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Assessment '24 - Mordecai > T3 - Vascular Disease Assessment > Flashcards

T3 - Vascular Disease Assessment Flashcards

1
Q

What is an aortic aneurysm?

A

An aortic aneurysm is a bulge in a section of the aorta caused by an underlying weakness in the aortic wall.

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2
Q

How are aortic dissections classified according to the DeBakey and Stanford systems?

A

The DeBakey system classifies aortic dissections into
- Type I (tear in the ascending aorta that propagates to the arch),
- Type II (tear confined to the ascending aorta), and
- Type III (tear in the descending aorta).

The Stanford system classifies them as
- Type A (tear in the ascending aorta) and
- Type B (tear in the descending aorta).

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3
Q

What is the treatment approach for ascending arch dissections?

A

Ascending arch dissections typically require emergent surgery.

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4
Q

How are descending arch dissections typically treated?

A

Descending arch dissections are rarely treated with urgent surgery.

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5
Q

What is the initial treatment for uncomplicated type B aortic dissections?

A

Uncomplicated type B dissections are often admitted for Blood pressure control, with short-acting beta-blockers being preferred, along with arterial line monitoring.

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6
Q

What symptoms indicate an impending rupture of an aortic dissection, and what is the treatment?

A

Symptoms of impending rupture include posterior pain, hypotension, and hemothorax, which indicate the need for surgical treatment.

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7
Q

What are the risk factors for aortic aneurysms and dissections?

A

Risk factors include hypertension (HTN), atherosclerosis, age, being male, smoking, and family history.

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8
Q

Which inherited disorders are associated with aortic aneurysms and dissections?

A

Inherited disorders associated with these conditions include Marfan’s syndrome, Ehlers-Danlos syndrome, bicuspid aortic valve, and non-syndrome familial history.

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9
Q

What are some causes of aortic dissection?

A

Causes of dissection include blunt trauma, cocaine use, and iatrogenic causes (caused by medical treatment).

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10
Q

What iatrogenic causes are related to aortic dissections?

A

Iatrogenic causes are related to cardiac catheterization, aortic manipulation, cross-clamping, and arterial incision.

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11
Q

Who is more commonly affected by aortic dissections?

A

Aortic dissection is more common in men and pregnant women in their third trimester.

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12
Q

What are the three main arterial pathologies in vascular disease?

A

The three main arterial pathologies are aneurysms, dissections, and occlusions.

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13
Q

Which vessels are more likely to be affected by aneurysms and dissections?

A

The aorta and its branches are more likely to be affected by aneurysms and dissections.

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14
Q

Which arteries are more likely to be affected by occlusions?

A

Peripheral arteries are more likely to be affected by occlusions.

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15
Q

What is the definition of an aortic aneurysm?

A

An aortic aneurysm is defined as the dilation of all three layers of an artery, with a greater than 50% increase in diameter

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16
Q

What symptoms might be present with an aortic aneurysm?

A

Symptoms of an aortic aneurysm may be due to compression of surrounding structures.

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17
Q

How are aortic aneurysms initially treated?

A

Aortic aneurysms are initially treated medically.

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18
Q

When is surgery indicated for an aortic aneurysm?

A

Surgery is indicated for an aortic aneurysm when its diameter exceeds 5.5 cm.

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19
Q

What is the mortality rate associated with a ruptured aortic aneurysm?

A

The mortality rate for a ruptured aortic aneurysm is approximately 75%.

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20
Q

Types of aneurysm image:

A
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21
Q

What are the two types of aortic aneurysms?

A

The two types of aortic aneurysms are fusiform and saccular.

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22
Q

What characterizes a fusiform aneurysm?

A

A fusiform aneurysm is a uniform dilation along the entire circumference of the arterial wall.

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23
Q

What is a saccular aneurysm?

A

A saccular aneurysm is a berry-shaped bulge to one side of the artery.

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24
Q

What are the symptoms of an aortic aneurysm?

A

Symptoms can be asymptomatic or include pain due to the compression of surrounding structures.

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25
Q

How are aortic aneurysms diagnosed?

A

Aortic aneurysms are diagnosed using CT, MRI, chest X-ray (CXR), angiogram, and echocardiogram.

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26
Q

What is the fastest and safest measure for obtaining a diagnosis of suspected aortic dissection?

A

In suspected aortic dissection, a Doppler echocardiogram is the fastest and safest measure for obtaining a diagnosis.

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27
Q

What is an aortic dissection?

