Questions and Answers
What are the layers of the vessel wall?
Tunica adventitia, media, and intima
What are aneurysms of the adventitia only considered?
What is a fusiform aneurysm?
A spindle-shaped bulge
What is a saccular aneurysm?
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What is an aortic dissection?
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What is the Debakey Classification for aortic dissection type I?
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What does the Stanford classification for aortic dissection type A involve?
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What is the most common cause of aneurysms?
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What are the most common types of aneurysms?
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What are common symptoms of thoracic aortic aneurysms?
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Which type of aneurysm requires CPB or partial CPB for repair?
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When does the aortic valve need to be replaced?
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When is circulatory arrest needed during aortic surgery?
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Where should the A-line and pulse ox be monitored during a thoracic procedure?
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What type of anesthesia is used for thoracic aneurysm repair (descending)?
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What is the most common factor that leads to dissection or changes in vessel wall integrity?
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What is the treatment for dissecting aortic lesions type A?
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For descending thoracoabdominal aneurysms, at what size is repair recommended?
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What are poor surgical outcomes related to?
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Pre-op renal function is directly related to what?
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What are the most devastating consequences of thoracic aortic surgery?
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Which nerve is related to hoarseness during thoracic surgery?
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What kind of ETT is needed for facilitating exposure of the descending thoracic aorta?
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What is the placement of monitors recommended for a distal arch or thoracic descending aneurysm?
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What is CSF access?
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What types of spinal cord injury can occur after surgery?
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What are post-op risk factors that increase the risk for spinal cord injury?
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What efforts can be made to decrease spinal cord injury during surgery?
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What is spinal cord perfusion pressure?
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What are the most influential interventions to protect the spinal cord during surgery?
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What are early complications following thoracoabdominal aortic aneurysm repair?
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What are late complications following thoracoabdominal aortic aneurysm repair?
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What should be done post-op regarding the double-lumen tube (DLT)?
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Study Notes
Vessel Wall Layers
- The vessel wall consists of three layers: tunica adventitia, tunica media, and tunica intima.
Aneurysm Types
- False aneurysms involve only the adventitia layer.
- Fusiform aneurysms have a spindle-shaped bulge.
- Saccular aneurysms feature a sac-like bulge on one side.
Aortic Dissection
- Aortic dissection is characterized by a tear in the intima, allowing blood to flow through a false passage.
Dissection Classifications
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Debakey Classification:
- Type I: Originates in the ascending aorta, may extend to the aortic arch and descending aorta.
- Type II: Starts and is confined to the ascending aorta.
- Type III: Originates in the descending aorta and extends distally.
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Stanford Classification:
- Type A: Involves the ascending aorta.
- Type B: Does not involve the ascending aorta.
Thoracoabdominal Aneurysms
- Crawford classification identifies five types based on the anatomical location of the aneurysm relative to the renal arteries and intercostal spaces.
Causes of Aneurysms
- Atherosclerosis is the most common cause of aneurysms.
- Descending and distal thoracic aorta aneurysms are the most prevalent types, commonly fusiform.
Diagnosis and Symptoms
- Symptoms include pain, stridor, hoarseness, and cough due to compression of thoracic structures.
- Aortic insufficiency may occur with ascending aneurysms.
- Diagnosis is made using CT or MRI imaging.
Surgical Interventions
- Resection of the ascending aorta requires cardiopulmonary bypass (CPB) and administration of heparin.
- Aortic valve replacement may be necessary when the aneurysm is near the aortic arch.
- Circulatory arrest is indicated to protect cerebral perfusion in cases of transverse arch aneurysms.
Anesthesia and Monitoring
- Anesthesia for descending thoracic aneurysm repair involves a double lumen tube and a left lateral decubitus position.
- A-line and pulse oximetry should be monitored on the right side to avoid complications from left subclavian impingement.
Dissection and Surgical Risks
- Hypertension is a significant factor contributing to aortic dissection and vessel wall integrity loss.
- Surgical treatment for type A dissections is necessary due to high rupture risk.
- Repair of descending thoracoabdominal aneurysms is recommended at sizes of 6 cm or greater.
Postoperative Considerations
- Poor surgical outcomes correlate with renal, cardiac, and neurological dysfunctions.
- Preoperative renal function is crucial for predicting post-operative renal failure.
- Paraplegia is one of the most severe consequences following thoracic aortic surgery.
Neurological Considerations
- Hoarseness may occur due to left recurrent laryngeal nerve involvement, which is closely related to the aortic arch.
- Establishing CSF access through lumbar drains can help monitor intracranial pressure.
- Monitoring spinal cord perfusion pressure is essential; it is calculated as arterial BP minus CSF pressure.
Preventing Spinal Cord Injury
- Efforts to mitigate spinal cord injury risk include SSEP and MEP monitoring, CSF drainage, mild hypothermia, and reattachment of intercostal arteries.
- Immediate and delayed spinal cord injuries can occur, influenced by dissection type, cross-clamp time, and surgical techniques.
Complications
- Early complications post-thoracoabdominal aortic aneurysm repair include respiratory failure, myocardial infarction, and early paraplegia.
- Late complications can include delayed paraplegia, graft thrombosis, and infection.
Postoperative Management
- After surgery, replace the double lumen tube with a single lumen unless airway edema is observed.
- Monitor for recurrent laryngeal nerve damage which could lead to respiratory issues during extubation.
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Description
This quiz focuses on key terms and definitions related to thoracic aortic aneurysms as outlined in Nagelhout Chapter 28. It includes important concepts such as the layers of the vessel wall, types of aneurysms, and aortic dissection. Perfect for students studying vascular anatomy and pathology.