Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Advanced Principles II > Vascular Surgery > Flashcards

Vascular Surgery Flashcards

1
Q

What is the Most Common Peripheral Vascular Occlusive Disease?

A

Atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The mortality rate in patients with vascular disease is ___ X higher than in
the general population

A

The mortality rate in patients with vascular disease is 2-6 X higher than in the general population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Surgical Therapies for PVD

A

Transluminal Angioplasty
Endarterectomy
Thrombectomy
Endovascular Stenting
Arterial Bypass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the Number 1 Complication of any Vascular Procedure?

A

Myocardial Infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the Number 2 Complication of Vascular Surgery?

A

Stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Vascular surgery patients are known to be at elevated risk of
perioperative ______

A

Vascular surgery patients are known to be at elevated risk of
perioperative MACE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 3 RF associated with PVD?

A

DM, Tobacco use and HLD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Major Ppen Vascular Cases can be associated with significant fluctuations in ______, _______, _________, _______, & ______

A

Major Ppen Vascular Cases can be associated with significant fluctuations in ______, _______, _________, _______, & ______

Fluid Volumes, Cardiac Filling Pressures, Systemic Blood Pressures, HR and Thrombogenicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A careful history must be taken to define the extent of any diagnosed ASCVD & to screen for any undiagnosed concurrent disease (e.g., _______ , __________, or ________ or __________
_________)

A

A careful history must be taken to define the extent of any
diagnosed ASCVD & to screen for any undiagnosed concurrent
disease (e.g., angina or equivalent, TIA, or mesenteric or peripheral
ischemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Physical examination should evaluate for any evidence of end
organ involvement (e.g., __________,
______, or
________) or cardiovascular decompensation
(e.g., _______,
___________,
________________,
______, _
______, or
_________)

A

Physical examination should evaluate for any evidence of end
organ involvement (e.g., diminished pulses,
S4 gallop,
or residual
deficit from previous stroke) or cardiovascular decompensation
(e.g., new or worsened murmur,
jugular venous distention, third heart sound on cardiac auscultation,
rales,
shortness of breath,
or
peripheral edema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What Labs or Tests would you order Preop?

A

CBC– if Blood loss, Anemia, and platelete count
Coagulation– If patient is on anticoagulants or regional is anticipated
Chemistry– ↑ risk of underlying renal insufficiency
12 lead EKG– Increased risk of MACE Done within 1 month
Ecco if previous LV dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

______ are recommended in patients at high risk for MI

A

β-BLOCKERS recommended in patients at high risk for MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When should B Blockers be started in vascular surgery patients?

A

Days to weeks before surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ideal HR for patients undergoing Vascular surgery ?

A

HR should be 50-60 BPM to ↓ Cardiac Stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A _______ should be instituted 30 days prior to the surgical
procedure & continued throughout the postoperative period

A

A STATIN should be instituted 30 days prior to the surgical
procedure & continued throughout the postoperative period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

STATINS have Cardioprotective effectrs as the
1.
2.
3.
4.
5.

A

Statins:
1. ↓ Vascular Inflammation
2. ↓ the incidence of thrombogenesis
3. ↑ Nitric Oxide Bioavailability
4. Stabilize atherosclerotic Plaques
5. ↓ Lipid Concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

According to the Poise trial Aspirin has what perioperative effect / Consequence?

A

Aspirin does not prevent MI and does ont alter the risk of Periopertative cardiovascular event

However does ↑ the risk of major bleeding event

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Indication for Carotid Endartectomy (4)

A
  1. TIA Associated with Ipsilateral Severe Carotid Stenosis
  2. Severe Ipsilateral Stenosis in patient with incomplete Stroke
  3. 30-70 % occlusion in a patient with Ipsilateral symptoms
  4. Historically– Asymptomatic Stenosis Lesions >60 % would be recommended for CEA, now they are stented
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Risk Factors for perioperative Mortality of CEA (6)

A
  1. Age >75
  2. Symptomatic Lesions
  3. Uncontrolled HTN
  4. Angina
  5. Carotid Thrombus
  6. Occlusions near the carotid Siphon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most likely site of a CEA?