A

An aortic dissection is a tear in the intimal layer of the artery, allowing blood to enter the medial layer.

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28
Q

What is the protocol for an ascending aortic dissection?

A

An ascending aortic dissection is catastrophic and requires emergent surgical intervention.

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29
Q

How are ascending aortic dissections classified?

A

Ascending aortic dissections are classified as Stanford A and DeBakey types 1 and 2.

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30
Q

How does mortality rate change over time with an aortic dissection?

A

The mortality rate increases by 1-2% per hour.

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31
Q

What is the overall mortality rate for aortic dissection?

A

The overall mortality rate for aortic dissection is 27-58%.

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32
Q

What are the symptoms of an aortic dissection?

A

Symptoms include severe, sharp pain in the posterior chest or back.

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33
Q

How is aortic dissection diagnosed in stable and unstable patients?

A

In stable patients, diagnosis can be made with CT, chest X-ray (CXR), MRI, or angiography. In unstable patients, echocardiography is used.

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34
Q

What are common risk factors for aortic aneurysms and dissections?

A

Risk factors include hypertension, atherosclerosis, age, male gender, smoking, and family history.

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35
Q

Which inherited disorders are associated with an increased risk of aortic aneurysms and dissections?

A

Marfan syndrome, Ehlers-Danlos syndrome, bicuspid aortic valve, and non-syndrome familial history are inherited disorders that increase the risk.

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36
Q

What are some causes of aortic dissection?

A

Causes include blunt trauma, cocaine use, and iatrogenic factors resulting from medical treatment.

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37
Q

What iatrogenic factors are related to aortic dissections?

A

Cardiac catheterization, aortic manipulation, cross-clamping, and arterial incision are iatrogenic factors related to dissections.

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38
Q

Who is more likely to experience an aortic dissection?

A

Aortic dissection is more common in men and in pregnant women during the third trimester.

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39
Q

What are the four primary causes of mortality related to surgeries of the thoracic aorta?

A

The four primary causes are myocardial infarction (MI), respiratory failure, renal failure, and stroke.

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40
Q

What should be assessed for in the preoperative evaluation for thoracic aorta surgery?

A

Assess for the presence of coronary artery disease, valve dysfunction, and heart failure.

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41
Q

What may be required before surgery in patients with ischemic heart disease?

A

Patients with ischemic heart disease may require cardiac intervention prior to surgery.

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42
Q

What are some cardiac evaluation tests used in the preoperative phase?

A

Cardiac evaluation tests can include stress testing, echocardiography, and radionuclide imaging.

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43
Q

Why might a patient be precluded from an abdominal aortic aneurysm (AAA) resection?

A

A severe reduction in forced expiratory volume in 1 second (FEV1) or renal failure may preclude a patient from AAA resection.

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44
Q

What are predictors of post-aortic surgery respiratory failure?

A

Smoking and chronic obstructive pulmonary disease (COPD) are predictors of respiratory failure after aortic surgery.

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45
Q

What tests can help define respiratory risk in the preoperative phase for thoracic aorta surgery?

A

PFT’s and ABGs

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46
Q

What preoperative interventions might be considered for patients at risk of respiratory complications?

A

Consider preoperative bronchodilators, antibiotics, and chest physiotherapy for patients at risk of respiratory complications.

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47
Q

What is the most important indicator of post-aortic surgery renal failure?

A

Preoperative renal dysfunction is the most important indicator of post-aortic surgery renal failure.

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48
Q

What are key preoperative management steps to mitigate renal failure risk in aortic surgery?

A

Key steps include ensuring preoperative hydration, avoiding hypovolemia, hypotension, low cardiac output, and nephrotoxic drugs.

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49
Q

What vascular evaluation should be done for a patient with a history of stroke or transient ischemic attack (TIA)?

A

For a patient with a history of stroke or TIA, a carotid ultrasound and an angiogram of brachiocephalic and intracranial arteries should be performed.

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50
Q

What should be considered if severe carotid stenosis is identified before elective aortic surgery?

A

If severe carotid stenosis is identified, consideration should be given to carotid endarterectomy (CEA) before elective surgery.

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51
Q

What are the inherited risk factors for cerebral vascular accidents?

A

Inherited risk factors include age, prior history of stroke, family history of stroke, black race, male gender, and sickle cell disease.

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52
Q

What are modifiable risk factors for cerebral vascular accidents?

