Vascular Disease

Question 1

Three main arerial pathologies

Answer 1

aneurysms, dissections, occlusions

Question 2

What anatomy is likely to be more affected by occlusions?

Answer 2

Peripheral Arteries

Question 3

Aortic aneruysm is a dialation of what

Answer 3

All three layers, leads to a 50% or greater increase in diameter

Question 4

When is surgery indicated for aneurysm?

Answer 4

> 5.5 cm

Question 5

Mortality rate of aortic aneurysm?

Answer 5

75%

Question 6

Two types of aortic anerysms

Answer 6

Saccular
Fusiform

Question 7

What is a saccular aneurysm?

Answer 7

Outpouching bulge to one side

Question 8

Fusiform aneurysm

Answer 8

Uniform cicumferential dialtaion

Question 9

What is the fastest/safest measure of obtaining a dianosis of aneurysm when dissection is suspected?

Answer 9

Doppler Echocardiogram

Question 10

Treatment for Aortic Aneurysm

Answer 10

Medical management to ↓expansion rate
Manage BP, Cholesterol, stop smoking
Avoid strenuous exercise, stimulants, stress
Regular monitoring for progression
Surgery indicated if >5.5 cm, growth >10mm/yr, family h/o dissection
Endovascular stent repair has become a mainstay over open surgery w/graft
AAA stent repair, CV surgeon on standby

Question 11

What layer of the vessel does a dissection occur in?

Answer 11

Intimal

Question 12

Worst type of dissection?

Answer 12

Ascending; mortality incrases by 1-2% an hour
27-58% overall mortality

Question 13

Dissection Classifications

Answer 13

Stanford Class A, B
DeBakey Class 1,2,3

Question 14

Stanford A

Answer 14

Ascending aorta

Question 15

If aortic arch involved what is indicated?

Answer 15

Surgical resection

Question 16

Major complication of aortic arch replacement

Answer 16

Neurologic defecit; Seen in 3-18% of pts

Question 17

What location of the aorta does a standford B dissection occur?

Answer 17

Descending Thoracic aorta

Question 18

If a type b dissection is uncomplicated and does not contain a hematoma, or branch vessel involvement how is it treated?

Answer 18

Medical management

Question 19

What does medical management for a type b dissection consist of?

Answer 19

1) intraarterial monitoring of SBP and UOP
 2) drugs to control BP and the force of LV contraction (BBs, Cardene, SNP)

Question 20

What is the mortality rate of someone in the hospital with a type b dissection?

Answer 20

10%

Question 21

What is the long term survival rate with medical treatment in someone who has a type b dissection?

Answer 21

60-80% at 5 years
40-50% at 10 years

Question 22

When is surgery indicated in a pt with a Type b dissection?

Answer 22

Signs of impending rupture
(persistent pain, hypotension, left-sided hemothorax) or compromised perfusion to the lower body

Question 23

What type of aortic dissection goes straight to emergent surgery?

Answer 23

Type A; ascending arch

Question 24

Risk factors for aortic dissection

Answer 24

HTN, atherosclerosis, aneurysm, family history, cocaine, inflammatory disease

Question 25

What inherited diseases increase risk for aortic dissection?

Answer 25

Marfans, Ehlers danlos, Bicuspid aortic valve

Question 26

Causes of dissection

Answer 26

Blunt trauma, cocaine, iatrogenic (c/b medical treatment)

Question 27

What are the iatrogenic causes of aortic dissection?

Answer 27

Cardiac catheterization, aortic manipulation, cross-clamping, arterial incision

Question 28

Who are dissections more common in?

Answer 28

-Men -pregnant women in 3rd trimester