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Sp: Coexisting I > 10. Vascular Disease > Flashcards

10. Vascular Disease Flashcards

1
Q

innermost layer of artery

A

endothelium

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2
Q

atherosclerosis

A

response to vessel wall injury

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3
Q

atherosclerosis results in

A

endothelia dysfunction

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4
Q

indication of vascular disease

A

claudication

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5
Q

aneurysm

A

abnormal weakening of vessel wall

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6
Q

dissection

A

tear in intima allows blood into extra luminal channel

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7
Q

does an aneurysm or dissection have false lumen?

A

dissection

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8
Q

risk factors for thoracic aortic disease

A

HTN
geriatric
atherosclerosis
genetic predisposition
smoking

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9
Q

genetic predisposition for thoracic aortic disease

A

connective tissue disorders
bicuspid aortic valve

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10
Q

primary causes of thoracic aortic disease

A

genetic
- connective tissue
- bicuspid aortic valve

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11
Q

stanford A

A

ascending involved

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12
Q

Stanford B

A

ascending not involved

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13
Q

abdominal aortic disease primary causes

A

lifestyle causing atherosclerosis

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14
Q

goal ACT for vascular cases

A

200-300s

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15
Q

heparin initial dose for vascular cases

A

100U/kg

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16
Q

indications for surgery in thoracic aortic aneurysm

A

symptomatic
>5cm diameter
growth >10mm/year

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17
Q

ascending and aortic arch dissection requires

A

urgent surgery

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18
Q

descending thoracic aortic dissection indications for surgery

A

diameter >5.5cm
rarely urgent

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19
Q

Type A repairs

A

bypass
deep hypothermia
circ arrest

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20
Q

thoracic aorta surgery risk

A

spinal cord ischemia risk increased for paraplegia with cross clamp > 30 mins

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21
Q

what side should you put the radial art line into for thoracic repair?

A

Right - shows perfusion to brain

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22
Q

thoracic aneurysm BP

A

above clamp: MAP 100 mmHg
below clamp: MAP > 50 mmHg

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23
Q

clevidipine

A

CCB

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24
Q

clevidipine dose

A

2mg/hr

(MAX: 32mg/hr)

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25
Q

3 ways to preserve neuro function during thoracic aneureysm repsir

A
  1. SSEP/EEG monitoring
  2. spinal cooling w/iced epidural
  3. CSF drain
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26
Q

induction drugs for thoracic aneurysm

A

minimize HTN
- versed
- propo
- narcotic (sufentanil)

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27
Q

most common congenital heart anomaly

A

bicuspid aortic valve

28
Q

ID ruptured AAA

A

hypotension
back pain
pulsatile abdominal mass

29
Q

DDx for ruptured AAA

A

renal colic
diverticulitis
gi hemorrhage

30
Q

treatment for ruptured AAA

A

open
endovascular

31
Q

what aneurysm can be treated with endovascular repair

A

descending thoracic aneurysm

32
Q

risks of endovascula repair of thoracic aneurysm

A

1. migrate/occlude carotid
- incr stroke risk
2. distal ischeia
3. strong HD forces
4. difficult arterial access

33
Q

risk of open AAA repair

A

incr M+M
high risk of complications

34
Q

risk of endovascular AAA repair

A

decr M+M
no cross clamp (decr stroke risk)
no hypoperfusion risk
endoleaks
stent migration
ischemia

35
Q

most common cause of reintervention during endovascular repair of AAA

A

stent migration

36
Q

carotid endartectomies managment

A

ID pressure range w/surgeon
vagal response likely
venous blood 20% baselione

37
Q

when can you extubate a carotid endarctectomy

A

once awake enough to follow commands

38
Q

injuries during carotid endarctectomy

A

laryngeal nerve injury
carotid body injury

39
Q

HTN treatment during carotid endartectomy

A

clevidipine
nipride
NTG
hydralazine
labetalol

40
Q

virchow’s triad

A

venous stasis
hypercoagulability
disruption of vascular endothelium

41
Q

most important complication of DVT

A

Pulmonary embolism

42
Q

DVT prevention

A

SCDs
lovenox
regional (early ambulation)

43
Q

DVT treatment

A

anticoag

44
Q

recurrent PE treatment

A

IVC filter

45
Q

DVT prevention in pts who are CI to anticoags

A

IVC filter

46
Q

primary causes of peripheral vascular disease

A

smoking
old age
family history
diabetes
HTN
obestity

47
Q

collateral importance

A

without collateral flow you get stroke
ensures cerebral perfusion

48
Q

coronary subclavian steal

A

proximal stenosis of Left Subclavian produces reversal of blood flow through LIMA

diverts blood from heart to arm

49
Q

subclavian steal

A

proximal stenosis reverses flow through ipsilateral vertebral artery

diverts blood from brain to arm*

50
Q

during subclavian steal, what do you expect the BP to be in the affected arm

A

lower

51
Q

raynauds

A

poor peripheral perfusion

52
Q

raynaud’s managment

A

keep warm
avoid art line
avoid adding epi in regional local anesthetic

53
Q

temporal arteritis risks

A

HIGH fire risk

54
Q

AAA rupture into

A

L retroperitoneum

55
Q

brains blood supply amoutn

A

20% of CO

56
Q

brain is supplied by

A

internal carotid arteries
vertebral arteries

57
Q

what connects in the circle of willis

A

internal carotids
basilar artery

58
Q

vertebral arteries join at

A

basilar artery

59
Q

A

A

external carotid

60
Q

B

A

internal carotid

61
Q

C

A

hypoglossal nerve

62
Q

D

A

vagus nerve

63
Q

E

A

common carotid

64
Q

if an internal carotid is clamped, perfusion relies on

A

collateral flow though circle of willis

65
Q

in order for collateral flow through circle of willis to occur

A

pressure must be high enough for retrograde flow to the contralateral anterior and middle cerebral arteries

66
Q

open aortic repair risk

A

blood loss
cardiac dysfunction
pulm dysfunction
renal dysfunction

Sp: Coexisting I (11 decks)

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