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Vascular Flashcards

1
Q

What are the three main arterial pathologies?

A

Aneurysms, dissections, occlusions

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2
Q

Which part of the vascular system is more likely to be affected by aneurysms and dissections?

A

Aorta and its branches

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3
Q

What part of the vascular system is affected by occlusions?

A

Peripheral arteries

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4
Q

What is an aortic aneurysm?

A

Dilation of all 3 layers of artery, leading to a >50% increase in diameter

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5
Q

What is the initial treatment for an aortic aneurysm?

A

Medical management

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6
Q

What causes symptoms due to aortic aneurysms?

A

Compression of surrounding structures

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7
Q

At what diameter is surgery indicated for an aortic aneurysm?

A

> 5.5 cm diameter
- Surgery is also indicated with growth >10 mm/yr or family history of dissection

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8
Q

What is the mortality rate associated with aortic aneurysm rupture?

A

75%

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9
Q

What are the two types of aortic aneurysms?

A
  • Saccular
  • Fusiform
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10
Q

What is the difference between saccular and fusiform?

A
  • Saccular: outpouching bulge to one side
  • Fusiform: Uniform circumferential dilation
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11
Q

What are the symptoms of aortic aneurysms?

A

Asymptomatic or pain due to surrounding compression

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12
Q

What diagnostic tools are used for aortic aneurysms?

A
  • CT
  • MRI
  • CXR
  • Angiogram
  • Echocardiogram
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13
Q

What is the fastest/safest measure to diagnose a suspected dissection?

A

Doppler echocardiogram

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14
Q

What is the main goal of medical management for aortic aneurysms?

A

To decrease expansion rate

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15
Q

What procedure is done for aortic aneurysms?

A

Endovascular stent repair

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16
Q

What are common symptoms of an aortic dissection?

A

Severe, sharp pain in posterior chest or back

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17
Q

What is the classification system for aortic dissections?

A

Stanford Class A, B and DeBakey Class 1, 2, 3

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18
Q

What is a dissection?

A

Tear in the intimal layer of the vessel, causing blood to enter the medial layer

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19
Q

What type of dissection is classified as Stanford A?

A

Ascending aorta involved

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20
Q

What is indicated for Stanford A dissection if the aortic arch is involved?

A

Surgical resection

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21
Q

Stanford B?

A

Descending aorta involved

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22
Q

DeBakey 1?

A

Ascending and descending aorta

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23
Q

DeBakey 2?

A

Ascending aorta

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24
Q

DeBakey 3?

A

Descending aorta

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25
Q

Is Stanford A or B a medical emergency?

A

Stanford A

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26
Q

What is required after aortic arch surgical resection?

A
  • Cardiopulmonary bypass
  • Hypothermia
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27
Q

What is a major complication of aortic arch replacement?

A

Neurologic deficit

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28
Q

What is the in-hospital mortality rate for type B aortic dissections treated medically?

A

10%

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29
Q

What are the risk factors for aortic dissections?

A
  • HTN
  • Atherosclerosis
  • Aneurysms
  • Family history
  • Cocaine use
  • Inflammatory diseases
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30
Q

What is a common triad of symptoms seen in aortic aneurysm rupture?

A
  • Hypotension
  • Back pain
  • Pulsatile abdominal mass
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31
Q

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

A

Preoperative renal dysfunction

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32
Q

What syndrome is caused by lack of blood flow to the anterior spinal artery?

A

Anterior Spinal Artery Syndrome

33
Q

What are the consequences of ischemia in the anterior spinal artery?

A
  • Loss of motor function below the infarct
  • Diminished pain and temperature sensation below the infarct
  • Autonomic dysfunction
34
Q

What percentage of CVAs are ischemic?

35
Q

What is a TIA?

A

Temporary, self-limited ischemia with symptoms resolving within 24 hours

36
Q

What is the first leading cause of disability in the US?

37
Q

What is the preferred surgical treatment for severe carotid stenosis?

A

Carotid Endarterectomy (CEA)

38
Q

What is Virchow’s Triad?

A
  • Venous stasis
  • Disrupted vascular endothelium
  • Hypercoagulability
39
Q

What are common symptoms of Peripheral Artery Disease (PAD)?

A
  • Intermittent claudication
  • Resting extremity pain
  • Weak pulses
  • Subcutaneous atrophy
  • Hair loss
  • Coolness
  • Cyanosis
40
Q

What is the ankle-brachial index (ABI) threshold for defining PAD?

41
Q

What are common causes of acute peripheral artery occlusion?

A
  • Cardiogenic embolism
  • Left atrial thrombus due to A-fib
  • Left ventricular thrombus due to cardiomyopathy after MI
42
Q

What is Subclavian Steal Syndrome?

A

Occlusion of the subclavian artery proximal to the vertebral artery causing diversion of flow

43
Q

What is Raynaud’s Phenomenon?

A

Episodic vasospastic ischemia of the digits

44
Q

What are the signs of Deep Vein Thrombosis (DVT)?

A
  • Extremity pain
  • Swelling
45
Q

What is the treatment for DVT?

A
  • Anticoagulation
  • Warfarin + Heparin or LMWH
46
Q

What is the purpose of prophylactic measures for DVT?

