Vascular Disease (Exam III) Stephen's Cards Flashcards
What are some coexisting diseases that are commonly seen in vascular surgery patients? Which 3 are the MOST common?
- CAD - 40-80% of vasc patient have this
- HTN- (most common)
- Diabetes- (most common)
- Smokers- (most common)
- CNS atherosclerosis
- Renal
What percentage of vascular surg patients will have an MI postop that results in death?
50% (not in the acute phase though)
If the surgical site has sclerosis what should we assume?
That other areas are sclerotic as well
What are the risk factors for vascular disease?
- Diabetes mellitus
- Dyslipidemia
- Family history
- Hypertension
- Obesity
- Older age: 75 y/o and up
- Smoking (2x)
What is the most common occlusive disease in the lower extremity arteries?
Atherosclerosis
What are three pathophysiologic processes that affect arteries?
- Plaque formation
- Thrombosis
- Aneurysm formation
What are 4 s/s are associated with peripheral occlusive disease?
- Claudication
- Ulcerations
- Gangrene
- Impotence
What are two common causes of vascular aneurysm?
- HTN
- Vascular damage
If a patient is on erectile dysfunction drugs what should we assume?
- That vascular disease is everywhere in the body → thats why they have impotence
What is the treatment for peripheral occlusive disease?
- Pharmacologic therapy OR;
- Transluminal angioplasty;
- Endarterectomy;
- Thrombectomies;
- Multiple bypass procedures
In a patient with vascular disease what other issues should we be sure to evaluate in preop? Why does it matter?
- CAD
- pulm dysfunction
- renal dysfunction
- neuro dysfunction
- endocrine dysfunction
- Matters d/t disease process not being limited to arterial beds in periphery → its everywhere
What is the primary goal for invasive monitoring of a vascular surg patient?
To detect cardiac problems; a-line might be necessary
What monitoring should we consider for a vascular surg patient?
Arterial line, PA cath, and TEE are all warranted for assessing CV function
Why are spinals and epidurals controversial for peripheral vascular surgery?
The patients are typically on anticoagulants
When doing bypass grafting on upper/lower extremities for occlusive disease or aneurysms what are some viable anesthesia options?
- General;
- Regional
What causes intermittent claudication?
- When O₂ demand exceeds supply
What is “Rest Pain”?
- Rest pain is a constant burning pain from wounds that won’t heal.
What can improve “Rest Pain”?
- ↑ hydrostatic pressure
- Albumin
What are some S/Sx of intermittent claudication?
- ↓ or absent pulses
- Bruits in abdoment pelvis inguinal area (remember clots often happen at bifurcations)
If a patient presents with hair loss on their lower extremities what should you think of?
- Peripheral vascular disease causes subq atrophy and hair loss
What are the three classifications of the Ankle-brachial index?
If ABI is:
- < 0.9 claudication
- < 0.4 rest pain
- < 0.25 impending gangrene
What is the ankle-brachial index (ABI)? How do we calculate it?
- the ratio of the BP at ankle to BP in upper arm
- Ankle SBP / Arm SBP
If the BP in the leg is lower than BP in the arm what does that tell us?
- ↓ leg BP indicates blocked arteries d/t PAD
What are some treatment options for PVD?
- Exercise;
- Stop smoking;
- Treat HTN CAD DM;
- β-antagonists MAYBE → If someone has demand ischemia Beta blockers can reduce peripheral perfusion;
- ↓ lipids;
- Revascularization vs amputation
When might revascularization for PVD be considered?
- Disabling claudication
- Ischemic rest pain
- Impending limb loss
What are the main components of the revascularization procedure?
- Angioplasty;
- May stent may not;
- Iliac and femoral/popliteal arteries common
What are some anesthesia concerns with revascularization cases?
- patients prob too sick to do surgical CAD → need pharmacological stress test;
- is patient on β blockers preop?;
- Vessels often harvested from other areas of body so regional might be tricky;
- Patient will be anticoagulated → more bleeding
What is the 3rd leading cause of death in the U.S.?
- Stroke
What two types of stroke are there and which is the most common?
- Hemorrhagic and Ischemic;
- 87% are ischemic
What is the difference between a TIA and a Stroke?
- TIA always caused by temporary ischemia never bleeding. Stroke can be bleeding or ischemia
If a patient suffered a TIA, what would you expect to occur soon?
- impending stroke
How strong is the correlation between TIA and impending stroke?
- 10x more likely than age/sex matched
What are risk factors for stroke?
- Age;
- Atrial fibrillation;
- Black race;
- History/family history;
- HTN/smoking/diabetes;
- Hypercholesterolemia;
- Male;
- Obesity;
- Sickle cell disease
What are some ways we might diagnose a stroke?
- Angiography;
- Carotid bruit;
- Carotid stenosis;
- Sudden neurological deficits
Where does carotid stenosis most often occur?
Carotid bifurcation
How do we treat an acute ischemic stroke?
- TPA within 3-5 hrs (NNT=10 →https://www.thennt.com/thennt-explained/);
- Intra-arterial thrombolysis