Abdominal Aortic Reconstruction

Question 1

Greatest risk in abdominal aortic reconstruction surgery

Answer 1

Post operative myocardial infarction

Question 2

6 Major Clinical Risk Factors

Answer 2

high-risk surgery
ischemic heart disease
high creatinine (>2.0)
hx TIA, CVA
Type 1 Diabetes
hx CHF

Question 3

Evaluating Risk Tests

Answer 3

Exercise EKG
Dipyridamole-Thallium Stress Test
Dobutamine Stress Echo

Question 4

3 Factors of Surgical Cardiac Assessment

Answer 4

Clinical Predictor, Functional Capacity, Surgical Risk

Question 5

High Risk Surgery

Answer 5

Emergent surgery; aortic and major vascular surg; periph vascular; prolonged surgery with large fluid shifts/blood loss

Question 6

Intermediate Risk Surgery

Answer 6

Carotid endart; head/neck; intraperitoneal/intrathoracic; orthopedic; prostate

Question 7

Low Risk Surgery

Answer 7

Endoscopic procedures, superficial procedure, cataract, breast, ambulatory surgery

Question 8

Breaking point for METs

Answer 8

4

Question 9

3 Risk Assessment Methods Used to Determine is Surgery Will Happen

Answer 9

METs, Number of risk factors, Risk of surgery

Question 10

CABG indicated

Answer 10

Stable angina and L main stenosis
Stable angina and 3-vessel CAD
Stable angina and 2-vessel CAD with LAD stenosis and EF< 0.5 or positive stress test
Unstable angina or acute MI

Question 11

Drug Eluting Stents (DES)

Answer 11

Metal is infused with drug that prevents the growth of tissue around the stent

Question 12

Stent risks

Answer 12

Platelets can be activated and cause thrombosis - patients must be on anti-platelet drugs
DES is at risk for this for longer than BMS

Question 13

Aortic aneurism size - surgery

Answer 13

> 5-6 cm

Question 14

What happens when you cross-clamp the aorta?

Answer 14

Increased after load
Increase preload
Increased contractility of the heart

Question 15

Increased after load causes release of

Answer 15

catecholamines and vasoconstrictors so that blood flows elsewhere

Question 16

What causes increased preload in cross clamping?

Answer 16

Distal to the clamp the vessels collapse and push the blood to the heart

Question 17

Clamp above the renal

Answer 17

Kidneys don’t get bloodflow

Question 18

Clamp above the celiac

Answer 18

Liver doesn’t get bloodflow
Increased blood in other areas
Significant hemodynamic changes

Question 19

Must monitor urine output during all clamping because

Answer 19

Decreased blood flow to the kidneys concerns you about kidney damage

Question 20

Unclamping

Answer 20

Vascular bed distal to the clamp is empty and dilated
Unclamping leads to hypotension
Fluid overload before unclamping, treat with vasoconstrictor

Question 21

Endostent Graft

Answer 21

To repair aortic aneurisms less invasively with less hemodynamic changes

Question 22

Risk of high (thoracic) aortic surgery is paraplegia because

Answer 22

The anterior spinal artery gets significantly reduced blood flow and the increased ICP further decreases blood flow in the spinal cord

Question 23

Spinal Drain

Answer 23

Used to help relieve the issues of decreased blood flow in the spinal cord

Question 24

Carotid Endarterectomy

Answer 24

Removes plaques of the carotid to reduce the risk of stroke

Question 25

Carotid sinus

Answer 25

Baroreceptor

Question 26

Carotid body

Answer 26

Chemoreceptor

Question 27

Carotid bruit

Answer 27

Sound heard when auscultating carotid indicating carotid artery stenosis

Question 28

Benefits of regional anesthesia for carotid endarterectomy

Answer 28

Cerebral monitoring

Question 29

Cerebral Oxygen Saturation

Answer 29

Concerned when 20% decrease

Question 30

Carotid Stenting

Answer 30

Filter, dilation, stent placement, dilation, removal of filter
Stretching of carotid sinus can cause hypotension, bradycardia, hyperperfusion

Question 31

Hyperperfusion syndrome

Answer 31

The blood going to the brain has been severely restricted by the stenosis
Vessels are dilated and are unable to auto regulate
Stenosis removed- vessels become overperfused
Craneal edema