A

To prevent venous thromboembolism

47
Q

What is the common diagnostic tool for assessing arterial stenosis in PAD?

A

Doppler U/S

48
Q

What are the advantages of LMWH over unfractionated heparin?

A
  • Longer half-life
  • More predictable dose response
  • Doesn’t require serial assessment of aPTT
49
Q

What are the advantages of LMWH over unfractionated heparin?

A

Longer half-life, more predictable dose response, doesn’t require serial assessment of aPTT, less risk of bleeding

LMWH stands for Low Molecular Weight Heparin.

50
Q

What are the disadvantages of LMWH?

A

Higher cost, lack of reversal agent

LMWH stands for Low Molecular Weight Heparin.

51
Q

What is the therapeutic INR range for Warfarin?

A

2-3

Warfarin is a vitamin K antagonist.

52
Q

When is Heparin discontinued in the treatment of Warfarin?

A

When Warfarin achieves therapeutic effect

Warfarin is typically initiated during heparin treatment.

53
Q

What is an IVC filter indicated for?

A

Recurrent PE or contraindication to anticoagulants

54
Q

What is systemic vasculitis?

A

Group of vascular inflammatory diseases categorized by the size of the vessels at the primary site of the abnormality

55
Q

Name two examples of large-artery vasculitis.

A
  • Takayasu arteritis
  • Temporal (giant cell) arteritis
56
Q

Which disease usually affects the coronary arteries and is classified as medium-artery vasculitis?

A

Kawasaki disease

57
Q

What are some examples of medium to small-artery vasculitis?

A
  • Thromboangiitis obliterans
  • Wegener granulomatosis
  • Polyarteritis nodosa
58
Q

What are the symptoms of Temporal (Giant Cell) Arteritis?

A
  • Unilateral headache
  • Scalp tenderness
  • Jaw claudication
59
Q

What can ophthalmic arterial branches lead to in Temporal Arteritis?

A

Ischemic optic neuritis and unilateral blindness

60
Q

What is the diagnosis for Temporal Arteritis?

A

Biopsy of temporal artery shows arteritis in 90% of patients

61
Q

What is the treatment for Temporal Arteritis when visual symptoms are present?

A

Corticosteroids indicated to prevent blindness

62
Q

What is Thromboangiitis Obliterans also known as?

A

Buerger Disease

63
Q

What is a major trigger for Thromboangiitis Obliterans?

A

Autoimmune response triggered by nicotine

64
Q

What are the five diagnostic criteria for Thromboangiitis Obliterans?

A
  • History of smoking
  • Onset before 50
  • Infrapopliteal arterial occlusive disease
  • Upper limb involvement
  • Absence of risk factors for atherosclerosis (outside of tobacco)
65
Q

What symptoms are associated with Thromboangiitis Obliterans?

A
  • Forearm, calf, foot claudication
  • Ischemia of hands & feet
  • Ulceration and skin necrosis
  • Raynaud’s is commonly seen
66
Q

What is the most effective treatment for Thromboangiitis Obliterans?

A

Smoking cessation

67
Q

What are the anesthesia implications for patients with Thromboangiitis Obliterans?

A
  • Meticulous positioning/padding
  • Avoid cold; warm the room and use warming devices
  • Prefer non-invasive BP and conservative line placement
68
Q

What conditions can Polyarteritis Nodosa lead to?

A
  • Glomerulonephritis
  • Myocardial ischemia
  • Peripheral neuropathy
  • Seizures
69
Q

What is the primary cause of death in Polyarteritis Nodosa?

A

Renal failure

70
Q

What are the treatment options for Polyarteritis Nodosa?

A
  • Steroids
  • Cyclophosphamide
  • Treating underlying cause (e.g., cancer)
71
Q

What are the implications for anesthesia in patients with Polyarteritis Nodosa?

A
  • Consider coexisting renal disease
  • Cardiac disease
  • Hypertension
  • Steroids likely beneficial
72
Q

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

73
Q

What are mild symptoms of Lower Extremity Chronic Venous Disease?

A
  • Telangiectasias
  • Varicose veins
74
Q

What are severe symptoms of Lower Extremity Chronic Venous Disease?

A
  • Edema
  • Skin changes
  • Ulceration
75
Q

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

A
  • Advanced age
  • Family history
  • Pregnancy
  • Ligamentous laxity
  • Previous venous thrombosis
  • LE injuries
  • Prolonged standing
  • Obesity
  • Smoking
  • Sedentary lifestyle
  • High estrogen levels
76
Q

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

A

Symptoms of leg pain, heaviness, fatigue confirmed by ultrasound showing venous reflux

77
Q

What is the initial treatment for Lower Extremity Chronic Venous Insufficiency?

A
  • Leg elevation
  • Exercise
  • Weight loss
  • Compression therapy
  • Skin barriers/emollients
  • Steroids
  • Wound management
78
Q

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

A
  • Diuretics
  • Aspirin
  • Antibiotics
  • Prostacyclin analogues
  • Zinc sulphate
79
Q

What surgical interventions may be performed for Lower Extremity Chronic Venous Disease?

A
  • Saphenous vein inversion
  • High saphenous ligation
  • Ambulatory phlebectomy
  • Transilluminated-powered phlebectomy
  • Venous ligation
  • Perforator ligation

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