Diseases of the Aorta

Question 1

An anatomic remnant of right aortic aorta

Answer 1

Kommerell’s Diverticulum

Question 2

Occurs near the insertion of the LIGAMENTUM ARTERIOSUM adjacent to the left subclavian artery

Answer 2

Coarctation of the Aorta

Question 3

The more dominant factor in AAA or DESCENDING THORACIC ANEURYSM

Answer 3

Atherosclerosis

Question 4

Associated with AAA

Answer 4

Hypertension

Question 5

Usually a HARBINGER OF RUPTURE and represents a medical emergency

Answer 5

Aneurysmal pain

Question 6

MC location of aortic aneurysm

Answer 6

Infrarenal aorta

Question 7

Defined as a pathologic focal dilation of the aorta that > 30 mm or 1.5 times the adjacent diameter of the normal aorta

Answer 7

Abdominal Aortic Aneurysm

Question 8

MC cause of AAA

Answer 8

degenerative process in the aortic wall

Question 9

Risk factors associated with AAA ↑ in size

Answer 9

HPN
COPD
Smoking

Question 10

SCREENING MODALITY OF CHOICE in AAA with high accuracy and sensitivity with a specificity of 100%

Answer 10

Abdominal Ultrasound

Question 11

The GOLD STANDARD for determination of anatomic eligibility for endovascular repair

Answer 11

Abdominal CT

Question 12

Indicated to ↓ the risk of cardiovascular events related to atherosclerosis

Answer 12

Statins

Question 13

Anatomic criteria for endovascular AAA repair

Answer 13

INFRARENAL NECK: length 15 mm or greater, diameter 30 mm or less, and anterior angulation less than 60 degrees

LANDING ZONE: ability to fixate distally proximal to at least one internal iliac artery

COMMON FEMORAL AND EXTERNAL ILIAC ARTERY DIAMETERS—at least 7 mm

RELATIVE CONTRAINDICATIONS: severely calcified iliac arteries and severely tortuous iliac arteries

Question 14

Indicated for abdominal aortic aneurysms of any size that are expanding rapidly or are associated with symptoms

Answer 14

Operative repair of the aneurysm with insertion of a prosthetic graft

OR

endovascular placement of an aortic stent graft

Question 15

An alternative approach to treat ruptured aneurysms and may be associated with a lower mortality rate

Answer 15

Endovascular repair with stent placement

Question 16

Represents a revolutionary and minimally invasive treatment for infrarenal AAA that only requires 1-2 days of hospitalization

Answer 16

Endovascular repair with stent placement

Question 17

First step of medical therapy followed by surgical repair

Answer 17

smoking cessation

Question 18

Anatomic eligibility for endovascular repair is mainly based on three areas:

Answer 18

proximal aortic neck
common iliac arteries
external iliac and common femoral arteries

Question 19

Usual distal landing zone

Answer 19

Common Iliac Artery

Question 20

Alternative site when the ipsilateral common iliac artery is aneurysmal or ectatic

Answer 20

External Iliac Artery

Question 21

An extravasation of contrast OUTSIDE THE STENT GRAFT and WITHIN THE ANEURYSM SAC

Answer 21

Endoleak

Question 22

Type I endoleak

Answer 22

attachment site leak

Question 23

Type II endoleak

Answer 23

Side branch leak caused by lumbar or inferior mesenteric arteries

Question 24

Type III endoleak

Answer 24

Junctional leak (of overlapping endograft components) and graft fabric defect

Question 25

Type IV endoleak

Answer 25

Endograft fabric porosity (FOURosity) leak

Question 26

Which endoleaks are treated aggressively and which are initially observed?

Answer 26

Type I and III endoleaks – aggressively treated by endovascular means (additional stent graft components and fixation site angioplasty/stent)

Type II endoleaks –most often will thrombose and are not reintervened on unless AAA sac growth is observed

Question 27

4 major acute aortic syndrome

Answer 27

AORTIC RUPTURE
AORTIC DISSECTION
INTRAMURAL HEMATOMA
PENETRATING ATHEROSCLEROTIC ULCER

Question 28

DeBakey Type I

Answer 28

An intimal tear occurs in the ASCENDING AORTA but involves the DESCENDING AORTA as well

Question 29

DeBakey Type II

Answer 29

Dissection is limited to the ASCENDING AORTA

Question 30

DeBakey Type III

Answer 30

Intimal tear is located in the DESCENDING AORTA with distal propagation of the dissection

Question 31

Stanford Type A

Answer 31

Dissection involves the ASCENDING AORTA (proximal dissection)

Question 32

Stanford Type B

Answer 32

Dissection limited to the ARCH and/or DESCENDING AORTA (distal dissection)

Question 33

Criteria for surgical management of aortic dissection

Answer 33

type A dissections – treated with emergent operation including replacement or repair of the ascending aorta, aortic root, and aortic valve

type B dissections – treated with early surgical intervention if visceral or extremity arterial origins are compromised
*aneurysmal dilation of the aorta to 6 cm or intractable back pain