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R9 > Chapter 84 - Upper extremity aneurysm > Flashcards

Chapter 84 - Upper extremity aneurysm Flashcards

1
Q

Usual age at which aneurysm degeneration occur in aberrant right subclavian

A

> 50 years

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2
Q

Define Kommerell’s diverticulum

A

Degenerative aneurysmal change in proximal portion of aberrant subclavian artery

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3
Q

Rate of Kommerell’s diverticulum in aberrant right subclavian

A

60%

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4
Q

Astley Cooper 1805, 1808 on arch vessel aneurysm

A

CCA aneurysm ligation

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5
Q

Mott 1818 on arch vessel aneurysm

A

Innominate artery ligation for subclavian artery aneurysm

dead in 1 month from necrotic aneurysm

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6
Q

1864 Smyth in New Orleans on subclavian artery aneurysm

A

first successful treatment by ligating CCA and innominate artery

recurred and ruptured 10 years later

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7
Q

Halsted 1892 John Hopkins on arch vessel aneurysm

A

Successful resection of subclavian artery aneurysm

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8
Q

Matas 1913 on arch vessel aneurysms

A

7 cases of subclavian aneurysm endoaneurysmorrhaphy

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9
Q

% of arch aneurysms that were degenerative

A

63%

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10
Q

Demographic of arch vessel aneurysms

A

men > 60 years

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11
Q

Causes of arch vessel aneurysms

A

1) degenerative
2) trauma
3) FMD
4) syphilis
5) cystic medial necrosis
6) vasculitis
7) contiguous tuberculous lymphadenitis
8) idiopathic congenital cause

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12
Q

Arch aneurysms as a percentage of all peripheral aneurysms

A

1%

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13
Q

Percentage of patients with arch aneurysms to have other peripheral aneurysms

A

30-50%

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14
Q

Subclavian aneurysm as percentage of all arch aneurysms

A

50%

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15
Q

Innominate aneurysm as percentage of arch aneurysms

A

2-5%

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16
Q

Causes of true aneurysms in the CCA

A

1) degenerative
2) FMD
3) marfan
4) Behcet
5) takayasu

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17
Q

Chance of bilateral CCA aneurysm

A

very rare

1) takayasu
2) cogan syndrome

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18
Q

Cogan syndrome

A

Multisystemic disease with vestibuloauditory dysfunction, inflammatory eye disease and vasculitis

Can cause recurrent aortic and carotid aneurysms

Mimic Marfans

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19
Q

Symptoms of arch vessel aneurysm

A

1) chest/neck/shoulder pain
2) UE ischemic symptoms
3) UE pain/neurologic dysfunction
4) hoarseness
5) respiratory insufficiency
6) TIA/stroke
7) dysphagia
8) hemoptysis
9) supraclavicular bruit
10) Horner syndrome

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20
Q

Risk of ligation in causing ischemia in arch aneurysms

A

25%

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21
Q

Kieffer et al innominate artery types

A

Type A: confined to innominate artery distal to origin
Type B (most common): innominate and origin
Type C: innominate artery and ascending aorta

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22
Q

Subclavian artery aneurysm classification

A

Proximal (degenerative): stenotomy

Distal (TOS): supra and infraclavicular incision

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23
Q

Relative contraindication to open repair of arch aneurysms

A

1) severely compromised pulmonary function
2) prior sternotomy
3) prior left thoracotomy
4) hemodynamic instability due to poly trauma

24
Q

Mortality of open arch aneurysm repair

A

11%

25
Q

What to do if needing to cover vertebral artery

A

1) contralateral needs to be adequate
2) carotid vertebral bypass first if needed
3) coil embolize vert if not ligated to limit endoleak