A

Bifurcation of the Carotid Artery with the proximal internal carotid involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Anatomical Structures near the carotid dissection (5)

A
  1. Hypoglossal Nerves
  2. Vagus Nerve
  3. RLN
  4. Mandibular Branch of Facial nerve
  5. Glossopharyngeal nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Chronic HTN shifts the Cerebral autoregulatory curve which way? meaning what?

A

Shifts to the right
CBF becomes BP dependant and narrows range for ideal flow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Profound Hypocarbia Causes Cerebral Vascular _______. Causing ___ in CBF

A

Profound Hypocarbia Causes Cerebral Vascular CONSTRICTION. Causing ↓ in CBF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

______ Occurs with Hypercarbia as it leads to Cerebral Vascular ________ in Cerebral Vessels

A

___Cerebral Steal__ Occurs with Hypercarbia as it leads to Cerebral Vascular __Dilation___ in Cerebral Vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Inhalation agents __ CBF d/t _______ in a dose dependant manner
Inhalation agents ↑ CBF due to cerebral vascular dilation in a dose-dependent fashion
26
Anesthetic Agents Except ______ ↓ CMRO2
Anesthetic Agents Except ____Ketamine__ ↓ CMRO2
27
Normal CBF
-- 50 mL/100g/ min
28
Each 100 ml of blood contains ___ mL of O2
20 mL of O2
29
CMRO2 in brain is ____
3-5 ml/100g/min AVG 3.5
30
Ischemia is apparent on EEG at CBF of ________
20 ml/100g/min
31
Neuronal Destruction occurs at CBF of _______
10 mL/100g/min
32
Carotid Circulation supplies _______% of the Brain other % is the ______
Carotid Circulation supplies __80-90%__% of the Brain other % is the __Vertebral Artery___
33
1 Goal for Anesthesia during CEA?
Avoid Hemodynnamic extremes
34
Extreme Hypocarbia causes a _____ Shift in the Oxyhemoglobin curve
Extreme Hypocarbia causes a ___Left__ Shift in the Oxyhemoglobin curve
35
What is Luxury perfusion?
Diseased Blood vessels are maximally dialate and will not constrict or dilate further. CO2 has little effect on their flow Increased CBF during normal state
36
Intracerebral Steal Syndrome ↑ in PaCCO2 causes ____ in normal vessels and _____ of blood from _____ vessels
Intracerebral Steal Syndrome ↑ in PaCCO2 causes _Dilation__ in normal vessels and __Shunting___ of blood from __diseased___ vessels
37
Modalities to protect the brain (4)
1. Hypothermia (low normal) 2. Aggressive Glucose Control (Avoid Glucose Solutions) 3. ↓ CMRO2 4. Shunts (During Cross Clamping)
38
Pitfalls of Carotid Shunt Placement (2)
Potential traumatic injury to the distal internal carotid artery intimate Potential for embolization of the atherosclerotic debris or air
39
Problems with Shunts (9)
1. Duslodgement of plaque or clot 2. Air Embolism 3. Kinking 4. Shunt occlusion against Art Wall 5. Dusruption of Distal Internal Carotid 6. Patient may still get EEG Changes 7. Shunt may impair surgical access 8. only beneficial if the cause is low flow 9. 65-95 % of neurologic deficits during CRA may be thromboembolic
40
Ways to monitor Cerebral Perfusion
EEG, SSEP, Cerebral Pulseox, Transcranial Doppeler, Awake patient, Direct Xenon Cerbral blood flow measure, Stump Pressure
41
Stump pressure normal and extreme values
Normal- 40 Extreme Values <25 >60
42
_______ – not recommended to allow for rapid neuro assessment postop
__Midazolam__ – not recommended to allow for rapid neuro assessment postop
43
Limit fluid to a max of _____ mL/kg in 2 hour
10 mL/kg
44
Benefits of LA in CEA
↓ Opioid use ↓ Baroreceptor mediated Bradycardia from carotid bodies
45
BP goal before and after carotid Cross clamping
