Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Health Assessment M > Vascular > Flashcards

Vascular Flashcards

1
Q

What is the triad of aortic aneurysm rupture?

A

Hypotension
Back pack
Pulsatile Abdominal Mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where do most aortic abdominal aneurysms rupture?

A

Left retroperitoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Though hypovolemic shock can be present, how can exsanguination in aortic aneurysm rupture?

A

clotting and the tamponade effect in the retroperitoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why would you defer euvolemic resuscitation until the rupture is controlled?

A

because it can result in an increase in BP without control of bleeding which may lead to loss of retroperitoneal tamponade leading to further HYPOTENSION, bleeding, and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Unstable Aortic Aneursym require immediate..

A

operation without preop testing or volume resuscitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 4 primary causes of mortality related to surgeries of thoracic aorta

A

MI
Resp failure
Renal Failure
Stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Aortic Aneurysm Resection Preop

_____ may require intervention prior to surgery

A

Ischemic heart disease

Cardiac eval test: stress test, echo, radionuclide imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What may preclude (prevent) a patient from having AAA resection?

A

SEVERE reduction in FEV1 or renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are predictors of post aortic surgery respiratory failure ?

A

Smoking
COPD

Use PFT and ABG to define risk

**consider brochodilators, ABX, or chest physiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

AAA rupture
Preop renal dysfunction is the most important indicator of post-aortic surgery renal failure

Make sure to

A

PreOp hydration
Avoid hypovolemia, Hypotension, low cardiac output

No nephrotoxic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Preop Eval for AAA
what if they had a history of stroke or TIA

Obtain a-___

A

carotid ultrasound

Angiogram of brachiocephalic and intracranial arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Preop Eval AAA

What if they have severe cartodi stenosis?

A

recommend work up for CEA

Carotid endarterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Anterior Spinal Artery Syndrome Patho

A

lack of blood flow to the anterior spinal artery

anterior spinal artery responsible perfusing 2/3 of spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does ischemia to the anterior spinal artery lead to

A

loss of motor function below the infarct

diminished pain and temp sensation below the infarct
autonomic dysfunction

leading to hypotension and loss of bowel and bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

why is anterior spinal artery syndrome the most common form of spinal ischemia?

A

because the anterior spinal artery has minimal collateral perfusion thus its very vulnerable

  • The posterior spinal cord has 2 spinal arteries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Common causes for ASA syndrome

A

Aortic aneurysm, aortic dissection, atherosclerosis, trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CVA percentage

A

87 ischemic
13 hemorrhagic

**sudden osent of neuro defecits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the prominent predictor of CVA

A

Carotid disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

CVA is the 1st leading ___

A

cause of disability in US

3rd leading cause of death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a TIA?

A

subset of self limited ischemic strokes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How long do TIAs take to resolve

A

24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Carotid Diagnostic Test

A

Angiography to diagnose vascular occlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

TIAS have a ____greater rx of subsequent strokes

A

10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What can identify both carotid disease and aneurysms, and AMV

A

CT and MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Cartoid Dx
What diagnostic may give you indirect evidence of vascular occulusions with rela time bedside monitoring?

A

transcranial doppler US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Carotid DZ

Diagnostic to identify bruits?

A

Carotid Auscultation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Cartoid DZ

Carotid Ultrasound can idenitfy___

A

degree of carotid stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Where does cartoid stenosis usually occur?

A

at the internal and external carotid birufication due to turbulent blood flow at the branch point

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Carotid DZ
Work Up Includes

A

evaluation for sources of emboli s/a Afib, heart failure, valvular vegetation, or paradoxical emboli in the setting of PFO (patent foramen ovale)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Treatment for CVA

A

TPA within 4.5 hours

Interventional radiology
-Intraarterial thrombolysis
-Intravascular thrombectomy

Carotid Endartectomy ( CEA)

Carotid Stenting
alternative to CEA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

when can you see the benefits of a CVA after an intravascular thrombectomy

A

8 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

(measurements)When is CEA indicated

A

LUMEN diameter 1.5 mm or greater than 70 percent blockage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Whats the major risk to carotid stenting

A

MICROEMBOLI - CVA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Ongoing Medical Treatment of CVA

A

Antiplatelet
Smoking cessation
BP control
cholesterol
Diet and physical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

CEA Preop

A

Neuro eval - for defecits

htn COMMON * estabilish acceptable BP to optimize CPP ( MAP - ICP_

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is CV dz prevelant with carotid stenosis

A

CAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is a major cause of perioperative mortality and mobidity in CEA