26
Q

Hybrid approach to subclavian and innominate aneurysms

A

Carotid-subclavian bypass or transposition

Proximal plug or endograft in innominate into CCA

27
Q

Subclavian stent graft patency

A

83-100% over 7-29 months

28
Q

Aberrant subclavian artery prevalence

A

0.5-1% of population

29
Q

Aberrant subclavian artery first described by

A

Hunauld 1735

30
Q

Dysphagia lusoria first described by

A

Impingement of aberrant vessel on esophagus

Bayford 1794

31
Q

Track of the anomalous right subclavian

A

Distal to left subclavian origin
Posterior and inferior on arch
80% cross midline between esophagus and spine
less likely cross between esophagus and trachea or anterior to trachea

32
Q

Embryology, left fourth arch becomes

A

Part of aortic arch

33
Q

Embryology, right fourth arch becomes

A

root of right subclavian artery

34
Q

Embryologic cause of aberrant subclavian

A

Right fourth aortic arch and rigth dorsal aorta involute cranial to 7th intersegmental artery

35
Q

What is aberrant subclavian artery associated with

A

Non-recurrent right laryngeal nerve

36
Q

Epidemiology of aberrant subclavian aneurysm

A

1) Age > 50

2) either sex

37
Q

Indication to repair aberrant artery aneurysm

A

Repair > 3cm in good risk patients

38
Q

Kommerell Diverticulum define

A

Proximal aberrant subclavian artery aneurysm

Described by Kommerell 1936

39
Q

Rate of Kommerell in aberrant subclavian

A

60%

40
Q

Who first called attention to the significance of aneurysm change in aberrant subclavian

A

McCallen and Schaff 1956

41
Q

Aberrant subclavian Classification by Kiefer

A

Group 1: nonaneurysmal aberrant right subclavian artery
Group 2: occlusive disease of nonaneurysmal ARCA
Group 3: aneurysmal dilation of ARSA without aortic involvement
Group 4: aneurysmal ARSA with aortic involvement

42
Q

Aberrant subclavian artery aneurysm presented as rupture or dissection in this % of patients

A

14-53%

43
Q

% of patients with aberrant subclavian aneurysm also have AAA

A

20%

44
Q

Mortality of open repair of Kommerell diverticulum

A

Up to 30%

45
Q

Hybrid approach to bilateral subclavian revasc and endo TEVAR - mortality

A

10% in 36 months

46
Q

Causes of axillary artery aneurysm

A

1) trauma: repetitious forceful extension of UE - abduction, external rotation and downward displacement of humeral head
2) congenital (Rare)

baseball pitchers

47
Q

Rob and Standeven 1956 on axillary artery aneurysms

A

Crutch-induced blunt trauma first described

Thickened walls and wrinkled roughed intima

loss of brachial pulse or emboli after prolonged crutch use

48
Q

Histological signs of chronic trauma

A

1) Fragmentation of medial elastic fibers

2) periadventitial fibrosis

49
Q

Symptoms of axillary artery aneurysm

A

1) emboli

2) brachial plexus compression

50
Q

Patency of open interpositional grafting of axillary artery

A

100% 3.2 years

51
Q

Patency of Endovascular treatment of axillary artery aneurysm

A

84.4% up to 70 months

52
Q

Causes of brachial artery aneurysm

A

1) traumatic (including IVDU injection and infecdtion)
2) Congenital aneurysm
3) idiopathic
4) Type IV Ehlers-Danlos
5) Kawasaki
6) Buerger
7) Kaposi sarcoma
8) cystic adventitial disease
9) dissection

53
Q

Symptoms of brachial artery aneurysm

A

1) median nerve compression

2) digital ischemia (thrombosis or emboli)

54
Q

Patency of brachial artery aneurysm open repair

A

100% 16 months

55
Q

Rate of brachial artery pseudoaneurysm and thrombosis after percutaneous access

A

Pseudoaneurysm 0.3%

Thrombosis 1-7%

56
Q

Thrombin injection for brachial artery pseudoaneurysm

A

1) too superficial
2) usually short neck

Can be done but usually not suitable

R9 (200 decks)

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