Term
| Q:Where in the vascular anatomy of the abdomen do the majority of AAAs occur? |
|
Definition
| A: Below the origin of the renal arteries and terminate at the bifurcation of the aorta or common iliac arteries |
|
|
Term
| Q:What is a common symptom of Atherosclerotic aneurysms of the femoral and popliteal arteries? |
|
Definition
| A: foot or calf pain; examination shows a pulsating mass in the groin or behind the knee and irregular red-blue patches of skin on the foot |
|
|
Term
| Q: What is the consistent sign of AAA rupture? |
|
Definition
| A:Severe abdominal and back pain with a pulsatile abdominal mass |
|
|
Term
| Q:Why is an iliac artery aneurysm more likely to rupture than aneurysms of the popliteal and femoral arteries? |
|
Definition
| A:They are generally not detected on physical examination or routine X-ray so they progress until they rupture(Pain symptoms?) |
|
|
Term
| Q:What common condition increases the likelihood of rupture for any given size of aneurysm? |
|
Definition
|
|
Term
| Q:What is the operative mortality of elective procedures to treat AAAs? |
|
Definition
|
|
Term
| Q:What is the operative mortality of treatment on emergent procedures done once a rupture has occurred? |
|
Definition
| A:may exceed 80% (for patient in shock) |
|
|
Term
| Q:what diagnostic imaging tool is most useful in diagnosing an AAA? |
|
Definition
| A:CT scan;it can provide information about the extent of the aneurysm, the location of the thromboembolytic material, and whether leakage has occurred |
|
|
Term
| Q:What diagnostic imaging tool can be used for initial detection of an AAA but not much more than that? |
|
Definition
| A:Ultrasound; aortic angiography is then performed to plan surgery in detail |
|
|
Term
| Q:What should the patient with an AAA be assessed for before undergoing aneurysmal repair and why? |
|
Definition
| A: coronary artery disease; because atherosclerosis of the coronary arteries is a major determinant of mortality after arterial reconstruction |
|
|
Term
| Q:For a AAA repair which two types of Dacron grafts are used and for which circumstances? |
|
Definition
| A:Bifurcated Dacron graft is used if common illiac arteries are involved and a straight Dacron graft is used when they aren't. |
|
|
Term
| Q:On the morning of surgery for a AAA what department and product should the ST confirm with to ensure is available |
|
Definition
| A:blood bank; ensure blood has been ordered and is immediately available |
|
|
Term
| Q:As the AAA repair procedure concludes at what point can the ST start breaking down the mayo and back table? |
|
Definition
| A:Not until the patient has left the OR |
|
|
Term
| Q: For surgical repair of an AAA where is the incision made and what retractors are typically used? |
|
Definition
| A:from the xiphoid to the pubis;large self retaining retractors such as Balfour of Bookwalter for the abdominal wall and large deaver or harrington retractors for the bowel |
|
|
Term
| Q:What type of clamp may be used to mobilize the aorta proximal to the aneurysm up to the level of the renal arteries |
|
Definition
| A: large right angle clamp |
|
|
Term
| Q: What knife handle and blade is used to open the aneurysm and what is used to complete it? |
|
Definition
| A:#11 blade on a #7 knife handle and completed with mayo scissors |
|
|
Term
| Q:After the the anterior aneurysm wall is opened what is used to force small peices of thrombus from the aortic wall? |
|
Definition
| A: a 20-mL syringe/heparin needle combination with heparinized saline |
|
|
Term
| Q:What type of suture is used for the proximal anastomosis of the aorta? |
|
Definition
| 4-0 Prolene (loaded onto a long vascular needle holder with a narrow diamond jaw) |
|
|
Term
| Q:What type of clamp is placed across the graft immediately distal to the anastomosis? |
|
Definition
|
|
Term
| Q:What type of suture is used to patch any leaks in the proximal anastomosis? |
|
Definition
| interrupted, pledgeted prolene sutures (most patch sutures are single-armed, so the surgeon may ask the surgical technologist to cut a double armed prolene suture in half) |
|
|