A

Modifiable risk factors include elevated blood pressure, smoking, diabetes, carotid artery disease, atrial fibrillation, heart failure, hypercholesterolemia, and obesity or physical inactivity.

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53
Q

What is a cerebral vascular accident (CVA)?

A

A CVA, also known as a stroke, can be ischemic (87% of cases) or hemorrhagic (13%) and is characterized by sudden-onset neurological deficits.

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54
Q

How significant a predictor of CVA is carotid disease?

A

Carotid disease is a prominent predictor of cerebral vascular accidents.

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55
Q

Where does CVA rank in leading causes of disability and death in the U.S.?

A

CVA is the first leading cause of disability and the third leading cause of death in the U.S.

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56
Q

What is a transient ischemic attack (TIA)?

A

A TIA is a subset of ischemic strokes that are self-limited, with symptoms resolving within 24 hours.

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57
Q

What is the risk of subsequent stroke after a TIA?

A

TIAs carry a risk that is 10 times greater for a subsequent stroke.

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58
Q

What can angiography diagnose in carotid disease?

A

Angiography can diagnose vascular occlusion.

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59
Q

What can CT and MRI reveal in carotid disease?

A

CT and MRI are less invasive tests that may also identify aneurysms and arteriovenous malformations (AVMs).

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60
Q

How is transcranial Doppler ultrasound useful in carotid disease?

A

Transcranial Doppler ultrasound may give indirect evidence of vascular occlusions with real-time bedside monitoring.

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61
Q

What can carotid auscultation detect?

A

Carotid auscultation can identify bruits, which are sounds indicative of turbulent blood flow due to narrowing or blockage.

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62
Q

What information does carotid ultrasound provide?

A

Carotid ultrasound can quantify the degree of carotid stenosis.

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63
Q

Where does carotid stenosis commonly occur and why?

A

Carotid stenosis commonly occurs at the internal/external carotid bifurcation due to turbulent blood flow at the branch-point.

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64
Q

What should the workup for carotid disease include?

A

The workup should include evaluation for sources of emboli such as atrial fibrillation, heart failure, valvular vegetation, or paradoxical emboli in the setting of a patent foramen ovale (PFO).

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65
Q

What does the American Heart Association recommend for the treatment of CVA?

A

The American Heart Association recommends tissue plasminogen activator (TPA) within 4.5 hours.

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66
Q

What interventional radiology techniques are used in the treatment of CVA?

A

Techniques include intra-arterial thrombolysis and intravascular thrombectomy.

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67
Q

How long after the onset of CVA can intravascular thrombectomy be beneficial?

A

Benefits of intravascular thrombectomy have been seen up to 8 hours after the onset of CVA.

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68
Q

What is a Carotid Endarterectomy (CEA)?

A

CEA is a surgical treatment for severe carotid stenosis, typically for blockages of 70-99%.

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69
Q

What is an alternative treatment to Carotid Endarterectomy?

A

Carotid stenting is an alternative to CEA.

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70
Q

What is a major risk associated with carotid stenting?

A

The major risk associated with carotid stenting is microembolization leading to CVA.

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71
Q

What devices have been developed to mitigate the risk of microembolization during carotid stenting?

A

Embolic protection devices have been developed to mitigate the risk; however, the CVA risk remains unchanged so far.

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72
Q

What constitutes ongoing medical therapy after a CVA?

A

Ongoing medical therapy includes:

  • Antiplatelet treatment
  • Smoking cessation
  • Blood pressure control
  • Cholesterol control
  • Maintaining a healthy diet and physical activity.
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73
Q

What is a crucial part of the preoperative evaluation for Carotid Endarterectomy?

A

A neurological evaluation to establish preoperative deficits is crucial, which may include post-CVA weakness, aphasia, etc.

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74
Q

Why is cardiovascular disease assessment important in CEA preparation?

A

Coronary artery disease (CAD) is prevalent in carotid disease, and myocardial infarction is a major cause of perioperative morbidity and mortality in CEA.

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75
Q

How common is hypertension in patients undergoing CEA and why is its management important?

A

Hypertension is common, and it’s important to establish an acceptable blood pressure range to optimize cerebral perfusion pressure (CPP) during surgery.

76
Q

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

A

CPP equals mean arterial pressure (MAP) minus intracranial pressure (ICP).

77
Q

Why is it important to maintain collateral blood flow through stenotic vessels during CEA?

A

It is essential to maintain collateral blood flow, especially during cross-clamping, to prevent cerebral ischemia.

78
Q

What should be avoided during CEA to prevent compromising blood flow?

