Vascular Disorders Flashcards
1
Q
Name the (3) Main arterial pathologies of Vascular Disease
A
- Aneuysms
- dissections
- occlusion
2
Q
____ and ______ are more likely to be affect by aneurysm and dissections.
A
- Aorta
- Branches
3
Q
______ arteries are more likely to be affect by occlussions.
A
Peripheral
4
Q
________ _________ is defined as a dilation of all 3 layers of artery, leading to > 50% increase in diameter
A
Aortic aneurysm
5
Q
Symptoms of Aortic Aneurysm are due to _________ of surrounding structures.
A
compression of surrounding structures
6
Q
Aortic Aneurysm that is > 5.5 cm diameter needs
A
Surgery
7
Q
What percent (%) mortality is associated with Aortic Aneurysm Rupture
A
75%
8
Q
Name (2) types of Aortic Aneurysms
A
- Fusiform
- Saccular
9
Q
This aortic aneurysm is a uniform dilation along entire circumference of arterial wall.
A
Fusiform
10
Q
This aortic aneurysm is berry-shaped bulge to one side.
A
saccular
11
Q
Aortic Aneurysms can be ________ or _______ d/t surrounding compression.
A
- asymptomatic
- or pain d/t surrounding compression
12
Q
In a suspected dissection, _______ _______ is the fastest/safest measure to obtain a diagnosis of aneurysm.
A
- doppler echocardiogram
13
Q
The Following are treatment for medical management of ______ __________
* Medical management to ↓expansion rate
* Manage BP, Cholesterol, stop smoking
* Avoid strenuous exercise, stimulants, stress
* Regular monitoring for progression
A
Aortic Aneurysm
14
Q
_______ is indicated if an Aortic Aneurysm is > 5.5 cm , growth of 10 mm/year and family history of dissection
A
Surgery
15
Q
_______ ______ ______ has become a mainstay over open surgery w/ graft for Aortic Aneurysms.
A
- Endovascular Stent Repair
16
Q
Aortic ______ is a tear in intimal layer of vessel, causing blood to enter the medial layer.
A
Dissection
17
Q
This type of dissection is catastrophic and requires emergent surgical interentions.
A
Ascending Dissection
18
Q
Name (3) classifications of Ascending Dissection
A
- Stanford A
- Debakey 1 & 2
19
Q
Mortality with Ascending Dissection increased __ - ___% per hour.
A
- 1-2%
20
Q
The overall mortality of an Ascending dissection is
A
27-58%
21
Q
A
22
Q
The classic symptoms of an Aortic Dissection are severe, sharp pain in _______ chest or _______.
A
- posterior chest
- back
23
Q
CT, CXR, MRI and Angiogram are used to diagnose a ____ Aortic Dissection
A
- Stable
24
Q
An Echocardiogram is used to Diagnose an ______ Aortic Dissection
A
Unstable
25
Below are the most common procedure for what type of dissection?
* ascending aorta & aortic valve replacement w/a composite graft
* replacement of the ascending aorta and resuspension of the aortic valve
* Stanford A Dissection: Ascending Aorta
26
All patients with this acute dissection involving the ascending aorta should be considered canditates for surgery.
* Stanford A Dissection: Ascending Aorta
27
In patients with __________: _____ _______ dissection, resection of the aortic arch is indicated. Surgery requires cardiopulmonary bypass, profound hypothermia, and a period of circulatory arrest
* Stanford A Dissection: Aortic Arch
28
For Aortic Dissections, a period of _____ ______ of 30-40 minutes at a body temperature of ___ - ___ degree Celcius can be tolerated by most patients.
* Circulatory arrest
* 15-18 degrees
29
____ ______ are the major complications associated with replacement of aortic arch.
* neurologic deficits
30
Neurologic deficits occur in __ - __ % of patients in aortic arch replacement and it appears that selective _______ cerebral perfusion decreases but does not completely elimiate the mobidity and mortality associated with this procedures.