A

MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

CEA during surgery

A

Maintain collateral blood flow through stenotic vessel

**Extreme head rotation/flexion/extension may compress contralateral artery flow

***Cerebral Oximetry Devices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Clinical Dilemma: Severe Carotid Disease + Severe CAD

A

Must stage cardiac revascularization and CEA

**most compirsed area should take priority

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Cerebral 02 consumption effected by:

A

Temperature
Anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Cerebral Oxygenation effected by:

A

MAP
COP
Sa02
HGB
PaC02

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Peripheral Artery Disease

A

Results in compromised blood flow to the extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Peripheral Artery Disease is defined by an ankle- brachial index of

A

ABI less than 0.9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

ABI is a ratio of SBP at tthe

A

ankle to the brachial artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

PAD
Chronic hypo-perfusion is typically due

A

atherosclerosis

may be due to vasculities

WHILE ACUTE occlusions are due to emboli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Incidence of PAD increase with

A

age exceeding by 70 percent by age 75

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Patients with PAD have 3-5 increased risk of

A

MI and CVA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

S/S PAD

A

intermittent claudication
Resting extremity pain
Decreased pulses
Subcutaneous atrophy
Hair loss
Coolness
Cyanosis

  • Relief with hanging LE extremity over bed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

PAD risk factors

A

Advanced Age
Family hx
Smoking
DM
HTN
Obesity
Cholesterol increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What do people with PAD have relief with hanging their lower extremities over the side of their bed

A

due to increased hydrostatic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

PAD Diagnosis

A

Doppler US - provide pulse waveform to identify arterial stenosis

Duplex US–> plaque formation and calcification

Trancutaneus Oximetry - assess ischemia

MRI with contrast angiography - to guide endovascular intervention or surgical bypass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

PAD medical treatment

A

Exercise
Bp control
Cholesterol control
Glucose control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

PAD medical intervention

A

Revascularization indicated w/ disabiling claudication or ischemia

Surgical reconstruction - arterial bypass procedure

Endovascular repair - transluminal angioplasty or stent placement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Acute Artery Occulsion is frequently due to

A

cardiogenic emboli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Common causes of Acute Artery Occlusion

A

Left artial thrombus arising from Afib
Left ventricular thrombus from dilated cardiomyopathy after MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Acute Artery Occlusion Less common causes

A

valvular heart dz, endocardidits , PFO

Noncardiac: atheroemboli, plaque rupture, hypercoagulability, trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

S.S of acute artery occlusion/acute limb ischemia

A

Limb ischemia, pain/parethesia, weakness, decrease peripheral pulses, cool skin, color changes distal to occulusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Acute Artery Oclussion Diagnosis

A

Arteriography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Treatment for Acute Artery Occlusion

A

surgical embolectomy, anticoagulation, amputation ( last resort)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Subclavian Steal Syndrome

A

SCA ( superior cerebellar artery) proximal to vertebral artery

– causing vertebral artery blood flow to be diverted away from brainstem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Subclavian Steal Syndrome ss

A

Syncope
Vertigo
Ataxia
Hemiplegia
**ipsilateral arm ischemia

**effected arm SBP may be 20 mmhg lower
Bruit over SCA *superior cerebellary artery

62
Q

Risk Factors for Subclavian Steal Syndrome

A

Atheroscelorisis

Takayasu Arteritis

aortic surgery

63
Q

Subclavian Steal Syndrome Rx

A

SC endarterectomy is curative

64
Q

Raynaud’s Phenomenom

A

Episodic vasospastic ischemia of the digits

effects more woman

65
Q

Raynauds S/S

A

CREST syndrome

digital blanching or cyanosis with cold exposure or SNS activation

66
Q

Raynauds Phenomenom treatment

A

protection from cold
CBB
Alpha channel bloclers

**surgical sympathectomy for severe ischemia

67
Q

Peripheral Venous Disease

What are the most common PVD process that occur during surgery?

A

superficial thrombophelibitis
deep vein thrombosis
chronic venous insufficiency

68
Q

Why is DVT a major concern

A

can lead to PE leading to increase MM

68
Q

What is Virshows Triad as it relates to Peripheral Venous Disease

A

hypercoagulability
venous stasis
*disrupted vascular endothelium

69
Q

Risk factors for thromboembolism

A

pregnancy
low cardiac output - chf
varicose veins
estrogen - oral contraceptives
Obesity
Inflammatory disease

70
Q

Superficial Thrombophlebitis & DVT is highest in what type of surgeries?

