Vascular- (Exam IV, Mordecai) Flashcards by Alex Lang

What is an aortic aneurysm?

Dilation of all 3 layers of the artery, >50% increase in diameter.

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What are the two types of aortic aneurysms?

Saccular: One-sided outpouching
Fusiform: Uniform dilation.

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When is surgery indicated for an aortic aneurysm?

Diameter >5.5 cm
rapid growth >10 mm/year
or family history of rupture/dissection

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What is the mortality rate of ruptured aortic aneurysm?

~75%

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What is an aortic dissection?

A tear in the intima allows blood to enter the media, splitting the layers.

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What is the most dangerous type of aortic dissection?

ascending aorta → requires emergent surgery.

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What is Stanford Type B dissection?

Involves descending thoracic aorta, often treated medically unless complications arise.

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What are classic symptoms of aortic dissection?

Sudden, severe chest/back pain + possible hypotension or hemothorax.

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5 Listed

Risk factors for aortic dissection?

HTN
atherosclerosis
connective tissue disorders (Marfan, Ehlers-Danlos)
cocaine
trauma

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What is the triad of a ruptured abdominal aortic aneurysm?

Back pain, hypotension, pulsatile abdominal mass.

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What causes Anterior Spinal Artery (ASA) syndrome?

Ischemia of the anterior 2/3 of the spinal cord due to impaired ASA perfusion.

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What are the key symptoms of ASA syndrome?

Loss of motor function
Loss of pain and temperature sensation
Autonomic dysfunction (bowel/bladder, hypotension)

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Why is ASA syndrome common in aortic disease?

The ASA has minimal collateral circulation → vulnerable to ischemia during aneurysms/dissections or cross-clamping the aorta during surgical repair

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What are the two main types of stroke?

Ischemic (87%)
Hemorrhagic (13%)

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What is a TIA?

Transient ischemic attack; temporary stroke-like symptoms that resolve within 24 hours.

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What is the biggest risk factor for a CVA?

Carotid artery disease

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How is carotid stenosis diagnosed?

Carotid ultrasound, angiography, CT/MRI, transcranial Doppler.

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When is a carotid endarterectomy (CEA) indicated?

Severe stenosis >70% or lumen <1.5 mm.

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What’s the biggest perioperative risk in CEA?

Myocardial infarction due to underlying CAD.

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What is cerebral oximetry used for?

To monitor real-time brain oxygenation during carotid or aortic surgery.

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7 factors listed

What affects cerebral oxygenation?

MAP, CO, Hgb, SaO₂, PaCO₂, temp, anesthetic depth.

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What are stroke treatment options?

tPA within 4.5 hours
Thrombectomy up to 8 hours
Long-term: antiplatelets, statins, BP and lifestyle control

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What defines Peripheral Artery Disease (PAD)?

Ankle-Brachial Index (ABI) < 0.9

ABI = SBP ankle / SBP brachial

5 listed

Common PAD symptoms?

Intermittent claudication
Rest pain
Weak pulses
Cool/cyanotic limbs
Relief by hanging leg off bed

What are PAD risk factors?

Age, smoking, diabetes, HTN, obesity, ↑ cholesterol, family history.

What imaging is used for PAD?

Doppler U/S, duplex U/S, MRI angiography, transcutaneous oximetry.

When is revascularization indicated in PAD?

Disabling claudication or tissue ischemia.

Most common cause of acute limb ischemia?

Cardiogenic embolism (e.g. A-fib, LV thrombus post-MI)

Classic signs of acute arterial occlusion?

Pain, paresthesia, paralysis, pulselessness, pallor, poikilothermia (the '6 Ps').

How is acute occlusion diagnosed and treated?

Dx: Arteriogram, Tx: Anticoagulation, surgical embolectomy, or amputation (last resort)

What is Subclavian Steal Syndrome?

Occlusion of subclavian artery proximal to vertebral artery → blood is 'stolen' from brain to arm.

Symptoms of subclavian steal?

Syncope, vertigo, hemiplegia, arm ischemia, SBP in affected arm >20 mmHg lower.

What are risk factors and treatment for subclavian steal?

RF: Atherosclerosis, prior aortic surgery, Takayasu arteritis, Tx: Subclavian endarterectomy

What is Raynaud’s phenomenon?

Episodic vasospasm of digital arteries, triggered by cold or stress.

What does Raynaud’s look like clinically?

Blanching, cyanosis, then redness of fingers or toes.

Treatment for Raynaud’s?

Avoid cold, CCBs, alpha-blockers; sympathectomy for severe cases.

What are the 3 elements of Virchow’s Triad?

Venous stasis, Endothelial injury, Hypercoagulability

What are common perioperative venous issues?

Superficial thrombophlebitis, Deep vein thrombosis (DVT), Chronic venous insufficiency

What are DVT risk factors?

Age >40, surgery >1 hr, cancer, orthopedic or abdominal surgery.

What are DVT prevention measures?

SCDs, compression stockings, subQ heparin, regional anesthesia to promote early ambulation.

How is DVT treated?

Heparin → Warfarin (INR 2–3); LMWH often preferred. IVC filter for anticoag contraindications.

What are the 3 size-based categories of vasculitis?

Large artery: Takayasu, Temporal arteritis; Medium artery: Kawasaki; Medium/small: Buerger’s, Wegener’s, Polyarteritis nodosa

What are symptoms of temporal arteritis?

Unilateral headache, scalp tenderness, jaw claudication, visual changes.

What is the biggest complication of temporal arteritis?

Permanent vision loss due to optic neuritis.

How is temporal arteritis diagnosed and treated?

Dx: Temporal artery biopsy; Tx: High-dose corticosteroids (ASAP if vision symptoms)

What causes Buerger’s Disease?

Autoimmune vasculitis triggered by tobacco/nicotine in men <45.

What are symptoms and diagnostic criteria for Buerger’s?

Claudication of arms/legs, Ischemia/ulcers; Diagnosis = biopsy + smoking history, young age, absence of atherosclerosis

What are treatment and anesthesia implications for Buerger’s?

Tx: Smoking cessation; Anesthesia: Meticulous padding, warm room, avoid vasoconstriction

What causes chronic venous insufficiency (CVI)?

Long-standing venous reflux and dilation.

What do CVI symptoms range from?

Telangiectasias → varicose veins → edema → skin changes → ulcers.

What are conservative treatments for CVI?

Leg elevation, weight loss, compression, emollients, wound care.

What are surgical options for CVI?

Saphenous vein ligation, Phlebectomy, Venous ablation/ligation

What is DeBakey Type I dissection?

Starts in ascending aorta Extends into the arch and descending aorta Most common and most dangerous

What is DeBakey Type II dissection?

Starts and stays in the ascending aorta only Does not extend past the arch Requires surgery

What is DeBakey Type III dissection?

Starts in the descending aorta, after the left subclavian May extend down the aorta Often treated medically unless complications arise