A

Extreme head rotation, flexion, or extension should be avoided as it may compress contralateral artery flow.

79
Q

How can cerebral oximetry devices be useful during CEA?

A

Cerebral oximetry devices like Foresight and INVOS are useful in determining cerebral perfusion.

80
Q

What is the clinical dilemma when a patient has severe carotid disease and severe coronary artery disease?

A

The dilemma is to stage cardiac revascularization and CEA appropriately, prioritizing the most compromised area.

81
Q

What factors affect cerebral oxygenation as monitored by cerebral oximetry?

A

Cerebral oxygenation is affected by:
What is a frequent cause of acute artery occlusion?
- Mean arterial pressure (MAP)
- Cardiac output (COP)
- Oxygen saturation (SaO2)
- Hemoglobin (HGB)
- Partial pressure of carbon dioxide (PaCO2).

82
Q

What is a frequent cause of acute artery occlusion?

A

Acute artery occlusion is frequently due to cardiogenic embolism.

83
Q

What are common causes of cardiogenic embolism leading to artery occlusion?

A

Common causes include a left atrial (LA) thrombus arising from atrial fibrillation and a left ventricular (LV) thrombus from dilated cardiomyopathy post-myocardial infarction.

84
Q

What are some less common thrombus causes for acute artery occlusion?

A

Less common thrombus causes include valvular heart disease, endocarditis, and a patent foramen ovale (PFO).

85
Q

What are noncardiac causes of acute artery occlusion?

A

Noncardiac causes include atheroemboli, plaque rupture, hypercoagulability, and trauma.

86
Q

What are the symptoms of acute artery occlusion?

A

Symptoms include limb ischemia, pain or paresthesia, weakness, decreased peripheral pulses, cool skin, and color changes distal to the occlusion.

87
Q

: How is acute artery occlusion diagnosed?

A

Acute artery occlusion is diagnosed with arteriography.

88
Q

What are the treatments for acute artery occlusion?

A

Treatments include surgical embolectomy, anticoagulation, and amputation as a last resort.

89
Q

How is peripheral artery disease defined in terms of the ankle-brachial index (ABI)?

A

Peripheral artery disease is defined by an ankle-brachial index (ABI) of less than 0.9.

90
Q

What is peripheral artery disease and what does it result in?

A

Peripheral artery disease is a condition that results in compromised blood flow to the extremities.

91
Q

What is the ankle-brachial index (ABI)?

A

The ABI is the ratio of the systolic blood pressure (SBP) at the ankle to the SBP at the brachial artery.

92
Q

What is the typical cause of chronic hypo-perfusion in PAD?

A

Chronic hypo-perfusion in PAD is typically due to atherosclerosis, but may also be caused by vasculitis.

93
Q

What typically causes acute occlusions in PAD?

A

Acute occlusions in PAD are typically due to embolism.

94
Q

How does the incidence of PAD change with age?

A

How does the incidence of PAD change with age?

95
Q

Why is atherosclerosis considered a systemic issue for patients with PAD?

A

Atherosclerosis is systemic, and patients with PAD have a 3-5 times higher risk of myocardial infarction (MI) and cerebral vascular accidents (CVA).

96
Q

What are the risk factors for peripheral artery disease (PAD)?

A

Risk factors include
- Advanced age
- Family history
- Smoking
- Diabetes mellitus (DM)
- hypertension (HTN)
- Obesity
- High cholesterol levels

97
Q

What are common signs and symptoms of peripheral artery disease?

A

Signs and symptoms include

  • Intermittent claudication,
  • Resting extremity pain,
  • Decreased pulses,
  • Subcutaneous atrophy,
  • Hair loss, coolness, and
  • Cyanosis.
98
Q

How can relief from peripheral artery disease symptoms be achieved?

A

Relief from symptoms can be achieved by hanging the lower extremities over the side of the bed, which increases hydrostatic pressure.

99
Q

What is Doppler ultrasound used for in PAD?

A

Doppler ultrasound with pulse volume waveform identifies arterial stenosis in PAD.

100
Q

How does duplex ultrasound help in PAD?

A

Duplex ultrasound can identify areas of plaque formation and calcification in PAD.

101
Q

What does transcutaneous oximetry assess in PAD?

A

Transcutaneous oximetry can assess the severity of tissue ischemia in PAD.

102
Q

When is MRI with contrast angiography used in PAD?

A

MRI with contrast angiography is used to guide endovascular intervention or surgical bypass in PAD.

