Aorto-occlusive disease Flashcards
Is characterized by atherosclerotic changes within the aorta (usually abdominal) that extend into the iliac and femoral arteries and result in hypoperfusion of vital organs and the lower extremities.
Aorto-occlusive disease
Seventy percent of aortic aneurysms are
infrarenal, and 30% include what arteries.
Renal
Operative or endovascular repair aneurismal disease should be undertaken when the aneurysm is ___ cm or larger.
6
National mortality from elective open abdominal aneurysm repair is
5
For repair of an acutely ruptured aneurysm, perioperative mortality remains high, about ___%.
50
What is the major cause of perioperative mortality and morbidity in aneurismal disease?
Coronary artery disease
The primary cause of postoperative
renal failure is?
Preexisting kidney disease
Study:
There is redistribution of renal blood flow to the cortex and a decrease in glomerular filtration. These changes persist to some degree even after cross-clamp removal. The potential for a clinically profound decrease in anterior spinal artery blood flow is more likely in thoracic aortic
repair, making spinal cord ischemia a risk.
Study:
Hypotension and a decrease in systemic vascular resistance are noted after unclamping. Ischemic metabolites, lactic acid, and potassium returning to the central circulation depress contractility and potentiate the hypotension.
Many clinicians believe that this
diuretic benefits the kidneys by increasing cortical blood flow and reducing endothelial edema and vascular congestion.
Mannitol
This drug is an antihypertensive agent that dilates renal and splanchnic vessels. This increase in renal blood flow may be advantageous, but more prospective studies are required.
Fenoldopam
a selective dopamine type 1 receptor agonist
Epidural anesthesia may suppress sympathetic tone and the stress response while providing excellent analgesia postoperatively. It is considered safe practice to use these techniques as long as there is a least how long from epidural placement to heparinization of the patient?
1 hour
Is a relatively new technique using stents passed through an artery (usually femoral) and guided to the aorta via fluoroscopy.
Endovascular repair of the aorta
During acute intraabdominal aortic rupture resuscitation by means of preparing how many units of blood is necessary?
10
A systolic blood pressure of __ to __ mm Hg is an ideal goal, although communication about hemodynamic goals should involve the surgeons.
80 to 100
The most common cause of perioperative mortality is?
Cardiac disease
