forces, points where the aorta is fixed, there is increased shear stress applied to the aortic wall
What percent has intimal tear in ascending aorta?
What percent has intimal tear in descending aorta?
What percent has intimal tear in descending aorta; isthmus (distal to left subclavian)
What percent has intimal tear in arch?
What percent has intimal tear in abdominal?
What percent has intimal tear in other areas?
How fast does propagation occur?
What is propagation driven by?
Pulse pressure and ejection velocity
What may be involved in aortic dissections?
Origins of arteries; vessel occlusions can also occur due to compression by the false lumen
3 types based upon location of intimal tear and which section of the aorta is involved; Type 1, 2, 3A, 3B
Debakey Classification: Type 1
Intimal Tear: Ascending Aorta
Dissection: All parts of the thoracic Aorta (ascending, arch, and descending)
DeBakey Classification: Type 2
Intimal Tear : Ascending Aorta
Dissection: Ascending Aorta only
stops before innominate artery