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Surgery study guide CARDIOLOGY Aortic Aneurysm -Occurs when blood collects between the aortic vessel layers with true Di ?erential aneurysms involving all layers intima media adventitia -Pseudoaneurysm a collection of blood and connective tissue located o

CARDIOLOGY Aortic Aneurysm -Occurs when blood collects between the aortic vessel layers with true Di ?erential aneurysms involving all layers intima media adventitia -Pseudoaneurysm a collection of blood and connective tissue located outside of the vessel wall -Most commonly occurs below the kidney Prognosis Risk Factors -Can spontaneously rupture -Smoking -Post-op complications MI reduced blood ow to LEs from emboli AKI mesenteric or spinal cord ischemia device -HTN migration or endoleak with graft placement -Hyperlipidemia -Male -Atherosclerosis -FH Abdominal Aortic Aneurysm Thoracic Aortic Aneurysm -Normally AA is cm becomes Workup -Further classi ?ed as ascending descending or arch Workup aneurysmal when cm -Abdominal US for diagnosis -Ascending thoracic AA usually due to elastin degradation which -CXR for widened mediastinum enlarged -Caused by atherosclerosis and -Abdominal CT for further can be normal aging or accelerated by HTN connective tissue aortic knob tracheal displacement in ammation characterization and measurement disorder RA or bicuspid aortic valve -MRI or CTA are test of choice for -Categorized based on morphology -Descending thoracic aneurysm is caused by atherosclerosis characterization and dx -Usually infrarenal in location Management -Arch aneurysm seen in trauma or deceleration injuries -Echo -Surgical repair indicated when Screening cm may be endovascular stent Signs Symptoms -USPSTF recommends US screen in all or open graft repair endovascular - Aortic insu ?ciency symptoms from dilation of valve F Management -BP conWURO -blockers preferred men - who have ever smoked has lower short-term -May also want to screen women with mortality morbidity but open -CHF -Compression of SVC by enlarging aorta ? SVC syndrome -Re-image with CT or MRI every mos -Surgical management is risky and complicated cardio risk factors and anyone with a FH repairs have better long-term outcome -Tracheal deviation -Cough rarely done need to weigh risk of rupture -Surgical repair indicated for thoracic -Watchful reimaging and risk -Hemoptysis cm rapid expansion of aneurysm or Signs Symptoms reduction if cm smoking -Dysphagia symptomatic aneurysm -Usually asymptomatic and discovered cessation -Hoarseness incidentally on abdominal exam -Consider elective nonrepair and -Steady deep severe substernal back or neck pain Prognosis -Abdominal or back pain cessation of surveillance imaging -Less likely to spontaneously rupture than -May have signs of limb ischemia if life expectancy is years AAA Varicose Veins -Usually occur in the saphenous veins Signs Symptoms Di ?erential Management -Dull or aching pain in legs that is worse after -Claudication -Compression stockings Causes standing -Super ?cial thrombophlebitis -Leg elevation -Incompetent valves from damage or venous -Pruritus -Arthritis -Venous ablation dilation -May have h o DVT -Peripheral neuropathy -Sclerotherapy -AV ?stula -Brownish thinning of the skin above the -Great saphenous vein stripping -Congenital venous malformations ankles Prognosis -Complication of thrombophlebitis CAortic Dissection -Occurs when tear in the inner wall of the aorta causes blood to ow between the wall layers ? Signs Symptoms -Sudden onset of ??ripping ? retrosternal and back pain creation of false lumen -HTN -Acute or chronic -Hypovolemia -Usually in ascending aorta -Syncope -Typically in men - -Shock -Debakey and Stanford classi ?cations -Pulse discrepancies -Cardiac