Normotension
46
BP goal During cross clamp
20% above baseline
47
Average cross clamping time
30 minutes
48
Baroreceptor Reflex S/s
Sudden Bradycardia and hyptension
49
Sudden Bradycardia and hypotension during CEA Treatment
Surgeon injects 1 % lidocain to the bifurcation of the carotid sinus This blocks sodium channels so no conduction from the nerves to the brain and no drop in HR This can result in post op Hypertension
50
How much heparin is given before cross clamping
50-100 u/kg
51
When is an ACT drawn
3 minutes and every 30 minutes thereafter
52
How much protamine is given
50 - 150 mg given SLOWLY
53
What level is necessary for Regional Anesthesia
C2-C4 Dermatome blocked Deep or superficial Cervical block
54
Advantages of Regional anesthesia for CEA (5)
Stable BP Inexpensive and easy Avoidance of tracheal intubation Avoidance of negative Inotropic anesthetic agents
55
Disadvantage for Regional for CEA (3)
1.Risk of Laryngeal nerve paralysis and phrenic nerve palsy 2. Requires highly cooperative patient 3. Unpredictable risk of sudden onset agitation and poor
56
Respiratory Complications of CEA
Recurrent Laryngeal / Hypoglossal injury d/t neck hematoma or deficient crotid body function Tension Pneumothorax @ apex
57
Risk Factors for Hematoma formation (2)
Failure to reverse Heparin Remaining intubated post op
58
What is the result of Cerebral hyperperfusion Syndrome? and what increases the risk?
Cerebral Edema HTN ↑ risk
59
Who does Cerebral Hyperperfusion synrome happen in mostly?
Those with a contralateral CEA w/i 3 months and a 2nd CEA on the ipsilateral side
60
ACT for Carotid Angioplasty and Stenting
>250 seonds
61
Sedation for Carotid Angioplsty and stenting
Minimal, Patient needs to be arousable and responsive
62
RF for AAA (7)
1. Advanced Age (50-80) 2. Male > Female 3. Family Hx 4. Smoking ↑ 5x 5. CAD, HTN, PVD, ↑ Cholesterol 6. COPD 7. Caucasian
63
Contraindication for Elective repair
1. Interactable Angina 2. Recent MI 3. Severe Pulmonary dysfunction 4. Chronic Renal Insufficiency
64
Law of Laplace
T (Wall Tension)= P (Transmural Pressure) x r (Vessel Radius)
65
↑ risk of rupture > ____cm Surgical repair > ____cm or growth > ____-____ cm/year
↑ risk of rupture > 5cm Surgical repair > 5.5cm or growth > 0.6-0.8 cm/year
66
Goals of AAA
Optimization of Myocardial O2 Supple and demand Modification of cardiac RF Done with B blockers and statins
67
What is the most important patient preperation to enhance cardiac function
Fluid loading restoration of intravascular volume
68
_______ is an ever-present threat, therefore the availability of blood & blood products should be ensured
__Massive hemorrhage__ is an ever-present threat, therefore the availability of blood & blood products should be ensured
69
Hypovolemia in AAA patients preop is caused by
Radiographic dye studies and bowel prep
70
Heparin ____ units/kg are administered 5 minutes before aortic cross clamping ACT Level Required
100-300 units/kg ACT >400
71
Main Anesthetic goals of AAA repair
Keep Patient Warm Keep HR Slow Avoid Anemia Prevent HTN -- Especially prior to clamping
72
Classic Triad of AAA
1.Severe Back pain 2. Altered Mental State d/t Hypotension 3. Apulsatile abdominal mass
73
Emergency AAA Repair Priorities
Treat Hypothermia Administer Ca d/t lack of citrate metabolism d.t lack of liver flow Vasopresin for catecholamine depletion
74
Primary goal of AAA rupture
Control of blood loss and reversal of hypotension Then preservation of hte myocrdial function
75
Directly related response to Aortic Cross-Clamping
Location of clamp (Most common is infrarenal) Intravscular Volume Cardiac Reserve
