Vascular Flashcards
Where are clots usually formed?
bifurcations / turbulent flow areas
Vascular Surgery Patients Coexisting diseases:
CAD 40-80%
HTN
Diabetes
Smokers
CNS; carotid disease, stroke
Renal
vasopressors- high dose
50% of Vascular Surgery Patients post op mortalities d/t
MI
Risk Factors for vasular dx
Older age: 75 y/o and >
Family history
Smoking (2x)
Diabetes mellitus
Hypertension
Obesity
Dyslipidemia
most common cause of occlusive disease in the arteries of lower extremities
Atherosclerosis
Symptoms associated with peripheral occlusive disease
Claudication, skin ulcerations, gangrene, and impotence
Extent of disability is influenced with development of ……
collateral blood flow
Treatment for peripheral occlusive disease:
Pharmacolgic therapy
Surgical therapy:
Transluminal angioplasty
Endarterectomy
Thrombectomies
Multiple bypass procedures
Postoperative considerations for PERIPHERAL VASCULAR DISEASE
Administration of narcotics
Epidural opioids and local anesthetics
Postoperative monitoring
Diagnosis of PVD;
Intermittent claudication
Rest at pain
Decreased/absent pulses
Bruits in the abdomen, pelvis, and inguinal area
Subq atrophy, hair loss
ultrasound no flow
Ankle-brachial index and associated levels
bp in ankle and brachial (non invasice)
< 0.9 claudication
< 0.4 rest pain
< 0.25 impending gangrene
Treatment for pvd
Exercise programs
Stop smoking
Treat HTN, CAD, DM
Lipid lowering
Revascularization vs amputation
Common places for revasularization
Iliac vs femoral/popliteal
advantages or regional over general
Increased blood flow
Anticoagulation
Dementia
Spine surgery
Upper extremity harvesting
Carotid Artery Disease rate of death and types
Stroke 3rd leading cause of death
Hemorrhagic
Ischemic
87% are ischemic
Most common carotid occlusion site
internal cartoid artery
thecarotidbifurcation, where thecommon carotiddivides into the internal and externalcarotid
Risk Factors for Carotid artery disease
Age
History/family history
Black race
Male
Sickle cell disease
HTN/smoking/diabetes
Atrial fibrillation
Hypercholesterolemia
Obesity
Procedure on aorta are complicated by
Need to cross-clamp the aorta
Potential for large intraoperative blood loss
Aortic cross-clamping
Acutely increases LV afterload; severe HTN, myocardial ischemia, LV failure, or aortic valve regurgitation
Comprises organ perfusion distal to point of occlusion; interruption of blood flow to the spinal cord and kidneys can produce paraplegia and renal failure
hardest aneurysm to treat
ascending
Indications for aortic surgery include
Aortic dissection
Aneurysms
Occlusive disease
Trauma
Coarctation
most common factor contributing to the progression of the lesion/ aneurysm
htn
AORTIC DISSECTION is what?
Characterized by a spontaneous tear of the vessel wall intima, permitting the passage of blood along a false lumen
Treatment of dissecting aortic lesions:
Proximal dissections are nearly always treated surgically
Distal dissections may be managed medically initially
