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Health Assessment > Vascular Disease Ex 3 > Flashcards

Vascular Disease Ex 3 Flashcards

1
Q

What is an aortic aneurysm?
When is surgery indicated?

A

Dilation of all 3 layers of artery leading to >50% inc in diameter.
Sx indicated at >5.5 cm diamer

Rupture associated w 75% mortality rate

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2
Q

Describe the 2 types of aneurysm (fusiform and sacular)?
What are the symptoms

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

s/s: Asymptomatic or pain d/t surrounding compression

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3
Q

Treatment for Aortic aneurysm?

A

Surgery indicated if >5.5 diameter, growth >10 mm a year, family history of dissection.
-medical managment to limit expansion, manage BP, cholesterol, stop smoking!
-endovascular stent repair > open surgery

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4
Q

What is aortic dissection?

What type of dissection requires emergency treatment?

A

-tear in intimal layer of vessel, causing blood to enter medial layer.

-Ascending dissection (standford A, debakey 1 &2) requires emergent surgical intervention! mortality >1-2% per hr, mortality 27-58%.

s/s severe sharp back pain

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5
Q

What is the most common procedures for Standard A dissection?

A
  • ascending aorta & aortic valve replacement w/a composite graft
  • replacement of the ascending aorta and resuspension of the aortic valve

standford A = ascending aorta

Aortic arch surgery requires bypass, hypothermia and a period of circulatory arrest

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6
Q

What deficits are common w replacement of aortic arch?

A

Neurological deficits :( ~3-18% pts
Selective antegrade cerebral perfusion decreases the morbidity and mortality risk

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7
Q

Standard B dissection affects what part of the aorta?

A
  • aka debakey III.
    Descending thoracic Aorta: acute, but uncomplicated type B aortic dissection w normal hemodynamics, no periaortic hematoma, and no branch vessel involvement. Can be treated with medical therapy :)
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8
Q

What is the medical therapy for descending thoracic aorta (type b)

A
  1. SBP arterial monitoring and UOP monitoring
  2. drugs to control BP and force of LV contraction (BB, Cardene, nitroprusside)

Rarely requires urgent surgery

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9
Q

Surgery is indicated for patients with type B dissection who have impending signs of rupture. What are the signs?

A

impending rupture: persistent pain, hypotension, left-sided hemothorax
other symptoms that call for surgery: ischemia of the legs, abdominal viscera, spinal cord, and/or renal failure

Has 29% in hospital mortality rate

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10
Q

Rish factors for aortic
dissections??

Inherited disorder risk factors??

A

HTN, aneurysms, fam hx, cocaine use, & inflammatory diseases

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

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11
Q

What are some causes of dissection?

A

-Causes of dissection: blunt trauma, cocaine, iatrogenic (c/b medical treatment)
-Iatrogenic causes related to: cardiac catheterization, aortic manipulation, cross-clamping & arterial incision

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12
Q

Dissection common in ____ and _____

A

men and preggo women in 3rd trimester

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13
Q

What are triad of symptoms in 1/2 cases of AA rupture?

Most aneurysms rupture into the ____

A

hypotension, back pain, pulsatile mass

left retroperitoneum

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14
Q

Euvolemic resuscitation may be deferred until rupture is surgically controled bc euvolemic resuscitation and the increase in BP without control of bleeding may lead to loss of ___, ____ , ____, ___

A

retroperitoneal tamponade, further bleeding, hypotension, and death

Unstable patients w suspected AAA require operation without preop testing or volume rescusitation!

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15
Q

What are 4 causes of mortality of thoracic aorta surgery?

Ischemic heart dx may require ____ before ____

A

MI, respiratory failure, renal failure and stroke

Ischemic heart diagnosis may require intervention prior to surgery

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16
Q

Severe reduction in ____ or ____ may preclude a pt from AAA resection.

What are 2 predictors of postaortic surgery respiratory failure?

A

FEV1 or renal failure!

Smoking and COPD

PFT and ABG to define risk

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17
Q

What interventions to take for renal protection?

What to get if pt has hx of stroke/tia

A

preop hydration, avoid hypovolemia/ hypotension and low CO, and avoid nephrotoxic drugs

Carotid US and angiogram of braciocephalic and intracranial arteries

carotid endarectomy workup before elective surgery if severe stenosis!

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18
Q

Ichemia to anterior spinal artery syndrome leads to what 3 things?

Anterior spinal artery responsible for anterior 2/3 of spinal cord

A
  • loss motor function below the infarct
  • diminished pain and temperature sensation below the infarct
  • antonomic dysfunction leading to hypotension and loss of bowel & bladder function
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19
Q

Why is anterior spinal artery the most common form of spinal cord ischemia?

A

Bc it has minimal collateral perfusion
Posterior spinal cord is perfused by 2 posterior spinal arteries! So it has better collateral circulation

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20
Q

What are 4 common causes of anterior spinal artery syndrome?