A

appox 50% total hip replacements

71
Q

DVT diagnostics

A

doppler U/S more sensitive for detecting PROXIMAL thrombosis over distal thrombosis

Venography and impedance plethysmography also useful

72
Q

DVT associated with these risk factors

A

↑risk factors: >age 40, surgery >1h, cancer, ortho surgeries on pelvis & LEs, abdominal surgery

73
Q

Prophylaxis for –> Superficial Thrombophlebitis & DVT

A

SCDs

SBQ heparin 2-3 days

74
Q

What type of anesthesia can decrease risk of superficial thrombophlebitits and DVT

A

Regional anesthesia can greatly ↓risk d/t earlier postop ambulation

75
Q

Risk and Predisposing Factors For Development of DVT

A

age greater than 40
knee or hip replacement ( high risk)
stroke
pregnancy ( low and med risk)

76
Q

Mod Risk Steps to Prevent DVT

A

subq heparin
iv dextran
compression

77
Q

High Risk DVT ways to prevent

A

compression
subq heparin
**warfarin
iv dextran or VENA CAVA FILTER

78
Q

Repeat on day _ and _
compression ultrasound of proximal veins or impedence plethysmography

A

2 and 7

79
Q

DVT treatments Anticoags

A

Warfarin + Heparin
or
LMWH

80
Q

DVT treatmemnt

LMWH advantages over unfractionated heparin

A

longer half life(?) and more predicatable dose response

Doesnt require serial assessment of APPT

Less bleeding

81
Q

DVT treatment

LMWH disadvantages

A

higher cost

lack of reversal agent

82
Q

DVT Treatment
Warfarin (vit K antagonist) is initiated during heparin treatment and adjusted to achieve INR btw ____

A

2-3

83
Q

DVT treatment
When is heparin discontinued

in terms with warfarin

A

heparin discontined when warfarin achieves therapeutic effect

84
Q

DVT treatment
PO anticoagulants continued _____

A

6 months or longer

85
Q

_____ may be placed in pts w/ recurrent PE, or have contraindication to anticoagulants

A

IVC Filter

86
Q

Systemic Vasculitis

A

Diverse group of vascular inflammatory diseases with characteristics that are often grouped by the size of the vessels at the primary site of the abnormality

87
Q

Large-artery vasculitis

A

Takayasu arteritis
Temporal (or giant cell) arteritis

88
Q

Medium-artery vasculitis includes:

A

Kawasaki disease, which is most prominently the coronary arteries

89
Q

Medium tosmall-artery vasculitis includes:

A

thromboangiitis obliterans
Wegener granulomatosis
polyarteritis nodosa

90
Q

Systemic Vasculities
Additionally,vasculitis can be a feature of connective tissue diseases such as

A

systemic lupus erythematosus and rheumatoid arthritis

91
Q

Temporal (Giant Cell) Arteritis

Is what?

A

Inflammation of arteries of the head and neck

92
Q

Temporal (Giant Cell) Arteritis
S/S

A

unilateral, headache, scalp tenderness, jaw claudication

93
Q

Temporal (Giant Cell) Arteritis

Opthalmic Arterial branches may lead to ___________

A

ischemic optic neuritis and unilateral blindness

94
Q

Temporal (Giant Cell) Arteritis Treatment

A

Prompt initiation of corticosteroids indicated for visual symptoms, to prevent blindness

95
Q

Temporal Giant Cell Arterities
Diagnostics

A

Biopsy of temporal artery shows arteritis in 90% of pts

96
Q

Aortic aneurysm: Dilation of all ___ layers of artery, leading to a >___increase in diameter

A

3

50 percent

97
Q

When is surgery indicated for aortic aneursym

A

Surgery indicated @ >5.5 cm diameter

Aortic aneurysmrupture is associated with a 75% mortality rate

98
Q

2 Types -Aortic Aneurysm

A

2 types:
Fusiform: Uniform dilation along entire circumference of arterial wall
Saccular: berry-shaped bulge to one side

99
Q

Whats the fastest way to diagnose a suspected dissection

A

*In suspected dissection, doppler echocardiogram is fastest/safest measure of obtaining adiagnosis ofaneurysm

100
Q

Thromboangiitis Obliterans “Buerger Disease”
Patho

A

Inflammatory vasculitis leading to small & medium vessel occlusions in the extremities

101
Q

What triggers Thromboangiitis Obliterans “ Buerger Disease”

A

autoimmune response trigged by nicotine

TOBACCO USE is the most predisposing factor

102
Q

Buerguer Disease more often in what gender

A

males less than 45

103
Q

5 diagnostic criteria for Thromboangiitis Obliterans

A
  1. history of smoking
    2.onset before 50
    3.infrapopliteal arterial occlusive
    4.upper lumb involvement
    5.absense of risk factors for atherosclerosis *outside of tobacco
104
Q