* 3-18%
* antegrade
31
This type of dissection will have normal hemodynamics, no periaortic hematoma and no branch vessel involvement can be treated with medical therapy.
* Standford B: Descending Thorasic Aorta
32
Medical treatment for this dissection consists of:
1. intraarterial monitoring of SBP and UOP
2. Drugs to control BP and force of LV contraction (BB, Cardene, SNP)
* Stanford B: Descending Thoracic Aorta
33
Stanford B: Descending Thoracic Aorta dissection has an in hospital mortality rate of ___%
10%
34
Long term survival of Stanford B: Descending Thoracic Aorta is ___ - ____% at 5 years and ___ - ___ % at 10 years
* 60-80%
* 40-50%
35
______ is indicated for patients with type B aortic dissection who have signs of impending reupture (persistent pain, Hypotension, Left-side hemothorax); ischemia of legs, abdominal viscera, spinal cord and/or renal failure
Surgery
36
Surgical treatment of distal aortic dissection is associated with ___% in-hospital mortality rate.
29%
37
_____ arch dissections requires emergent surgery
Ascending
38
______ arch dissections are rarely treated with urgent surgery
Descending
39
Uncomplication type __ dissections are often admitted for BP control (SA BB preferred, A-line)
Uncomplicated Type B
40
Posterior Pain, HoTN, and hemothorax are all symptoms of an ______ arch dissection that requires surgical treatment
Descending
41
HTN, artherosclerosis, aneurysms, family history, cocaine use and inflammatory disease are all risk factors for __________ _________.
Aortic Dissections
42
Name (4) inherited disorders that can cause Aortic Dissections
* Marfans
* Ehlers Danlos
* Biscuspid Aortic Valve
* non-syndrome familiar history
43
Name (3) common causes of Aortic Dissections
* blunt trauma
* cocaine
* iatrogenic (medical treatment)
44
Cardiac catherization, aortic manipulation, cross-clamping and arterial incision are all common ____ causes related to Aortic Dissections
Iatrogenic
45
Aortic Dissections are more common in men and _____ women in __ trimester.
* men
* pregnant women in 3rd trimester
46
The triad of symptoms that are experience in 1/2 of all cases of Aortic Aneurysm Rupture are _______, ______ pain and pulsatile _______ mass.
* Hypotension
* Back pain
* pulsatile abdominal mass
47
Most abdominal aortic aneurysms rupture into the _____ _______.
* left retroperitoneum
48
Although ____ shock may be present in an AA Rupture, ________ can be prevented by clotting and the ____ effect in the retroperitoneum.
* hypovolemic
* exsanguination
* tamponade
49
In an AA reputure, _________ _____ may be deferred until the rupture is surgically controlled because it can result in increased blood pressure without control of bleeding may lead to loss of __________ __________, leading to futhering bleeding, hypotension and death.
* Euvolemic resuscitation
* retroperitoneal tamponade
50
Patients in ____ condition who have a suspected ____ abdominal aortic aneurysm require immediate operation without preoperative testing or volume resuscitaion.
* unstable
* ruptured
51
Name the (4) Primary causes of mortality r/t surgeries of thoracic aorta.
* MI
* Respiratory Failure
* Renal Failure
* Stroke
52
Name (3) cardiac conditions assess for before AA Rupture Surgery
* CAD
* Valve dysfunction
* heart Failure
53
____ heart diagnosis may require intervention prior to Aortic Aneurysm Surgery.
ischemic
54
Cardiac evaluation testing such as stress test, ECHO and ____ imaging should be completed before AA surgery.
* radionuclide imaging
55
Severe reduction in ____ or _____ ____ may preclude a patient from AAA resection.
* FEV1
* Renal Failure
56
____ and ____ are predictors of post aortic surgery respiratory failure
* Smoking
* COPD
57
Preop ____ ____ is the most important indicator of post aortic surgery renal failure.
