Term
| Abdominal Aortic Aneurysm is what |
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Definition
• Aorta is the largest artery in the body
• AAA = wall of the aorta progressively weakens and begins to bulge
• May continue to enlarge and eventually rupture if left untreated causing severe internal bleeding and possibly death |
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Term
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Definition
• Men
• Historyofatherosclerosis
• FamilyhistoryofAAA
• Smoking(5xoddsofgetting)
• Stoppingsmokingdecreasesriskofgrowthand rupture
• Hypertension
• Chroniclungdisease
• Diabetes decreases risk of AAA(maybe because of hardening of arteries) |
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Term
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Definition
| ascending aorta aneurysm, aortic arch aneurysm, descending aorta aneurysm, abdomincal aorta aneurysm (below renal arteries). saccular, fusiform, pseudoaneurysm |
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Term
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Definition
• Most asymptomatic
• Abdominal pain
• Lower back pain
• Pulsatile abdominal mass
• “Blue toes”
• Collapse
-can feel for aorta on abdomen |
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Term
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Definition
• Ultrasound:usefulforinitialdiagnosisand monitoring until approaching size for repair
– Interobserver reliability within 5mm diam 84%
• UnderestimatesCTdiameterbyabout2-4mm
• CT:essentiallygoldstandard
– Interobserver reliability for 5mm is 91%
• CTAbestforpreoperativeplanning – Sees calcium well
• MRI
– Like CT but slower and more expensive and does not see calcified plaque well |
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Term
| AAA USPSTF recommendations |
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Definition
| screen men aged 65-75 who have smoked once. consider other risk factors to screen other populations |
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Term
| risk of rupture of AAA and risk of dying |
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Definition
• Risk of rupture depends on size
– <5 cm – 5-6 cm – 6-7 cm – >7 cm
<5%/year 10%/year 15-20%/year >20%/year
• Risk of dying from aneurysm surgery = ~5% |
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Term
| indications to operate for AAA |
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Definition
Operate when
– AAA > 5.5 cm in otherwise healthy individual – >5 mm expansion in 6 months
– Symptomatic AAA
– Rupture
-insert graft |
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Term
| other places you can have aneurysms |
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Definition
• Femoral aneurysms
– Up to 85% with have AAA;72%bilateral
– Usually iatrogenic pseudo-aneurysms
• Popliteal aneurysms
– Up to 62% of patients with have concomitant AAA
– ~50%bilateral
– Most common peripheral aneurysm~1% menaged 65- 80 years
– Usually present with thrombosis/embolism/ischemia as opposed to rupture
– Aneurysmsbelowtheinguinalligamentrarelyrupture
• Visceral aneurysms (e.g. splenic, celiac, SMA)
– Incidenceabout1%ofpopulation
– Splenic aneurysm is most common~60% of all visceral aneurysms |
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Term
| Carotid Artery Disease results when, can lead to |
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Definition
• Carotid arteries are two main arteries that carry blood from your heart, up through your neck, to your brain.
• Carotid artery disease results when the carotid arteries become too narrow or obstructed from plaque and limit the blood flow to the brain.
• Strokes result either from obstruction of blood flow to the brain by the plaque or when bits of plaque and clots break off from the plaque and flow to the brain. |
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Term
| Carotid Artery Disease and strokes |
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Definition
• Stroke is the 5th leading cause of death in the U. S. with nearly 129,000 people dying annually
• A large proportion of strokes are caused by plaque in the carotid arteries |
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Term
| causes and risk factors for carotid artery disease |
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Definition
• Age
• High blood pressure
• Diabetes
• Smoking
• High cholesterol
• Obesity
• Lack of exercise
• Irregular heartbeat
• Family history of Atherosclerosis (hardening of the arteries) and/or stroke` |
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Term
| carotid artery disease TIAs and symptoms |
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Definition
• Transient ischemic attacks are usually temporary lasting a few minutes to a few hours, and should be treated as serious medical emergencies requiring immediate treatment.
