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.
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).
3
Q
What is the treatment approach for ascending arch dissections?
A
Ascending arch dissections typically require emergent surgery.
4
Q
How are descending arch dissections typically treated?
A
Descending arch dissections are rarely treated with urgent surgery.
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.
6
Q
What symptoms indicate an impending rupture of an aortic dissection, and what is the treatment?
A
posterior pain,
hypotension,
hemothorax,
indicate the need for surgical treatment.
7
Q
What are the risk factors for aortic aneurysms and dissections?
A
hypertension (HTN),
atherosclerosis,
age,
being male,
smoking,
family history.
8
Q
Which inherited disorders are associated with aortic aneurysms and dissections?
A
Marfan’s syndrome,
Ehlers-Danlos syndrome,
bicuspid aortic valve
non-syndrome familial history.
9
Q
What are some causes of aortic dissection?
A
blunt trauma,
cocaine use,
iatrogenic causes (caused by medical treatment).
10
Q
What iatrogenic causes are related to aortic dissections?
A
cardiac catheterization,
aortic manipulation,
cross-clamping,
arterial incision.
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.
12
Q
What are the three main arterial pathologies in vascular disease?
A
The three main arterial pathologies are aneurysms, dissections, and occlusions.
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.
14
Q
Which arteries are more likely to be affected by occlusions?
A
Peripheral arteries are more likely to be affected by occlusions.
15
Q
An aortic aneurysm is defined as the dilation of _______ of an artery, with a greater than 50% increase in diameter
A
An aortic aneurysm is defined as the dilation of all three layers of an artery, with a greater than 50% increase in diameter
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.
17
Q
How are aortic aneurysms initially treated?
A
Aortic aneurysms are initially treated medically.
18
Q
When is surgery indicated for an aortic aneurysm?
A
diameter exceeds 5.5 cm.
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%.
20
Q
Types of aneurysm image:
A
21
Q
What are the two types of aortic aneurysms?
A
fusiform and saccular.
22
Q
What characterizes a fusiform aneurysm?
A
A fusiform aneurysm is a uniform dilation along the entire circumference of the arterial wall.
23
Q
What is a saccular aneurysm?
A
A saccular aneurysm is a berry-shaped bulge to one side of the artery.
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.
25
How are aortic aneurysms diagnosed?
Aortic aneurysms are diagnosed using CT, MRI, chest X-ray (CXR), angiogram, and echocardiogram.
26
What is the fastest and safest measure for obtaining a diagnosis of suspected aortic dissection?
a Doppler echocardiogram
27
What is an aortic dissection?
An aortic dissection is a tear in the intimal layer of the artery, allowing blood to enter the medial layer.
28
What is the protocol for an ascending aortic dissection?
An ascending aortic dissection is catastrophic and requires emergent surgical intervention.
29
How are ascending aortic dissections classified?
Ascending aortic dissections are classified as Stanford A and DeBakey types 1 and 2.
30
How does mortality rate change over time with an aortic dissection?
The mortality rate increases by 1-2% per hour.
31
What is the overall mortality rate for aortic dissection?
The overall mortality rate for aortic dissection is 27-58%.
32
What are the symptoms of an aortic dissection?
severe, sharp pain in the posterior chest or back.
33
How is aortic dissection diagnosed in stable and unstable patients?
In stable patients, diagnosis can be made with CT, chest X-ray (CXR), MRI, or angiography.
In unstable patients, echocardiography is used.
34
What are common risk factors for aortic aneurysms and dissections?
Risk factors include hypertension, atherosclerosis, age, male gender, smoking, and family history.
35
Which inherited disorders are associated with an increased risk of aortic aneurysms and dissections?
Marfan syndrome, Ehlers-Danlos syndrome, bicuspid aortic valve, and non-syndrome familial history are inherited disorders that increase the risk.
36
What are some causes of aortic dissection?
Causes include blunt trauma, cocaine use, and iatrogenic factors resulting from medical treatment.
37
What iatrogenic factors are related to aortic dissections?
Cardiac catheterization, aortic manipulation, cross-clamping, and arterial incision are iatrogenic factors related to dissections.
38
Who is more likely to experience an aortic dissection?
Aortic dissection is more common in men and in pregnant women during the third trimester.
