Vascular Flashcards
(44 cards)
2 types of aneurysms
Saccular (outpouching, mushroom)
Fusiform (entire diameter grows)
Difference bt aneurysm and dissection
aneurysm = all layers of arterial wall (intima, media, adventitia) dissection = defect in intima, allows blood to go bt layers
Branches of abd aorta
celiac trunk SMA IMA renal arteries gonadal arteries 95% of abd aneurysms are distal to the takeoff of the renal arteries.
PhysEx for abd ao aneurysm
pulsatile abd mass
lower extremity pallor, cool temp, unequal/diminished pulses
Diagnostic eval for abd aneurysms
US- size and if there’s a clot in the arterial lumen
CT or MRI- anatomic detail and localization
Aortogram- can check for involvement of other vessels, help plan surgery
Rx for abd ao aneurysm
If asx: depends on size-
<4cm medical- beta blockers
4-5cm- can do early op or can do close followup.
5+cm surgical repair.
surgery- new use of stent grafts via femoral
If ruptured/leaking- fluids and immed op
Surgical repair of AAA
midline incision or oblique over 11th IC space.
Midline: push bowel to right, incision of posterior peritoneum to the L of the Ao exposes entire Ao.
Oblique- only for retroperitoneal approach. Entire peritoneal contents pushed to right, exposing Ao.
Get prox and distal control, give heparin before clamping, place graft w permanent sutures.
If transabd approach, close peritoneum over graft.
branches off of thoracic aorta
brachiocephalic, L common carotid, L subclavian, bronchial arteries, esophageal, intercostal arteries
Cause of thoracic Ao aneurysms
Cystic medial necrosis or atherosclerosis
less common- trauma, dissection, infection
HPE for thoracic Ao aneurysm
Most are asx
if ruptured- chest pain/prs
if expanded- can compress tracha –> cough, if erodes into trachea –> hemoptysis
if close to Ao valve, can cause dilation of the annulus–> Ao insuff and chest pain, dyspnea, syncope
on physEx- hypotension, tachycard
if involves annulus, ao regurg and CHF
Dx Eval for thoracic Ao aneurysm
CXR- wide mediastinum
EKG- myocardial ischemia
If asx- do CT or echo
Aortography for planning op
Rx for thoracic Ao aneurysm
If asx, operate if 5+cm
Sxtic- immed op
Why do Ao dissections occur (path)?
HTN, trauma, Marfan syndrome, Ao coarctation
HPE Ao dissection
Immediate onset severe pain, tearing, in chest, back, abd.
Also nausea, lightheadedness
May be hypotensive, may have diminished periph pulses
Dx Eval of Ao dissection
CXR- wide mediastinum
CT- may show dissection or clot in arterial lumen
Dx via TEE, MRI, or aortogram
Classifications of Ao dissection
DeBakey Type I: both ascending and descending Ao
Type II: just ascending
Type III: just descending
Rx for Ao dissection
Depends on type. DeBakey Type II (ascending)- surgery! bc can go retrograde to Ao root. Give anti-HTN before surgery to halt progression
DeBakey Type III (descending)- medical only. give anti-HTN: Na+Nitroprusside and B Block.
From where does the common carotid arise?
On right side: from brachiocephalic (which comes off of Ao)
On left: directly from Ao.
What arteries does the common carotid branch into?
Bifurcates into Internal and External branches.
Internal carotid gives of opthalmic artery, then continues to circle of willis in brain.
Why does carotid artery disease occur (pathogenesis)?
Atherosclerosis.
But you get the stroke bc of plaque rupture, ulceration, hemorrhage, thrombosis, low flow states.
Pt Hx in carotid artery dz
Prev neurologic events:
TIA (24 hr resolution); fixed neuro deficit
Amarosis fugax
What is amarosis fugax
transient mono-ocular blindness
shade being pulled down.
d/t occlusion of a branch of the opthalmic artery (which is a branch of the internal carotid
PhysEx in carotid artery dz
May have fixed neuro deficit
Hollenhorst plaques on retinal exam = evidence of previous emboli
Carotid bruit - evidence of turbulent carotid flow
Dx Eval of carotid artery dz
Carotid duplex scanning
Angiography more accurate for assessing degree of stenosis