• Some symptoms include:
– Weakness, numbness, or tingling on one side of the body
– Inability to control movement of a body part
– Loss of vision or blurred vision in one or both eyes
– Amaurosis fugax • Curtain of darkness descending over one eye
– Inability to speak clearly
– Difficulty talking or comprehending what others are saying
– Dizziness or confusion |
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Term
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Definition
• Palpation
• Bruit
– Sound made by vibrating arterial wall
– Caused by turbulent blood flow making arterial wall vibrate
– Indicates the presence of an arterial lesion |
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Term
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Definition
• Duplex:
– Individualized to each vascular laboratory
• Other Imaging:
– CT Angiography
– MR Angriography
– Conventional Angiography (X- ray, fluoroscopy) |
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Term
| treatment for Asymptomatic Carotid Disease |
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Definition
• Risk factor reduction (aspirin, statin, ACE- I)
– Observation with regular duplex scans
– Antiplatelet agent
– Greater than 80% stenosis
• Carotid endarterectomy surgery |
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Term
| Carotid artery disease Medical Therapy |
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Definition
• AntiplateletTherapy
– ASA 81mg statistically significant benefit in reducing rate of stroke from any cause, but not death or cardiac events
– 81mg as effective as 325mg with less bleeding complications/risks
• Statin
– Reduction in in-hospital mortality, perioperative stroke and death rates, but not in-hospital cardiac events
– 3-fold reduction in stroke, 5-fold reduction in death |
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Term
| symptomatic carotid disease treatment |
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Definition
• Symptomatic = TIA or strokes attributable to the affected carotid
• Carotid endarterectomy
– CEA better if symptomatic with stenosis >70%
• Carotid stent for high risk patients |
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Term
| complication of carotid artery disease |
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Definition
Aortic Dissection
• Tear in intimal layer with blood entering the media
– Peak incidence 6th–7th decades
– Men > women 2:1
– H/O HTN 80% of cases
• Majority occur in ascending aorta within several centimeters of the valve (65%)
• Descending aortic: distal to the left subclavian artery (20%)
• Aortic arch (10%)
• Abdominal aorta (5%) |
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Term
| DeBakey aortic dissection types |
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Definition
– Type I originates in the
ascending aorta and propagates to the arch or beyond
– Type II originates and is limited to the ascending aorta
– Type III originates in the descending aorta and goes distal or rarely retrograde |
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Term
| stanford aortic dissection types |
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Definition
– Type A: all involving ascending
aorta
– Type B: all others |
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Term
| aortic dissection symptoms, clinical findings and physical exam |
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Definition
• Clinical
– Severe chest pain 75–90% of cases
• Sudden onset, severe at inception; ripping/tearing/stabbing pain
– Migration of the pain 70% of cases – Location
• Anterior pain more common ascending involvement
• Posterior pain more common descending involvement
• PE
– HTN
• Difference of >20 mm Hg in blood pressure between arms
– Pulse deficits
– Murmur of aortic regurgitation
– Neurological: CVA, altered consciousness or coma – Widened pulse pressure |
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Term
| aortic dissection diagnostic findings |
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Definition
• CXR: widened mediastinum or silhouette 80-90%
• Contrast-enhanced CT
• MRI: current "gold standard"
• TEE/TTE |
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Term
| aortic dissection management |
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Definition
• Untreated mortality about 1% per hour
• Monitor BP, rhythm, and urine output
– Start 2 large-bore IVs
• Central venous line (patients with hypotension or CHF)
• Reduce systolic blood pressure to 100-120 mm Hg
• Beta blockers (to reduce contractility)
• Morphine (to treat CP)
• Surgical consultation |
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Term
| SUPERIOR VENA CAVA SYNDROME (SVCS) is what, causes |
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Definition
• Blockage or compression of the SVC causing an obstruction of blood flow from the head, neck, thorax, and upper extremities to the heart
• 80% of cases related to bronchogenic carcinoma, followed by lymphoma with 15% of cases
• Tumor invasion and lymphadenopathy are the most common causes
• Prognosis = short life expectancy |
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Term
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Definition
• Shortness of Breath (Usually 1st symptom)
• Edema
– Face, neck, upper extremities
– Increased in the morning, after being supine, or with bending over
• Superficial veins on thorax
• Jugular venous distension
• Headache
• Chest Pain
• Dizziness |
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Term
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Definition
• Often diagnosed on physical exam alone combined with medical history
– CT
– CXR
– DopplerStudies
– Invasive Contrast Venography |
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Term
| Treatment of SVC Syndrome |
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Definition
• Symptom Management
– Elevation of upper body
– Oxygen
– Diuretics and Fluid Restriction – Steroids
• Radiation Therapy
• Chemotherapy
• SVC Stent |
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