* renal dysfunction
58
You can avoid post-op aortic surgery renal failure through ______ hydration, _____ HoTN, hypovolemia, low CO and avoid _______ drugs
* Preop hydration
* Avoid HoTN, hypovolemia, and low CO
* Avoid nephrotoxic drugs
59
Patients with a history of stroke or TIA who need aortic surgery should have a ______ ultrasound and angiogram of ___________ and intracranial arteries.
* carotid ultrasound
* Angiogram of brachiocephalic and intracranial arteries
60
Before AA surgery, those with severe carotid stenosis should have a workup for ________ ________ before elective surgery.
Carotid endarectomy (CEA)
61
______ _____ _____ __ is caused by lack of blood flow to the anterior spinal artery.
Anterior Spinal Artery Syndrome
62
The anterior artery is responsible for perfusion the anterior ___/___ of the spinal cord
2/3
63
Ischemia of the anterior spinal artery can lead to:
1. loss of ______ function below the infarct.
2. diminished _____ and _____ sensation below the infarct
3. autonomic dysfunction leading to ________ and loss of bowel and bladder function.
*Motor
* pain and temperature
* hypotension
64
Anterior Spinal artery syndrome is the most common form of spinal cord ischemia because the anterior spinal artery has ________ collateral perfusion, making it vulnerable.
minimal
65
The Posterior spinal cord is perfused by ________ posterior spinal arteries, allowing for better collateral circulation.
2
66
Aortic aneurysms, aortic dissection, atherosclerosis, and trauma area all common causes of _______________.
Anterior Spinal Syndrome
67
______% of CVAs are ischemic
________% of CVAs are hemorrhagic
* 87 %
* 13 %
68
A CVA is characterised byt a ________ - onset of ________ deficits.
* sudden
* neurological
69
______ disease is a prominent predictor of CVA
Carotid
70
CVAs are the ____ leading cause of disability in the US and ____ leading cause of death in US.
* 1st
* 3rd
71
Carotid auscultation can identify______.
Carotid _______ can quantify degree of carotid stenosis.
* bruit
* ultrasound
72
________ _______ commonly occurs at internal/external carotid bifurcation due to turbulent blood flow at the branch-point.
Carotid Stenosis
73
AHA recommends TPA within ______ hours
4.5 hours
74
(2) Interventional Radiology treatments for CVAs are intra-arterial _______ and intravascular _____________.
* intra-arterial thrombolysis
* intravascular thrombectomy
75
Intra-arterial Thrombolysis _____ clot at site.
dissolves
76
Intravascular thrombectomy benefits is seen up to _____ hours after onset of CVA
8
77
________ _______ is a surgical treatment for severe carotid stenosis with a lumen diamete 1.5 mm or >70 % blockage.
Carotid Endarectomy
78
_____ ______ is an alternative to Carotid Endarectomy (CEA), but has a major risk of microembolization.
Carotid Stenting
79
Anti-platelet treatment, smoking cessation, BP control, cholesterol control and Diet & Physical activity are all medical treatments for _______.
CVA
80
____ is a major cause of perioperative morbidity and mortality in Carotid Endarectomy (CEA).
MI
81
Exteme head ____, Flexion and ________ may compress contralateral artery flow.
* rotation
* extension
82
What is the equation for Cerebral Perfusion Pressure?
CPP = MAP-ICP
83
_____ _____ devices are useful in determining cerebral perfusionduring surgery.
Cerebral Oximetry
84
Clinical Dilemma: Severe Carotid disease and severe CAD
* Must stage cardiac revascularization and CEA
* Most _________ area should take priority
* Compromised
85
MAP, COP, SaO2, HGB and PaCO2 all effect ______ _______.
Cerebral Oxygenation
86
Cerebral O2 consumption is effected by: _____ and _____.
* Temperature
* Anesthesia
87
_____ ______ ______ results in compromised blood flow to the extremites.
Peripheral Artery Disease
88
Peripheral Artery Disease is defined by an ankle-branchial index (ABI) ____.
* <0.9
89
ABI = ratio of SBP of ______ and SBP of ______ artery.
