Vascular surgery Flashcards
vascular disease:
- what is the earliest lesions of atherosclerosis? (FS)
- what is the hallmark of atherosclerosis? (P)
- what are the 3 component of plaque? (L, SMC, CTM)
- is the goal for plaque for it to be stable?
- is stable or unstable plaque vulnerable to cause acute thrombosis?
- fatty streak
- plaque
- lipid, smooth muscle cells, CT matrix
- yes
- unstable
what are the 12 risk factors for developing an therosclerotic lesion? (ET, H, G, CS, H, DM, O, SL, M, IGR, H, CRP)
- elevated triglycerides
- hypercholesterolemia
- genetics
- cigarette smoking
- HTN
- diabetes mellitus
- obesity
- sedentary lifestyle
- male
- impair glucose regulation
- homocysteine
- c-reactive protein
vascular disease:
- expect atherosclerosis in what 3 artery groups? (C,C,R)
- more than half the mortality associated with PVD results from adverse what events? (C)
- what % of pts presenting with AAA repair have significant CAD?
- coronary, cerebral, renal
- cardiac
- 42%
Revised cardiac risk index:
- what type of surgery? (HR)
- history of what 3 things? (IHD, HF, CVD)
- DM requiring what? (I)
- preop creatinine greater than what mg/dL?
- high risk
- ischemic heart disease, heart failure, cerebrovascular disease
- insulin
- > 2 mg/dL
% of major C/V event:
- no risk factors
- 1 risk factor
- 2 risk factors
- 3 or more risk factors
- 0.4%
- 1%
- 6.6%
- 11%
what are the 3 major periop CV risks? (UCS, DCHF, SA)
unstable coronary syndrome, decompensated CHF, significant arrythmias
define unstable coronary syndrome:
- MI less than how many days with evidence of ischemic risk by clinical symptoms?
- unable or severe what? (A)
- < 30 days
2. angina
what are the 3 types of significant arrythmias? (HGAVB, PVCs, SAwUVR)
- high grade AV block
- PVCs
- supraventricular arrhythmias with uncontrolled ventricular rate
what are the 4 intermediate periop CV risks? (MA, PMI, CCHF, DM)
- mild angina
- prior MI (Q wave on EKG)
- compensated CHF
- diabetes mellitus
what are the 6 minor periop CV risks? (AA, AE, ROTNS, LFC, HOCVA, HOUH)
- advanced age
- abnormal ECG
- rhythm other than normal sinus
- low functional capacity
- history of CVA
- history of uncontrolled HTN
HIGH risk noncardiac procedures:
- cardiac risk > what %?
- what type of major operations, particularly in the elderly? (E)
- anticipated prolong surgical procedures associated with large fluid waht and/or what else? (S, BL)
- what 2 types of vascular procedures? (PV, MV/A)
- > 5%
- emergent
- shift, blood loss
- peripheral vascular, major vascular/aorta
Intermediate cardiac risk, non-cardiac procedures:
- cardiac risk less than what %?
- what 7 procedures? (CHIP, ION)
- < 5%
2. carotid endarterectomy, head, intrathoracic, prostate, intraperitoneal, orthopedic, neck
Low cardiac risk, non-cardiac procedures:
- < what %?
- what 4 procedures? (B,E,C,S)
- < 1%
2. breast, endoscopic, cataract, superficial
EKG is indicated if what:
- for what system symptoms? (C/V)
- surgery risk of what? with > how many risk factors?
- any pt undergoing what risk of surgery?
- cardiovascular
- intermediate risk, >1
- high risk
chest x ray:
- indicated for pts with new or unstable what S/S? (CP)
- is it indicated for an asymptomatic health pt?
- should pts with an increased risk have one done if the results would alter surgery?
- cardiopulmonary
- no
- yes
TTE:
- pts should get one if ischemic heart disease with reduced what? (FC)
- pts should get one if there is a murmur in the presence of what 2 systems’ symptoms? (C,R)
- pts should get one if one of these 3 symptoms are present? (USOB, AE, ACXR)
- Is a repeat TTE needed if the previous TTE was within 12 months and there is no change in clinical status?
- functional capacity,
- cardiac, respiratory
- unexplained SOB, abnormal EKG, abnormal chest x ray
- no
dobutamine stress echo predicts what in vascular surgery but is expensive? (M)
morbidity
higher or lower risk for vascular surgery if coronary revascularization precedes the vascular procedure?
lower
Patients with systemic manifestations of atherosclerotic heart disease & are at risk for ischemia in what 4 places? (C, C, R, SC)
- cardiac
- cerebral
- renal
- spinal cord
Vascular procedures physiologic changes:
- hypercalcemia or hypocalcemia?
- hyperthermia or hypothermia?
- acidosis or alkalosis?
- what are 3 other changes? (FS, TS, BL)
- hypocalcemia
- hypothermia
- acidosis
- fluid shift, third spacing, blood loss
Carotid Endarterectomy (CEA):
- the carotid artery is incised and what is removed from the lumen to improve cerebral blood flow? (P)
- severity of ischemia is related to degree of blood flow what? (C)
- Asymptomatic patients are potential candidates for CEA if > what % occlusion of common internal carotid?
- CEA performed in an asymptomatic 70% stenosis reduces stroke by what % over 2 years?
- with TIAs or stroke, untreated lesions have annual stroke incidence of what %?
- is it a recommended procedure in pts with < 50% stenosis?
- is it a recommended procedure in pts with chronic total occlusion of targeted carotid artery?
- is it a recommended procedure in pts with severe disability caused be cerebral infarction that precludes preservation of useful function?
- plaque
- collateralization
- 70%
- 17%
- 5%
- no
- no
- no
Carotid Endarterectomy (CEA):
- what is the most common risk during and after? (S)
- what is associated with up to 50% of all mortalities after CEA?
- HTN in about what % of pts?
- HTN in pts undergoing a CEA have an increased risk of what? (S)
- what 4 things can impact whether or not a pt strokes during the CEA?
- stroke
- myocardial infarction
- 70%
- stroke
- collateral blood flow, concurrent atherosclerosis, plaque size, presenting symptoms
CEA cerebral monitoring:
- what is the gold standard for monitoring?
- carotid stump pressure assesses collateral flow to distal portion of what after cross clamping? (OCA)
- stump pressure < what mmHg range reflects hypoperfusion and need for shunt placement?
- what monitor assess BF velocity in the MCA? (TD)
- what monitor assess cerebral regional oxygen saturation using near-infrared spectrometry? (CO)
- decrease of O2 saturation by what range of % for > 4 minutes indicates potential for deficits?
- EEG
- operative carotid artery
- <40-50 mmHg
- transcranial doppler
- cerebral oximetry
- 20-25%
Carotid Endarterectomy (CEA):
- do all pts need an art line?
- how many IVs?
- yes
2. 2 (IVF and blood; another for drips)