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NA 3 > Cuuebm > Flashcards

Cuuebm Flashcards

1
Q

What is the aorta?

A

The 1st and largest artery in the body that transports nutrient-rich blood to systemic circulation after LV ejection

Extends from the aortic valve to the proximal iliac bifurcation at L4.

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2
Q

What are the three segments of the aorta?

A
  • Ascending aorta
  • Descending aorta
    • Thoracic aorta
    • Abdominal aorta

Segments are based on the aorta’s course and location.

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3
Q

Where does the ascending aorta begin and end?

A

Begins at the aortic valve and ends at the beginning of the aortic arch, around the level of the sternal angle

This is between the 2nd and 3rd rib.

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4
Q

What are the features of the ascending aorta?

A
  • Gives rise to coronary arteries
  • Supplies blood to the heart

This occurs at the top of the left ventricle.

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5
Q

What are the beginning and ending points of the aortic arch?

A

Begins at the end of the ascending aorta and ends just after the origin of the three main arteries at the level of the T4 vertebra

These arteries are the brachiocephalic trunk, left common carotid artery, and left subclavian artery.

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6
Q

What is the function of the descending thoracic aorta?

A

Supplies blood to the chest wall, lungs, and esophagus

It begins just after the aortic arch at the T4 vertebra.

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7
Q

What are the beginning and ending points of the abdominal aorta?

A

Begins at the aortic hiatus in the diaphragm (around T12) and ends at the L4 vertebra, where it bifurcates into the common iliac arteries

Supplies blood to the abdominal and pelvic organs, as well as the lower limbs.

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8
Q

What are the five major branches of the abdominal aorta?

A
  • Celiac trunk
  • Superior mesenteric artery
  • Left renal artery
  • Right renal artery
  • Inferior mesenteric artery

These branches supply various abdominal organs.

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9
Q

What is the artery of Adamkiewicz?

A

A critical blood vessel that supplies most of the oxygenated blood to the spinal cord

Typically originates between T8 and T12 vertebrae.

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10
Q

What is the primary blood supply function of the artery of Adamkiewicz?

A

Provides crucial blood flow to the anterior spinal artery, which supplies the anterior two-thirds of the spinal cord

This region is responsible for motor function and sensation.

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11
Q

What is atherosclerosis?

A

A condition where plaque builds up on the walls of arteries, causing narrowing and stiffness

It leads to reduced blood flow and can result in Peripheral Vascular Disease (PVD).

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12
Q

What are the steps in plaque formation in atherosclerosis?

A
  • Endothelial injury and dysfunction
  • Lipid accumulation and oxidation
  • Recruitment of inflammatory cells
  • Formation of foam cells
  • Smooth muscle cell migration and proliferation
  • Extracellular matrix production
  • Plaque formation
  • Plaque rupture and thrombosis

Each step contributes to the progression of atherosclerosis.

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13
Q

What are the common risk factors for developing atherosclerotic lesions?

A
  • Advanced age
  • Smoking
  • Hypertension
  • Diabetes mellitus
  • Insulin resistance
  • Obesity
  • Family history/genetic predisposition
  • Physical inactivity
  • Gender (M > F)
  • Hyper/hypomocysteinemia
  • Elevated C-reactive protein
  • Hyperglyceridemia, hyperlipidemia
  • Renal disease

These factors increase the likelihood of atherosclerosis and associated vascular diseases.

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14
Q

What is the role of statins in atherosclerosis treatment?

A
  • Lower cholesterol levels
  • Stabilize plaques
  • Improve endothelial function
  • Reduce vascular inflammation
  • Have cardioprotective properties

Common statins include Crestor, Lipitor, and Zocor.

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15
Q

What is the significance of beta-blockers in vascular surgery?

A

Used for patients with PVD at high risk for myocardial ischemia and infarction

They help with myocardial oxygen supply and demand.

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16
Q

What is the purpose of carotid endarterectomy?

A

To prevent further events in patients with symptomatic carotid artery stenosis or significant asymptomatic stenosis

Usually performed within two weeks of a TIA or minor stroke.

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17
Q

What are the types of vascular surgical procedures?

