ABD 1 - Pathological Conditions of the Great Vessels

5 sections of aorta

Root, ascending, descending, abdominal, bifurcation

Aortic variant type 1

Replaced common hepatic artery taking origin from superior mesenteric artery

Aortic variant type 3

Replaced right hepatic artery taking origin from SMA

Ectasia

implies the diffuse dilation of a vessel

<3cm

The aorta measures

Hemodynamic compromise

If you are not getting enough 02 to the legs your legs are compromised and you may end up with claudication symptoms.

Arteriosclerosis

General term for hardening and loss of elasticity of arteries leading to blood flow restriction

Atherosclerosis

a specific form of arteriosclerosis causing plaque build up in the tunica intima and can restrict blood flow

30-60%

What percentage of AAA are asymptomatic?

Abdominal, back, or leg pain or palpable and pulsatile abdominal mass

Signs and symptoms of AAA

excruciating abdominal pain, shock and expanding abdominal mass

Signs and symptoms of AAA rupture

Dissecting aneurysm

chest pain that radiates to the back. 15% have no pain

Aneurysm

abnormal, permanent dilatation of a blood vessel usually secondary to arteriosclerotic change

Bulges

Aneurysms cause atrophy of smooth muscle causing ____ due to pressure of blood

All 3 layers

Most true aneurysms involve

95%

What percentage of aneurysms are infrarenal and extends into iliacs

Mural thrombus

Common with larger aneurysms

Mycotic aneurysm

The result of infection often seen near kidneys

>5cm

Surgery is considered when an aneurysm reaches

Aneurysm

a permanent localized dilation of an artery, with an increase in diameter of greater than 1.5 times its normal diameter

Berry aneurysm

small saccular aneurysms that effect the cerebral vessels.

Saccular aneurysm

very rare, is a localized weakness causing a “saclike bulge” in a portion of the wall diameter

Saccular aneurysm

very rare, is a localized weakness causing a “saclike bulge” in a portion of the wall diameter

Dissecting aneurysm

occurs when blood seeps between the wall layers, usually through an intimal tear

<6

When the aorta is ____cm, patients are assessed at yearly intervals

5cm

When is surgery for AAA considered

6cm

When is AAA at risk for rupture

7cm

When is AAA risk for fatal rupture

95%

Percent AAA occur below renal arteries aka infrarenal

>2cm

Iliac artery aneurysm is

colon

Iliac aneurysm can rupture into

HTN males 40-60yrs

Dissecting anuerysms occurs in

Type 1 and 2 dissection

ascending aorta and aortic arch

Type 3 dissection

descending aorta at level of inferior subclavian artery

Type 1 and 2 cause they originate from coronary arteries leading to obstruction of flow to head and neck

Highest rate of mortality is in which dissection and why?

Cystic medial necrosis

weakening of arterial wall which can lead to type 2 and is breakdown of collagen, elastin, and smooth muscle seen in connective tissue disorders

Marfan’s syndrome

Associated with type 2 and is a connective tissue disorder where walls of major arteries are weakened and can tear with non-stiff structures slender fingers, long arms and legs, curvature of spine and eye problems

Highest risk patients

Aneurysms >6 to 7 cm in diameter and increases with age and other medical problems

Renal and iliac involvement

When is surgical intervention needed for AAA

Tube graft, aortobiiliac graft, aortobifemoral graft

Procedures performed with postinterventional AAA open surgical treatment

Native artery prox (inflow), entire length of graft, native artery dist (outflow)

Document diameters and PSV of

Endovascular aneurysm repair

aorticiliac or aortabifemoral graft placed

Endovascular aneursym repair

EVAR

Endoleak

Persistent blood flow within aneurysm sac after placement of endograft

an endoleak

Any increase in sac size, pulsatility of sac, or areas of echolucency in sac are suggestive

renal displacement

AAA rupture can cause

lateral wall on left side

most common place of rupture

CT (not hampered by bowel gas)

First choice for imaging of a ruptured aorta

True aneurysm

Forms when the tensile strength of the wall decreases and secondary to underlying diseases

Pseudoaneurysm

A pulsatile hematoma results from leakage of blood into the soft tissue abutting the punctured artery, with subsequent fibrous encapsulation and failure of the vessel wall to heal (trauma, catheterizations)

To and fro pattern in neck and swirling pattern is pseudo itself

Describe psuedoaneurysms pattern

Arteriovenous fistula

Abnormal connection between an artery and a vein developed secondary to trauma or surgery with color bruit or pulsatile mass

IVC tributaries

3 anterior hepatic veins, 3 lateral veins, 5 pattern abd wall, 3 veins of origin

RRA

Vessel posterior to IVC

Duplication of IVC

• 3% of population

• Lt IVC → LCIV to LRV

• Pulmonary emboli

• Adenopathy

Transposition of IVC

• Situs inversus - mirror reversal location of vessels and organs

• Asplenia - IVC ant to aorta

• Partial - retrohepatic IVC is normal but IVC ties left of Ao below renal sinus

Retroaortic left renal vein

• LRV courses pos to the aorta

• Important finding for surgical procedures such as AAA and renal surgeryImportant finding for surgical procedures such as AAA and renal surgery

Azygous continuation of IVC

• Congenital absence of IVC

• Azygous veins dilated and seen posterior to diaphragmatic crura

• Polysplenia syndrome

Hepatic portion of IVC

• Masses are right adrenal, neurogenic, and hepatic

• IVC is compressed

• Mass would produce pos, lat, med displacement of IVC

Pancreatic portion of IVC

Middle of IVC may elevate cava from abnormalities of the right renal artery, right kidney, lumbar spine, or lymph node masses.

Small bowel segment

Lumbar spine abnormalities or lymph nodes would elevate the inferior vena cava

Leiomyosarcoma

a tumor seen in the IVC originating from the wall. Seen in middle aged women. Large intramural mass with mid level echoes

renal cells

most common tumor to invade the IVC through the renal veins (9-30% cases)

Hepatomas

invade the IVC & the Rt atrium through the hepatic veins

IVC thrombus

• partial or complete (deadly)

• homogenous echogenic mass

IVC dilatation

Occurs with Rt Ventricular failure CHF & HTN and IVC fails to collapse (50%) (>2.5cm)

Thrombosis

May result from propagation of lower extremity thrombosis (most common)

compressed instead of displaced

With enlargement of the liver, the cava is

IVC filters

The most common origin of pulmonary emboli in venous thrombus from the lower extremities.

IVC filters

placed in the IVC for these patients to prevent future/recurrent embolization who cant have anticoagulantss

IVC filter

Device used to protect patients from pulmonary emboli and trap thromboemboli from LE DVT

May-Thurner syndrome (iliac vein compression syndrome)

Occurs when left common iliac vein is compressed between overlying right common iliac artery and underlying vertebral body

Budd-Chiari syndrome

Thrombosis of hepatic veins. Hepatic veins are small, with echogenic material

Portal Venous Hypertension

increased pressure with low velocity in portal system. Determine hepatopetal versus hepatofugal flow. Loss of respiratory variation

Cavernous Transformation of the Portal Vein

This is seen in patients with chronic portal vein obstruction. Periportal collateral vessels are present

Spontaneous Shunting

There are four main sites: gastroesophageal, paraumbilical vein, hemorrhoidal anastomoses, and retroperitoneal anastomoses