* ankle
* brachial artery
90
Chronic hypo-perfusion is typically due to ______ and ________.
* artheroscleosis
* Vasculitis
91
Acute occlussion are typically due to ______.
embolism
92
PAD incidence increased w/ age, exceeding ____% by age ___.
* 70%
* 75 years
93
Patients w/ PAD have a __ - ___ x increase risk of MI and CVA.
3-5 x
94
Advanced age, Family history, smoking, DM, HTN. Obesity, and ↑Cholesterol are risk factors of
Peripheral Artery Disease
95
The following are s/s of what disease process:
* intermittent claudication
* Resting extremity pain
* decreased pulses
* subcutaneous atrophy
* hair loss
* coolness
* cyanosis
* Relief w/ hanging LE over side of bed (↑hydrostatic pressure).
PAD
96
PAD: Doppler US provides a ______ volume waveform to identify arterial _________.
* pulse
* stenosis
97
PAD: Duplex U/S can identify areas of ____ formation and ______.
* plaque
* calcification
98
_________ oximetry can assess the severity of tissue ischemia.
Transcutaneous
99
PAD: MRI w/contrast angiography is used to guide _________ interventions or surgical _______.
* endovascular
* surgical bypass.
100
Medical Intervention ______________ indicated with disabling claudiction or ischemia.
Revascularization
101
PAD surgical reconstruction is an ____ bypass procedure.
arterial
102
PAD Endovascular Repair is a transluminal _____ or stent placement.
* angioplasty
103
______ ____ Occlusion is frequently due to cardiogenic embolism.
* Acute Artery
104
Left Atrial thrombus arising from afib and Left ventricular thrombus arising from dilated cardiomyopathy after MI are common causes of _______ ________ ___________.
* Acute Artery Occlusion
105
Less common thrombus causes of Acute Artery Occulsion are______ heart disease, ______ and Patent Foramen Ovale (PFO)
* valvular heart disease
* endocarditis, PFO
106
Non Cardiac causes of thrombus for Acute Artery Occlussion are artheroemboli, _______ rupture, hypercoagulablity and ________.
* Plaque
* trauma
107
Limb ischemia, pain/paresthesia, weakness, ↓peripheral pulses, cool skin, color changes distal to occlusion are all common symptoms of _________.
Acute Artery Occlusion
108
An ____ is used to diagnosis Acute Artery Occulusion.
Arteriography
109
Name (3) treatments for Acute Artery Occlusion
* surgical embolectomy
* anticoagulation
* amputation (last resort)
110
______ _______ _____ is causing vertebral artery blood flow to divert away from brainstem.
Subclavian Steal Syndrome
111
Subcalvian Steel is an occluded ____, proximal to ____ artery
* SCA
* vertebral
112
Symptoms of Subclavian Steal Syndrome includes syncope, _____, ataxia, hemiplegia, and ________ arm ischemia.
* vertigo
* ipsilateral
113
Subclavian Steel Syndome affect arm SBP may be _ mmhg lower.
20 mmHg
114
You will hear a _ over the subclavian artery with Subclavian Steal Syndrome.
Bruit
115
Artheroscelosis, Takayasu Arteritis, and aortic surgery are common risk factors for ____ _____ _______.
Subclavian Steal Syndrome.
116
Name the treatment that is curative for Subclavian Steal Syndrome.
* SC endarectomy
117
________ _________ is an episodic vasospastic ischemia of the digits , effects women > men and may appear with CREST syndrome.
Raynaulds Phenomenon
118
Symptoms of Raynauld's Phenomenon are digital blanchiing or cyanosis w/ cold exposure or ____ activation
Raynaulds
* SNS
119
Treatment for _____ _____ involves protection from cold, CCBs, and alpha-blockers
Raynaulds Phenomenon
120
For severe ischemia with Raynaulds Phenomenon, the treatment is surgical __________.