103
Q

What constitutes the medical treatment for PAD?

A

Medical treatment for PAD includes exercise, blood pressure control, cholesterol control, and glucose control.

104
Q

When is medical intervention such as revascularization indicated in PAD?

A

Revascularization is indicated in PAD with disabling claudication or ischemia.

105
Q

What surgical options are available for PAD?

A

Surgical options for PAD include arterial bypass procedures.

106
Q

What diagnostic test identifies arterial stenosis in PAD and how?

A

Doppler ultrasound identifies arterial stenosis through pulse volume waveforms.

107
Q

What endovascular repairs are used in PAD?

A

Endovascular repairs in PAD include transluminal angioplasty and stent placement.

108
Q

How does duplex ultrasound contribute to the diagnosis of PAD?

A

Duplex ultrasound can identify areas of plaque formation and calcification.

109
Q

What is the purpose of transcutaneous oximetry in PAD?

A

What is the purpose of transcutaneous oximetry in PAD?

110
Q

When is MRI with contrast angiography used in PAD?

A

MRI with contrast angiography is used to guide endovascular intervention or surgical bypass.

111
Q

What constitutes medical treatment for PAD?

A

Medical treatment includes exercise, blood pressure control, cholesterol control, and glucose control.

112
Q

What surgical options are available for PAD?

A

Surgical reconstruction options include arterial bypass procedures.

113
Q

What endovascular repairs are possible for PAD?

A

Endovascular repairs include transluminal angioplasty and stent placement.

114
Q

What is Subclavian Steal Syndrome?

A

Subclavian Steal Syndrome occurs when the subclavian artery is occluded proximal to the vertebral artery, causing blood flow in the vertebral artery to be diverted away from the brainstem.

115
Q

What are the symptoms of Subclavian Steal Syndrome?

A

Symptoms include syncope, vertigo, ataxia, hemiplegia, and ipsilateral arm ischemia.

116
Q

How is blood pressure affected in the arm by Subclavian Steal Syndrome?

A

The affected arm’s systolic blood pressure may be approximately 20mmHg lower.

117
Q

What clinical sign might be present over the subclavian artery in Subclavian Steal Syndrome?

A

A bruit may be heard over the subclavian artery.

118
Q

How is Subclavian Steal Syndrome treated?

A

Subclavian artery endarterectomy is curative for Subclavian Steal Syndrome.

119
Q

Subclavian steal video:

A

https://www.youtube.com/watch?v=XCEzAqsGdxI

120
Q

What is Raynaud’s phenomenon?

A

Raynaud’s phenomenon is episodic vasospastic ischemia of the digits, affecting more women than men.

121
Q

What are the primary causes of Raynaud’s phenomenon?

A

The primary causes are idiopathic, meaning they occur spontaneously without a known cause.

122
Q

What are some secondary causes of Raynaud’s phenomenon?

A

Secondary causes include:

  • Connective tissue diseases like systemic sclerosis,
  • Mixed connective tissue disease (MCTD),
  • Systemic lupus erythematosus (SLE),
  • Drugs and toxic agents,
  • Endocrine diseases,
  • Trauma or lesions of the great vessels,
  • Arterial diseases,
  • Hematologic disorders, and neoplasias.
123
Q

How may Raynaud’s phenomenon appear in patients with CREST syndrome?

A

Raynaud’s phenomenon may appear with CREST syndrome, a subtype of scleroderma.

124
Q

What are the symptoms of Raynaud’s phenomenon?

A

Symptoms include digital blanching or cyanosis with cold exposure or sympathetic nervous system activation.

125
Q

How is Raynaud’s phenomenon diagnosed?

A

Diagnosis is based on history and physical examination.

126
Q

Diagnosis is based on history and physical examination.

A

Treatments include protection from cold, calcium channel blockers (CCBs), alpha-blockers, and surgical sympathectomy for severe ischemia.

127
Q

What are common peripheral venous disease (PVD) processes that may occur during surgery?

A

Common PVD processes include superficial thrombophlebitis, deep vein thrombosis (DVT), and chronic venous insufficiency.

128
Q

Why is deep vein thrombosis (DVT) a major concern in the perioperative setting?

A

DVT is a major concern because it can lead to pulmonary embolism (PE), which is a leading cause of perioperative morbidity and mortality.

129
Q

What is Virchow’s Triad?

A

Virchow’s Triad refers to the three major factors that predispose to venous thrombosis: venous stasis, hypercoagulability, and disrupted vascular endothelium.