39
What are the **four primary causes of mortality** related to surgeries of the thoracic aorta?
myocardial infarction (MI),
respiratory failure,
renal failure
stroke.
40
What should be assessed for in the preoperative evaluation for thoracic aorta surgery?
coronary artery disease,
valve dysfunction,
heart failure.
41
What may be required before surgery in patients with ischemic heart disease?
Patients with ischemic heart disease may require cardiac intervention prior to surgery.
42
What are some cardiac evaluation tests used in the preoperative phase?
stress testing,
echocardiography,
radionuclide imaging.
43
Why might a patient be precluded from an abdominal aortic aneurysm (AAA) resection?
A **severe reduction in forced expiratory volume in 1 second (FEV1)**or**renal failure** may preclude a patient from AAA resection.
44
What are predictors of post-aortic surgery respiratory failure?
Smoking and chronic obstructive pulmonary disease (COPD)
45
What tests can help define respiratory risk in the preoperative phase for thoracic aorta surgery?
PFTs & ABGs
46
What **preoperative interventions** might be considered for patients at risk of respiratory complications?
bronchodilators,
antibiotics,
chest physiotherapy
47
What is the most important indicator of post-aortic surgery renal failure?
Preoperative renal dysfunction .
48
What are key preoperative management steps to mitigate renal failure risk in aortic surgery?
Key steps include ensuring preoperative hydration, avoiding hypovolemia, hypotension, low cardiac output, and nephrotoxic drugs.
49
What vascular evaluation should be done for a patient with a history of stroke or transient ischemic attack (TIA)?
**carotid ultrasound** and an **angiogram** of brachiocephalic and intracranial arteries
50
What should be considered if severe carotid stenosis is identified before elective aortic surgery?
If severe carotid stenosis is identified, consideration should be given to**carotid endarterectomy (CEA) before elective surgery**
51
What are the inherited risk factors for cerebral vascular accidents?
age,
prior history of stroke,
family history of stroke,
black race,
male gender,
sickle cell disease.
52
What are modifiable risk factors for cerebral vascular accidents?
elevated blood pressure,
smoking,
diabetes,
carotid artery disease,
atrial fibrillation,
heart failure,
hypercholesterolemia,
obesity
physical inactivity.
53
What is a cerebral vascular accident (CVA)?
A CVA, also known as a stroke, can be **ischemic (87% of cases)** or **hemorrhagic (13%)** and is characterized by sudden-onset neurological deficits.
54
How significant a predictor of CVA is carotid disease?
**Carotid disease** is a prominent predictor of cerebral vascular accidents.
55
Where does CVA rank in leading causes of disability and death in the U.S.?
**CVA is the first leading cause** of disability and the **third leading cause of death in the U.S.**
56
What is a transient ischemic attack (TIA)?
A TIA is a subset of ischemic strokes that are self-limited, with symptoms resolving within 24 hours.
57
What is the risk of subsequent stroke after a TIA?
TIAs carry a risk that is **10 times greater** for a subsequent stroke.
58
What can angiography diagnose in carotid disease?
Angiography can diagnose **vascular occlusion**.
59
What can CT and MRI reveal in carotid disease?
CT and MRI are less invasive tests that may also **identify aneurysms and arteriovenous malformations (AVMs).**
60
How is transcranial Doppler ultrasound useful in carotid disease?
Transcranial Doppler ultrasound may give **indirect evidence of vascular occlusions with real-time bedside monitoring**.
61
What can carotid auscultation detect?
Carotid auscultation can **identify bruits, which are sounds indicative of turbulent blood flow due to narrowing or blockage.**
62
What information does carotid ultrasound provide?
Carotid ultrasound can quantify the degree of carotid stenosis.
63
Where does carotid stenosis commonly occur and why?
Carotid stenosis **commonly occurs at the internal/external carotid bifurcation** due to turbulent blood flow at the branch-point.
64
What should the workup for carotid disease include?
evaluation for sources of emboli such as
- atrial fibrillation,
- heart failure,
- valvular vegetation,
- paradoxical emboli in the setting of a **patent foramen ovale (PFO)**
65
What does the American Heart Association recommend for the treatment of CVA?
tissue plasminogen activator (TPA) within 4.5 hours.
