aortic branches

7/24/2019 Aortic Branches

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Surgery of Aortic

BranchesBy: Joao Luis Nunes


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Function and Histology

It supplies all of the systemiccirculation, which means that the entirebody, except for the respiratory zone ofthe lung

It is an elastic artery

!he thic"ness of the aorta re#uires an

extensi$e networ" of tiny blood $esselscalled $asa $asorum aortic arch

contains baroreceptors and chemoreceptors that relay information concerningB%,p&, p'() le$els to the medullaoblongata*


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Anatomy

+i$ided in sections:

scending aorta

ortic arch

+escending aorta:

!horacic aorta

bdominal aorta

'ommon iliac arteries - mediansacral artery*


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Anatomy

Branches from the aorta are:

.rom ascending aorta:

Left and /ight coronary arteries*

.rom aortic arch:

Brachiocephalic artery 0/ightcommon carotid artery - /ight subcla$ian artery1

Left common carotid artery Left subcla$ian artery*

.rom thoracic aorta:

Intercostal and 2ubcostal arteries

Left bronchial arteries

Branches to the esophagus, mediastinum,pericardium and diaphragm*


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Anatomy

.rom bdominal aorta:

Lumbar and 3usculophrenicarteries

/enal and 3iddle suprarenalarteries

4isceral arteries 0the celiactrun", the superior mesentericartery and the inferiormesenteric artery1*


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Diseases of Aorta

ortic dissection

typical aortic dissection:

Intramural haematoma

%enetrating atherosclerotic ulcer

ortic aneurysm

ortic atherosclerotic disease

'oarctation

ortic trauma5 transection*


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Aortic dissection

+escription: tear in intima layer allowsblood to lea" into the intima5mediaspace* Blood enlarges this spacecreating a 6true7 and a 6false7 lumen*

/is" factors: &ypertention, pregnancy,trauma, atheromatous pla#ues*

2ymptoms: %ain 0in almost all cases,se$ere1, syncope 0fainting1, Neurological0paraparesis and parestesia1, 3I 0$eryrarely1*

2igns: %ulse de8cits, aorticregurgitation, neurologicalmanifestations, altered conciousness*


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Aortic dissection

+iagnosis: '!, !995!!9 0transesophagealechochardiogram and transthoracic1, aortography,3/I*

'omplications: /upture, cardiac tamponade, aorticregurgitation

2urgical treatments:

(pen aortic surgery: with replacement of the damagedsection of aorta with a tube graft, if no damage to$al$e*

Bentall procedure /eplacement of the damagedsection of aorta and replacement of the aortic $al$e*

+a$id procedure /eplacement of the damagedsection of aorta and reimplantation of the aortic $al$e*

!94/ 0thoracic endo$ascular aortic repair1, a minimallyin$asi$e surgical procedure usually combined with on;

going medical management


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Atypical aortic dissection: Penetratingatherosclerotic ulcer

%enetrating atherosclerotic ulcer: lmost exclusi$elly located on descemay also be a percursor to a classical aortic dissection or to an aortic


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Aortic aneurysm

+e8nition: %athological dilation of normal aortic lumen, seen as a bulge in thartery* 3ore common in descending aorta then on ascending one*

/is" factors: =ea"ness of aortic wall 0elastic 8ber degeneration1, theroscler0ascending aorta1, infectious aortitis, hypertention, 3arfans syndrome, smo"

2ymptoms: 3ost cases are assymptomatic ect symptoms 0$ena ca$a syndrome, trachea

: abdominal pain, bac" pain, mass e>ect 0leg numbness, hoarse $oice from strleft recurrent laryngeal ner$e1*

3ain complitation: ortic rupture is a surgical emergency, and has a high moprompt treatment*


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Aortic aneurysm

2creening: !he most cost;e?cient screening test is an abdominal aorticultrasound study 0specially on smo"ing men o$er @A years of age1*

%re$ention: control blood pressure, cholesterol le$els, stop smo"ing*

2urgery: +ecisions about repairing an aortic aneurysm are based on thebalance between the ris" of aneurysm rupture without treatment $ersusthe ris"s of the treatment itself* If the bene8ts outbalance the ris"s andthe patient agrees***

(pen surgery: (pen surgery typically in$ol$es exposure of thedilated portion of the aorta and insertion of a synthetic0+acron or ore;!ex1 graft 0tube1*

9ndo$ascular: minimally in$asi$e alternati$e to open surgeryrepair* It in$ol$es placement of an endo;$ascular stent throughsmall incisions at the top of each leg into the aorta*

A ti


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Aorticatheroscleroticdisease

!ypes: atheroma, protruding atheroma, complexpla#ue 0Cmm or more thic" and5or with amobile component1*

!hey are detected by !99 and are recognizedas an important cause of stro"e and peripheralembolic disease*

/is" factors: 2mo"ing, &igh cholesterol, &ighblood pressure, +iabetes, bdominal obesity,2tress, 9xcess alcohol inta"e,Not exercising regularly*

%re$ention


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Coarctation of aorta (CoA)

+e8nition: congenital narrowing of upperdescending thoracic aorta adDacent to the site ofattachment of ductus arteriosus* 3ore commonin boys*

2igns and symptoms: 2ymptoms may be absentwith mild narrowings 0coarctation1* +i?culty

breathing, poor appetite, failure to thri$e* Lateron, children may de$elop symptoms related toproblems with blood Eow and an enlarged heart*

!reatment: conser$ati$e if asymptomatic*2urgical resection of the narrow segment if thereis arterial hypertension*


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Aortic trauma transection

+e8nition: transection refers to the rupture ofaorta due to trauma*

3echanism: !he inDury is usually caused by highspeed impacts such as those that occur in $ehiclecollisions and serious falls*

Location: most common site for tearing intraumatic aortic rupture is the proximal

descending aorta 0ligamentum arteriosum ma"esthe site prone to shearing forces during suddendeceleration1*

+iagnosis: '! angiogram* 'F/ 0when the patientis unstable1*

!reatment with surgery


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!&9 9N+

aortic branches

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