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Exam 4 - Vascular Diseases Flashcards

1
Q

What are more likely to be affected by aneurysms and dissections?
Occlusions?

A

Aortas and its branches = aneurysms and dissections
Peripheral arteries = occlusions

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2
Q

What defines an aortic aneurysm?

A

Dilation of all 3 layers of the artery, causing >50% increase in diameter

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3
Q

When is surgery indicated for an aortic aneurysm?

A

> 5.5 cm in diameter, > 10 mm/yr, family history of dissection

test question

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4
Q

Aortic aneurysm rupture is associated with ____ mortality rate?

A

75%

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5
Q

What are the two types of aneurysm and their definitions?

A

Saccular: outpouching bulging to one side
Fusiform: uniform circumfrential dilation

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6
Q

What causes pain from an aortic aneurysm?

A

Compression of surrounding structures

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7
Q

What is the fastest/safest way to diagnonse an aortic aneurysm?

A

Doppler echocardiogram

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8
Q

Treatments for aortic aneurysms?

A
  • Manage BP and cholesterol
  • Smoking cessation
  • Avoid strenous exercise, stimulants, and stress
  • Surgery
  • Endovascular stent repair
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9
Q

What is a aortic dissection?

A

Tear of intimal layer of vessel causing blood to pool in the medial layer

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10
Q

What dissection requires emergent surgical intervention?

A

Ascending dissection

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11
Q

Symptoms of a dissection?

A

Severe pain in the posterior chest or back

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12
Q

What can used to diagnose a dissection if the patient is unstable?

A

Echocardiogram

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13
Q

What are the classifications for aortic dissections?

A

Stanford A: Ascending aorta or entire aorta
Stanford B: Descending
Debakey I: Entire aorta
Debakey II: Ascending
Debakey III: Descending

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14
Q

Which dissection classification usually needs emergent surgery?

A

Stanford A, DeBakey I and II
Ascending Aorta involvement

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15
Q

What does aortic arch dissection repair involve?

A
  • Cardiopulmonary Bypass
  • Profound Hypothermia
  • Circulatory arrest
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16
Q

What can most patients tolerate for circulatory arrest during hypothermia?

A

Body temp of 15-18℃ for 30-40 mins

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17
Q

Major complication associated with aortic arch replacement?

A

Neurologic deficits

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18
Q

When is surgery indicated for type B dissection?

A

Signs of impending rupture: persistant pain, hypotension, left-sided hematoma, or compromised perfusion of LE

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19
Q

Risk factors for aortic dissections?

A
  • HTN
  • Atherosclerosis
  • Cocaine use
  • Marfans
  • Ehlers Danlos
  • Bicuspid aortic valve
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20
Q

Dissections are more common in:

A

Men and pregnant women in 3rd trimester

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21
Q

Triad of symptoms for aneurysm rupture?

A
  • Hypotension
  • Back pain
  • Pulsatile abdominal mass
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22
Q

Where do most aneurysms rupture?

A

Left retroperitoneum

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23
Q

What are the anesthetic concerns if retroperitoneal tamponade occurs?

A
  • Delay resusitaction until rupture surgically controlled
  • Maintain lower BP to reduce risk of exsanguination
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24
Q

What are the 4 primary causes of death from aortic surgeries?

A
  • MI
  • Resp failure
  • Renal failure
  • Stroke
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25
Q

What two things may preclude a patient from aortic resection?

A
  • Low FEV1
  • Renal Failure
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26
Q

Predictors of post aortic surgery resp failure include?

A

Smoking and COPD

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27
Q

What should be preformed prior to surgery if someone has a history of stroke of TIA?

A
  • Carotid ultrasound
  • Angiogram
  • Possible CEA if carotid stenosis
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28
Q

What is anterior spinal syndrome?

A

Lack of blood flow to anterior artery causing:
Loss of motor function
Diminished pain and temp sensation
ANS dysfunction → hypotension and bowel/bladder dysfunction

Most susceptible d/t lack of collateral flow

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29
Q

The anterior spinal artery perfuses the anterior ____ of the spinal cord

A

2/3

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30
Q

Causes of ASA syndrome?

A
  • Aortic aneurysms and dissections
  • Atherosclerosis
  • Trauma
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31
Q

Most CVA’s are ____ ?

32
Q

____ is a prominent predictor of CVA?

A

Carotid disease

33
Q

Pt’s who have TIA’s are at ____ risk of a subsequent stroke.

34
Q

Where does carotid stenosis commonly occur?

A

The carotid bifurcation

35
Q

TPA should be given within how long of CVA onset?

36
Q

Intravascular thrombectomy can be beneficial ____ after CVA onset?

37
Q

When is surgical treatment indicated for carotid stenosis?

A

Lumen diameter < 1.5mm or >70% blockage

38
Q

What CVA treatment carries a high risk of microembolization?

A

Carotid stenting

39
Q

Anesthetic concerns for CEA?

A
  • Be aware that positioning may compress contralateral artery flow
  • Use a cerebral oximetry device to help gauge and trend cerebral perfusion
40
Q

Cerebral oxygenation is affected by?

A
  • MAP
  • CO
  • SaO2
  • Hb
  • PaCO2
41
Q

Cerebral oxygen consumption is affected by?

A
  • Temperature
  • Depth of anesthesia
42
Q

How is PAD diagnosed?

A

ABI < 0.9
ABI = ankle SBP:brachial SBP

43
Q

If someone has PAD, what should you assume?

