Vascular Diseases 2025 (Exam 4)

Question 1

3 main arterial pathologies

Answer 1

Aneurysms
Dissections
Occlusions

Question 2

Peripheral arteries are more likely to be effected by which main pathology?

Answer 2

Occlusions

POA

Question 3

When is surgery indicated for aortic aneurysms?

Answer 3

Surgery is indicated at > 5.5 cm in diameter
Growth > 10 mm/year
Family history of dissection

Question 4

Which diagnostic is fastest/safest for suspected aortic dissection with aortic anurysm if unstable?

Answer 4

Doppler echocardiogram

Question 5

Symptoms of aortic dissection

Answer 5

Severe sharp pain in posterior chest or back

Question 6

Ascending aortic Dissections are what classification?

Answer 6

Stanford A & Debakey 1 & 2

Question 7

Ascending aortic aneurysms are what classification?

Answer 7

None.
Only Dissections have classifications

Question 8

Goals for medically managing aortic aneurysm aim to

Answer 8

↓expansion rate

Manage BP, cholesterol, stop smoking

Question 9

What temp and time for circulatory arrest is tolerated by most patients for ascending dissection repair?

Answer 9

15-18 C for 30-40 minutes

Question 10

What is a major complication associated with aortic arch replacement surgery?

Answer 10

Neurological deficit (3-18%)

Question 11

What is medical therapy for Stanford B (Descending) dissection? (3)

Answer 11

1. Arterial monitoring of SBP and UOP
2. Drugs to decrease BP
3. Drugs to decrease force of LV contraction
   (BB, Cardene, SNP)

Question 12

What type of dissection is catastrophic and emergent, requiring emergent surgical intervention

Answer 12

Ascending aortic dissection (Stanford A, Debakey 1 & 2)

Question 13

Surgery is indicated for pts with ____ dissection with signs of ____ ____. These signs include:

Answer 13

Surgery is indicated for pts with Type B dissection with signs of impending rupture.

Persistant pain
hypotension
left-sided hemothorax

Question 14

Signs of impending rupture with Descending aortic arch dissection:

If seen what is done?

Answer 14

Posterior pain
hypotension
hemothorax

Surgical treatment

Question 15

Aortic Dissection is more commonly seen in who?

Answer 15

Men
Women in the 3rd trimester of pregnancy

Question 16

What are the triad of symptoms seen in aortic aneurysm rupture in about 50% of cases?

Answer 16

Hypotension
Back pain
Pulsatile abdominal mass

Question 17

Most abdominal aortic aneurysms rupture into which space?

Answer 17

Left Retroperitoneum

Question 18

What should be done if retroperitoneal tamponade occurs?

Answer 18

Euvolemic resuscitation should be delayed until the rupture is controlled surgically.

Question 19

What could happen if volume resuscitation is given to a pt with a retroperitoneal tamponade?

Answer 19

Further bleeding
hypotension
death

Question 20

What are 4 primary causes of mortality related to surgeries of the thoracic aorta?

Answer 20

• MI
• Respiratory failure
• Renal failure
• Stroke

Question 21

What 2 things may preclude a patient from aortic resection?

Answer 21

Low FEV1 and Renal failure (bad outcomes)

Question 22

What is a predictor of post aortic surgery respiratory failure?
What interventions could help to avoid this?

Answer 22

Smoking/COPD
- Consider bronchodilators, ABX, and chest physiotherapy

Question 23

What is the most significant indicator of post-aortic surgery renal failure?
How can this be avoided?

Answer 23

Preop Renal Dysfunction

Preoperatively hydrate
Avoid hypovolemia & low CO
Avoid nephrotoxins

Question 24

The ASA perfuses the ______ ____ of the spinal cord

Answer 24

Anterior 2/3

Question 25

ASA ischemia leads to: (3)

Answer 25

1. Loss of function below the infarct 2. Diminished pain and temperature sensation below the infarct 3. Autonomic Dysfunction - (Hypotension and bowel/bladder problems)

Question 26

What are 4 causes of ASA syndrome?