A

Aortic aneurysms, aortic dissection, atherosclerosis, trauma

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21
Q

TIA symptoms resolve within ____.

What is a prominent predictor of CVA?

A

24 hours

Carotid disease

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22
Q

Carotid disease testing

Angiography can diagnose what ?
CT/ MRI may identify ___ and ____

A
  • Angiography- can diagnose vascular occlusion
  • CT & MRI- less invasive, may also identify aneurysms and AVMs
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23
Q

Transcranial doppler US may give indirect evidence of:

Carotid auscultation may help identify

Carotid U/S may quantify degree of

A

vascular occlusion w real time bedside monitoring

bruits

carotid stenosis

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24
Q

What is the treatment for CVA?

A

IR: thrombolysis (tpa within 4.5 hr) thrombectomy
Carotid endarterectomy (for severe >70% blockage)
Carotid stenting *has major risk for microembolization (CVA)

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25
Q

What is the medical treatment for CVA? (5)

AHA recommends TPA within

A

-antiplatelet tx, smoking cessation, BP control, cholesterol control, diet and phyical activity

4.5 hr

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26
Q

During carotid endarecotmy,
maintain _____ through stenotic vessels (especially during cross clamping)

A

Maintain collateral blood flow!

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27
Q

Extreme head rotation/flexion during CEA may ____ contralateral artery flow.
Cerebral oximetry devices may be useful in determining ___ ____

A

compress

cerebral perfusion

28
Q

Cerebral O2 consumption is affected by: (2)

Cerebral oxygenation affected by: (5)

A

temperature and anesthesia!

Oxygenation affected by MAP, CO, SaO2, HGB, PaCO2

29
Q

What is peripheral artery disease defined by?

A

Ankle branchial index <0.9
ABI= ratio of SBP at ankle/ SBP at brachial artery

30
Q

PAD

Common cause of acute occlusion?

Common cause of chronic hypo perfusion?

A

acute: embolism

Chronic: atherosclerosis

atherosclerosis is systemic! they have 3-5x risk of and CVA

31
Q

How is PAD diagnosed (4) ?

A

-doppler u/s: provides pulse volume waveform, identifies arterial stenosis
-duplex u/s: identifies areas of plaque & calcification
-transcutanous oximetry: assesses severity of tissue ischemia
-MRI w contast: guides endo intervention & surgical bypass

32
Q

S/S of PAD

A
  • Intermittent claudication
  • Resting extremity pain
  • Decreased pulses
  • Subcutaneous atrophy
  • Hair loss
  • Coolness
  • Cyanosis
    Relief w hanging extremities over side of the bed to increase hydrostatic pressure
33
Q

What is the treatment for PAD?

A

revascularization indicated w disabling ischemia.
Surgical reconstruction artery bypass procedure
endovascular repair: transluminal angioplasty or stent placement

34
Q

What are s/s of acute artery occlusion?
What are 2 common causes?

A

s/s limb ischemia, pain/parethesia, weakness, diminshed pulses, cool skin, color changes distal to occlusion

L atrial thrombus from a fib and LV thrombus from dilatated cardiomyopathy

35
Q

How is acute attery occlusion diagnosed and what is the treatment?

A

diagnosed with arteriogram.
Treatment: surgical embolectomy, anticoagulation and amputation (last resort)

36
Q

What is subclavian steal syndrome?

What is the treatment?

A

SC steal: occluded subclavian artery, proximal to vertebral artery. Vertebral blood flow is diverted away from brain stem.

Subclavian endarterectomy

37
Q

What are s/s for subclavian steal syndrome?

A

s/s syncope, vertigo, ataxia, hemiplagia, ipsilateral arm ischemia, affected arm
SBP 20 mmHG lower
bruit over SCA

Risk factors: athersclerosis, takayasu arteritis, aortic sx

38
Q

Raynaud’s phenomenon may appear with ___ syndrome

A

CREST

39
Q

PVD

What is virchows triad?

3 major factors that predispose to venous thrombosis

A

Venous stasis, Hypercoagulability, and Disrupted vascular endothelium

40
Q

What are 3 common PVD processes that occur during surgery?

A
  • Superficial thrombophlebitis
  • Deep vein thrombosis
  • Chronic venous insufficiency
41
Q

DVT treatment: AC w/ warfarin + heparin or LMWH

What are advantages for LMWH over unfractionated heparin?

What are 2 disadvantages?

A

longer HL & more predictable dose response
doesn’t require serial assessment of activated partial thromboplastin time
Less risk of bleeding

higher cost and lack of reversal agent

42
Q

DVT treatment

Warfarin is initiated during ____ treatment and adjusted to achieve what levels of INR?

When is heparin d/c?

How long are PO AC continued for

A

heparin, INR between 2-3

Heparin d/c when warfarin achieves therapeutic effect

6 months or longer

IVC filter may be required if AC contraindication! or recurrent PE!