130
Q

What conditions can lead to venous stasis, which is a part of Virchow’s Triad?

A

Conditions that can lead to venous stasis include recent surgery, trauma, lack of ambulation, pregnancy, low cardiac output from congestive heart failure or myocardial infarction, stroke, and varicose veins.

131
Q

What factors can contribute to a hypercoagulable state, increasing the risk of venous thrombosis?

A

Factors contributing to a hypercoagulable state include
- Drug-induced irritation,
- Estrogen therapy
- Surgery
- Cancer
- Deficiencies of endogenous anticoagulants like antithrombin III
- Protein C
- Protein S
- Stress response associated with surgery
- Inflammatory bowel disease
- History of previous thromboembolism
- Morbid obesity
- Advanced age

132
Q

How common are superficial thrombophlebitis and DVT in surgery, particularly in total hip replacements?

A

Superficial thrombophlebitis and DVT occur in approximately 50% of total hip replacements.

133
Q

What is the typical clinical course of superficial thrombophlebitis and DVT post-surgery?

A

These conditions are normally subclinical and completely resolve.

134
Q

What symptoms are associated with DVT?

A

DVT is associated with extremity pain and swelling.

135
Q

What factors increase the risk of developing DVT post-surgery?

A

Risk factors for DVT include age over 40, surgery lasting more than 1 hour, cancer, orthopedic surgeries on the pelvis and lower extremities, and abdominal surgery.

136
Q

What diagnostic tools are useful for detecting thrombosis in superficial thrombophlebitis and DVT?

A

Doppler ultrasound is sensitive for detecting proximal thrombosis over distal thrombosis. Venography and impedance plethysmography are also useful diagnostic tools.

137
Q

What are some prophylactic measures to prevent superficial thrombophlebitis and DVT in surgical patients?

A

Prophylactic measures include the use of sequential compression devices (SCDs) and subcutaneous heparin injections 2-3 times a day.

138
Q

How does regional anesthesia contribute to reducing the risk of superficial thrombophlebitis and DVT post-surgery?

A

Regional anesthesia can significantly decrease the risk due to earlier postoperative ambulation.

139
Q

Slide 25

A
140
Q

What is the standard anticoagulation treatment for DVT?

A

The standard anticoagulation treatment for DVT involves using a combination of Warfarin (or another oral anticoagulant) along with Heparin or Low Molecular Weight Heparin (LMWH).

141
Q

What are the advantages of using LMWH over unfractionated heparin for DVT treatment?

A

LMWH has a longer half-life and more predictable dose response compared to unfractionated heparin. Additionally, LMWH does not require serial assessment of activated partial thromboplastin time (aPTT), and it is associated with a lower risk of bleeding.

142
Q

What are the disadvantages of using LMWH for DVT treatment?

A

LMWH may have a higher cost compared to unfractionated heparin, and there is a lack of a specific reversal agent for LMWH.

143
Q

How is Warfarin initiated and adjusted during DVT treatment?

A

Warfarin, a vitamin K antagonist, is initiated during heparin treatment and adjusted to achieve an International Normalized Ratio (INR) between 2 and 3.

144
Q

When is heparin discontinued during DVT treatment?

A

Heparin is discontinued when Warfarin achieves a therapeutic effect, as indicated by achieving the target INR range.

145
Q

How long are oral anticoagulants typically continued for DVT treatment?

A

Oral anticoagulants are typically continued for 3 to 6 months or longer, depending on individual patient factors and the presence of risk factors for recurrence.

146
Q

In what circumstances may an inferior vena cava (IVC) filter be placed for DVT treatment?

A

IVC filters may be placed in patients with recurrent pulmonary embolism (PE) or those who have contraindications to anticoagulant therapy.

147
Q

What is temporal (giant cell) arteritis?

A

Temporal arteritis is inflammation of the arteries of the head and neck.

148
Q

What are the symptoms of temporal arteritis?

A

Symptoms include unilateral headache, scalp tenderness, and jaw claudication.

149
Q

Symptoms include unilateral headache, scalp tenderness, and jaw claudication.

A

Temporal arteritis can affect vision by involving the ophthalmic arterial branches, leading to ischemic optic neuritis and unilateral blindness.

150
Q

What is the recommended treatment for temporal arteritis?

A

Prompt initiation of corticosteroids is indicated for visual symptoms and to prevent blindness.

151
Q

Prompt initiation of corticosteroids is indicated for visual symptoms and to prevent blindness.

