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Health Assessment Exam 3 > Vascular Disorders > Flashcards

Vascular Disorders Flashcards

1
Q

Name the (3) Main arterial pathologies of Vascular Disease

A
  • Aneuysms
  • dissections
  • occlusion
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2
Q

____ and ______ are more likely to be affect by aneurysm and dissections.

A
  • Aorta
  • Branches
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3
Q

______ arteries are more likely to be affect by occlussions.

A

Peripheral

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4
Q

________ _________ is defined as a dilation of all 3 layers of artery, leading to > 50% increase in diameter

A

Aortic aneurysm

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5
Q

Symptoms of Aortic Aneurysm are due to _________ of surrounding structures.

A

compression of surrounding structures

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6
Q

Aortic Aneurysm that is > 5.5 cm diameter needs

A

Surgery

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7
Q

What percent (%) mortality is associated with Aortic Aneurysm Rupture

A

75%

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8
Q

Name (2) types of Aortic Aneurysms

A
  • Fusiform
  • Saccular
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9
Q

This aortic aneurysm is a uniform dilation along entire circumference of arterial wall.

A

Fusiform

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10
Q

This aortic aneurysm is berry-shaped bulge to one side.

A

saccular

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11
Q

Aortic Aneurysms can be ________ or _______ d/t surrounding compression.

A
  • asymptomatic
  • or pain d/t surrounding compression
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12
Q

In a suspected dissection, _______ _______ is the fastest/safest measure to obtain a diagnosis of aneurysm.

A
  • doppler echocardiogram
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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

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14
Q

_______ is indicated if an Aortic Aneurysm is > 5.5 cm , growth of 10 mm/year and family history of dissection

A

Surgery

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15
Q

_______ ______ ______ has become a mainstay over open surgery w/ graft for Aortic Aneurysms.

A
  • Endovascular Stent Repair
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16
Q

Aortic ______ is a tear in intimal layer of vessel, causing blood to enter the medial layer.

A

Dissection

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17
Q

This type of dissection is catastrophic and requires emergent surgical interentions.

A

Ascending Dissection

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18
Q

Name (3) classifications of Ascending Dissection

A
  • Stanford A
  • Debakey 1 & 2
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19
Q

Mortality with Ascending Dissection increased __ - ___% per hour.

A
  • 1-2%
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20
Q

The overall mortality of an Ascending dissection is

A

27-58%

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21
Q
A
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22
Q

The classic symptoms of an Aortic Dissection are severe, sharp pain in _______ chest or _______.

A
  • posterior chest
  • back
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23
Q

CT, CXR, MRI and Angiogram are used to diagnose a ____ Aortic Dissection

A
  • Stable
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24
Q

An Echocardiogram is used to Diagnose an ______ Aortic Dissection

A

Unstable

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25
Q

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

A
  • Stanford A Dissection: Ascending Aorta
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26
Q

All patients with this acute dissection involving the ascending aorta should be considered canditates for surgery.

A
  • Stanford A Dissection: Ascending Aorta
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27
Q

In patients with __________: _____ _______ dissection, resection of the aortic arch is indicated. Surgery requires cardiopulmonary bypass, profound hypothermia, and a period of circulatory arrest

A
  • Stanford A Dissection: Aortic Arch
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28
Q

For Aortic Dissections, a period of _____ ______ of 30-40 minutes at a body temperature of ___ - ___ degree Celcius can be tolerated by most patients.

A
  • Circulatory arrest
  • 15-18 degrees
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29
Q

____ ______ are the major complications associated with replacement of aortic arch.

A
  • neurologic deficits
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30
Q

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.

A
  • 3-18%
  • antegrade
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31
Q

This type of dissection will have normal hemodynamics, no periaortic hematoma and no branch vessel involvement can be treated with medical therapy.