76
Applcation of Aortic Cross ClampCreates _____
Central Hypervolemia ↓ Venous Capacity resulting from a shift in a large portion of blood volume proximal to the clamp and increasing venous return
77
Removal of Arotic cross clamp creates ____
Central Hypovolemia--Large ↓ in BP Venous capacity is restored blood shifts back to lower body below clamp capillary beds leak decreasing intravascular volume and ↓ venous return
78
CV Canges with Cross Clamp HR- CO- Above Clamp? Below Clamp?
HTN above the cross clamp Hypotension below cross clamp Due to ↑ SVR aortic impedence and after load Cardiac Output ↓ or remains HR remains unchanged
79
Hemodynamic Changes with Cross Clamp Increased (6)
Art BP Above Clamp Segmental Wall motion abnormalities Left Ventricular Wall Tension (↑ Afterload) PAOP CVP CA Blood Flow (↑ Demand/Adenosine) Myocardial O2 Demand -- ↑ Afterload and ↑ Preload & Conractility
80
Hemodynamic Changes Decreased... (4)
Art BP Below Clamp EF CO Renal Blood Flow
81
Metabolic Changes Increased... (3)
Mixed Venous O2 Epi and Norepi Respiratory Alk and Met Acidosis
82
Metabolic Changes Decreases ...
total-Body O2 Consumption Total Body CO2 Production Total Body O2 Extraction
83
Fluid Shifts from ____ to ____ distal to clamp and ____ to ____ proximal of Clamp
Fluid Shifts from __Iterstitial__ to _intravascular___ distal to clamp and _intravascular___ to _interstitial___ proximal of Clamp
84
Hemodynamic Change-- ↑ BP Above Clamp Metabolic Change ↓ Total Body O2 Consumption Intraop intervention
↓ Afterload--> Na Nitroprusside Inhaled Anesthetics Milrinone Shunts and Aorta to Femorlal Bipass
85
Hemodynamic Change-- ↓ in arterial BP below Clamp Metabolic Change-- ↓ in CO2 Production Intraop Intervention:___
Nitroglycerin Atrial to Femoral Bypass
86
Hemodynamic Changes-- ↑ Wall Motion abnormalities and LV wall Tension Metabolic Change: ↑ Mixed venous O2 Sat Intraop Interventions:
renal Protection: Fluid Manitol Lasix Dopamine N-Acetylcystein renal Cold Perfusion
87
Effects of Cross Clamping on the Lungs
↑ PVR and PAP
88
Ischemia Generates Thromboxane Which ...
↑ PAP, induces Neutrophil Entrapment in lungs, ↑ Pulmonary permeability resulting in Pulnmonary edema and shunting
89
Aortic Cross Clamping of the kidneys results in _______, Which activates _______
Aortic Cross Clamping of the kidneys results in ___Hypoperfusion__, Which activates ___Renin- Angiotensin system__
90
What is the best way to effective protect the kidneys from ischemia?
Optimization of systemic hemodynamics including ciorculating blood volume
91
The major effect of Angiotensin II is ___
↑ in renal vascular resistance and sodium reabsorption Directly (Proximal and tubular) and indirectly (by ↑ of aldosterone
92
____ reduces the degree of the ↓ in renal blood flow during cross clamp
__Manitol__ reduces the degree of the ↓ in renal blood flow during cross clamp
93
Paraplegia/Anterior Cord Syndrom is characterized by ____
loss of motor & pinprick sensation but preservation of vibration & proprioception
94
Where is the Artery of Adma owicz located?
Usually T8-T12 but can be L1-L2
95
Spinal Cord Ischemia Prevention Measures
Short Cross Clamp Times Fast Surgery Maintenance or normal Cardiac Function Higher Perfusion Pressures Monitoring SSEPs and MEPs
96
Ideal ICP for these Patients
10-12
97
Do not drain more than ____ mLs of CSF /hour. Risk for SAH
20 mL/hour
98
Hemodyamic Response to Unclamping
↓ Myocardail Contraction (Stunting), Arterial BP, CVP, Venous Return, CO, SVR and Preload ↑ in PAP
99
Unclamping Metabolic Changes
