AO/IVC

lateral; kidneys

%. The greater the size of the aneurysm the greater the risk for rupture. An AAA >7 cm in diameter has a 20-50% risk of rupture in 5 yrs, <6 cm has a risk for rupture of 20% within 5 yrs and <5 cm has a 5% risk in 5 yrs. Sonographically the aortic rupture is rarely seen prior to surgery. Most aneurysms rupture into the _____ wall below the _____. Post surgically, it is common to see a massive hematoma around the surgical graft and in the retroperitoneum.

abdominal ; echogenic ;

AAA Rupture Clinical Excruciating _____ pain Shock Expanding abdominal mass Sono · Mass in region or an artery that has had trauma · Contains variable amount of clot (_____ material) · Pulsations · May have swirling of blood · Spectral Doppler will have a to and fro pattern · Color Doppler will have turbulent flow · Communication (neck) to artery

endoleak ; diameter

AAA follow up 1. Determine if persistence flow in aneurysm (_____blood flow outside of the endovascular graft into the aortic aneurysm) 2. Characterize type of endoleak 3. Measure max residual aneurysm sac ____. An excluded aneurysm form blood flow does not get bigger! It will stay the same or decrease in size. An increase in size suggest blood flow to the aneurysm making it at risk for rupture. Look for an endoleak! 4. Assess flow thru graft

•Tube grafts(limited to the aorta) •End-to-end aortoiliac grafts •End-to-side aorta bi-iliac or aorta bifemoral grafts

AAA repair can be done by surgical bypass using synthetic grafts. There are 3 types. They have a life expectancy of 10 years. These patients require lifelong follow up. This can be done by MRI, CT or ultrasound with ultrasound becoming the modality of choice for initial screening. Below is what will be included in the assessment. What are the 3 types?

thrill (bruit) proximal; Distal

AV fistula Clinical · Presence of ________ with a dilated pulsatile mass · Low back and abdomen pain · Swelling of lower trunk and legs Sono Doppler will show pulsatile venous system Increased arterial flow _____ to fistula Decreased ____ arterial flow Doppler will have irregular waveform and high velocities due to the severely disturbed blood flow.

3;

An aneurysm is a localized, abnormal dilatation of a weakened part of an arterial wall. The artery is measured from outer wall to outer wall of the vessel. Measurements of > ____ cm in diameter of the aorta are considered aneurysmal. To account for other factors(what could these be??), another method of determining AAA is with an increase of 1.5 times the normal diameter of the aorta

An aneurysm is a localized, abnormal dilatation of a weakened part of an arterial wall.

An aneurysm is a......

3 layers ;

Aneurysms are either TRUE or FALSE (pseudoaneurysms). True aneurysms involve all _____ of the aorta. False aneurysms result from injury to the vessel wall and blood leaks out and is walled off by surrounding tissues and does not involve all 3 walls of the vessel. False aneurysms mimic true aneurysms.

RCC

IVC Obstruction Tumor formation (most common _____) Thrombosis (most commonly from the lower extremity DVT)

Rt ventricular failure CHF Constrictive pericarditis Tricuspid valve disease Rt heart obstructive tumors Hepatomegaly Later stages of pregnancy Masses (can cause the IVC to be elevated also)

IVC Dilation/Compression Dilation/Compression may be caused by many factors. Name some!!

bulbous and dumbbell.

Other terms to describe AAA are ___ and ____

Our job is to describe this AAA Size L x W x H Shape Location Extension Description of wall thickening Blood flow Soft vs calcified plaque

Our job is to describe this AAA.. HOW???

clot;

Pseudoaneurysms (FALSE) do not have a wall but are surrounded by ____. They result from a tear in the vessel wall that allows blood to escape into surrounding tissues. Trauma or arterial catheterizations are the most common causes. These are commonly found in the groin after catheterizations into the femoral arteries.

4; 5-6

Size and treatment options •Aneurysms <____ cm in diameter are followed every 6 months with intervention if the patient becomes symptomatic. •For aneurysms 4 to 5 cm in diameter, surgical intervention may be suggested if the patient is in good health. •Aneurysms >___-___cm may benefit from surgical repair, especially if patient has other factors for rupture (e.g., hypertension, smoking, COPD). •Highest risk patients: Aneurysms >6 to 7 cm in diameter pose the greatest risk; risk increases with age and other medical problems.

Intimal; flow rates;

Sono aortic dissection · ____ flap, which is created, thin, echogenic, linear structure · The 2 channels will have different ___ ___ documented with Doppler · Para-aortic hematoma may occur from leaking, no flow or color

iliac veins; hammocking ex. of tributaries= hepatics and renals

The IVC is formed by the union of the _______. Caudal to the renal vein entrance the IVC shows posterior "______" through the bare area of the liver. What are the tributaries of the IVC? Remember it is like a river and has confluences.

renal arteries; iliac; popliteal

The ____ arteries and those superior are infrequently involved. ____ (>2.0 cm) and _____ artery aneurysms (1.0 cm) are commonly associated with aortic aneurysms. An increase in size of up to 0.5 cm/yr is considered acceptable. Typically, AAA are not surgically repaired unless over 5.0 cm.

1. Root of the aorta 2. Ascending aorta 3. Descending aorta 4. Abdominal aorta 5. Bifurcation of the aorta into iliac arteries

The aorta is the largest artery of the body. It is divided into 5 sections:

12th ; 4th

The area of that we will be concentrating on is the abdominal aorta. The aorta enters the abdominal cavity by piercing the diaphragm in a posterior location in front of the ____ thoracic vertebra in the retroperitoneal space. It continues anterior to the vertebral column to the level of the ____ lumbar vertebra where it bifurcates into the rt and lt iliac arteries. The aorta lays lt of midline. It tapers as it courses inferior to the bifurcation. It is considered enlarged if the diameter measures >3 cm.

infrarenal aortic;

Treatment of Abdominal Aortic Aneurysms •Surgical intervention •Is suggested with associated renal and iliac involvement. •Length of the____ ____ neck is important to help determine the surgical approach. •Endovascular stent grafts for treatment are a less invasive approach to the repair of an aneurysm.

hepatic veins; lateral; suprarenal; median sacral vein

Tributaries of the IVC •Three anterior _____ •Three ____ tributaries •Right _____ vein (the left vein drains into the left renal vein) •Renal veins •Right testicular or ovarian vein •Five lateral abdominal wall tributaries: the inferior phrenic vein and the four lumbar veins •Three veins of origin: the two common iliac veins, and the _________

1. Type 1a origin at proximal stent 1b distal stent attachment site. 2. Type 2 originating from a branch vessel 3. Type 3 originating at the junctions between components (break in actual graft) 4. Type 4 porosity of graft

Types of endoleak 1. 2. 3. 4.

5

Typically, AAA are not surgically repaired unless over ____ cm OR if pt is symptomatic

Causes Over age 60 Family history Smoke COPD HTN Vascular disease Male 5:1 Inflammation

What are some causes of AAA?

You need to be able to describe WHERE the aneurysm is. Depending on if it is suprarenal or infrarenal will determine what the rad needs to do to fix it. With supra renal, you wouldn't be able to put a stent in. Para renal, you may need to do a full bypass.

Why is it important to know where your renal arteries are?

Saccular

____ aneurysms are characterized by a sudden transition between normal and abnormal. It is a focal, out pouching on 1 side of the vessel that does not involve the entire vessel circumference. They are spherical and larger (5-10 cm) than fusiform. The "mouth" may be as large as the aneurysm. Be careful to attach to aorta to make sure it is not a mass. They are not as common as fusiform and are often due to trauma. Most mycotic (bacterial) infected aneurysms are saccular and have asymmetrical wall thickening.

PSEUDOANEURYSM

_____ •A pulsatile hematoma that results from the leakage of blood into the soft tissue abutting the punctured artery, with subsequent fibrous encapsulation and failure of the vessel wall to heal Blood escapes through a hole in the intima of the vessel wall but is contained by the deeper layers of the aorta or by the adjacent tissue

IVC filter

_____ •Most common origin of pulmonary emboli is venous thrombosis from the lower extremities. •Surgical and angiographic placement of transvenous filters into the IVC have been used to prevent recurrent embolization in patients who cannot tolerate anticoagulants.

Ectasia

_____ implies the diffuse dilation of a vessel, whereas an abdominal aortic aneurysm is a region of focal enlargement. Tortuous aorta

Aortic rupture

_____ is a very significant complication of aortic aneurysms. ). If untreated the mortality rate is nearly 50%. The operative mortality rate is 40-60%.

Fusiform

______ aneurysms are characterized by uniform tubular swelling of the walls of the artery. It has a gradual change from normal to abnormal and resembles a "football" shape. This is the most common type of atherosclerotic aneurysm. They develop inferorenal (85% 164) and extend to bifurcation. MOST ATHEROSCLEROTIC AAAs ARE THIS TYPE.

Aortic ectasia

______ is a DIFFUSE, mild enlargement of the aorta without distal tapering (3-4 cm in diameter).

ARTERIOSCLEROSIS; atherosclerosis

______ is the MOST COMMON cause of aneurysm with _______ the most common form of it. Most AAAs are in the distal aorta.

TRUE ANEURYSM

_______ •Forms when the tensile strength of the wall decreases •Secondary to underlying diseases (small percentage)

Inflammatory

_______ AAA is a variant. The wall of aneurysm is thickened and surrounded by fibrosis and adhesions.

Arteriovenous (A - V) fistula;

_______ is an abnormal connection between an artery and vein. This is not a common finding with ultrasound. Most develop 2nd to trauma but can be caused by surgery, inflammation, neoplasm or be congenital. This would be suspected when the IVC is markedly dilated especially with lower trunk and leg swelling. In the abdomen, these can develop as a complication of arteriosclerotic AAA.

Aortic Dissections

________ occur because of a tear in the intimal lining of the vessel. There are 3 classes of dissection based on the DeBakey model: Types I, II (ascending aorta and arch), and III (descending aorta). This creates a false lumen within the media of the vessel allowing blood to pass (dissect) between these layers. This type is often related to systemic hypertension.