A
  • Standford B: Descending Thorasic Aorta
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32
Q

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)

A
  • Stanford B: Descending Thoracic Aorta
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33
Q

Stanford B: Descending Thoracic Aorta dissection has an in hospital mortality rate of ___%

A

10%

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34
Q

Long term survival of Stanford B: Descending Thoracic Aorta is ___ - ____% at 5 years and ___ - ___ % at 10 years

A
  • 60-80%
  • 40-50%
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35
Q

______ 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

A

Surgery

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36
Q

Surgical treatment of distal aortic dissection is associated with ___% in-hospital mortality rate.

A

29%

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37
Q

_____ arch dissections requires emergent surgery

A

Ascending

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38
Q

______ arch dissections are rarely treated with urgent surgery

A

Descending

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39
Q

Uncomplication type __ dissections are often admitted for BP control (SA BB preferred, A-line)

A

Uncomplicated Type B

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40
Q

Posterior Pain, HoTN, and hemothorax are all symptoms of an ______ arch dissection that requires surgical treatment

A

Descending

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41
Q

HTN, artherosclerosis, aneurysms, family history, cocaine use and inflammatory disease are all risk factors for __________ _________.

A

Aortic Dissections

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42
Q

Name (4) inherited disorders that can cause Aortic Dissections

A
  • Marfans
  • Ehlers Danlos
  • Biscuspid Aortic Valve
  • non-syndrome familiar history
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43
Q

Name (3) common causes of Aortic Dissections

A
  • blunt trauma
  • cocaine
  • iatrogenic (medical treatment)
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44
Q

Cardiac catherization, aortic manipulation, cross-clamping and arterial incision are all common ____ causes related to Aortic Dissections

A

Iatrogenic

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45
Q

Aortic Dissections are more common in men and _____ women in __ trimester.

A
  • men
  • pregnant women in 3rd trimester
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46
Q

The triad of symptoms that are experience in 1/2 of all cases of Aortic Aneurysm Rupture are _______, ______ pain and pulsatile _______ mass.

A
  • Hypotension
  • Back pain
  • pulsatile abdominal mass
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47
Q

Most abdominal aortic aneurysms rupture into the _____ _______.

A
  • left retroperitoneum
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48
Q

Although ____ shock may be present in an AA Rupture, ________ can be prevented by clotting and the ____ effect in the retroperitoneum.

A
  • hypovolemic
  • exsanguination
  • tamponade
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49
Q

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.

A
  • Euvolemic resuscitation
  • retroperitoneal tamponade
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50
Q

Patients in ____ condition who have a suspected ____ abdominal aortic aneurysm require immediate operation without preoperative testing or volume resuscitaion.

A
  • unstable
  • ruptured
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51
Q

Name the (4) Primary causes of mortality r/t surgeries of thoracic aorta.

A
  • MI
  • Respiratory Failure
  • Renal Failure
  • Stroke
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52
Q

Name (3) cardiac conditions assess for before AA Rupture Surgery

A
  • CAD
  • Valve dysfunction
  • heart Failure
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53
Q

____ heart diagnosis may require intervention prior to Aortic Aneurysm Surgery.

A

ischemic

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54
Q

Cardiac evaluation testing such as stress test, ECHO and ____ imaging should be completed before AA surgery.

A
  • radionuclide imaging
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55
Q

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

A
  • FEV1
  • Renal Failure
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56
Q

____ and ____ are predictors of post aortic surgery respiratory failure

A
  • Smoking
  • COPD
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57
Q

Preop ____ ____ is the most important indicator of post aortic surgery renal failure.

A
  • renal dysfunction
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58
Q

You can avoid post-op aortic surgery renal failure through ______ hydration, _____ HoTN, hypovolemia, low CO and avoid _______ drugs

A
  • Preop hydration
  • Avoid HoTN, hypovolemia, and low CO
  • Avoid nephrotoxic drugs
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59
Q

Patients with a history of stroke or TIA who need aortic surgery should have a ______ ultrasound and angiogram of ___________ and intracranial arteries.