↓ in Mixed Venous O2 Sat, Temperature ↑ in O3 Consumption, Lactate, prostoglandins, Myocardial depressant Factors and aNetabolic Acidosis
100
Unclamping Intraop Interventions
↓ Anesthetic Depth ↓ Vasodilators ↑ Fluids ↑ Vasoconstrictors Reapply Cross Clamp for Severe Hypotenion Consider administration of mannitol and sodium bicarb
101
Whatcauses repurfusion syndrome?
Restoration of blood flow t tissues with ↑ inflammatory cell influx and cytotoxic substance wash out into central circulation
102
What is the severity of repurfusion syndrome dependant on?
Duration of clamping
103
Repurfusion syndrom results in: (6)
Myocardial Stunning and dysrhythmias Hypotension Acute Repiratory distress syndrome Renal Failure COmpartment syndrome MODS
104
What influences the magnitude or Change in CO after Unclamping?
Intravascular Volume Site Duration of Clamp
105
Anesthetic Interventions to unclamping
↓ Anesthetic Depth ↓ Vasodilators and ↑ Constrictors ↑ Fluids Fluid Load prior to unclamping Reapply Clam and Gradual release
106
What Thoracic AAA Classification is this?
Debakey I Stanford A
107
What Thoracic AAA Classification is this?
Debakey II Stanford A
108
What Thoracic AAA Classification is this?
Debakey III Stanford B
109
What Side A-Line for a Thoracic AAA repair
R Side
110
Anesthetic Management of AAA Preload:
↓
111
Anesthetic Management of AAA Afterload
↓ with Anesthetics, analgesics, and aerterial dilators Keep Systolic <100-120
112
Anesthetic Management of AAA Contractility
Maintain or ↑ Titrate Myocardial Depressant carefully
113
Advanctages to Endovascular Adbominal aortic repair
less Invasive Shorter Hospital Stay Lower Cost No Aortic cross Clamping ↓ Embolic events ↓ blood loss Reduce in stress response Reduce organ dysfunction ↓ aortic interruption ↓ postop pain
114
Disadvantages tot Endovascular abdominal aortic repair
Endoleak Graft Thrombosis Ggraft migration Graft Rupture Graft infection iliac artery rupture Lower Extremity ischemia Late AAA rupture No long term all cause moratality or quality of life advantage for evar
115
ACT for Endovascular Abdominal Aortic Repair
ACT >200
116
What is the critical phase in endovascular thoracic aortic repair?
Device Deployment
117
ACT for Lower Extremity revascularization?
>200 s
118
Regional Spinal Level for Lewer Extremity Revascularizatino?
T10
119
Repurfusion of Lwer Extremity causes release of ____, ____ and _____ that causes ____ and ______
Repurfusion of Lwer Extremity causes release of __Potassium__, __Cytokines__ and ___Metabolic acidosis__ that causes _Hypotension___ and ___Myocardial Depression__
120
Anesthesia for Vena Cava Filter?
Usually Local or MAC with light sedation
121
TIPS Procedure ______ or ____ within the first 6 months
TIPS Procedure ___Reocclusion___ or __thrombosis__ within the first 6 months
122
What is the most painful part of a TIPs procedure?
Balloon Dilation of the tract
123
Anesthesia considerations for TIPs procedure
RSI for Ascites Coagulopathy Hyperdynamic circulation metabolism of drugs respiratory alkalosis Hemorrhage risk
124
Indications of Radiofrequency Ablation therapy for varicose veins
Symptomatic Superficial insufficiency of veins >3 mm that is refractory for those with compression stockings >18 yo
125
Contraindications for Radiofrequency Ablation of VV (7)
1. INcompetent superficial vein diameter <2mm 2. Hx of extensive DVT in the same leg 3. Active superficial DVT in the same vein 4. History of prior surgical or endovenous treatment of the same leg 5. Pregnancy Known Malignancy 6. Overall poor health frail immobile 7. Known bleeding or clotting disorders

Advanced Principles II (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions