Vascular Pathology and Aneurysms Flashcards

Following endovascular aortic aneurysm repair (EVAR), which type of endoleak involves retrograde flow from aortic branch vessels (IMA or lumbar arteries) into the aneurysm sac?

Answer: Type II endoleak

Type II endoleaks result from retrograde filling of the sac through collateral vessels such as the inferior mesenteric artery or lumbar arteries.

A renal artery aneurysm is most likely to require intervention based on which criterion?

Answer: Diameter > 2 cm, or any size in women of childbearing age or with hypertension

Renal artery aneurysms > 2 cm or any size in women of childbearing potential (rupture risk during pregnancy) are generally treated.

In aortic dissection, which ultrasound finding distinguishes the true lumen from the false lumen?

Answer: The false lumen is typically larger with slower flow and may contain spontaneous echo contrast or thrombus

The false lumen is often larger, has lower velocity swirling flow, may show spontaneous echo contrast (smoke), and may be partially thrombosed.

Which duplex finding is most consistent with impending rupture or rapid expansion of an AAA?

Answer: New periaortic hypoechoic halo or retroperitoneal fluid collection

A periaortic hypoechoic halo or retroperitoneal fluid suggests contained rupture or active leaking, requiring emergency evaluation.

Which pathological process is the primary cause of most infrarenal abdominal aortic aneurysms?

Answer: Atherosclerosis with inflammatory degradation of the media and adventitia

Atherosclerosis combined with inflammatory mediators (MMPs, T-cells) causes degradation of medial elastin and collagen, leading to infrarenal AAA.

A patient has a known popliteal artery aneurysm. Contralateral popliteal artery evaluation is recommended because:

Answer: Popliteal aneurysms are bilateral in approximately 50% of cases

Popliteal artery aneurysms are bilateral in roughly 50% of patients, making contralateral evaluation a standard part of the examination.

What is the significance of an 'endoleak type I' on post-EVAR duplex surveillance?

Answer: High-pressure leak at the proximal or distal graft attachment zone requiring urgent reintervention

Type I endoleaks represent inadequate seal at the proximal or distal graft fixation zones, resulting in direct high-pressure sac pressurization and requiring prompt reintervention.