A

Diagnosis is often confirmed by biopsy of the temporal artery, which shows arteritis in 90% of patients.

152
Q

What is Thromboangiitis Obliterans, also known as Buerger’s Disease?

A

Thromboangiitis Obliterans is an inflammatory vasculitis that leads to small and medium vessel occlusions in the extremities.

153
Q

What triggers the autoimmune response in Thromboangiitis Obliterans?

A

The autoimmune response is triggered by nicotine, making tobacco use the most predisposing factor for the disease.

154
Q

: Who is most commonly affected by Thromboangiitis Obliterans?

A

Thromboangiitis Obliterans is most prevalent in men under the age of 45.

155
Q

What are the diagnostic criteria for Thromboangiitis Obliterans?

A

The diagnostic criteria include:
* Onset of symptoms before the age of 50
* Infrapopliteal arterial occlusive disease
* Upper limb involvement
* Absence of risk factors for atherosclerosis outside of tobacco use.

156
Q

How is the diagnosis of Thromboangiitis Obliterans confirmed?

A

Diagnosis is confirmed with a biopsy of vascular lesions.

157
Q

What are the clinical manifestations of Thromboangiitis Obliterans (Buerger’s Disease) in terms of claudication?

A

Thromboangiitis Obliterans presents with forearm, calf, and foot claudication due to ischemia of the hands and feet.

158
Q

What are some complications of Thromboangiitis Obliterans involving the skin?

A

Complications include ulceration and skin necrosis.

159
Q

Which condition is commonly seen alongside Thromboangiitis Obliterans?

A

Raynaud’s phenomenon is commonly observed in individuals with Thromboangiitis Obliterans.

160
Q

What is the most effective treatment for Thromboangiitis Obliterans?

A

Smoking cessation is considered the most effective treatment for Thromboangiitis Obliterans.

161
Q

What are the options for surgical treatment in Thromboangiitis Obliterans?

A

Surgical revascularization may be considered as a treatment option.

162
Q

Are there effective pharmacological treatments for Thromboangiitis Obliterans?

A

No, there are currently no effective pharmacological treatments for Thromboangiitis Obliterans.

163
Q

What are the anesthesia implications for patients with Thromboangiitis Obliterans?

A

Anesthesia implications include meticulous positioning and padding, avoidance of cold, warming the room, and using warming devices. Additionally, non-invasive blood pressure monitoring and conservative line placement are preferred.

164
Q

What is Polyarteritis Nodosa?

A

Polyarteritis Nodosa is an antineutrophil cytoplasmic antibody (ANCA) negative vasculitis characterized by inflammation of small and medium arteries.

165
Q

What conditions may be associated with Polyarteritis Nodosa?

A

Polyarteritis Nodosa may be associated with Hepatitis B, Hepatitis C, or Hairy Cell Leukemia.

166
Q

What are some manifestations of Polyarteritis Nodosa?

A

Manifestations include inflammation resulting in glomerulonephritis, myocardial ischemia, peripheral neuropathy, and seizures. Hypertension is generally caused by renal disease, and renal failure is the primary cause of death.

167
Q

What are the treatment options for Polyarteritis Nodosa?

A

Treatment options include steroids, cyclophosphamide, and treating the underlying cause, such as cancer.

168
Q

What are the anesthesia implications for patients with Polyarteritis Nodosa?

A

Anesthesia implications include considering coexisting renal disease, cardiac disease, and hypertension. Steroids are likely to be beneficial in these patients.

169
Q

What is Lower Extremity Chronic Venous Disease characterized by?

A

Lower Extremity Chronic Venous Disease is characterized by long-standing venous reflux and dilation.

170
Q

What proportion of the population is affected by Lower Extremity Chronic Venous Disease?

A

Lower Extremity Chronic Venous Disease affects approximately 50% of the population.

171
Q

What are the manifestations of Lower Extremity Chronic Venous Disease?

A

Manifestations range from mild to severe and include telangiectasias, varicose veins (mild), and edema, skin changes, and ulceration (severe).

172
Q

What are some risk factors for Lower Extremity Chronic Venous Disease?

A

Risk factors include
- Advanced age
- Family history
- Pregnancy
- Ligamentous laxity
- Previous venous thrombosis
- Lower extremity injuries
- Prolonged standing
- Obesity
- Smoking
- Sedentary lifestyle
- High estrogen levels

173
Q

What are the diagnostic criteria for Lower Extremity Chronic Venous Insufficiency?