66
What** inte**rventional radiology techniques** are used in the treatment of CVA?
Techniques include **intra-arterial thrombolysis** and **intravascular thrombectomy.**
67
How long after the onset of CVA can intravascular thrombectomy be beneficial?
up to 8 hours after the onset of CVA.
68
What is a Carotid Endarterectomy (CEA)?
CEA is a surgical treatment for severe carotid stenosis, typically for blockages of 70-99%.
69
What is an alternative treatment to Carotid Endarterectomy?
Carotid stenting is an alternative to CEA.
70
What is a major risk associated with carotid stenting?
microembolization leading to CVA.
71
What devices have been developed to mitigate the risk of microembolization during carotid stenting?
Embolic protection devices have been developed to mitigate the risk; however, the CVA risk remains unchanged so far.
72
What constitutes ongoing medical therapy after a CVA?
Ongoing medical therapy includes:
- Antiplatelet treatment
- Smoking cessation
- Blood pressure control
- Cholesterol control
- Maintaining a healthy diet and physical activity.
73
What is a crucial part of the preoperative evaluation for Carotid Endarterectomy?
A neurological evaluation to establish preoperative deficits is crucial, which may include post-CVA weakness, aphasia, etc.
74
Why is cardiovascular disease assessment important in CEA preparation?
Coronary artery disease (CAD) is prevalent in carotid disease, and **myocardial infarction is a major cause of perioperative morbidity and mortality in CEA**.
75
How common is hypertension in patients undergoing CEA and why is its management important?
Hypertension is common, and it's important to establish an acceptable blood pressure range to **optimize cerebral perfusion pressure (CPP) during surgery.**
76
What is the formula for calculating cerebral perfusion pressure (CPP)?
CPP =MAP - ICP
77
Why is it important to maintain collateral blood flow through stenotic vessels during CEA?
It is essential to maintain collateral blood flow, especially during cross-clamping, **to prevent cerebral ischemia.**
78
What should be **avoided during CEA** to prevent compromising blood flow?
**Extreme head rotation, flexion, or extension** should be avoided as it may compress contralateral artery flow.
79
How can cerebral oximetry devices be useful during CEA?
Cerebral oximetry devices like Foresight and INVOS are useful in **determining cerebral perfusion**.
80
What is the clinical dilemma when a patient has severe carotid disease and severe coronary artery disease?
The dilemma is **to stage cardiac revascularization and CEA appropriately**, prioritizing the most compromised area.
81
What factors affect cerebral oxygenation as monitored by cerebral oximetry?
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
What is a frequent cause of acute artery occlusion?
Acute artery occlusion is frequently due to **cardiogenic embolism**.
83
What are **common causes of cardiogenic embolism** leading to artery occlusion?
left atrial (LA) thrombus arising from atrial fibrillation
left ventricular (LV) thrombus from dilated cardiomyopathy
post-myocardial infarction.
84
What are some less common thrombus causes for acute artery occlusion?
valvular heart disease,
endocarditis,
patent foramen ovale (PFO).
85
What are noncardiac causes of acute artery occlusion?
atheroemboli,
plaque rupture,
hypercoagulability,
trauma.
86
What are the symptoms of acute artery occlusion?
Symptoms include limb ischemia, pain or paresthesia, weakness, decreased peripheral pulses, cool skin, and color changes distal to the occlusion.
87
: How is acute artery occlusion diagnosed?
arteriography.
88
What are the treatments for acute artery occlusion?
surgical embolectomy,
anticoagulation,
amputation as a last resort.
89
How is peripheral artery disease defined in terms of the ankle-brachial index (ABI)?
(ABI) < 0.9.
90
What is peripheral artery disease and what does it result in?
Peripheral artery disease is a condition that results in compromised blood flow to the extremities.
91
What is the ankle-brachial index (ABI)?
ratio of the systolic blood pressure (SBP) at the ankle to the SBP at the brachial artery.
92
What is the typical cause of chronic hypo-perfusion in PAD?
atherosclerosis, but may also be caused by vasculitis.
93
What typically causes acute occlusions in PAD?
Acute occlusions in PAD are typically due to embolism.
94
How does the incidence of PAD change with age?
