Endoleak Type I
From proximal or distal anastamosis.
Endoleak Type II
From branch of the aorta (eg. IMA, etc.)
Endoleak Type III
From junction between modular devices, or tears.
Endoleak Type IV
Graft porosity.
EDVG Problems (4)
Endoleaks
Migration, kinking
Endotension
Disassociation
Criteria for mesenteric ischemia (3)
2 of 3 splanchnic arteries stenosed or occluded
Celiac > 200 cm/sec
SMA > 275 cm/sec
Causes of portal vein occlusion (4)
Thrombosis secondary to cirrhosis
Tumor from liver or panceas
Pancreatitis
Schistosomiasis
Criteria for portal HTN (6)
Flow < 15 cm/sec PV diameter > 13mm Splenomegaly > 13cm Waveform to/fro or reversed Hepatofugal direction of flow Development of shunts
Budd-Chiari Syndrome symptoms:
hepatic vein obstruction
hepatomegaly abdominal pain ascites jaundice hepatocellular dysfunction
Renal artery progression
Renal arteries
>Anterior - 4 segmental arteries
>Posterior - 1 segmental artery
>Segmental arteries: in renal pelvis
>Interlobar arteries (in parenchyma)
>Arcuate arteries (curve around corticomedullary junction)
>Cortical branches (in cortex)Criteria for Renal Artery Stenosis (5)
RAS
Renal/Aortic ratio > 3.5 PSV > 180 cm/sec Accel time > 0.1 sec Accel index < 300 cm/sec2 Loss of early systolic peak
Criteria for aneurysm (1)
Diameter ≥ 1.5 times normal
Types of aneurysms (4)
True: all layers stretched
Pseudo: hole in atrial wall
Dissecting: separation of intima and media
Mycotic: infection destroys part of wall causing rupture
Renal artery doppler signature (2)
Low resistance
Early systolic peak
Forms of aneurysms (4)
Fusiform/Diffuse (gradual)
Bulbous/Focal (sharp)
Concentric: equal all around
Saccular: off to one side
Indications of Renovascular HTN (3)
Hypertension, esp. in younger patients
Decreased renal function
Abdominal bruit
Hepatic vein Doppler signature
Phasic with pulsations from RA, often above and below baseline.
Most common location for AAA?
Distal to the renal arteries.
Symptoms of AAA?
Pain in abdomen, back, or legs.
What is the 2 cm rule?
If the proximal portion of AAA is ≥2 cm beyond SMA origin, the renal arteries are probably not involved.
3 objectives of aneurysm repair surveillance:
To determine if anastomoses feeding AAA.
To check for fluid collection.
To examine for hematoma, abcesses, pseudoaneurysms.
Describe Median Arcuate Ligament syndrome:
The median arcuate ligament compresses the celiac artery during exhalation, causing pain.
Describe the surgical anastomoses for renal allografts.
Renal artery: end-to-end for internal iliac artery, end-to-side for external iliac artery.
Renal vein: end-to-side for external iliac vein.
Ureter: to bladder with anti-reflux device.
Kidney transplant complications (3):
Renal artery stenosis: from intimal damage.
Renal artery or Renal vein thrombosis: from surgical complications.
Pseudoaneurysms or artery to vein fistula (AVF).
