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Summer 2020 - APA Foundations 2 - Other > Vascular Surgery - Quiz 3 > Flashcards

Vascular Surgery - Quiz 3 Flashcards

1
Q

Along with the other common risk factors, Elevated Homocystein & C-Reactive Protein are associated with which disease?

A

Peripheral Vascular Disease

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2
Q

What are symptoms of PVD?

A

Claudication

Skin Ulcers

Gangrene

Impotence

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3
Q

What are the mortality rates for PVD at 5 & 10 years?

A

5 years; 30%

10 years: 70%

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4
Q

How is PVD Treated?

A

Medications

Transluminal Angioplasty

Endartarectomy

Thrombectomy

Stenting

Arterial Bypass

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5
Q

What are the different Arterial Bypass procedures used to treat PVD?

A

Aorto-Fem

Axillo-Fem

Fem-Fem

Fem-Pop

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6
Q

Peripheral Vascular Occlusive disease may indicate what other areas that may be effected?

A

Coronary, Cerebral, and Renal Arteries

>50% of motality from PVD is due to PeriOperative Cardiac Events

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7
Q

What meds can be given d/t high risk of Cardiac Pathology related to PVD?

A

B-Blockers - decrease O2 demand and corrects O2 Supply-Demand mismatch

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8
Q

What is the primary monitoring objective when for Vascular Surgeries?

A

Detecting Myocardia Ischemia

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9
Q

Why is pain control important for Vascular Surgeries?

A

Pain greatly increases SNS stimulation - pain control improves comfort & cardiac stability

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10
Q

What are the Contributing Factors of Abdominal Aortic Aneurysms?

A

Atherosclerosis

HTN

Smoking

Genes

Obesity

Proteolysis of Elastin & Collagen of Vessel Walls

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11
Q

What are ways used to Diagnose an AAA?

A

Imaging

Contrast Studies

Digital Subtraction Angiography

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12
Q

When are Abdominal Aortic Aneurisms at the highest risk for rupturing?

A

Aneurysms > 5 cm

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13
Q

What are the AHA Pre-Operative guidelines for managing a patient w/ an AAA?

A

Glucose Control

Temperature Maintenance

Cardiac Optimization

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14
Q

What are the Renal Considerations regarding an AAA?

A

EVAR - stent migration

Contrast Exposure

Clamped Aorta alters Renal Hemodynamics

Hypotension & Perfusion

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15
Q

What is involved in an EVAR?

A

Guidewire thru Iliac artery to place a stent graft to restrict flow to the aneurysm. Sheath is deployed and hooks & barbs are placed to prevent stent migration

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16
Q

What meds are given before an EVAR?

A

Heparin 50-100 units/kg

&

ABX - 1st Gen. Cephalosporin

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17
Q

What are the Advantages of an EVAR?

A

↑Hemodynamic Stablity

↓Embolic Events

↓Blood Loss

↓Stress, Cortisol, Immune Response

↓Sepsis

↓Renal Dysfunction

↓Post Op Pain

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18
Q

What are the EVAR complications?

A

Graft Problems

Iliac Artery Rupture

Low Extremity Ischemia

Ischemic Gut

Endo Leak

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19
Q

What happens w/ the serious complication of an Endoleak?

A

Persistent blood flow & pressure b/t graft & aortic aneurysm

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20
Q

What are Type I & III Endoleaks?

A

Device Related

Type I: attachment site leak / perigraft channels

Type III: Graft Defect, Tear, Disconnection

Fix w/ second graft or open repair

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21
Q

What are Type II Endoleaks?

A

Collateral Retrograde Perfusion involving other Arteries

Spontaneously closes w/in first month

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22
Q

What is a Type IV Endoleak?

A

Holes in the Graft

Just observe patient

23
Q

When is Surgical AAA Repair Contraindicated?

A

Recent MI

Intractable Angina

Severe Pulm. Dysfunction

Chronic Renal Insufficiency

24
Q

What makes an AAA repair high risk?

A

> 85 y.o

Home O2

PaO2 < 50 mmHg

FEV1 < 1 L/s

Creatinine > 3 mg/dL

Severe CHF, CAD, EF < 30%, Ectopy, Angina

25
Q

Which EKG leads should specifically be monitored for an AAA?

A

Lead II - Dysrythmias

Lead V5 - Ischemic ST Changes

26
Q

What is the standard approach to an AAA Procedure?

A

Transperitoneal to expose infrarenal & iliac vessels as well as intraabdominal organs

Ends w/ rapid closure

27
Q

What are the complications of the Transperitoneal approach for an AAA procedure?

A

Increased Fluid Loss

Prolonged Ileus

Post-Op Pain

Pulm. Complications

Mesenteric Traction Syndrome: Hypotension, Tachycardia, Facial Flushing, ↑CO

28
Q

What are the advantages of a Retroperitoneal approach for an AAA Procedure?