Buerger Disease Diagnosis is confirmed with

A

Biopsy of vascular lesions

105
Q

Thromboangiitis Obliterans “Buerger Disease” SS

A

forearm, calf, foot claudication
Ischemia of hands and feet
ulceration and skin necrosis
Raynaud’s is commonly seen

106
Q

Thromboangiitis Obliterans “Buerger Disease” Treatment

A

Smoking Cessation ** is most effective

Surgical revascularization

No effective pharmacologic tx

107
Q

Anesthesia implications for Thromboangiitis “Beurger Disease”

A

Meticulous Positioning/Padding

Avoid cold; warm the room and use warming devices

**PREFER NON invasive BP versus conservative line placement

108
Q

Polyarteritis Nodosa patho

A

Antineutrophyl cytoplasmic antibody (ANCA) negative vasculitis

Small & medium arteries involved

109
Q

Polyarteritis Nodosa is associated with

A

Hep B, Hep C, or hairy cell leukemia

110
Q

Polyarteritis Nodosa
Inflammation results in

A

glomerulonephritis, myocardial ischemia, peripheral neuropathy and seizures

111
Q

What is the primary cause of death for polyarteritis nodosa?

A

renal failure

**htn in this disease is generally caused by this disease

112
Q

Polyarteritis Nodosa RX

A

Tx: steroids, cyclophosphamide, treating underlying cause (s/a cancer)

113
Q

Polyarteritis Nodosa Anesthesia Complications

A

Consider coexisting renal dz,cardiac dz and htn

**STEROIDS BENEFICIAL

114
Q

Lower Extremity Chronic Venous Disease is due to

A

Long standing venous reflux & dilation

Effects 50% of the population

115
Q

Lower Extremity Chronic Venous Diseasess

A

Ranges mild-severe
Mild sx: telangiectasias, varicose veins
Severe sx: edema, skin changes, ulceration

116
Q

Lower Extremity Chronic Venous Disease Risk Factors

A

advanced age
family hx
pregnancy
ligamentous laicity
previous venous thrombosis
LE injuries
prolonged standing
obesity
smoking
sedentary lifestyle
high estrogen levels

117
Q

Lower Extremity Chronic Venous Insufficiency Diagnosis

A

Diagnostic criteria: Sx of leg pain, heaviness, fatigue
Confirmed by ultrasound showing venous reflux
Retrograde blood flow > 0.5 seconds

118
Q

Lower Extremity Chronic Venous Insufficiency treatment

A

Treatment: initially conservative
Leg elevation
Exercise
Weight loss
Compression therapy
Skin barriers/emollients
Steroids
Wound management

119
Q

Lower Extremity Chronic Venous DiseaseConservative medical management:

A

Conservative medical management:
Diuretics
Aspirin
Antibiotics
Prostacyclin analogues
Zinc sulphate

*If management fails, ablation may be performed

120
Q

Ablation for Chronic Venous Dz

Indications

A

Venous hemorrhage
Thrombophlebitis
Symptomatic venous reflux

121
Q

methods chronic venous insufficiency

A

Thermal ablation w/laser
Radiofrequency ablation
Endovenous laser ablation
Sclerotherapy

122
Q

Contraindications for Ablation for Chronic Venous

A

Pregnancy
Thrombosis
PAD
Limited mobility
Congenital venous abnormalities

123
Q

Lower Extremity Chronic Venous

A

Surgical Intervention

Procedures
Saphenous vein inversion
High saphenous ligation
Ambulatory Phlebectomy
Transilluminated-powered phlebectomy
Venous ligation
Perforator ligation

124
Q

___________are the leading cause of perioperative morbidity and mortality in patients undergoing noncardiac surgery

A

Cardiac complications

The incidence of these complications is higher in patients undergoing vascular surgery

125
Q

_______ is a systemic disease. Pts with peripheral arterial dz have a 3-5 times greater risk of cardiovascular ischemic events

A

Atherosclerosis

126
Q

Data from ______________ and _________ studies suggest thatcarotid artery stenosis with a residual luminal diameter of 1.5 mm (70–75% stenosis)represents significant stenosis. If collateral cerebral blood flow is notadequate, TIAs and ischemic infarction can occur

A

transcranial doppler and carotid duplex ultrasound

127
Q

_____________ may be observed frequently during and after carotid endarterectomy

A
  • Both hypertension and hypotension
128
Q

__________ is typically caused by cardiogenic embolism. Emboli may arise from a thrombus in the left ventricle that develops because of MI or dilated cardiomyopathy