A
  • carotid ultrasound
  • Angiogram of brachiocephalic and intracranial arteries
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60
Q

Before AA surgery, those with severe carotid stenosis should have a workup for ________ ________ before elective surgery.

A

Carotid endarectomy (CEA)

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61
Q

______ _____ _____ __ is caused by lack of blood flow to the anterior spinal artery.

A

Anterior Spinal Artery Syndrome

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62
Q

The anterior artery is responsible for perfusion the anterior ___/___ of the spinal cord

A

2/3

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63
Q

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.

A

*Motor
* pain and temperature
* hypotension

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64
Q

Anterior Spinal artery syndrome is the most common form of spinal cord ischemia because the anterior spinal artery has ________ collateral perfusion, making it vulnerable.

A

minimal

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65
Q

The Posterior spinal cord is perfused by ________ posterior spinal arteries, allowing for better collateral circulation.

A

2

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66
Q

Aortic aneurysms, aortic dissection, atherosclerosis, and trauma area all common causes of _______________.

A

Anterior Spinal Syndrome

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67
Q

______% of CVAs are ischemic
________% of CVAs are hemorrhagic

A
  • 87 %
  • 13 %
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68
Q

A CVA is characterised byt a ________ - onset of ________ deficits.

A
  • sudden
  • neurological
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69
Q

______ disease is a prominent predictor of CVA

A

Carotid

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70
Q

CVAs are the ____ leading cause of disability in the US and ____ leading cause of death in US.

71
Q

Carotid auscultation can identify______.
Carotid _______ can quantify degree of carotid stenosis.

A
  • bruit
  • ultrasound
72
Q

________ _______ commonly occurs at internal/external carotid bifurcation due to turbulent blood flow at the branch-point.

A

Carotid Stenosis

73
Q

AHA recommends TPA within ______ hours

74
Q

(2) Interventional Radiology treatments for CVAs are intra-arterial _______ and intravascular _____________.

A
  • intra-arterial thrombolysis
  • intravascular thrombectomy
75
Q

Intra-arterial Thrombolysis _____ clot at site.

76
Q

Intravascular thrombectomy benefits is seen up to _____ hours after onset of CVA

77
Q

________ _______ is a surgical treatment for severe carotid stenosis with a lumen diamete 1.5 mm or >70 % blockage.

A

Carotid Endarectomy

78
Q

_____ ______ is an alternative to Carotid Endarectomy (CEA), but has a major risk of microembolization.

A

Carotid Stenting

79
Q

Anti-platelet treatment, smoking cessation, BP control, cholesterol control and Diet & Physical activity are all medical treatments for _______.

80
Q

____ is a major cause of perioperative morbidity and mortality in Carotid Endarectomy (CEA).

81
Q

Exteme head ____, Flexion and ________ may compress contralateral artery flow.

A
  • rotation
  • extension
82
Q

What is the equation for Cerebral Perfusion Pressure?

A

CPP = MAP-ICP

83
Q

_____ _____ devices are useful in determining cerebral perfusionduring surgery.

A

Cerebral Oximetry

84
Q

Clinical Dilemma: Severe Carotid disease and severe CAD
* Must stage cardiac revascularization and CEA
* Most _________ area should take priority

A
  • Compromised
85
Q

MAP, COP, SaO2, HGB and PaCO2 all effect ______ _______.

A

Cerebral Oxygenation

86
Q

Cerebral O2 consumption is effected by: _____ and _____.

A
  • Temperature
  • Anesthesia
87
Q

_____ ______ ______ results in compromised blood flow to the extremites.

A

Peripheral Artery Disease

88
Q

Peripheral Artery Disease is defined by an ankle-branchial index (ABI) ____.

89
Q

ABI = ratio of SBP of ______ and SBP of ______ artery.

A
  • ankle
  • brachial artery
90
Q

Chronic hypo-perfusion is typically due to ______ and ________.