Answer 26

1. Aortic aneurysm 2. Aortic Dissection 3. Atherosclerosis 4. Trauma

Question 27

AHA recommends TPA within ____ hrs of symptom onset of a CVA

Answer 27

4.5 hrs of symptom onset

Question 28

CEA is indicated for carotid stenosis when lumen diameter is _____ mm or > _____ % blockage

Answer 28

CEA when diameter 1.5 mm or > 70% blockage (benefits outweigh risks)

Question 29

CEA preop eval should include:

Answer 29

Neurologic evaluation: **establish preop deficits** Post-CVA weakness aphasia disorientation

Question 30

CPP =

Answer 30

MAP - ICP

Question 31

Cerebral O2 consumption is effected by:

Answer 31

1. Temperature 2. Depth of anesthesia

Question 32

Peripheral artery disease (compromised blood flow to extremities) is defined by ankle-brachial index (ABI) < ___?

Answer 32

ABI < 0.9

Question 33

PAD pt. have relief when doing what?

Answer 33

When hanging LE over the side of the bed (increased hydrostatic pressure)

Question 34

Common causes of acute peripheral artery occlusion are (2)

Answer 34

1. LA thrombus d/t A-Fib 2. LV Thrombus due to cardiomyopathy after MI

Question 35

Sublcavian steal syndrome is characterized by:

Answer 35

Occluded Subclavian artery proximal to the vertebral artery

Question 36

What does SC steal syndrome cause?

Answer 36

Vertebral artery blood flow to be diverted away from brain stem

Question 37

If you have right SC steal syndrome, the ____ arm will have SBP ____ mmHg lower

Answer 37

Right arm; 20 mmHg lower

Question 38

A symptom of SC steal syndrome:

Answer 38

Bruit heard over SCA

Question 39

Raynaud's Phenomenon may appear with ____

Answer 39

CREST Syndrome **(scleroderma subtype)** Scleroderma and vasculitis

Question 40

What is Virchow’s triad?

Answer 40

3 Factors that predispose pts to venous thrombosis (VHD) -Venous stasis -Hypercoagulability -Disrupted vascular endothelium

Question 41

Risk factors for DVT? (5)

Answer 41

1. Age > 40 2. Surgery over 1 hour 3. Cancer 4. Ortho surgery on pelvis and LE 5. Abdominal surgery

Question 42

What are prophylactic intervention for DVT?

Answer 42

1. compression stocking 2. SCD 3. SQ heparin 2-3x per day

Question 43

What are LMWH advantages over unfractionated heparin? (4)

Answer 43

1. Longer half-life 2. More predictable dose-response 3. No serial aPTT assessment 4. Less bleeding risk

Question 44

Large-artery Vasculitis includes

Answer 44

- Takayasu Arteritis - in neck - Temporal (giant cell) Arteritis - head and neck

Question 45

Medium-small artery Vasculitis includes

Answer 45

- **Thromboangiitis Obliterans** --> BUERGER - Wegener Granulomatosis - **Polyarteritis Nodosa**

Question 46

Treatment for Temporal arteritis

Answer 46

Corticosteroids for visual symptoms and to prevent blindness (might need stress-dosing)

Question 47

Thromboangiitis Obliterans is an autoimmune response triggered by ____ with ____ use being the most predisposing factor in men < 45 years

Answer 47

Nicotine; **Tobacco**

Question 48

5 diagnostic criteria for Thromboangiitis Obliterans

Answer 48

1. Hx of smoking 2. Onset before 50 3. Infrapopliteal arterial occlusive disease 4. Upper limb involvement 5. Absence of risk factors for atherosclerosis (outside of tobacco)

Question 49

S/s of Thromboangiitis Obliterans (4)

Answer 49

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

Question 50

Inflammation of the small/medium vessels leading to glomerulonephritis, myocardial ischemia, peripheral neuropathy and seizures is?

Answer 50

Polyarteritis Nodosa

Question 51

What is the primary cause of death in Polyarteritis Nodosa

Answer 51

Renal failure (HTN results in renal disease)

Question 52

Contraindications for ablation of chronic venous disease (5)

Answer 52

1. **Pregnancy** 2. Thrombosis 3. PAD 4. Limited mobility 5. Congenital venous abnormalities