Thoracic Aneurysms and Aortic Dissection Flashcards
(17 cards)
The type of aortic aneurysm characterized by an outpouching of the aorta
Saccular
- Aortic aneuryms can be true or false
- True: Fusiform or Saccualr
- Fusiform: more common; symmetrical dilatations of the aorta
- Saccular: localized outpouchings
- True: Fusiform or Saccualr
Most common cause of thoracic aortic aneurysms?
Nonspeciffic medial degenration
- Histologic findings
- fragmentation of elastic fibers and loss of smooth muscles
The most common complciation of extensive repair for distal aortic aneuryms?
Pulmonary dysfunction
- With aneuryms adjacent to the left subclavian artery, the vagus and left recurrent laryngeal nerves are often adherent to the aortic wall and thus are susceptible to injury
- SPinal cord ischemia
- renal failure
MArfans yndrome is caused by an abnormality in ________
Fibrillin
- Tall stature, high palate, joint hypermobility, eye lens disordersm mitral valve prolapse, and aortic aneurysms
- Long arm of chromosome 15
Anastomotic pseudoaneurysms
- Can be caused by technical problems by deterioration of native aortic tissue, graft material or suture
- Commonly occurs in patients with Marfan syndrome
- Tissue degeneration usually is relatedto either progressive degenerative disease or infection
- high incidence of morbidity and rupture
The most common cause of death in patients with type IV Ehlers-Danlos syndrome is
Ruptured visceral artery
- Vascular type : Type III
The most common presenting symptom in patients with an ascending thoracic aneurysm
Anterior chest pain
- Aneurysmal expansion and impingement on adjacent structures
- micmics angina
- Aneuryms of the ascending aorta and transverse aortic arch can cause symptoms related to compression of the SVC, pulmonary artery, the airway or the sternum
Endoleaks
Type I and type IV generally require early and aggressive intervention
- complication of descending thoracic aortic stent grafting
- there is persistent flow of blood into the aneurysm sac
The most useful imaging study fo thoracic aneuryms is
CT scan
- provides visualization of the entire thoracic and abdominal aorta
- permits multiplanar and 3d reconstructions
- location, extent, anatomic anomalies and relationsip to the major branch vessels
- absolute diameter of the aorta
A patient with Marfan syndrome who has undergone “aortic surger” most ;likely had
Aotic root replacement (valve and acending aorta)
In the case of aortic dissection
- Diagnostic delays are common
- diagnostic delays are common, delays beyond 24 hours after hospitaliztion occur in up to 39% of cases
Moratlity rates of operative repair of an aortic arch aneurysm have been significantly reduced intraoperatively by
Deep hypothermia to allow circulatory arrest
- aneurysms isolated to the ascending segment
- standard CPB and distal ascending aortic clamping
- Transverse aortic arch
- hypothermia must be initiated before pump flow is stopped
- 22-24 degrees celsius
According to Crawford classification schems, surgical repair of thoracoabdominal aortic aneurysms with repairs beginning near the left subclavian artery but extending distally into the infrarenal abdominal aorta often reaching the bifurcation is classified as
EXTENT II
- Extent I - most of the descending aorta, beginiing neer the left subclavian artery, and extend down ot the suprarenal abdominal aorta
- Extent III - extend from the lower descending thoracic aorta (below the 6th rib) and into the abdomen
- Exten IV begin at the diaphragmatic hiatus and often involve the entire abdominal aorta
Treatment of descending aprtic dissection by nonoperative, pharmacologic management
A ct scan obtained on day 2 or 3 and on day 8 and 9 of treatment compared with the initial scan is sufficient to rule out significant aortic expansion
- Beta antagonis is initiated when systolic pressure is consistently between 100 adn 110 mmHg and the neurologic, renal, and CVS are stable
Typical preenting symptom in a patient with an aortic dissection
Severe chest or back pain clasically described as tearing, that migrates distally as the dissection progresses along the length of the aorta.
Delayed treatment for ascending aprtic dissection should be considered in
- present with severe acute stroke or mesenteric ischemia
- elderly and have substantial comorbidity
- stable condition and may benefit from transfer to a specialized centers
- have undergone a cardiac operation in the remote past (3 weeks)
A patient with a subclavian artery malperfusion as a complciation of aortic dissection would likely experience
Cold, painful extremity