A

Acute arterial occlusion

129
Q

Other cardiac causes of systemic emboli are _________

A

valvular heart disease, prosthetic heart valves, infective endocarditis, left atrial myxoma, Afib, and atheroemboli

130
Q
  • __________is an inflammatory vasculitis leading to occlusion of small and medium-sized arteries and veins in the extremities
A

Thromboangiitis obliterans

131
Q

Pts at low risk for DVT require minimal prophylactic measures such as

A

early postop ambulation and compression stockings

132
Q

The risk of DVT may be much ______ in patients >40 y/o who are undergoing surgery >1 hour, especially LE orthopedic, pelvic or abdominal surgery, and surgeries that require a prolonged bed rest or limited mobility

A

higher

133
Q

Endovascular repair of aortic lesions is a relatively new technique with significant improvements in perioperative mortality

A

t/f

134
Q

Aortic Dissection patho

A

Dissection: Tear in intimal layer of the vessel, causingblood to enter the medial layer

135
Q

__________procedures have emerged as alternative, less invasive methods of arterial repair

A

Endovascular arterial

136
Q

Ascending dissection: Catastrophic, requiresemergent surgical intervention

A

Stanford A, Debakey 1 & 2
Mortality increases by 1-2% per hr
Overall mortality 27-58%

137
Q

Aortic Dissection S/S

A

Sx: Severe sharp pain in posterior chest or back

138
Q

Aortic Dissection
Stable Versus Unstable Diagnosis

A

Diagnosis:
Stable= CT, CXR, MRI, Angiogram
Unstable=Echocardiogram

139
Q

Stanford A Dissection

A

Ascending aorta: All patients with acute dissection involving the ascending aorta should be considered candidates for surgery
The most commonly performed procedures:
ascending aorta & aortic valve replacement w/a composite graft
replacement of the ascending aorta and resuspension of the aortic valve

140
Q

Stanford A Dissection

A

Aortic Arch: in patients with acute aortic arch dissection, resection of the aortic arch isindicated. Surgery requires cardiopulmonary bypass, profound hypothermia, and aperiod of circulatoryarrest
With current techniques, a period of circulatory arrest of 30-40 minutes at a bodytemperature of 15-18°C can be tolerated by mostpatients
Neurologic deficits are the major complications associated with replacement of theaorticarch
These occur in 3-18% of pts, and it appears that selective antegrade cerebral perfusiondecreases but does notcompletely eliminatethe morbidity and mortality associated with thisprocedure.

141
Q

Stanford B Dissection

A

Descending thoracic Aorta: Pts with an acute, but uncomplicated type B aortic dissection who have normal hemodynamics, no periaortic hematoma, and no branch vessel involvement can be treated with medical therapy
Medical therapy consists of:
 1) intraarterial monitoring of SBP and UOP
 2) drugs to control BP and the force of LV contraction (BBs, Cardene, SNP)
This patient population has an in-hospital mortality rate of 10%
The long-term survival rate with medical therapy only is 60-80% at 5 years and 40-50% at 10 years

Surgery is indicated for patients with type B aortic dissection who have signs of impending rupture (persistent pain, hypotension, left-sided hemothorax); ischemia of the legs, abdominal viscera, spinal cord, and/or renal failure
Surgical treatment of distal aortic dissection is associated with a 29% in-hospital mortality rate

142
Q

_____ arch dissections- emergent surgery

A

Ascending

143
Q

Descending arch dissections- rarely treated with urgent surgery

A

Uncomplicated type B → often admitted for BP control (SA BBs preferred, Aline)

144
Q

Impending rupture of type b dissection

A

Sx of impending rupture (posterior pain, HoTN, hemothorax)→surgical tx

145
Q

Aortic Dissection Risk Factore

A

Risk Factors: HTN, atherosclerosis, aneurysms, fam hx, cocaine use, & inflammatory diseases

146
Q

Aortic Dissection Inherited Disorders

A

Marfans, Ehlers Danlos, Bicuspid Aortic Valve, non-syndrome familial hx

147
Q

Causes of Dissection

A

Causes of dissection: blunt trauma, cocaine, iatrogenic (c/b medical treatment)

148
Q

Dissection - Iatrogenic causes

A

Iatrogenic causes related to: cardiac catheterization, aortic manipulation, cross-clamping & arterial incision

149
Q

Dissection is more common in

A

in men and pregnant women in 3rd trimester

Health Assessment M (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions