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Surgery EOR (billie) > Acute arterial occlusion, aortic aneurysm, aortic dissection > Flashcards

Acute arterial occlusion, aortic aneurysm, aortic dissection Flashcards

1
Q

What are the essentials of diagnosis for acute arterial occlusion

A
  1. Sudden pain in limb + absent limb pulses
  2. Some degree of neurologic dysfunction with numbness, weakness, or complete paralysis
  3. Loss of light touch sensation requires revascularization within 3 hours to save limb
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2
Q

what is the presentation of acute arterial occlusion

A
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3
Q

what are the diagnostics used to diagnose acute arterial occlusion

A

most often clinical diagnosis, doppler used for pulse identification

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4
Q

what is the treatment for acute arterial occlusion

A
  • IV heparin 1st
  • then endovascular surgery for revascularization
  • identify source (embolus = warfarin, PAD = statins, ASA, ACE)
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5
Q

what is the timing for revascularization in acute arterial occlusion

A
  • should be accomplished w/in 3 hours
  • irreversible tissue damage approaches 100% at 6 hours.
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6
Q

what are the essentials of diagnosis for abdominal aortic aneurysms

A
  1. Most AAAs are asymptomatic until rupture
  2. 80% measuring 5 cm are palpable; threshold for treatment is 5.5 cm
  3. Back or abdominal pain with aneurysmal tenderness may precede rupture
  4. Rupture is catastrophic: excruciating abdominal pain that radiates to the back; hypotension
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7
Q

when is abdominal aortic dilation considered an aneurysm

A

when dilation is >3cm

rare to rupture under 5cm

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8
Q

where do 90% of AAA develop

A

below the renal arteries

usually involves aortic bifurcation and common iliac arteries

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9
Q

what are risk factors for AAA

A
  • male gender
  • smoking
  • family hx
  • old age
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10
Q

what are the two major classification groups for AAA

A
  • fusiform: circumferential expansion
  • saccula: outpouching of a segment of the aorta
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11
Q

what is hte presentation of AAA

A
  • could be asymptomatic
  • mild-severe mid abdominal pain radiating to back
  • exacerbation by palpation
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12
Q

what is the presentation of abdominal aortic aneurysm rupture

A
  • severe pain
  • palpable abdominal mass
  • hypotension
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13
Q

what is the diagnostic study of choice for AAA

A

abdominal US

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14
Q

what are the screening reccomendations for AAA

A

1 time screening for men 65-75 who have smoked

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15
Q

If an aneurysm is found, what is the screening reccomendation after

A
  • 3.0 - 3.4 cm : every 2 years
  • 3.5 - 4.4 cm: every 12 months
  • 4.5 - 5.4 cm: every 6 months and vascular surgery referral
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16
Q

what indicates elective vascular repair for AAA

A
  • > 5.5 cm
  • > 0.5cm growth within 6 months
  • severe symtpoms
17
Q

what is the leading cause of death in patients who undergo AAA repair

A

MI

18
Q

what are the essentials of diagnosis of a thoracic aortic aneurysm

A
  • Widened mediastinum on chest radiograph
  • With rupture, sudden onset chest pain radiating to the back
19
Q

what are possible causes of thoracic aneurysm

A
  • atherosclerosis (MC)
  • connective tissue disorders (marfans/EDS)
  • bicuspid aortic valve disease
20
Q

what is the presentation of a thoracic aortic aneurysm

A
  • substernal back/neck pain
  • Pressure on the trachea, esophagus, or superior vena cava can result in dyspnea, stridor, or brassy cough; dysphagia; and edema in the neck and arms as well as distended neck veins
  • hoarsness (larygneal nerve pressure)
  • aotic regurgitation murmur
21
Q

how do you diagnose a thoracic aortic aneurysm

A
  • CXR initially = widened mediastinum
  • CT scan w contrast = modality of choice to show size and anatomy
22
Q

what is the management for a thoracic aneurysm

A
  • referall to CT surgeon regardless of size
  • control risk factors
  • control BP
23
Q

what are the indications for surgical repair of a thoracic aortic aneurysm

A

> 5.5cm

24
Q

what are the essentials of diagnosis of aortic dissection

A
  • Sudden searing chest pain radiating to the back, abdomen, or neck in a hypertensive patient
  • Widened mediastinum on CXR
  • Pulse discrepancy in extremities
  • Acute aortic regurg may develop
25
Q

type A vs type B aortic dissection

A
  • A = involves arch PROXIMAL to left subclavian artery
  • B = DISTAL to left subclavian artery
26
Q

what is the presntation of aortic dissection

A
  • sudden severe chest pain radiating to back
  • usually hypertensive
  • aortic regurg murmur
27
Q

what are the diagnostic modalities for aortic dissection

A
  • EKG - LVH
  • CXR widened mediastinum
  • CT chest/abdomen w contrast = diagnostic modality of choice
28
Q

what is the management for aortic dissection

A
  • Lower systolic BP to 100-120 w labetalol or esmolol
  • if its not lowering add on nicardipine or nitroprusside
  • Morphine for pain
29
Q

which aortic dissections require surgery

A
  • all type A dissections
  • type B dissections with sins of malperfusion

Surgery EOR (billie) (24 decks)

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