Chest and Abdomen- Exam 3- Vascular Conditions

The abdominal aorta has 3 separate tissue layers called

Intima

Media

Adventitia

The diameter of the (normal) aorta _______ from its thoracic portion to its abdominal and infrarenal portions

Decreases

Most abdominal aortic aneurysms begin _________ and end _______

Caudal to the renal arteries cephalic to iliac arteries

What refers to the act of becoming wider, larger or more open

Dilation

What refers to the action of being dilated beyond normal dimensions

Dilatation

Dilation is what kind of process

Passive process

Dilatation is what kind of process

Active process

Dilation is

Physiologic

Dilatation is

Pathological

What are the different AAA shapes

Saccular

Fusiform

Describe a saccular shape AAA

Bubble shape, focal weakness point

Describe fusiform shape AAA

Longer, wider, weakening of walls

Describe how AAA shapes are on a spectrum

You could have a fusiform with saccular shape on it

Space available for blood to flow

Blood pool

You want the blood pool to be

As large as possible

Factors that influence the risk of an aneurysm

Smoking (NUMBER 1 RISK)

Advancing age

Hypertension

Hhypercholesterolaemia

Diabetes

Junk that is inside the space available for blood to flow

Thrombus

-this decreases the blood pool

Example of narrowing of the blood pool

The healthy aorta diameter is influenced by

Age

Sex

Height

Body habitus

What is the only controllable thing that can influence the healthy aorta diameter

Body habitus (someone's weight)

What are the 2 things that increase the risk of an aorta aneurysm over time

Age and body habitus

Aneurysms are defined as

Focal dilation in an artery with at least 50% increase over the vessels normal diameter

Older we get the _____ diameter of aorta

Increase

Males have a _____ diameter of aorta

Larger

Taller means _____ diameter aorta

Larger

Most common location for aneurysm to occur

Between renal and common iliac arteries

What is the name of the location of the most common place of an AAA to occur

Infrarenal

What type of AAA involves the renal arteries

Pararenal AAA

What type of AAA is right against the renal arteries but doesn't involve them

Juxtarenal AAA

Example of suprarenal AAA

What are the most common arterial aneurysms

AAA

Adults of what age are most likely to get AAA

50 and older (prevalence increase with age)

Higher prevalence where in the world

Western countries

Higher in Australia than US and Europe

Symptoms of AAA

Back pain, diminished pulses

-similar to muscular skeletal complaints

A ruptures AAA has a mortality rate of

59-90% if occurring outside a hospital setting

Emergency AAA operative mortality rates

40%

Elective AAA surgical repair mortality rates

0.6 to 5.3

What is the most common AAA

Infrarenal

When above what size should you start monitoring an AAA

Above 3.5 cm

Most normal Abdominal aorta are what size

2 cm

Annual rate of rupture for a 4.0-4.9 cm size AAA

1% (monitor situation)

What size of AAA is it now considered for elective surgical repair

5.0-5.9 cm

Annual rate of rupture for 5.0-5.9 cm size AAA

5-10%

Annual rate of rupture for 6.0-6.0 cm size AAA

10-20 %

Annual rate of rupture for a 7.0-7.9 cm size AAA

20-40 %

Annual rate of rupture for a AAA grater than 8.0 cm

30-50%

AAA risk factors

Older age

Male

Smoking (ever 100 or more in a lifetime)

Hypertension

Heredity

Aging

Hyperlipidemia

Atherosclerotic occlusive disease

How does hyperlipidemia increase risk of AAA

High cholesterol means increase risk of clot and plaque formation

Often time when it comes to symptoms being noticed with AAA then

It's often too late

How do the symptoms typically work with AAA

Silent until expansion impacts distal and adjacent structures (intrinsic and/or extrinsic compression)

What is a big symptom of AAA

Vague but persistent and deep back and abdominal pain

If ruptured what are some signs and symptoms of AAA

Abdominal pain

Back pain

Groin, buttocks, legs, scrotal pain

Tachycardia, dizziness with standing

Syncope

Sweaty/clammy skin, nausea, vomitting

Periumbilical Ecchymosis (Cullen sign)

Flank Ecchymosis (grey turner sign)

What is Cullen sign with AAA

Perimbilical Ecchymosis

-brushing around belly button

What is grey turner sign with AAA

Flank Ecchymosis

-grey on side

What are 2 pretty non specific signs of AAA

Cullen sign (perimbilical ecchymosis)

Grey turner sign (flank ecchymosis)

Normally what is the size of the aorta when on a lateral radiograph taken at 40 SID

Less than 3 cm

Abdominal aorta is considers abnormal if

Diameter greater than 3.5 or any focal contour change is seen

The larger the vessel then

The more likely rupture will occur

What diameter is associated with a 50% chance of rupture in the next few years

5-6 cm diameter

Rupture fatality is near _______

90%

Rupture is usually in which direction

Retroperitoneal

AAA is often associated with the triad of

Back pain

Pulsation abdominal mass

Hypotension

AAA only occurs on what percentage of x rays

50-85%

-often doesn't have enough or any calcification

What is really good at seeing AAA

Ultrasonography (nearly 100% accurate)

What imagines is used to demonstrate excellent detail and is used for surgical mapping of AAA

CT

What imaging for AAA is angiography contrast study

Arteriography

What are some good ways to see AAA

Ultrasonography

Ateriography

Angiography

CT

Example of AAA on ultrasonography

Example of a good blood pool present on ultrasonography

Example of a big aneurysm with blood pool visible in the middle of it on ultrasonography

Example of aneurysm vs normal on ateriogrpahy/angiography

Normal is on the right

Example of being able to see the aneurysm, blood poopoo and thrombus on CT

Abdominal aortic aneurysm can cause what on the spine

Anterior vertebral body scalloping

Example of how the blood pool can look on an aneurysm on a lateral CT

Stents are common in

Iliac, abdominal aorta and carotid

Example of lateral x ray with gallstone and abdominal aortic aneurysm

Example of calcified iliac arteries on lateral x ray

AAA surgical repair is more likely if

Symptomatic

AAA surgical repair is also more likely if rate of growth expands

By more than 0.5 cm in 6 months

AAA surgical repair is more likely if it is what shape

Saccular

What would be the biggest driver to determine if there needs to be AAA surgical repair

The shape, especially if it is saccular form

Stent visible on CT

Left iliac artery stent on x ray

1 time screening via ultrasonography for AAA in men aged 65-76 years who have ever smoked is

B recommendation

Selective offer screening for AAA with ultrasonography in men aged 65-75 who have never smoked routinely

C recommendation

Recommended against routine screening for AAA with ultrasonography in women who have never smoked and have no family history of AAA

D recommendation