* sympathectomy
121
Name (3) PVD processes that occur during surgery
* Superficial thrombophlebitis
* Deep vein thrombosis
* Chronic venous insufficency
122
______ are major concern b/c it can lead to PE's, a leading cause of peripheral Morbidity and mortality.
DVTs
123
(3) Major factors in Virchows Triad are Venous _________, Hypercoagulability and ______vascular endotherlium.
* venous Stasis
* Hypercoagulability
* Disrupted vascular endothelium
124
Superficial Thrombophelbitis & DVTs are common in surgery and occur in _____ % of total _____ replacements.
* 50%
* Hip
125
DVTs are associated with extemity ____ and swelling.
* pain
126
High Risk Factors of DVTs are
* >40 years
* surgery > 1 hr
* cancer
* orthosurgeries on pelvis and lower extremities
* abdominal surgery
127
T/F: Doppler Ultrasound is sensitive for detecting distal thrombosis.
* False:
* detects proximal thrombosis > distal thrombosis
128
Prophylactic measure for DVTS are _____ and SQ ____ 2-3x a day.
* SCDs
* heparin
129
Regional anesthesia can greatly ____ risk of DVTs d/t earlier post-op ambulation.
decrease
130
LMWH _____________ over unfractionated heparin:
* longer Half-life and more predictable dose response
* doesn't require serial assessment of activate partial thromboplastin time
* Less risk of bleeding
advantages
131
LMWH _________:
* higher cost
* lack of reversal
* disadvantages
132
________ is initiated during heparin treatment and adjusted to achieve INR btw 2-3.
Warfarin
133
DVT treatment with PO anticoagulants continue for ______ months or longer.
6
134
For DVTs an _____ filter may be placed in patients with recurrent ____ or have contraindication to anticoagulants.
* IVC
* PEs
135
________ ____________ is a diverse group of vascular inflammatory disease with characteristics that are often grouped by the size of the vessels at the primary site of the abnormality.
Systemic Vasculitis
136
_________ - artery vasculitis includes Takayasu arteritis and Temporal (or giant cell) arteritis.
Large
137
______ - artery vasculitis includes Kawassaki disease, which is most prominently the coronary arteries.
* medium
138
Vasculitus can be a feature of connective disease sush as systemic __________ and rheumatoid arthritis
lupus erythematosus
139
_______ _________is inflammation of arteries of the head and neck
Temporal Arteritis
140
Symptoms of ______ ________ include unilateral, headache, scalp tenderness, and jaw claudication.
Temporal (Giant Cell) Arteritis
141
_______ Arterial branches may lead to ischemic optic neuritis and unilateral blindness.
Opthalmic
142
Treatment of Temporal Arteritis is prompt initiation of ________ for visual symptoms, to prevent blindness.
* corticosteroids
143
Temporal Arteritis biopsy of temporal artery shows arteritis in _% of patients.
90%
144
____________ is inflammatory vasculitis leading to small and medium vessel occlusions in the extremities. An autoimune response triggered by **Nicotine** and prevalent in men <45.
Thromboangiitis Obliterans "Buerger Disease"
145
5 diagnostic criteria for ________ includes:
* h/o smoking
* onset before 50
* infrapopliteal arterial occlusion
* upper limp involvement and absence of risk facors for artherosclerosis
Thromboangiitis Obliterans “Buerger Disease”
146
Symptoms of Thromboangiitis Obliterans “Buerger Disease” include:
* Forearm, calf, foot _______
* ______ of hands and feet
* Ulcerations and skin necrosis
* ________ is commonly seen.
* ulcerations
* ischemia
* Raynaulds
147
The treatment of Thromboangiitis Obliterans “Buerger Disease” involves:
* ______ cessation ( ______ effective)
* surgical revascularization
* no effective pharmacological treatment.
* smoking cessation is most effective
148
_______ ________ are antineutrophyl cytoplasmic antibody (ANCA) negative vasculitis. May be associated with Hep B, Hep C or Hairy Cell Leukemia
Polyarteritis Nodosa
149
Polyarteritis Nodosa involves small and medium ______. Inflammation results in glomerulonephritis, __________ ischemia, peripheral neruopathy and seizures.