A
  • artheroscleosis
  • Vasculitis
91
Q

Acute occlussion are typically due to ______.

92
Q

PAD incidence increased w/ age, exceeding ____% by age ___.

A
  • 70%
  • 75 years
93
Q

Patients w/ PAD have a __ - ___ x increase risk of MI and CVA.

94
Q

Advanced age, Family history, smoking, DM, HTN. Obesity, and ↑Cholesterol are risk factors of

A

Peripheral Artery Disease

95
Q

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).

96
Q

PAD: Doppler US provides a ______ volume waveform to identify arterial _________.

A
  • pulse
  • stenosis
97
Q

PAD: Duplex U/S can identify areas of ____ formation and ______.

A
  • plaque
  • calcification
98
Q

_________ oximetry can assess the severity of tissue ischemia.

A

Transcutaneous

99
Q

PAD: MRI w/contrast angiography is used to guide _________ interventions or surgical _______.

A
  • endovascular
  • surgical bypass.
100
Q

Medical Intervention ______________ indicated with disabling claudiction or ischemia.

A

Revascularization

101
Q

PAD surgical reconstruction is an ____ bypass procedure.

102
Q

PAD Endovascular Repair is a transluminal _____ or stent placement.

A
  • angioplasty
103
Q

______ ____ Occlusion is frequently due to cardiogenic embolism.

A
  • Acute Artery
104
Q

Left Atrial thrombus arising from afib and Left ventricular thrombus arising from dilated cardiomyopathy after MI are common causes of _______ ________ ___________.

A
  • Acute Artery Occlusion
105
Q

Less common thrombus causes of Acute Artery Occulsion are______ heart disease, ______ and Patent Foramen Ovale (PFO)

A
  • valvular heart disease
  • endocarditis, PFO
106
Q

Non Cardiac causes of thrombus for Acute Artery Occlussion are artheroemboli, _______ rupture, hypercoagulablity and ________.

A
  • Plaque
  • trauma
107
Q

Limb ischemia, pain/paresthesia, weakness, ↓peripheral pulses, cool skin, color changes distal to occlusion are all common symptoms of _________.

A

Acute Artery Occlusion

108
Q

An ____ is used to diagnosis Acute Artery Occulusion.

A

Arteriography

109
Q

Name (3) treatments for Acute Artery Occlusion

A
  • surgical embolectomy
  • anticoagulation
  • amputation (last resort)
110
Q

______ _______ _____ is causing vertebral artery blood flow to divert away from brainstem.

A

Subclavian Steal Syndrome

111
Q

Subcalvian Steel is an occluded ____, proximal to ____ artery

A
  • SCA
  • vertebral
112
Q

Symptoms of Subclavian Steal Syndrome includes syncope, _____, ataxia, hemiplegia, and ________ arm ischemia.

A
  • vertigo
  • ipsilateral
113
Q

Subclavian Steel Syndome affect arm SBP may be _ mmhg lower.

114
Q

You will hear a _ over the subclavian artery with Subclavian Steal Syndrome.

115
Q

Artheroscelosis, Takayasu Arteritis, and aortic surgery are common risk factors for ____ _____ _______.

A

Subclavian Steal Syndrome.

116
Q

Name the treatment that is curative for Subclavian Steal Syndrome.

A
  • SC endarectomy
117
Q

________ _________ is an episodic vasospastic ischemia of the digits , effects women > men and may appear with CREST syndrome.

A

Raynaulds Phenomenon

118
Q

Symptoms of Raynauld’s Phenomenon are digital blanchiing or cyanosis w/ cold exposure or ____ activation

A

Raynaulds
* SNS

119
Q

Treatment for _____ _____ involves protection from cold, CCBs, and alpha-blockers

A

Raynaulds Phenomenon

120
Q

For severe ischemia with Raynaulds Phenomenon, the treatment is surgical __________.

