Vascular Flashcards
MC congenital hypercoagulable disorder
Factor 5 Leiden – resistance to activated protein C
MC acquired hypercoagulable disorder
Smoking
Stages of atherosclerosis
Foam cells (macrophages that have absorbed fat and lipids), smooth muscle proliferation, intimal disruption
MC risk factor for CVA
HTN
MC stie of stenosis in carotid
Bifurcation
T/F ICA has continuous forward flow
True
T/F ECA has triphasic flow
True
First branch of ICA
Opthalmic artery
First branch of ECA
S. thyroid a.
Most commonly diseased intracranial artery
MCA
Cerebral ischemic events are most likely 2/2
arterial embolization from ICA (not thrombosis); can occur through low flow state
Most common second source of emboli in CVA
Heart
ACA/MCA/PCA events
ACA: AMS, release, slowing
MCA: Contralateral motor/speech, fac droop
PCA: Vertigo, tinnitus, drop attacks, incoordination
Carotid traumatic injury with fixed deficit
If occluded, do not repair
If not occluded, repair – stent or open
When to repair carotid
> 50% & symptomatic
>70% & asymptomatic
Emergent CEA
Fluctuating neurologic symptoms or creschendo/evolving TIA
CEA removes which layers?
Intimaa, media
When to shunt in a CEA
If back pressure < 50 mm Hg or if the contra-lateral side is tight or occluded
Most common complications from CEA
Vagus n. injury; hypoglossal, glossopharyngeal, ansa
Acute event after CAE
Back to IR for flap/thrombosis check
Pseudo-aneurysm CEA
Pulsatile, bleeding mass after CAE; drape/prep, intubate, repair
Hypertension following CEA is 2/2
Injury to carotid body; use nipride
MC cause of non-stroke morbidity and mortality following CAE
MI
Innominate artery is on L or R
R
Indications for repair of ascending aortic aneurysm
Compression of vert – back pain, RLN, bronchi, esophagus
- Acutely symptomatic, > 5.5cm (>5 Marfan’s), rapid increase in size > 0.5cm/year
When to repair TAA
Endo: > 5.5 cm; open > 6.5cm
Risk of mortality open TAA repair
20% mort/paraplegia
T/F Aortic dissecion can mimic MI
True
95% of people with Type A HTN have severe HTN at presentation
True
Which layer does dissection occur in blood vessel wall?
Medial
Initial treatment of Type A dissection
Esmolol, Nipride
When to operate on descending aortic dissections
visceral, extremity ischemia, contained rupute
Paraplegia following TAA repair
SC ischemia 2/2 occlusion of intercostal arteries and A. of Adamkiewicz
Diagnosis of aortic aneurysm rupture
CTA
Where is the aorta most likely to rupture?
Left postero-lateral wall, 2-4 cm below the renals
Indications for AAA repair
> 5.5 cm for average male; > 5 cm for women, or those with high risk
1 cm/year; symptomatic; infected; EVAR»_space; surgery for high risk
Major venous injury with proximal cross-clamp of aorta
Retro-aortic L renal vein
Mortality of elective AAA repair
5%
1 cause of acute death after AAA repair
MI
1 cause of late death after AAA repair
Renal failure
1, 2, 3 bugs that infect aortic grafts
Staph epi; Staph aureus, E. coli
