vascular procedures 5/6 Flashcards
what are positives of having an epidural during aortic surgery
- can blunt catecholamine response
2. less hypotension than spinal
how long do you want to wait after doing patient epidural before giving heparin during procedure
2 hours
what is the spinal risk of aortic cross-clamping
ischemia d/t interruption of great radicular artery (artery of adamkiewicz) which may lead to paralysis (paraplegia)
what type of process is atherosclerosis
inflammatory process of arterial tree with endothelial dysfunction
6 steps leading to aneurysm:
- plaque formation (stenosis or obstruction)
- thrombosis causes acute ischemia
- emboli from atheramatous debris
- decerase of distal blood flow
- weakening of the arterial wall
- aneurysm
12 risk factors for aneurysm:
- HTN
- hypercholesterolemia and triglycerides
- genetic predisposition
- smoking
- heredity
- C reactive protein
- male gender
- caucasian
- sedentary lifestyle
- type A personality
- diabetes
- obesity
what is takayasu’s arteritis?
called pulseless disease
it is an inflammatory disease of the aorta in which one or more branches of the aortic arch become occluded
- what is thromboangitis obliterans?
2. who does it occur mostly in?
- a chronic vascular occlusive disease of peripheral arteries and veins (affects extremities)
- occurs mostly in smokers
common sites for arthreosclerotic lesions:
- coronary arteries
- carotid bifurcations
- abdominal aorta
- iliac and femoral arteries
s/s of atherosclerosis:
- intermittnend claudication (improves with activity)
- cramping
- tiredness
- pain
- weakness
Management of atherosclerosis (medical & behavioral):
- exercise
- smoking cessation
- asa
- control HTN and DM
- antiplatelet therapy: (cox 2)
- adenosine diphosphate (adp)antagonists: (ticlid, plavix)
- glycoprotein (IIb/IIIa) inhibitor: (integrilin, reapro)
surgican tx for atherosclerosis:
(revascularize the artery via:)
- stent placement
- transluminal angioplasty
- endarterectomy
- thromboctomy
- bypass procedure
name 4 types of bypass procedures for atherosclerosis:
- aortofemoral
- axillofemoral
- femfem
- fempop
what does the presence of collateral circulation provide in PVD patients
cardiovascular stability
if a patient is on anticoagulants, what must you do as far as anesthesia?
reverse anticoagulation (ffp, vitamin k, protamine) prior to spinal or epidural or they will need GA
monitoring for arterial bypass procedure
- what leads?
- blood pressure?
- GI/GU?
- II & V5
- arterial line
- foley and OGT