666 Section III / Subspecialty Surgery |
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What is the treatment? |
Replace with graft, open or endovascular |
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stent |
What are the dreaded |
Paraplegia (up to 20%) |
complications after |
Anterior spinal syndrome |
treatment of a thoracic |
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aortic aneurysm? |
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What is anterior spinal |
Syndrome characterized by: |
syndrome? |
Paraplegia |
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Incontinence (bowel/bladder) |
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Pain and temperature sensation loss |
What is the cause? |
Occlusion of the great radicular artery |
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of Adamkiewicz, which is one of the |
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intercostal/lumbar arteries from T8 to L4 |
AORTIC DISSECTION |
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What is it? |
Separation of the walls of the aorta from |
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an intimal tear and disease of the tunica |
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media; a false lumen is formed and a |
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“reentry” tear may occur, resulting in |
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“double-barrel” aorta |
What are the aortic |
DeBakey classification |
dissection classifications? |
Stanford classification |
Define the DeBakey |
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classifications: |
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DeBakey type I |
Involves ascending and descending |
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aorta |
Chapter 72 / Cardiovascular Surgery 667
DeBakey type II |
Involves ascending aorta only |
DeBakey type III |
Involves descending aorta only |
Define the Stanford |
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classifications: |
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Type A |
Ascending aorta (requires surgery) |
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Descending aorta (includes DeBakey |
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types I and II) |
668 Section III / Subspecialty Surgery |
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Type B |
Descending aorta only (nonoperative, |
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except for complications) (same as |
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DeBakey type III) |
What is the etiology? |
HTN (most common) |
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Marfan’s syndrome |
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Bicuspid aortic valve |
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Coarctation of the aorta |
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Cystic medial necrosis |
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Proximal aortic aneurysm |
What are the signs/ |
Abrupt onset of severe chest pain, |
symptoms? |
most often radiating/“tearing” to the |
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back; onset is typically more abrupt than |
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that of MI; the pain can migrate as the |
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dissection progresses; patient describes a |
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“tearing pain” |
Note three other sequelae. |
1. Cardiac tamponade; Beck’s triad— |
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distant heart sounds, c CVP with JVD, |
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T BP |
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2. Aortic insufficiency—diastolic murmur |
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3. Aortic arterial branch occlusion/ |
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shearing, leading to ischemia in the |
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involved circulation (i.e., unequal pulses, |
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CVA, paraplegia, renal insufficiency, |
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bowel ischemia, claudication) |
Which diagnostic tests are |
CXR: |
indicated? |
1. Widened mediastinum |
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2. Pleural effusion |
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TEE |
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CTA (CT angiography) |
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Aortography (definitive gold standard but |
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time-consuming!) |