A
  • sympathectomy
121
Q

Name (3) PVD processes that occur during surgery

A
  • Superficial thrombophlebitis
  • Deep vein thrombosis
  • Chronic venous insufficency
122
Q

______ are major concern b/c it can lead to PE’s, a leading cause of peripheral Morbidity and mortality.

123
Q

(3) Major factors in Virchows Triad are Venous _________, Hypercoagulability and ______vascular endotherlium.

A
  • venous Stasis
  • Hypercoagulability
  • Disrupted vascular endothelium
124
Q

Superficial Thrombophelbitis & DVTs are common in surgery and occur in _____ % of total _____ replacements.

125
Q

DVTs are associated with extemity ____ and swelling.

126
Q

High Risk Factors of DVTs are

A
  • > 40 years
  • surgery > 1 hr
  • cancer
  • orthosurgeries on pelvis and lower extremities
  • abdominal surgery
127
Q

T/F: Doppler Ultrasound is sensitive for detecting distal thrombosis.

A
  • False:
  • detects proximal thrombosis > distal thrombosis
128
Q

Prophylactic measure for DVTS are _____ and SQ ____ 2-3x a day.

A
  • SCDs
  • heparin
129
Q

Regional anesthesia can greatly ____ risk of DVTs d/t earlier post-op ambulation.

130
Q

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

A

advantages

131
Q

LMWH _________:
* higher cost
* lack of reversal

A
  • disadvantages
132
Q

________ is initiated during heparin treatment and adjusted to achieve INR btw 2-3.

133
Q

DVT treatment with PO anticoagulants continue for ______ months or longer.

134
Q

For DVTs an _____ filter may be placed in patients with recurrent ____ or have contraindication to anticoagulants.

135
Q

________ ____________ 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.

A

Systemic Vasculitis

136
Q

_________ - artery vasculitis includes Takayasu arteritis and Temporal (or giant cell) arteritis.

137
Q

______ - artery vasculitis includes Kawassaki disease, which is most prominently the coronary arteries.

138
Q

Vasculitus can be a feature of connective disease sush as systemic __________ and rheumatoid arthritis

A

lupus erythematosus

139
Q

_______ _________is inflammation of arteries of the head and neck

A

Temporal Arteritis

140
Q

Symptoms of ______ ________ include unilateral, headache, scalp tenderness, and jaw claudication.

A

Temporal (Giant Cell) Arteritis

141
Q

_______ Arterial branches may lead to ischemic optic neuritis and unilateral blindness.

142
Q

Treatment of Temporal Arteritis is prompt initiation of ________ for visual symptoms, to prevent blindness.

A
  • corticosteroids
143
Q

Temporal Arteritis biopsy of temporal artery shows arteritis in _% of patients.

144
Q

____________ is inflammatory vasculitis leading to small and medium vessel occlusions in the extremities. An autoimune response triggered by Nicotine and prevalent in men <45.

A

Thromboangiitis Obliterans “Buerger Disease”

145
Q

5 diagnostic criteria for ________ includes:
* h/o smoking
* onset before 50
* infrapopliteal arterial occlusion
* upper limp involvement and absence of risk facors for artherosclerosis

A

Thromboangiitis Obliterans “Buerger Disease”

146
Q

Symptoms of Thromboangiitis Obliterans “Buerger Disease” include:
* Forearm, calf, foot _______
* ______ of hands and feet
* Ulcerations and skin necrosis
* ________ is commonly seen.

A
  • ulcerations
  • ischemia
  • Raynaulds
147
Q

The treatment of Thromboangiitis Obliterans “Buerger Disease” involves:
* ______ cessation ( ______ effective)
* surgical revascularization
* no effective pharmacological treatment.

