Vascular Disorders Flashcards
Name the (3) Main arterial pathologies of Vascular Disease
- Aneuysms
- dissections
- occlusion
____ and ______ are more likely to be affect by aneurysm and dissections.
- Aorta
- Branches
______ arteries are more likely to be affect by occlussions.
Peripheral
________ _________ is defined as a dilation of all 3 layers of artery, leading to > 50% increase in diameter
Aortic aneurysm
Symptoms of Aortic Aneurysm are due to _________ of surrounding structures.
compression of surrounding structures
Aortic Aneurysm that is > 5.5 cm diameter needs
Surgery
What percent (%) mortality is associated with Aortic Aneurysm Rupture
75%
Name (2) types of Aortic Aneurysms
- Fusiform
- Saccular
This aortic aneurysm is a uniform dilation along entire circumference of arterial wall.
Fusiform
This aortic aneurysm is berry-shaped bulge to one side.
saccular
Aortic Aneurysms can be ________ or _______ d/t surrounding compression.
- asymptomatic
- or pain d/t surrounding compression
In a suspected dissection, _______ _______ is the fastest/safest measure to obtain a diagnosis of aneurysm.
- doppler echocardiogram
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
Aortic Aneurysm
_______ is indicated if an Aortic Aneurysm is > 5.5 cm , growth of 10 mm/year and family history of dissection
Surgery
_______ ______ ______ has become a mainstay over open surgery w/ graft for Aortic Aneurysms.
- Endovascular Stent Repair
Aortic ______ is a tear in intimal layer of vessel, causing blood to enter the medial layer.
Dissection
This type of dissection is catastrophic and requires emergent surgical interentions.
Ascending Dissection
Name (3) classifications of Ascending Dissection
- Stanford A
- Debakey 1 & 2
Mortality with Ascending Dissection increased __ - ___% per hour.
- 1-2%
The overall mortality of an Ascending dissection is
27-58%
The classic symptoms of an Aortic Dissection are severe, sharp pain in _______ chest or _______.
- posterior chest
- back
CT, CXR, MRI and Angiogram are used to diagnose a ____ Aortic Dissection
- Stable
An Echocardiogram is used to Diagnose an ______ Aortic Dissection
Unstable
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
All patients with this acute dissection involving the ascending aorta should be considered canditates for surgery.
- Stanford A Dissection: Ascending Aorta
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
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
____ ______ are the major complications associated with replacement of aortic arch.
- neurologic deficits
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
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
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
Stanford B: Descending Thoracic Aorta dissection has an in hospital mortality rate of ___%
10%
Long term survival of Stanford B: Descending Thoracic Aorta is ___ - ____% at 5 years and ___ - ___ % at 10 years
- 60-80%
- 40-50%
______ 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
Surgical treatment of distal aortic dissection is associated with ___% in-hospital mortality rate.
29%
_____ arch dissections requires emergent surgery
Ascending
______ arch dissections are rarely treated with urgent surgery
Descending
Uncomplication type __ dissections are often admitted for BP control (SA BB preferred, A-line)
Uncomplicated Type B
Posterior Pain, HoTN, and hemothorax are all symptoms of an ______ arch dissection that requires surgical treatment
Descending
HTN, artherosclerosis, aneurysms, family history, cocaine use and inflammatory disease are all risk factors for __________ _________.
Aortic Dissections
Name (4) inherited disorders that can cause Aortic Dissections
- Marfans
- Ehlers Danlos
- Biscuspid Aortic Valve
- non-syndrome familiar history
Name (3) common causes of Aortic Dissections
- blunt trauma
- cocaine
- iatrogenic (medical treatment)
Cardiac catherization, aortic manipulation, cross-clamping and arterial incision are all common ____ causes related to Aortic Dissections
Iatrogenic
Aortic Dissections are more common in men and _____ women in __ trimester.
- men
- pregnant women in 3rd trimester
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
Most abdominal aortic aneurysms rupture into the _____ _______.
- left retroperitoneum
Although ____ shock may be present in an AA Rupture, ________ can be prevented by clotting and the ____ effect in the retroperitoneum.
- hypovolemic
- exsanguination
- tamponade
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
Patients in ____ condition who have a suspected ____ abdominal aortic aneurysm require immediate operation without preoperative testing or volume resuscitaion.
- unstable
- ruptured
Name the (4) Primary causes of mortality r/t surgeries of thoracic aorta.
- MI
- Respiratory Failure
- Renal Failure
- Stroke
Name (3) cardiac conditions assess for before AA Rupture Surgery
- CAD
- Valve dysfunction
- heart Failure
____ heart diagnosis may require intervention prior to Aortic Aneurysm Surgery.
ischemic
Cardiac evaluation testing such as stress test, ECHO and ____ imaging should be completed before AA surgery.
- radionuclide imaging
Severe reduction in ____ or _____ ____ may preclude a patient from AAA resection.
- FEV1
- Renal Failure
____ and ____ are predictors of post aortic surgery respiratory failure
- Smoking
- COPD
Preop ____ ____ is the most important indicator of post aortic surgery renal failure.
- renal dysfunction
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
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
Before AA surgery, those with severe carotid stenosis should have a workup for ________ ________ before elective surgery.
Carotid endarectomy (CEA)
______ _____ _____ __ is caused by lack of blood flow to the anterior spinal artery.
Anterior Spinal Artery Syndrome
The anterior artery is responsible for perfusion the anterior ___/___ of the spinal cord
2/3
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
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
The Posterior spinal cord is perfused by ________ posterior spinal arteries, allowing for better collateral circulation.
2
Aortic aneurysms, aortic dissection, atherosclerosis, and trauma area all common causes of _______________.
Anterior Spinal Syndrome
______% of CVAs are ischemic
________% of CVAs are hemorrhagic
- 87 %
- 13 %
A CVA is characterised byt a ________ - onset of ________ deficits.
- sudden
- neurological
______ disease is a prominent predictor of CVA
Carotid