A

Exposure to Justa/SupraRenal Aneurysm

↓Fluid Loss

↓Pain

↓Pulm. & GI Complications

No Mesenteric Traction Syndrome

29
Q

What are the sites that Aortic Cross-Clamping can be?

A

Infrarenal - Most Common

Juxtarenal

Suprarenal

30
Q

What are the risks associated with Higher Aortic Cross-Clamping?

A

Impact on CV System and Vital Organs d/t Hypoperfusion & Ischemia

31
Q

What are the CV changes w/ Aortic Cross-Clamping?

A

HTN above Clamp

Hypotension Below Clamp

Blood Redistribution

No Distal Blood Flow

↓CO or No Change

↑PAOP or No Change

32
Q

What drugs are normally used during Aortic Cross-Clamping?

A

Vasoactive Drugs

Nitroglycerin - ↓Preload & O2 Demand

Dopamine & Dobutamine - ↑CO

Nipride - ↓Afterload

Isolfurane - ↓SVR

33
Q

What is the Neuroendrocrine response to Aortic Cross-Clamping?

A

Inflammation

↑Temp

Leukocytosis

Tachycardia

Tachypnea

Fluid Sequestration

34
Q

Renal Failure may happen from Aortic Cross-Clamping, what can be given to prevent this?

A

Mannitol before Clamping

Dopamine

Lasix after Clap Removal

Fluids

35
Q

How can Post-Op Paraplegia happen from an AAA Procedure?

A

Spinal Cord damage to the Adamkiewicz Artery / Radicular Artery from absence of collateral blood flow d/t higher clamp positions.

Maintain the MAP

36
Q

Ischemia to which vessel can cause Ischemic Colon during an AAA repair?

A

Inferior Mesenteric Artery that supplies the Left Colon

37
Q

What happens w/ Declamping Shock Syndrome?

A

Liberation of Anaerobic Metabolites

↓SVR

↓Venous Return

Reactive Hyperemia

↓Preload & Afterload

38
Q

What is vital to providing circulatory stability before clamp release?

A

Volume loading Fluids to restore circulating volume to CVP by 3-5mmHg or PAOP by 3-4mmHg

39
Q

What is the mortality rate for a Rupture AAA?

A

94%

Primary Objective - Hemodynamic stability & Fluid Resuscitation

40
Q

Besides Abdominal, what are the other types of Aortic Aneurysms?

A

Thoracic Aortic

Aortic Dissection

Descending Thoracic

Thoracoabdominal

41
Q

What causes a TIA or Stroke?

A

Abrupt decrease in Cerebral Blood Flow

42
Q

How long does a TIA last?

A

Seconds to Minutes and can happen again after 24 hours

No loss of conciousness

43
Q

Why are Carotid Endarterectomies performed on patients w/ TIAs?

A

>50% of strokes happen after a TIA

30% after 2 yrs & 55% after 12 yrs

44
Q

What are the symptoms of a TIA w/ Vertebral Involvement?

A

Confusion

Dizziness

Vision Problems

45
Q

What are the TIA symptoms when the Carotid is involved?

A

Unilateral Blindness or weakness

46
Q

What can be used to Diagnose Cartoid Artery Stenosis?

A

Duplex Ultrasonography - Definity

Arteriography

CT

MRI

47
Q

What contributes to poor surgical outcomes for a patient w/ CAD undergoing a CEA?

A

Myocardial Infarction more than stroke

48
Q

What does a Positive Dipyridamol-Thallium imaging suggest?

A

Increased risk of adverse cardiac events

49
Q

How does brain receive adequate blood flow when the carotid is clamped?

A

CPP is maintained by collateral blood flow

Cerebovascular Autoregulation

Shunt may also be placed

50
Q

What EEG measurements may indicate neuro dysfunction?

A

Loss of Beta Waves

Loss of Amplitude

Emergence of Slow Waves

51
Q

What Carotid stump pressures indicate neuro hypoperfusion?

A

Stump Pressures < 40-50 mmHg = neuro hypoperfusion

Needs shunt placed

52
Q

At what MAP does CBF remain constant?

A

MAP of 60-160 mmHg

Chronic HTN shifts curve to the right, needing higher map to ensure adequare Cerebral Perfusion

53
Q

What are PostOp considerations for CEA’s?

A

HTN

Carotid Hemorrhage

Neuro Decline

Cerebral Hyperperfusion Syndrome

54
Q

What is the ACT requirement for Carotid Artery Stenting?

A

> 250 Seconds

Questionable safety and efficacy d/t increased stroke risk

Done under Local

Summer 2020 - APA Foundations 2 - Other (10 decks)

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