A
  • smoking cessation is most effective
148
Q

_______ ________ are antineutrophyl cytoplasmic antibody (ANCA) negative vasculitis. May be associated with Hep B, Hep C or Hairy Cell Leukemia

A

Polyarteritis Nodosa

149
Q

Polyarteritis Nodosa involves small and medium ______. Inflammation results in glomerulonephritis, __________ ischemia, peripheral neruopathy and seizures.

A
  • arteries
  • myocardial
150
Q

___________ is the primary cause of death for Polyarteritis Nodosa

A

Renal failure

151
Q

Treatment for _______ __________ includes steroids, cyclophosphamides and treating underlying causes such as cancer.

A

Polyarteritis Nodosa

152
Q

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

A

Lower Extremity Chronic Venous Disease

153
Q

____________ is due to long standing venous reflux and dilation and effects more than 50% of the population.

A

Lower Extremity Chronic Venous Disease

154
Q

Lower Extremity Chronic Venous Disease
* _____ symptoms include telangiectaisias and varicose veins
* ______ symptoms include edema, skin changes and ulcerations

A
  • Mild
  • Severe
155
Q

_________ _______ management for Lower Extremity Chronic Venous Disease includes:
* diuretics
* ASA
* antibiotics
* Prostacyclin analogues
* zinc suplphate

A

Conservative Medical

156
Q

If medical management of Lower Extremity Chronic Venous Disease fails, ______ may be performed.

157
Q

Methods of Ablation for Chronic Venous Disease includes:
* ____ ablation w/ laser
* Radiofrequency
* Endovenous laser
* ___________

A
  • Thermal
  • sclerotherapy
158
Q

Venous hemorrhage, thrombophlebitis and symptomatic venous reflux are all Indications for ________ for Chronic Venous Disease.

159
Q

Contraindications for Ablation for Chronic Venous Disease includes:
* Pregnancy
* __________
* PAD
* ________ mobility
* Congenital venous abnormalities

A
  • thrombosis
  • Limited
160
Q

___________ interventions for Lower Extremity Chronic Venous Disease includes
* Sephenous vein inversion
* High saphenous ligatino
* Ambulatoy Phlebectomy
* Transilluminated -powered phlebectomy
* Venous ligation
* Perforator ligation

161
Q

Surgical Interventions are a _____________ for Lower chronic venous disease

A

last resort

162
Q

Cardiac Complications are the leading cause of perioperative _________ and ________ in patients undergoing noncardiac surgery

A

mobidity and mortality

163
Q

The incidenced of complications is higher in patients undergoing __________ surgery.

164
Q

____________ is a systemic disease. Pt with peripheral arterial disease have a __ to __ x times greater risk of cardiovascular ischemic events.

A
  • Artherosclerosis
  • 3-5 x
165
Q

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.

A
  • 1.5 mm
  • TIA
166
Q

Both _______ and ________ may be observed frequently during and after carotid endarectomy.

A
  • hypertension
  • hypotension
167
Q

Acute Arterial Occlussionis typically caused by __________ embolism. Emboli may arise from a thrombus in the _______ ventricle that developes because of MI or dilated cardiomyopathy.

A
  • cardiogenic
  • left
168
Q

Other cardiac caused of systemic emboli are ________ heart disease, ________ heart valves, infective _____________, left atrial myxoma, afib and atheroemboli.

A
  • valvular
  • prosthetic
  • endocarditis
169
Q

Thromboangiitis obliterans is an inflammatory ___________ leading to occlusion of small and medium-sized arteries and veins in the extremites.

A

vasculitis

170
Q

Pts at low risk for DVT require minimal prophylactic measures such as ____________ and compression stockings.

A
  • early postop ambulation
171
Q

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.

A
  • > 40 y/o
  • > 1 hour
  • bed rest
172
Q

____________ repair of aortic lesions is a relatively new technique with significant improvements in perioperative ____________.

A
  • Endovascular
  • mortality
173
Q

_____________ arterial procedures have emerged as alternative, less invasive methods of arterial repair.

A

Endovascular

Health Assessment Exam 3 (5 decks)

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