Vascular

Question 1

Name coexisting diseases for vascular surgery patients

Answer 1

CAD 40-80%
HTN
Diabetes
Smokers
CNS; carotid disease, stroke
Renal

Question 2

What causes 50% of postop mortalities

Answer 2

MI

Question 3

What are risk factors for PAD?

Answer 3

Older age: 75 y/o and >
Family history
Smoking (2x)
Diabetes mellitus
Hypertension
Obesity
Dyslipidemia

Question 4

______ is most common cause of occlusive disease in the arteries of lower extremities

Answer 4

athleroscleorosis

Question 5

in athlerosclerosis _____ may obstruct the vessel lumen causing a reduction in distal blood flow

Answer 5

Atheromatous plaques

Question 6

What are the most common places for thrombi formation?

Answer 6

Places with turbulent flow

Question 7

Pathophysiologic processes that affect arteries:

Answer 7

Plaque formation
Thrombosis
Aneurysm formation

Question 8

What can cause aneurysm formation that we dont typically think of? Something that anesthesia may cause?
How can we monitor this?

Answer 8

Vascular damage, Arterial lines!

Can monitor perfusion with spo2 on thumb of hand with art line

Question 9

Symptoms associated with peripheral occlusive disease

Answer 9

Claudication, skin ulcerations, gangrene, and impotence

Question 10

The extent of disability is influenced with development of ________?
(What can develop with chronic occlusion?)
What type of occlusion wouldnt be able to develop this?

Answer 10

Collateral circulation

Acute occlusion

Question 11

As PAD progresses what happens to the limb?

Answer 11

Ischemia

Question 12

What surgical interventions are used for Peripheral occlusion?

Answer 12

Transluminal angioplasty
Endarterectomy
Thrombectomies
Multiple bypass procedures

Question 13

What is an important thing to have found before the patients go to PACU?

Answer 13

MARK THE PULSES

Question 14

What concurrent disease processes in systems should be monitored for in the preop eval?

Answer 14

concurrent CAD, pulmonary, renal, neurologic, and endocrine dysfunction

Question 15

Monitoring for PAD patients?

Answer 15

• Usually related to their disease process.
• These patients typically need heparin intraop–> need to monitor PTT, THEY NEED ART LINES.
• PA catheter and TEE monitoring for assessing cardiac function

Question 16

How is PAD diagnosed? What symptoms?

Answer 16

Intermittent claudication
Rest pain
Decreased/absent pulses
Bruits in abdomen, pelvis, inguinal area
Subq atrophy
hair loss in effected extremity
Ankle brachial index

Question 17

What is intermittent claudication?

Answer 17

Demand exceeds supply of blood flow

Question 18

What is rest pain?

Answer 18

Minor trauma non-healing wound
Improves with ↑ hydrostatic pressure

Question 19

What is ankle brachial index scale?

Answer 19

< 0.9 claudication
< 0.4 rest pain
< 0.25 impending gangrene

Question 20

What is an ankle brachial index test? Describe it?

Answer 20

Theankle-brachial pressure index(ABPI) orankle-brachial index(ABI) is the ratio of theblood pressureat theankleto the blood pressure in theupper arm(brachium). Compared to the arm, lower blood pressure in the leg suggests blocked arteries due toperipheral artery disease(PAD). The ABPI is calculated by dividing thesystolicblood pressureat the ankle by the systolic blood pressure in the arm.

Question 21

Treatment for these patients?
non pharmacological mods?
treat what enderlying causes?
What drugs should not be given? why?
What drugs do we give?
Surgical decisions?

Answer 21

Exercise programs
Stop smoking
Treat HTN, CAD, DM
B-antagonists ??not??
Can cause demand ischemia
Lipid lowering  Statin therapy
Revascularization vs amputation