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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
What two things may preclude a patient from aortic resection?
- Low FEV1 - Renal Failure
26
Predictors of post aortic surgery resp failure include?
Smoking and COPD
27
What should be preformed prior to surgery if someone has a history of stroke of TIA?
- Carotid ultrasound - Angiogram - Possible CEA if carotid stenosis
28
What is anterior spinal syndrome?
Lack of blood flow to anterior artery causing: Loss of motor function Diminished pain and temp sensation ANS dysfunction → hypotension and bowel/bladder dysfunction ## Footnote Most susceptible d/t lack of collateral flow
29
The anterior spinal artery perfuses the anterior ____ of the spinal cord
2/3
30
Causes of ASA syndrome?
- Aortic aneurysms and dissections - Atherosclerosis - Trauma
31
Most CVA's are ____ ?
Ischemic
32
____ is a prominent predictor of CVA?
Carotid disease
33
Pt's who have TIA's are at ____ risk of a subsequent stroke.
10x
34
Where does carotid stenosis commonly occur?
The carotid bifurcation
35
TPA should be given within how long of CVA onset?
4.5 h
36
Intravascular thrombectomy can be beneficial ____ after CVA onset?
8 hrs
37
When is surgical treatment indicated for carotid stenosis?
Lumen diameter < 1.5mm or >70% blockage
38
What CVA treatment carries a high risk of microembolization?
Carotid stenting
39
Anesthetic concerns for CEA?
- Be aware that positioning may compress contralateral artery flow - Use a cerebral oximetry device to help gauge and trend cerebral perfusion
40
Cerebral oxygenation is affected by?
- MAP - CO - SaO2 - Hb - PaCO2
41
Cerebral oxygen consumption is affected by?
- Temperature - Depth of anesthesia
42
How is PAD diagnosed?
ABI < 0.9 ABI = ankle SBP:brachial SBP
43
If someone has PAD, what should you assume?
They have systemic atherosclerosis (MI, CVA)
44
S/S of PAD?
- Intermittent claudication - Weak pulses - Hair loss - Coolness - Relief when hanging legs over bed (↑hydrostatic pressure)
45
What diagnostic tool can identify arterial stenosis?
Doppler US
46
What diagnostic tool can identify areas of plaque and calcification?
Duplex US
47
Common causes of acute peripheral artery occlusion?
* LA thrombus from a fib * LV thrombus d/t cardiomyopathy post MI
48
TX for acute peripheral artery occlusion?
- Anticoagulation - Surgical embolectomy - Amputation (last resort)
49
What is subclavian steal syndrome?
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
Symptoms of subclavian steal syndrome?
- Syncope - Vertigo - Hemiplegia - Ipsilateral arm ischemia (pain) - SBP decreased by ~20 mmHg in effected arm
51
Risk factors and treatments for subclavian steal syndrome?
Risk factors: Atherosclerosis, Takayasu Arteritis, hx of aortic surgery Treatment: SC endarterectomy
52
Symptoms of Raynaud's?
* Digital blanching or cyanosis with cold or SNS increase * Effects women more than men
53
Raynaud's treatments?
- Cold protection - CCB - ⍺-blockers - Surgical sympathectomy for severe ischemia
54
3 common PVD processes that occur during surgery?
- Superficial thrombophlebitis - DVT - Chronic venous insufficiency
55
What are the factors that predispose to venous thrombosis?
Virchow's Triad - Venous stasis - Disrupted endothelium - Hypercoagulability
56
Some risk factors for thromboembolism?
- Recent surgery - Pregnancy - Trauma - Varicose veins - Oral contraceptives - Cancer
57
What surgery results in 50% of patients having superficial thrombophlebitits or DVT?
Hip replacements Usually sublclinical and resolves on their own
58
Why are we so concerned with clotting during surgery?
Because patients older than 40 and having a surgery longer than 1 hour have a 10-40% risk of DVT without prophylaxis
59
LMWH advantages over unfractionated heparin?
- Longer 1/2 life - More predictable response - Less bleeding - Doesnt require serial labs
60
Disadvantages of LMWH?
- Higher cost - No reversal agent
61
Desirable INR for patients on warfarin?
2-3
62
Large artery vasculitis includes?
- Takayasu arteritis - Temporal (giant cell) arteritits
63
Medium artery vasculitis includes?
Kawasaki Disease
64
Medium to small artery vasculitis includes?
- Thromboangitis obliterans - Wegener granulomatosis - Polyarteritis nodosa
65
What is Temporal (giant cell) arteritis?
Inflammation of the arteries of the head and neck
66
Symptoms of Temporal (giant cell) arteritis?
- **Unilateral** headache - Scalp tenderness - Jaw claudication - Opthalmic branches may cause optic neuritis and unilateral blindness
67
Diagnosis and treatments for Temporal (giant cell) arteritis?
Dx: Biopsy of temporal artery Tx: corticosteroids for visual symptoms to prevent blindness
68
Another name for thromboangiitis obliterans?
Buerger Disease
69
What is thromboangiitis obliterans? What causes it?
- Inflammatory vasculitis leading to small and medium vessel occlusion in the extremities - Autoimmune response caused by nicotine (smoking)
70
Diagnostic critera for thromboangiitis obliterans?
- Smoker - Men < 50 - Infrapopliteal arterial occlusive dx - upper limb involvement - No additional artherosclerosis risk factors
71
Symptoms for thromboangiitis obliterans?
- LE claudication - Ischemia of hands and feet - Ulceration and skin necrosis - Raynauds
72
Treatment and anesthesia concerns for thromboangiitis obliterans?
Treatments: Smoking cessation, revascularization Anesthesia concerns: Meticulous padding, avoid cold, conservative line placement
73
What is polyarteritis nodosa?
- Vasculitis of the small and medium vessels - Leads to renal failure, MI, seizures, and peripheral neuropathy - Asssoc. with hepatitis or hairy cell leukemia
74
Treatment and anesthesia concerns for polyarteritis nodosa?
Treatment: steroids, cyclophosphamide Anesthesia concerns: consider coexisting renal and cardiac dx, may be HTN and need steroids | Renal dx is primary cause of death
75
Chronic Venous Disease effects ____ of the population?
50%
76
Diagnostic criteria for chronic venous insufficiency? Treatment?
- 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 (22 decks)

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