A
  • Lower Extremity Chronic Venous Insufficiency is diagnosed based on symptoms of leg pain, heaviness, and fatigue
  • Confirmed by ultrasound showing venous reflux with retrograde blood flow lasting more than 0.5 seconds.
174
Q

Symptoms of Chronic Venous Insufficiency image:

A
175
Q

What are the initial treatment options for Lower Extremity Chronic Venous Insufficiency?

A

Initial treatment typically involves conservative measures such as leg elevation, exercise, weight loss, compression therapy, skin barriers/emollients, steroids, and wound management.

176
Q

What are some conservative medical management options for Lower Extremity Chronic Venous Disease?

A

Conservative medical management options include diuretics, aspirin, antibiotics, prostacyclin analogues, and zinc sulfate.

177
Q

What is the next step if conservative medical management fails in Lower Extremity Chronic Venous Disease?: If conservative medical management fails, ablation may be performed.

A

:
If conservative medical management fails, ablation may be performed.

178
Q

Vein Ablation Image:

A
179
Q

What are the methods of ablation used for treating chronic venous disease?

A
  • Thermal ablation with laser
  • Radiofrequency ablation
  • Endovenous laser ablation
  • Sclerotherapy
180
Q

What are the indications for ablation therapy in the treatment of chronic venous disease?

A
  • Venous hemorrhage
  • Thrombophlebitis
  • Symptomatic venous reflux
181
Q

What are the contraindications for ablation therapy in chronic venous disease?

A
  • Pregnancy
  • Thrombosis
  • Peripheral Artery Disease (PAD)
  • Limited mobility
  • Congenital venous abnormalities
182
Q

**

Question: What are the contraindications for ablation therapy in chronic venous disease?

A

Pregnancy
Thrombosis
Peripheral Artery Disease (PAD)
Limited mobility
Congenital venous abnormalities

183
Q

**

What are the various methods of ablation used for the treatment of chronic venous disease?

A
  • hermal ablation with laser: This method involves the use of laser energy to heat and close off diseased veins.
  • Radiofrequency ablation: Utilizes radiofrequency energy to heat and collapse the vein wall, leading to closure of the vein.
  • Endovenous laser ablation: A specific form of thermal ablation that uses laser energy to seal off varicose veins.
  • Sclerotherapy: Involves the injection of a solution into the vein, causing it to scar and blood to reroute through healthier veins.
  • ChatGPT additon
184
Q

What medical conditions indicate the need for ablation therapy in patients with chronic venous disease?

A
  • Venous hemorrhage: Ablation can be used to treat veins that are prone to bleeding.
  • Thrombophlebitis: Inflammation of the vein due to a blood clot can be managed with ablation.
  • Symptomatic venous reflux: Ablation is indicated for the treatment of venous reflux that causes symptoms such as pain, swelling, and varicose veins.

*ChatGPT addition

185
Q

What are the contraindications for undergoing ablation therapy for chronic venous disease?

A
  • Pregnancy: Ablation is generally not recommended due to the risk of complications.
  • Thrombosis: The presence of an active blood clot is a contraindication for ablation.
  • Peripheral Artery Disease (PAD): Patients with PAD may not be suitable candidates due to circulation issues.
  • Limited mobility: Patients with limited mobility may experience complications post-ablation.
  • Congenital venous abnormalities: Ablation may not be advised due to the risk of damaging structurally abnormal veins.
  • ChatGPT addition
186
Q

When is surgical intervention considered in the treatment of chronic venous disease?

A

Surgical intervention is usually considered as the last resort when other less invasive treatments have failed or are not suitable.

187
Q

What are the types of surgical procedures available for chronic venous disease?

A
  • Saphenous vein inversion: A technique where the saphenous vein is turned inside out and removed through a small incision.
  • High saphenous ligation: The saphenous vein is tied off or ligated near its junction with the deep vein to prevent blood reflux.
  • Ambulatory Phlebectomy: Minimally invasive removal of surface varicose veins through small punctures or incisions.
  • Transilluminated-powered phlebectomy: A procedure that uses light to transilluminate the skin, helping to guide the removal of varicose veins with a powered device.
  • Venous ligation: Veins are tied off to prevent blood flow through the affected vein.
  • Perforator ligation: Ligation of the communicating veins that connect the superficial and deep veins, usually when they are contributing to venous insufficiency.
  • Includes additional ChatGPT descriptions

Assessment '24 - Mordecai (10 decks)

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