How does the incidence of PAD change with age?
95
Why is atherosclerosis considered a systemic issue for patients with PAD?
Atherosclerosis is systemic, and patients with PAD have a 3-5 times higher risk of myocardial infarction (MI) and cerebral vascular accidents (CVA).
96
What are the risk factors for peripheral artery disease (PAD)?
Risk factors include
- Advanced age
- Family history
- Smoking
- Diabetes mellitus (DM)
- hypertension (HTN)
- Obesity
- High cholesterol levels
97
What are common signs and symptoms of peripheral artery disease?
Signs and symptoms include
- Intermittent claudication,
- Resting extremity pain,
- Decreased pulses,
- Subcutaneous atrophy,
- Hair loss, coolness, and
- Cyanosis.
98
How can relief from peripheral artery disease symptoms be achieved?
hanging the lower extremities over the side of the bed, which increases hydrostatic pressure.
99
What is Doppler ultrasound used for in PAD?
Doppler ultrasound with pulse volume waveform identifies arterial stenosis in PAD.
100
How does duplex ultrasound help in PAD?
Duplex ultrasound can identify areas of plaque formation and calcification in PAD.
101
What does transcutaneous oximetry assess in PAD?
Transcutaneous oximetry can assess the severity of tissue ischemia in PAD.
102
When is MRI with contrast angiography used in PAD?
MRI with contrast angiography is used to guide endovascular intervention or surgical bypass in PAD.
103
What constitutes the medical treatment for PAD?
Medical treatment for PAD includes exercise, blood pressure control, cholesterol control, and glucose control.
104
When is medical intervention such as revascularization indicated in PAD?
with disabling claudication or ischemia.
105
What surgical options are available for PAD?
Surgical options for PAD include arterial bypass procedures.
106
What diagnostic test identifies arterial stenosis in PAD and how?
Doppler ultrasound identifies arterial stenosis through pulse volume waveforms.
107
What endovascular repairs are used in PAD?
transluminal angioplasty and stent placement.
108
What constitutes medical treatment for PAD?
Medical treatment includes exercise, blood pressure control, cholesterol control, and glucose control.
109
What is Subclavian Steal Syndrome?
subclavian artery is occluded proximal to the vertebral artery, causing **blood flow in the vertebral artery to be diverted away from the brainstem**
110
What are the symptoms of Subclavian Steal Syndrome?
syncope,
vertigo,
ataxia,
hemiplegia,
ipsilateral arm ischemia.
111
How is blood pressure affected in the arm by Subclavian Steal Syndrome?
The affected arm's systolic blood pressure may be approximately 20mmHg lower.
112
What clinical sign might be present over the subclavian artery in Subclavian Steal Syndrome?
A bruit may be heard over the subclavian artery.
113
How is Subclavian Steal Syndrome treated?
Subclavian artery endarterectomy is curative for Subclavian Steal Syndrome.
114
What is Raynaud's phenomenon?
is episodic vasospastic ischemia of the digits, affecting more women than men.
115
What are the primary causes of Raynaud's phenomenon?
The primary causes are idiopathic,
116
What are some secondary causes of Raynaud's phenomenon?
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.
117
How may Raynaud's phenomenon appear in patients with CREST syndrome?
Raynaud's phenomenon may appear with CREST syndrome, a subtype of scleroderma.
118
What are the symptoms of Raynaud's phenomenon?
Symptoms include digital blanching or cyanosis with cold exposure or sympathetic nervous system activation.
119
How is Raynaud's phenomenon diagnosed?
Diagnosis is based on history and physical examination.
120
Diagnosis is based on history and physical examination.
cold,
calcium channel blockers (CCBs),
alpha-blockers,
surgical sympathectomy for severe ischemia.
121
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What are common peripheral venous disease (PVD) processes that may occur during surgery?
superficial thrombophlebitis,
deep vein thrombosis (DVT),
chronic venous insufficiency.
122
Why is deep vein thrombosis (DVT) a major concern in the perioperative setting?
DVT is a major concern because it can lead to pulmonary embolism (PE), which is a leading cause of perioperative morbidity and mortality.
123
What is Virchow's Triad?
Virchow's Triad refers to the three major factors that predispose to venous thrombosis:
venous stasis,
hypercoagulability
disrupted vascular endothelium.
