Vascular Anesthesia

Question 1

Why are vascular surgeries so high-risk?

Answer 1

• Often have overt or occult CAD
  
  • <10% of vascular surgery pts have normal coronary arteries
• CAD is leading cause of perioperative and long-term mortality after vascular surgery
  
  • nearly 10% have significant mycardial injury in perioperative period
  • 2% with MACE (major adverse cardiac events)

Question 2

What are the definitions of MACE?

Answer 2

• Narrowly: nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death
• Broader: CVD events, admission for HF, ischemic cardiovascular events, cardiac death

Question 3

Review of the anatomy off the aortic arch

Answer 3

Question 4

How is plaque formed?

Answer 4

• Stage 1:
  
  • Endothelium is damaged d/t hemodynamic shear stress, oxidized LDL desctuction, chronic inflammatory response, infection….
  • Lipoproteins enter the arterial intimal layer via endothelium and become trapped.
    
    • this promotes inflammation
    • macrophages become lipid laden and turn to foam cells
• Stage 2:
  
  • Fibrous plaque forms from lipid accumulation, inflammatory cells, proliferated smooth muscle, and calcium deposits
  • blood flow reduced, thrombus risk
• Stage 3: Advanced lesion
  
  • Plaque with lipid rich necrotic core is at high risk of rupturing and releasing thrombus
  • complete occlusion possible