* arteries
* myocardial
150
___________ is the primary cause of death for Polyarteritis Nodosa
Renal failure
151
Treatment for _______ __________ includes steroids, cyclophosphamides and treating underlying causes such as cancer.
Polyarteritis Nodosa
152
Risk Factors for _________________ include:
* advanced age
* family hx
* pregnancy
* igamentous laicity
* previous venous thrombosis
* LE injuries
* prolonged standing
* obesity
* smoking
* sedentary lifestyle
* high estrogen levels
Lower Extremity Chronic Venous Disease
153
____________ is due to long standing venous reflux and dilation and effects more than 50% of the population.
Lower Extremity Chronic Venous Disease
154
Lower Extremity Chronic Venous Disease
* _____ symptoms include telangiectaisias and varicose veins
* ______ symptoms include edema, skin changes and ulcerations
* Mild
* Severe
155
_________ _______ management for Lower Extremity Chronic Venous Disease includes:
* diuretics
* ASA
* antibiotics
* Prostacyclin analogues
* zinc suplphate
Conservative Medical
156
If medical management of Lower Extremity Chronic Venous Disease fails, ______ may be performed.
ablation
157
Methods of Ablation for Chronic Venous Disease includes:
* ____ ablation w/ laser
* Radiofrequency
* Endovenous laser
* ___________
* Thermal
* sclerotherapy
158
Venous hemorrhage, thrombophlebitis and symptomatic venous reflux are all Indications for ________ for Chronic Venous Disease.
Ablation
159
Contraindications for Ablation for Chronic Venous Disease includes:
* Pregnancy
* __________
* PAD
* ________ mobility
* Congenital venous abnormalities
* thrombosis
* Limited
160
___________ interventions for Lower Extremity Chronic Venous Disease includes
* Sephenous vein inversion
* High saphenous ligatino
* Ambulatoy Phlebectomy
* Transilluminated -powered phlebectomy
* Venous ligation
* Perforator ligation
Surgical
161
Surgical Interventions are a _____________ for Lower chronic venous disease
last resort
162
Cardiac Complications are the leading cause of perioperative _________ and ________ in patients undergoing noncardiac surgery
mobidity and mortality
163
The incidenced of complications is higher in patients undergoing __________ surgery.
vascular
164
____________ is a systemic disease. Pt with peripheral arterial disease have a __ to __ x times greater risk of cardiovascular ischemic events.
* Artherosclerosis
* 3-5 x
165
Carotid artery stenosis with a residual luminal diameter of _____ mm or (70-75% stenosis) represents significant stenosis. If collateral cerebral blood flow is not adequate, ________ and ischemic infarctions can occur.
* 1.5 mm
* TIA
166
Both _______ and ________ may be observed frequently during and after carotid endarectomy.
* hypertension
* hypotension
167
Acute Arterial Occlussionis typically caused by __________ embolism. Emboli may arise from a thrombus in the _______ ventricle that developes because of MI or dilated cardiomyopathy.
* cardiogenic
* left
168
Other cardiac caused of systemic emboli are ________ heart disease, ________ heart valves, infective _____________, left atrial myxoma, afib and atheroemboli.
* valvular
* prosthetic
* endocarditis
169
Thromboangiitis obliterans is an inflammatory ___________ leading to occlusion of small and medium-sized arteries and veins in the extremites.
vasculitis
170
Pts at low risk for DVT require minimal prophylactic measures such as ____________ and compression stockings.
* early postop ambulation
171
The risk of DVT may be much higher in patients > ___ years, who are undergoing surgery >___hour, especially LE orthopedic, pelvic or abdominal surgery, and surgeries that require a prolonged __________ or limited mobility.
* >40 y/o
* >1 hour
* bed rest
172
____________ repair of aortic lesions is a relatively new technique with significant improvements in perioperative ____________.
* Endovascular
* mortality
173
_____________ arterial procedures have emerged as alternative, less invasive methods of arterial repair.
Endovascular