A
  • Stenting
  • Atherectomy
  • Bypass surgery
  • Endarterectomy
  • Thrombolysis or thrombectomy
  • Open aneurysm repair
  • Endovascular aneurysm repair (EVAR)
  • Vein procedures

These procedures address various vascular issues, including blockages and aneurysms.

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18
Q

What is the relationship between peripheral vascular disease (PVD) and coronary artery disease (CAD)?

A

There is a clear association between PVD and the development of CAD and aortic aneurysms

Cardiac pathology must be managed appropriately during surgery.

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19
Q

What are common complications of vascular surgery related to renal function?

A

Acute kidney injury (AKI) is a common complication with high morbidity and mortality

Incidence ranges from 16-22%.

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20
Q

What is the primary blood supply function of the artery of Adamkiewicz?

A

Supplies the anterior spinal artery, affecting motor function and sensation

Damage to this artery can lead to severe motor deficits or paralysis.

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21
Q

What is the importance of managing diabetes in vascular surgery?

A

Diabetes increases the risk of myocardial infarction and wound infection

Tight control of blood glucose is critical for preventing complications.

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22
Q

What should be done regarding aspirin (ASA) preoperatively?

A

Do not give preoperatively due to increased risk of bleeding; restart 2-8 days after surgery

Research indicates preoperative ASA does not alter the risk of perioperative cardiovascular events.

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23
Q

What is Carotid Endarterectomy (CEA)?

A

A surgical procedure to remove plaque from the carotid arteries to prevent stroke and TIA.

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24
Q

What percentage of carotid artery stenosis typically warrants CEA after a TIA or mild stroke?

A

70-99% stenosis.

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25
Q

In which cases might CEA be considered for patients with 50-69% stenosis?

A

If there are high stroke risk factors.

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26
Q

When is CEA usually recommended after a TIA or minor stroke?

A

Within two weeks.

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27
Q

What are the indications for CEA in asymptomatic patients?

A

Considered for 60-99% stenosis, especially in those under 75 years old and in good health.

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28
Q

What are common signs and symptoms of carotid disease?

A
  • Amaurosis fugax
  • Paresthesia
  • Clumsiness of extremities
  • Speech problems
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29
Q

What is the primary noninvasive diagnostic tool for carotid artery stenosis?

A

Carotid duplex ultrasonography.

30
Q

What is the sensitivity and specificity of duplex ultrasound for detecting stenosis greater than 60%?

A

Approximately 94%.

31
Q

What is an angiogram?

A

An imaging test that uses X-rays to visualize the carotid arteries after injecting a contrast dye.

32
Q

Where do the carotid arteries originate?

A
  • Right common carotid artery (RCCA): from the brachiocephalic artery
  • Left common carotid artery (LCCA): from the arch of the aorta.
33
Q

What are the two main branches of the common carotid arteries?

A
  • Internal carotid artery (ICA)
  • External carotid artery (ECA)
34
Q

What is the role of the carotid body?

A

Sensitive to blood gas changes and alerts the brain to adjust respiratory rate.

35
Q

What do carotid sinus baroreceptors respond to?

A

Changes in the stretch of the blood vessel to maintain blood pressure.

36
Q

What is cerebral autoregulation?

A

The brain’s intrinsic ability to maintain stable blood flow across a range of blood pressures.

37
Q

What is the formula for cerebral perfusion pressure (CPP)?

A

CPP = MAP - ICP.

38
Q

What happens to the autoregulatory curve in chronic hypertension?

A

It shifts to the right, requiring higher MAP.

39
Q

How can impaired autoregulation affect patients?

A

Reduces the range and effectiveness of blood flow regulation, increasing vulnerability to ischemia.

40
Q

What is a key goal in the anesthetic management of CEA?

A

Protection of heart and brain from ischemic injury.

41
Q

What is the ideal blood pressure range during CEA?

A

10% above baseline during cross-clamping.

42
Q

What is the purpose of measuring stump pressure during CEA?

A

To assess collateral flow and determine the need for a shunt.

43
Q

What are the criteria for shunt placement during CEA?