43
Q

What is 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
44
Q

Large artery vasculitis includes:

A

Takayasu arteritis
* Temporal (or giant cell) arteritis

45
Q

Systemic vasculitis can be a feature of connective tissue diseases such as what 2 disorders?

A

Lupus and rheumatoid arthritis

46
Q

Medium artery vasculitis includes:

A
  • Kawasaki disease, which is most prominently the coronary arteries
47
Q

Medium to small artery vasculitis includes: (3)

A
  • thromboangiitis obliterans
  • Wegener granulomatosis
  • polyarteritis nodosa
48
Q

Temporal arteritis is inflammation of which arteries (giant cell)

What are the s/s (3)

A

inflamamtion of arteries of the head and the neck.

s/s unilateral; headache, scalp tenderness, jaw claudication

49
Q

Temporal (giant cell) arteritis

Opthalmic arterial branches may lead to ischemic ____ ______ and unilateral _____

A

ischemic optic neuritis and unilateral blindness

50
Q

What is the treatment of temporal arteritis?

How is it diagnosed

A

Treatment: corticosteroid initiation to prevent blindness!

Dx: biopsy of temporal artery

51
Q

What is thromboangiitis obliterans burger disease?

Tx?

A
  • Inflammatory vasculitis leading to small & medium vessel occlusions in the extremities
  • Autoammune response to nicotine! MEN 45>

surgical revascularizaiton, no effective pharm tx, stop smoking!!

52
Q

Thromboangiitis Obliterans

What are 5 diagnostic criteria for buerger disease

What confirms diagnosis?

A
  • h/o smoking
  • onset before 50
  • infrapopliteal arterial occlusive dz
  • upper limb involvement
  • Absence of risks factors for atherosclerosis (outside of tobacco)

biopsy of vascular lesions

53
Q

S/S of thromboangiitis obliterians disease

A

S/S
* forearm, calf, foot claudication
* Ischemia of hands & feet
* Ulceration and skin necrosis
* Raynaud’s is commonly seen

54
Q

Thromboangiitis Obliterans

What are 3 anesthesia implications for burger disease?

A
  • Meticulous positioning/padding
  • Avoid cold; Warm the room and use warming devices
  • Prefer non-invasive BP and conservative line placement
55
Q

What is polyarteritis nodosa?

What diseases is it associated with ?

Which arteries are involved

A
  • Antineutrophyl cytoplasmic antibody (ANCA) negative vasculitis
  • May be assoc w/ Hep B, Hep C, or Hairy Cell Leukemia

Medium and small arteries!

56
Q

In polyarteritis nodosa, inflammation results in what 4 complications?

What is the treatment?

A
  • Inflammation results in glomerulonephritis, myocardial ischemia, peripheral neuropathy and seizures

Tx: steroids, cyclosphamide, treat cause (Cancer)

anethesia: consider renal disease, cardiac disease and HTN, steroids!

57
Q

Diagnostic criteria for lower extremity chornic disease includes:

A

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

Initially, therapy for lower extremity chornic disease is conservative!

58
Q

What are 4 types of ablation treatment for lower extremity chronic venous disease if medical managment fails?

A

thermal ablation w laser, radiofrequency ablation, endovenous lase ablation and sclerotherapy

59
Q

If medical therapy fails, ablation may be performed

What are the indications for ablation therapy for chronic venous diasease

A

Indications:
* Thrombophlebitis
* Symptomatic venous reflux
* Venous hemorrhage

60
Q

What are some contraindications for chronic venous disease ablation? (5)

A

Pregnancy
Thrombosis
PAD
Limited mobility
Congenital venous abnormalities

61
Q

Surgical intervention for lower extremity chronic venous disease is usually ___ ____.
What are 6 possible procedures?

A

last resort!

  • Saphenous vein inversion
  • High saphenous ligation
  • Ambulatory Phlebectomy
  • Transilluminated-powered phlebectomy
  • Venous ligation
  • Perforator ligation
62
Q

What is the leading cause of mortality in pt undergoing non cardiac surgery?

Data from transcranial doppler and carotid duplex us suggest that carotic stenosis w. 1.5 mm diameter represents _____. What may occur?

A

cardiac complications

significant stenosis! TIA and ischemic infarctions may occur if collateral flow is not adequate

63
Q

What 2 complications are oberved during and after carotid endarectomy?

Acute arterial occlusion is typically caysed by ___ _____

A

hypotension and hypertension.

cardiogenic embolism *arising from LV due to MI or dilated cardiomyopathy

64
Q

The risk of DVT is higher in patients over 40 y/o undergoing what types of surgeries?

Endovascular repair of aortic lesions is a new technique with improvements in ___ _____

A

surgery >1 hour, especially LE orthopedic, pelvic or abdominal surgery, and surgeries that require a prolonged bed rest or limited mobility

Perioperative mortality. They are less invasive :)

65
Q

What’s the best diagnostic tool in case you suspect a aneurysm dissection

A

Doppler echo is safest measure of diagnosing aneurysm

Health Assessment (30 decks)

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