10. Vascular Disease Flashcards
innermost layer of artery
endothelium
atherosclerosis
response to vessel wall injury
atherosclerosis results in
endothelia dysfunction
indication of vascular disease
claudication
aneurysm
abnormal weakening of vessel wall
dissection
tear in intima allows blood into extra luminal channel
does an aneurysm or dissection have false lumen?
dissection
risk factors for thoracic aortic disease
HTN
geriatric
atherosclerosis
genetic predisposition
smoking
genetic predisposition for thoracic aortic disease
connective tissue disorders
bicuspid aortic valve
primary causes of thoracic aortic disease
genetic
- connective tissue
- bicuspid aortic valve
stanford A
ascending involved
Stanford B
ascending not involved
abdominal aortic disease primary causes
lifestyle causing atherosclerosis
goal ACT for vascular cases
200-300s
heparin initial dose for vascular cases
100U/kg
indications for surgery in thoracic aortic aneurysm
symptomatic
>5cm diameter
growth >10mm/year
ascending and aortic arch dissection requires
urgent surgery
descending thoracic aortic dissection indications for surgery
diameter >5.5cm
rarely urgent
Type A repairs
bypass
deep hypothermia
circ arrest
thoracic aorta surgery risk
spinal cord ischemia risk increased for paraplegia with cross clamp > 30 mins
what side should you put the radial art line into for thoracic repair?
Right - shows perfusion to brain
thoracic aneurysm BP
above clamp: MAP 100 mmHg
below clamp: MAP > 50 mmHg
clevidipine
CCB
clevidipine dose
2mg/hr
(MAX: 32mg/hr)
3 ways to preserve neuro function during thoracic aneureysm repsir
- SSEP/EEG monitoring
- spinal cooling w/iced epidural
- CSF drain
induction drugs for thoracic aneurysm
minimize HTN
- versed
- propo
- narcotic (sufentanil)
most common congenital heart anomaly
bicuspid aortic valve
ID ruptured AAA
hypotension
back pain
pulsatile abdominal mass
DDx for ruptured AAA
renal colic
diverticulitis
gi hemorrhage
treatment for ruptured AAA
open
endovascular
what aneurysm can be treated with endovascular repair
descending thoracic aneurysm
risks of endovascula repair of thoracic aneurysm
1. migrate/occlude carotid
- incr stroke risk
2. distal ischeia
3. strong HD forces
4. difficult arterial access
risk of open AAA repair
incr M+M
high risk of complications
risk of endovascular AAA repair
decr M+M
no cross clamp (decr stroke risk)
no hypoperfusion risk
endoleaks
stent migration
ischemia
most common cause of reintervention during endovascular repair of AAA
stent migration
carotid endartectomies managment
ID pressure range w/surgeon
vagal response likely
venous blood 20% baselione
when can you extubate a carotid endarctectomy
once awake enough to follow commands
injuries during carotid endarctectomy
laryngeal nerve injury
carotid body injury
HTN treatment during carotid endartectomy
clevidipine
nipride
NTG
hydralazine
labetalol
virchow’s triad
venous stasis
hypercoagulability
disruption of vascular endothelium
most important complication of DVT
Pulmonary embolism
DVT prevention
SCDs
lovenox
regional (early ambulation)
DVT treatment
anticoag
recurrent PE treatment
IVC filter
DVT prevention in pts who are CI to anticoags
IVC filter
primary causes of peripheral vascular disease
smoking
old age
family history
diabetes
HTN
obestity
collateral importance
without collateral flow you get stroke
ensures cerebral perfusion
coronary subclavian steal
proximal stenosis of Left Subclavian produces reversal of blood flow through LIMA
diverts blood from heart to arm
subclavian steal
proximal stenosis reverses flow through ipsilateral vertebral artery
diverts blood from brain to arm*
during subclavian steal, what do you expect the BP to be in the affected arm
lower
raynauds
poor peripheral perfusion
raynaud’s managment
keep warm
avoid art line
avoid adding epi in regional local anesthetic
temporal arteritis risks
HIGH fire risk
AAA rupture into
L retroperitoneum
brains blood supply amoutn
20% of CO
brain is supplied by
internal carotid arteries
vertebral arteries
what connects in the circle of willis
internal carotids
basilar artery
vertebral arteries join at
basilar artery
A
external carotid
B
internal carotid
C
hypoglossal nerve
D
vagus nerve
E
common carotid
if an internal carotid is clamped, perfusion relies on
collateral flow though circle of willis
in order for collateral flow through circle of willis to occur
pressure must be high enough for retrograde flow to the contralateral anterior and middle cerebral arteries
open aortic repair risk
blood loss
cardiac dysfunction
pulm dysfunction
renal dysfunction