A

Stump pressure < 40-50 mm Hg indicates hypoperfusion.

44
Q

What is hyperperfusion syndrome?

A

A rare complication after CEA characterized by increased blood flow leading to symptoms like severe headache and confusion.

45
Q

What are common risk factors for aortic aneurysms?

A
  • Age (over 65)
  • Gender (more common in men)
  • Family history
  • Smoking
  • High blood pressure
  • Atherosclerosis
  • Genetic disorders
  • Infections or inflammation.
46
Q

What is the typical symptom presentation of an aortic aneurysm?

A

75% are asymptomatic; may include abdominal, chest, or back pain.

47
Q

What is the risk of rupture associated with an abdominal aortic aneurysm (AAA)?

A

Increases significantly when the aneurysm is >4.5-5 cm in diameter.

48
Q

What does the Law of Laplace state in relation to aneurysms?

A

The tension in the wall of a vessel is proportional to the diameter of the vessel.

49
Q

What does AAA stand for?

A

Abdominal Aortic Aneurysm

AAA represents dilatation of the abdominal aorta below the level of the renal arteries

50
Q

What is the risk of rupture in AAA directly related to?

A

The luminal diameter of the aneurysm

Risk increases once the aneurysm is >4.5-5 cm in diameter

51
Q

What does the Law of Laplace state regarding AAA?

A

The stress in the AAA wall is proportional to its diameter

52
Q

What are the common monitoring modalities used in open aortic surgery?

A
  • 5 Lead ECG (II, V)
  • 2 large bore PIV (RIJ)
  • A-line (dominant arm)
  • Central Access/SG
  • ACT
  • TEE or PVV
  • Fluid Warmers
  • Cell Saver + hemocue
  • NGT
53
Q

What should be avoided during induction to prevent aneurysm rupture?

A

Hypertension

Use esmolol for gentle induction

54
Q

What induction agents are typically used for open AAA surgery?

A
  • Etomidate
  • Propofol
55
Q

What is the preferred induction agent if the patient has a high risk of hemodynamic instability?

A

Etomidate

56
Q

Fill in the blank: Both hypotension and hypertension should be ______ during open AAA surgery.

A

prevented

57
Q

What is the main complication associated with aortic cross-clamping?

A

Spinal Cord Injury (SCI)

58
Q

What is the role of the Artery of Adamkiewicz?

A

Provides major blood supply to the anterior thoracolumbar spinal cord

59
Q

What is a common symptom of Type A aortic dissection?

A

Anterior chest pain with a ripping or tearing sensation

60
Q

What diagnostic tests are used for aortic dissection?

A
  • ECG
  • Chest X-ray
  • CT/MRI
  • Angiography
  • TEE
  • Labs
61
Q

True or False: Aortic dissection is more common in females.

A

False

More common in males

62
Q

What is an endovascular stent graft primarily used to treat?

A
  • Abdominal Aortic Aneurysms (AAAs)
  • Thoracic Aortic Aneurysms (TAAs)
63
Q

What complication is associated with endovascular stenting?

A

Endoleak

64
Q

What are the three clinical indications for lower extremity revascularization?

A
  • Claudication
  • Ischemic rest pain or ulceration
  • Gangrene
65
Q

What is a benefit of using regional anesthesia in lower extremity revascularization?

A
  • Reduces blood loss
  • Reduces DVT rates
  • Improves pain control
66
Q

What happens to blood pressure upon unclamping of the aortic cross-clamp?

A

It may drop suddenly

67
Q

What is the typical volume of estimated blood loss (EBL) during open AAA surgery?

A

600-2000 ml

68
Q

What should be monitored every 30 minutes during open AAA surgery?

A

Urine output

69
Q

What is the purpose of administering mannitol prior to aortic clamping?

A

Renal protection

70
Q

Fill in the blank: Aortic dissection occurs when blood penetrates the ______.

A

aortic intima

71
Q

What is a common complication during the unclamping of the aortic cross-clamp?

A

De-clamping shock

72
Q

What is the effect of aortic cross-clamping on blood pressure below the clamp?

A

Hypotension

NA 3 (5 decks)

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