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Fundamental 2 > Vascular Procedures > Flashcards

Vascular Procedures Flashcards

1
Q

What is the most common cause of occlusive disease in the lower extremity?

A

Peripheral Vascular Disease

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2
Q

What are the 11 risk factors associated with development if atherosclerotic disease?

A
  1. Cigarette smoking*
  2. Hypertension
  3. DMII*
  4. Obesity
  5. Hypercholestrolemia.
  6. Elevated triglycerides
  7. Genetic predisposition
  8. Gender Male>female
  9. Impaired glucose regulation
  10. Homocysteine
  11. C-reactive protein
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3
Q

What are the 4 main symptoms of PVD?

A
  1. Claudication
  2. Skin ulceration
  3. Gangrene
  4. Impotence.
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4
Q

What are the 5 and 10 year mortality rates of PVD?

A

5yr= 30%

10yr=70%

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5
Q

T/F: If cardiologist says “ok to proceed”, this eliminates any of your own liability?

A

False

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6
Q

What is risk of having a cardiac event d/t vascular surgery?

A

1-5%

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7
Q

What three coexisting diseases are present in nearly 50% of abdominal aortic resection patients?

A

Hypertension
Heart disease
COPD

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8
Q

What extra monitoring equipment is needed for AAA surgeries?

A
  1. Arterial line
  2. Possible PAC (CVL with CVP instead)
  3. EKG (at least a 5 lead)
  4. TEE- to visualize ischemia
  5. Good IV access (bare minimum 18g IV
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9
Q

What must be avoided postop for AAA repairs?

A
  1. Pain
  2. Tachycardia
  3. Hypertension
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10
Q

How frequently are AAA repairs performed?

A

36.2 of 100,000 procedures

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11
Q

What coexisting disease may mask signs and symptoms of AAA?

A

Obesity

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12
Q

What is the primary cause/contributing factor for AAA?

A

Atherosclerosis (90%)

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13
Q

What is the best diagnostic tool for supra-renal aneurysms?

A

Digital subtraction angiography

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14
Q

What is the untreated mortality rate for AAA?

A

100%

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15
Q

If an AAA is 3.5cm, what is the recommendation?

A

Medically manage until over 5cm

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16
Q

What are 7 things that have significantly reduced mortality rates for AAA?

A
  1. Early detection
  2. Early interventio
  3. Extensive peoperative preparation
  4. Refined surgical technique
  5. Improved hemodynamic monitoring
  6. Improved anesthetic technique
  7. Improved postop management
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17
Q

How much heparin is given for ELG for AAA?

A

50-100units/kg

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18
Q

Why would MAC not be a good choice for ELG placement?

A

Need for “quiet” (no movement) during fluoroscopy

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19
Q

What must also be prepared for when doing an endovascular AAA repair?

A

Preparation for RAPID conversion to open procedure

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20
Q

What is endoleak?

A

Persistent blood flow and pressure between the endovascular graft and the aortic aneurysm

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21
Q

Describe the 5 types of endoleak:

A 
I. Leaking around the graft
II. Peripheral vessel leaking in (back flow)
III. Rupture or misalignment of graft
IV. Pressure in the graft
V. Leaking directly through the graft
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22
Q

What is the most common type of endoleak?

A

II. Peripheral vessel leaking in (back flow)

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23
Q

T/F: If a patient is young, we will definitely perform an endovascular AAA repair

A

False: Will perform open d/t longer lasting repair

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24
Q

What are 4 contraindications to elective AAA repair?

A
  1. Intractable angina
  2. Recent MI
  3. Severe pulmonary dysfunction
  4. Chronic Renal Insufficiency
25
Q

Which patients are High risk AAA repair?

A
  1. > 85years
  2. Home O2 use, PaO2<50mmHg, FEV1 <1l/sec
  3. Creatinine >3
  4. Class III-IV angina, EF<30%, Recent CHF, Complex ventricular ectopy, severe-noncorrectable CAD
26
Q

What monitoring devices are needed for open AAA?

A
  1. EKG with Lead II and V5, ST analysis
  2. Pulse ox/capnography
  3. Temp
  4. Urinary catheter
  5. Nerve stimulator (will need NMBA)
  6. Art line
  7. CVL/PA cath
27
Q

What two major pathophysiologic factors happen with cross clamping aorta?

A
  1. Heart over-work/stress

2. Hypoperfused gut/kidneys

28
Q

What will happen to patient’s BP with aortic cross clamping?

A

Increase above the clamp.

Decrease below the clamp

29
Q

What happens to MAP, Afterload, and SVR above the aortic cross clamp?

A

All three increase which increase myocardial work load/wall tension

30
Q

What happens to PAOP with aortic cross clamping?

A

Increase or remain unchanged

31
Q

What is first line treatment for hypertension d/t aortic cross clamping?

A

Nitroglycerine because fast onset and short duration of action

32
Q

What are other treatment options for hypertention during aortic cross clamping?

A

Nipride and increase anesthetic gas concentration

33
Q

With a decrease in venous capacity during aortic cross clamping, what happens to the body?

A

Increase in blood volume to a) lungs, b) intracranial c) venous return
d) muscles (above clamp)

34
Q

What type of metabolic alterations occur during aortic cross clamping?

A
  1. Hypoxia of distal tissues
  2. Accumulation of anaerobic metabolites like lactate
  3. Increase in plasma Epi/NE
  4. Neuroendocrine response
35
Q

What are some interventions if aortic cross clamp is supra-renal?

A

Give mannitol prior to clamping, avoid hypovolemia, lasix after cross clamping

36
Q

T/F: The lower the cross clamping, the higher the risk of spinal cord damage?

A

False; the higher the cross clamping, the higher the risk of spinal cord damage

37
Q

Which artery can often times be interrupted during aortic cross clamping?

A

Artery of Adamkiewicz (Greater Ridicular Artery)

38
Q

Which artery can become ischemic and cause ischemic colon?

A

Inferior mesenteric artery

39
Q

Unclamping of aortic cross clamp will most likely necessitate what two interventions?

A
  1. Vasopressors

2. Fluid administration

40
Q

What 6 things are associated with Declamping Shock Syndrome?

A
  1. Liberation of anaerobic metabolites
  2. Decrease SVR
  3. Decrease venous return
  4. Reactive hyperemia
  5. Further decrease in preload/afterload
  6. Hemodynamic instability
41
Q

T/F: Blood products should be ready in blood bank for all open AAA procedures?

A

False; should be kept inside the room

42
Q

What is the mortality rate for ruptured AAA?

A

94%

43
Q

What is the primary objective during a ruptured AAA?

A

Hemodynamic stability through fluid resuscitation

44
Q

Where should the art line and pulse oximeter be placed for AAA repairs?

A

Art line in right hand (less interuption)

Pulse ox on left hand to watch for blockage or ischemia

45
Q

What is the 3rd leading cause of death in the US?

A

Cerebrovascular accidents/strokes

46
Q

If plaque ruptures, what 4 things are released into circulation?

A
  1. Fibrin
  2. Calcium
  3. Cholestrol
  4. Inflammatory cells
47
Q

What are the 5 major risk factors leading to CVA?

A
  1. Abdominal obesity
  2. HTN
  3. Diabetes
  4. Smoking
  5. Heart disease (including A fib)
48
Q

A symptomatic pt with <50% carotid stenosis, what is the therapy?

A

Optimize medical therapy

49
Q

If a patient is asymptomatic with 75% stenosis and low perioperative risk- what is the therapy?

A

Carotid endarterectomy

50
Q

If a patient is symptomatic with 70% stenosis with high operative risk- what is the therapy?

A

Carotid artery stenting

51
Q

T/F: Patients with no significant medical history, normal physical exam, and normal EKG are still considered high surgical risk for carotid endarterectomy?

A

False; considered lower surgical risk

52
Q

Which test is very suggestive o increase risk of adverse cardiac events during carotid endarterectomy?

A

Dipyridamole-thallium imaging (stress test)

53
Q

What three things are of highest priority from an anesthesia perspective during carotid endarterectomy/stenting?

A
  1. Maintain cerebral perfusion/oxygenation
  2. Maintain myocardial perfusion/oxygenation
  3. Facilitate smooth, rapid emergence
54
Q

When is the best time to perform a neurological exam after extubation?

A

Immediately after emergence

55
Q

What happens to cerebral blood flow during carotid cross clamping?

A

Can decrease if opposite side carotid is also stenotic

56
Q

What can the surgeon do to help with bradycardia?

A

Inject local anesthetic around carotid artery to block vagal response

57
Q

What post-operative complications are of highest important with carotid endarterectomies/ stenting?

A
  1. Airway is priority (because bleeding is so close to airway)
  2. BP/Blood loss
  3. Stroke d/t no carotid perfusion
58
Q

When carotid surgeries are performed under GA, what other monitoring devices can be used to ensure neurological preservation?

A
  1. EEG

2. Cerebral oxygenation (keep within 20% of baseline)

Fundamental 2 (7 decks)

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