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Flashcards in Aortic Surgery- Exam 2 Deck (115)
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1

What is the goal of aortic surgery?

Enable aortic repair while limiting ischemic injury to the CNS

2

We utilize different perfusion strategies depending on what?

What portion of the aorta is affected

3

What are the 4 portions of the aorta?

Ascending
Arch
Thoracic
Descending

4

What are the two different types of aortic conditions?

Aneurysms
Dissections

5

Ascending Aorta

Begins at the AV annulus and extends to the proximal innominate artery

6

Transverse Arch

Where 3 brachiocephalic branches arise

7

How does the treatment for ascending and transverse arch compare?

Very similar

8

Descending Thoracic and Thoracoabdominal Aorta

Lies just beyond the subclavian to the aortoiliac bifurcation

9

Dissection

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

10

Are the branching vessels affected in a dissection?

May not be

11

Aneurysm

Dilation of all 3 layers

12

Incidence of Aortic Dissections

According to European Autopsy Study
Occurs in 3.2 dissections per 100,000 autopsies

13

What occurs in more deaths: Aortic Dissection or Aneurysm rupture?

Aortic dissection

14

Aortic Dissection risk factors

Hypertension (90% pts), advanced age (>60), male sex, Marfan's Syndrome, Coarctation, bicuspid AV, pregnancy, toxins and diet

15

Marfan's Disease

Connective Tissue disorder

16

Aortic Dissection Causes (Inciting Events)

Increased Physical Activity
Emotional Stress
Blunt Trauma
Can occur w/o any physical activity (i.e. cannulation for bypass)

17

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

18

What percent has intimal tear in ascending aorta?

61%

19

What percent has intimal tear in descending aorta?

24%

20

What percent has intimal tear in descending aorta; isthmus (distal to left subclavian)

16%

21

What percent has intimal tear in arch?

9%

22

What percent has intimal tear in abdominal?

3%

23

What percent has intimal tear in other areas?

1%

24

How fast does propagation occur?

Within seconds

25

What is propagation driven by?

Pulse pressure and ejection velocity

26

What may be involved in aortic dissections?

Origins of arteries; vessel occlusions can also occur due to compression by the false lumen

27

DeBakey Classification

3 types based upon location of intimal tear and which section of the aorta is involved; Type 1, 2, 3A, 3B

28

Debakey Classification: Type 1

Intimal Tear: Ascending Aorta
Dissection: All parts of the thoracic Aorta (ascending, arch, and descending)

29

DeBakey Classification: Type 2

Intimal Tear : Ascending Aorta
Dissection: Ascending Aorta only
stops before innominate artery

30

DeBakey classificaiton: Type 3A

Intimal Tear: Descending Aorta
Dissection: Descending Thoracic only distal to left subclavian, ends above diaphragm