124
What conditions can lead to venous stasis, which is a part of Virchow's Triad?
recent surgery,
trauma,
lack of ambulation,
pregnancy,
low cardiac output from congestive heart failure or myocardial infarction,
stroke,
varicose veins.
125
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What factors can contribute to a hypercoagulable state, increasing the risk of venous thrombosis?
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
126
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How common are superficial thrombophlebitis and DVT in surgery, particularly in total hip replacements?
Superficial thrombophlebitis and DVT occur in approximately 50% of total hip replacements.
127
What is the typical clinical course of superficial thrombophlebitis and DVT post-surgery?
These conditions are normally subclinical and completely resolve.
128
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What symptoms are associated with DVT?
DVT is associated with extremity pain and swelling.
129
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What factors increase the risk of developing DVT post-surgery?
age over 40,
surgery lasting more than 1 hour,
cancer,
orthopedic surgeries on the pelvis
lower extremities,
abdominal surgery.
130
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What diagnostic tools are useful for detecting thrombosis in superficial thrombophlebitis and DVT?
Doppler ultrasound is sensitive for detecting proximal thrombosis over distal thrombosis.
Venography and impedance plethysmography are also useful diagnostic tools.
131
What are some prophylactic measures to prevent superficial thrombophlebitis and DVT in surgical patients?
Prophylactic measures include the use of sequential compression devices (SCDs) and subcutaneous heparin injections 2-3 times a day.
132
How does regional anesthesia contribute to reducing the risk of superficial thrombophlebitis and DVT post-surgery?
Regional anesthesia can significantly decrease the risk due to earlier postoperative ambulation.
133
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134
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What is the standard anticoagulation treatment for DVT?
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).
135
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What are the advantages of using LMWH over unfractionated heparin for DVT treatment?
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)
it is associated with a lower risk of bleeding.
136
What are the disadvantages of using LMWH for DVT treatment?
LMWH may have a higher cost compared to unfractionated heparin, and there is a lack of a specific reversal agent for LMWH.
137
How is Warfarin initiated and adjusted during DVT treatment?
Warfarin, a vitamin K antagonist, is initiated during heparin treatment and adjusted to achieve an International Normalized Ratio (INR) between 2 and 3.
138
When is heparin discontinued during DVT treatment?
Heparin is discontinued when Warfarin achieves a therapeutic effect, as indicated by achieving the target INR range.
139
How long are oral anticoagulants typically continued for DVT treatment?
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.
140
In what circumstances may an inferior vena cava (IVC) filter be placed for DVT treatment?
recurrent pulmonary embolism (PE)
contraindications to anticoagulant therapy.
141
What is temporal (giant cell) arteritis?
Temporal arteritis is inflammation of the arteries of the head and neck.
142
What are the symptoms of temporal arteritis?
unilateral headache,
scalp tenderness,
jaw claudication.
143
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Symptoms include unilateral headache, scalp tenderness, and jaw claudication.
Temporal arteritis can affect vision by involving the ophthalmic arterial branches, leading to ischemic optic neuritis and unilateral blindness.
144
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What is the recommended treatment for temporal arteritis?
Prompt initiation of corticosteroids is indicated for visual symptoms and to prevent blindness.
145
Prompt initiation of **corticosteroids** is indicated for visual symptoms and to prevent blindness.
Diagnosis is often confirmed by biopsy of the temporal artery, which shows arteritis in 90% of patients.
146
What is Thromboangiitis Obliterans, also known as Buerger's Disease?
Thromboangiitis Obliterans is an inflammatory vasculitis that leads to **small and medium vessel occlusions in the extremities**
147
What triggers the autoimmune response in Thromboangiitis Obliterans?
by nicotine,
making tobacco use the most predisposing factor for the disease.
148
: Who is most commonly affected by Thromboangiitis Obliterans?
Thromboangiitis Obliterans is most prevalent in men under the age of 45.
149
What are the diagnostic criteria for Thromboangiitis Obliterans?
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.
150
How is the diagnosis of Thromboangiitis Obliterans confirmed?
Diagnosis is confirmed with a biopsy of vascular lesions.
151
What are the clinical manifestations of Thromboangiitis Obliterans (Buerger's Disease) in terms of claudication?
Thromboangiitis Obliterans presents with forearm, calf, and foot claudication due to ischemia of the hands and feet.
152
What are some complications of Thromboangiitis Obliterans involving the skin?
Complications include ulceration and skin necrosis.
153
Which condition is commonly seen alongside Thromboangiitis Obliterans?
Raynaud's phenomenon is commonly observed in individuals with Thromboangiitis Obliterans.
154
What is the most effective treatment for Thromboangiitis Obliterans?
Smoking cessation
155
What are the options for surgical treatment in Thromboangiitis Obliterans?
Surgical revascularization may be considered as a treatment option.
156
Are there effective pharmacological treatments for Thromboangiitis Obliterans?
No, there are currently no effective pharmacological treatments for Thromboangiitis Obliterans.
157
What are the anesthesia implications for patients with Thromboangiitis Obliterans?
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.
158
What is Polyarteritis Nodosa?
Polyarteritis Nodosa is an **antineutrophil cytoplasmic antibody (ANCA)negative vasculitis** characterized by **inflammation of small and medium arteries**
159
What conditions may be associated with Polyarteritis Nodosa?
Hepatitis B, Hepatitis C, or Hairy Cell Leukemia.
160
What are some manifestations of Polyarteritis Nodosa?
inflammation resulting in glomerulonephritis,
myocardial ischemia
peripheral neuropathy
seizures.
Hypertension is generally caused by renal disease, and renal failure is the primary cause of death.
161
What are the treatment options for Polyarteritis Nodosa?
steroids,
cyclophosphamide, and
treating the underlying cause, such as cancer.
162
What are the anesthesia implications for patients with Polyarteritis Nodosa?
Anesthesia implications include considering coexisting renal disease, cardiac disease, and hypertension. **Steroids are likely to be beneficial in these patients**
163
What is Lower Extremity Chronic Venous Disease characterized by?
by long-standing venous reflux and dilation.
164
What proportion of the population is affected by Lower Extremity Chronic Venous Disease?
Lower Extremity Chronic Venous Disease affects approximately 50% of the population.
165
What are the manifestations of Lower Extremity Chronic Venous Disease?
Manifestations range from mild to severe and include telangiectasias, varicose veins (mild), and edema, skin changes, and ulceration (severe).
166
What are some risk factors for Lower Extremity Chronic Venous Disease?
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
167
What are the diagnostic criteria for Lower Extremity Chronic Venous Insufficiency?
- 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**
168
Symptoms of Chronic Venous Insufficiency image:
169
What are the initial treatment options for Lower Extremity Chronic Venous Insufficiency?
leg elevation,
exercise,
weight loss,
compression therapy,
skin barriers/emollients,
steroids,
wound management.
170
What are some conservative medical management options for Lower Extremity Chronic Venous Disease?
diuretics,
aspirin,
antibiotics,
prostacyclin analogues,
zinc sulfate.
171
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.
172
Vein Ablation Image:
173
What are the methods of ablation used for treating chronic venous disease?
* Thermal ablation with laser
* Radiofrequency ablation
* Endovenous laser ablation
* Sclerotherapy
174
What are the indications for ablation therapy in the treatment of chronic venous disease?
* Venous hemorrhage
* Thrombophlebitis
* Symptomatic venous reflux
175
What are the contraindications for ablation therapy in chronic venous disease?
* Pregnancy
* Thrombosis
* Peripheral Artery Disease (PAD)
* Limited mobility
* Congenital venous abnormalities
176
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Question: What are the contraindications for ablation therapy in chronic venous disease?
Pregnancy
Thrombosis
Peripheral Artery Disease (PAD)
Limited mobility
Congenital venous abnormalities
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What are the various methods of ablation used for the treatment of chronic venous disease?
* 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
178
What medical conditions indicate the need for ablation therapy in patients with chronic venous disease?
* 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
179
What are the contraindications for undergoing ablation therapy for chronic venous disease?
* 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.
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When is surgical intervention considered in the treatment of chronic venous disease?
Surgical intervention is usually considered as the last resort when other less invasive treatments have failed or are not suitable.
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What are the types of surgical procedures available for chronic venous disease?
* 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.
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