Arterial Surgeries Flashcards
?
A test to prove collateral circulation; involves the radial and ulnar arteries
> Test will show a hidden occlusion in the ulnar artery
Allen’s Test
PAD
- A patient who has intermittent claudication at rest can progress to occlusion and pain can be felt at rest
- Once an artery is occluded and the collateral circulation does not compensate for this occlusion, tissue injury or death can occur
?
Is indicated with incapacitating intermittent claudication, pain of extremity with rest or severe ulceration, and gangrene that threatens the viability of the limb
- Procedure consists of inserting a catheter with an internal balloon into the femoral artery
Percutaneous Transluminal Angioplasty (PTA)
- Once in the artery, the catheter is placed in the area of stenosis and balloon is inflated
- Ballon cracks the shell of the intimal atherosclerotic plaque; stretches media of the vessel wall
- Procedure is most successful on lesions that are <10 cm in length
- High rate of restenosis; up to 50% in 1 year
- Stents at the time of angioplasty decrease the rate of restenosis and arterial dissection
- Paclitaxel-coated stents studied for decreasing the risk of new tissue growth. Antiplatelet agents are used to reduce the risk of platelet aggregation at the site
- For plaques that don’t respond to PTA, there are laser-assisted angioplasties which emit heat and vaporize the plaque or an atherectomy is similar to a PTA with a rotational device known as a rotablator that scrapes the plaque from the vessel surface
Complications of PTA
- Bleeding or hematoma @ insertion site
- Retroperitoneal bleeding (if there’s an arterial tear)
- Arterial thrombus or embolus
- Pseudoaneurysm or A/V fistula
- Acute renal failure (may be r/t contrast dye aeb decreased urine output and increased BUN and creatinine)
- Patients are on bedrest & lying flat for a few hrs
- Retroperitoneal bleed - drop in BP w/tachycardia, drop in H/H and back or flank pain
- CMS checks of extremity & compare to nonsurgical site; pulse check & 6 P’s
- A pseudoaneurysm in a vessel that’s been through trauma like a PTA exhibits as a pulsatile mass at the insertion site (hear a bruit over that site)
- Monitor urine output, bun/creat, & provide adequate hydration
- Anticipate a renal protectant, like acetylcysteine (Mucomyst), & may be given pre & post-procedure
?
Is the opening of the artery and physically removing the obstructing plaque
- A patch can be used to widen the lumen of the artery postop to prevent graft failure; anticoagulants & antiplatelet aggregates like aspirin, dextran, Lovenox (enoxaparin), heparin, Coumadin, & clopidogrel
Endarterectomy
- Is commonly performed in the carotid arteries
- You’ll hear a bruit as the blood rushes past the plaque
- To bypass the blood flow, vessels may be clamped & there may be shunting of the blood flow. Stent also used to keep the vessel open
- Bleeding at site & hematoma; collection could put pressure on airway in trachea secondary to infection
! Thrombus occurring at the site or an embolus which would cause a stroke (monitor for FAST)
What is FAST?
F = facial symmetry (smile, tongue)
A = Arms (no drift)
S = Speech
T = Timely
- CN can be impaired from surgery or swelling (affect swallowing, hoarseness, gag reflex, facial palsy, asymmetry, ability to turn head w/sternocleidomastoid muscles, ability to shrug shoulders)
- Another risk factor is intracranial bleeding r/t HTN
- Increased intracranial pressure d/t plaque removal & nothing slowing down blood flow
- Hypotension can lead to under-perfusion of the brain
Grafting
- Allows blood flow around or bypass the stenosis or occlusion
- Saphenous vein harvested & treated w/heparinized solution until it’s re-anastomosed is a common graft
?
Is a possible complication of surgical procedures like grafting
If the area in the fascia swells, capillary perfusion to the tissues becomes impaired; low inflow of oxygen causes ischemia. Waste products cannot be cleared from the tissues which causes a buildup
> Combined waste buildup and low oxygen causes aching pain and increased edema in the compartment; necrosis will occur if action is not taken
Compartment Syndrome
- Peripheral arterial pulses may be felt and cause a false sense of security. The particular compartment that is edematous may not involve arteries associated with pulses in the foot
Key is out of proportion pain in relation to surgery
- Fasciotomy is done to release rising pressures in the compartment
Postoperative Nursing Diagnosis
- Pain r/t surgical site
- Potential pain r/t compartment syndrome and potential for fasciotomy
- Potential for alteration in tissue perfusion r/t graft occlusion, embolus, hypotension, etc.
- Potential for decreased cardiac output - s/s of hypovolemia (potentially from bleeding)
- Potential for infection - from the actual surgical site
> Surgery - monitor for pneumonia, UTI, cellulitis
Amputation - Types/Levels
- AK = above the knee
- BK = below the knee
- Foot-ankle, hip disarticulation
- Upper extremity, digits
- Depend on trauma and level of disease
- Above knee (transfemoral)
- Through knee (knee disarticulation - Gritti-Stokes)
- Below knee (transtibial)
- Ankle (ankle disarticulation - Symes)
- Forefoot (transmetatarsal)
- Prevent contractures at hip and knee (if BKA)
- Could have surgery to release contractures
Pain
- Incision pain
- Muscle spasm
- Chronic stump pain
- Neuroma formation
- Phantom limb sensation/pain
- Wrapping above and below the knee (sterile procedure)
- Partial or full weightbearing (see MD orders)
Diagnoses
- Acute pain r/t trauma, muscle spasms, incision pain
- Risk for disturbed sensory perception r/t nerve trauma
- Impaired skin integrity r/t healing of surgical wound
- Impaired physical mobility r/t loss of limb
- Self-care deficit r/t loss of limb
- Risk of dysfunctional grieving r/t loss
Types
> Saccular
Fusiform
Ruptured
Dissection
> Blood separates layers of arterial wall & starts to fill in the space
- To treat AAA - endograft/endovascular graft
- Suture-less, going through groin
- Migration of graft affecting urinary output, emboli formation
- Can go in through groin or open patient up to place graft
- Emergency surgery indicated for ascending thoracic aneurysms
- Put on coronary bypass & graft is sutured to native aortic wall