A

They have systemic atherosclerosis (MI, CVA)

44
Q

S/S of PAD?

A
  • Intermittent claudication
  • Weak pulses
  • Hair loss
  • Coolness
  • Relief when hanging legs over bed (↑hydrostatic pressure)
45
Q

What diagnostic tool can identify arterial stenosis?

A

Doppler US

46
Q

What diagnostic tool can identify areas of plaque and calcification?

47
Q

Common causes of acute peripheral artery occlusion?

A
  • LA thrombus from a fib
  • LV thrombus d/t cardiomyopathy post MI
48
Q

TX for acute peripheral artery occlusion?

A
  • Anticoagulation
  • Surgical embolectomy
  • Amputation (last resort)
49
Q

What is subclavian steal syndrome?

A

Stenosis/occlusion of the prevertebral subclavian artery causes a lower pressure past the stenosis and reverse flow in the ipsilateral vertebral artery, decreasing brain stem perfusion

50
Q

Symptoms of subclavian steal syndrome?

A
  • Syncope
  • Vertigo
  • Hemiplegia
  • Ipsilateral arm ischemia (pain)
  • SBP decreased by ~20 mmHg in effected arm
51
Q

Risk factors and treatments for subclavian steal syndrome?

A

Risk factors: Atherosclerosis, Takayasu Arteritis, hx of aortic surgery
Treatment: SC endarterectomy

52
Q

Symptoms of Raynaud’s?

A
  • Digital blanching or cyanosis with cold or SNS increase
  • Effects women more than men
53
Q

Raynaud’s treatments?

A
  • Cold protection
  • CCB
  • ⍺-blockers
  • Surgical sympathectomy for severe ischemia
54
Q

3 common PVD processes that occur during surgery?

A
  • Superficial thrombophlebitis
  • DVT
  • Chronic venous insufficiency
55
Q

What are the factors that predispose to venous thrombosis?

A

Virchow’s Triad
- Venous stasis
- Disrupted endothelium
- Hypercoagulability

56
Q

Some risk factors for thromboembolism?

A
  • Recent surgery
  • Pregnancy
  • Trauma
  • Varicose veins
  • Oral contraceptives
  • Cancer
57
Q

What surgery results in 50% of patients having superficial thrombophlebitits or DVT?

A

Hip replacements
Usually sublclinical and resolves on their own

58
Q

Why are we so concerned with clotting during surgery?

A

Because patients older than 40 and having a surgery longer than 1 hour have a 10-40% risk of DVT without prophylaxis

59
Q

LMWH advantages over unfractionated heparin?

A
  • Longer 1/2 life
  • More predictable response
  • Less bleeding
  • Doesnt require serial labs
60
Q

Disadvantages of LMWH?

A
  • Higher cost
  • No reversal agent
61
Q

Desirable INR for patients on warfarin?

62
Q

Large artery vasculitis includes?

A
  • Takayasu arteritis
  • Temporal (giant cell) arteritits
63
Q

Medium artery vasculitis includes?

A

Kawasaki Disease

64
Q

Medium to small artery vasculitis includes?

A
  • Thromboangitis obliterans
  • Wegener granulomatosis
  • Polyarteritis nodosa
65
Q

What is Temporal (giant cell) arteritis?

A

Inflammation of the arteries of the head and neck

66
Q

Symptoms of Temporal (giant cell) arteritis?

A
  • Unilateral headache
  • Scalp tenderness
  • Jaw claudication
  • Opthalmic branches may cause optic neuritis and unilateral blindness
67
Q

Diagnosis and treatments for Temporal (giant cell) arteritis?

A

Dx: Biopsy of temporal artery
Tx: corticosteroids for visual symptoms to prevent blindness

68
Q

Another name for thromboangiitis obliterans?

A

Buerger Disease

69
Q

What is thromboangiitis obliterans?
What causes it?

A
  • Inflammatory vasculitis leading to small and medium vessel occlusion in the extremities
  • Autoimmune response caused by nicotine (smoking)
70
Q

Diagnostic critera for thromboangiitis obliterans?

A
  • Smoker
  • Men < 50
  • Infrapopliteal arterial occlusive dx
  • upper limb involvement
  • No additional artherosclerosis risk factors
71
Q

Symptoms for thromboangiitis obliterans?

A
  • LE claudication
  • Ischemia of hands and feet
  • Ulceration and skin necrosis
  • Raynauds
72
Q

Treatment and anesthesia concerns for thromboangiitis obliterans?

A

Treatments: Smoking cessation, revascularization
Anesthesia concerns: Meticulous padding, avoid cold, conservative line placement

73
Q

What is polyarteritis nodosa?

A
  • Vasculitis of the small and medium vessels
  • Leads to renal failure, MI, seizures, and peripheral neuropathy
74
Q

Treatment and anesthesia concerns for polyarteritis nodosa?

A

Treatment: steroids, cyclophosphamide
Anesthesia concerns: consider coexisting renal and cardiac dx, may be HTN and need steroids

75
Q

CVD effects ____ of the population?

76
Q

Diagnostic criteria for chronic venous insufficiency?
Treatment?

A
  • Confirmed by ultrasound showing venous reflux
  • Retrograde flow > 0.5 seconds
  • Tx: Conservative at first (weight loss, wound management), diuretics, aspirin, prostacyclin analouges.
  • If management fails may need ablation, ligation, or phlebectomy.

Assessment (17 decks)

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