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HA > Vascular > Flashcards

Vascular Flashcards

1
Q

Where are clots usually formed?

A

bifurcations / turbulent flow areas

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2
Q

Vascular Surgery Patients Coexisting diseases:

A

CAD 40-80%
HTN
Diabetes
Smokers
CNS; carotid disease, stroke
Renal

vasopressors- high dose

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3
Q

50% of Vascular Surgery Patients post op mortalities d/t

A

MI

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4
Q

Risk Factors for vasular dx

A

Older age: 75 y/o and >
Family history
Smoking (2x)
Diabetes mellitus
Hypertension
Obesity
Dyslipidemia

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5
Q

most common cause of occlusive disease in the arteries of lower extremities

A

Atherosclerosis

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6
Q

Symptoms associated with peripheral occlusive disease

A

Claudication, skin ulcerations, gangrene, and impotence

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7
Q

Extent of disability is influenced with development of ……

A

collateral blood flow

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8
Q

Treatment for peripheral occlusive disease:

A

Pharmacolgic therapy
Surgical therapy:
Transluminal angioplasty
Endarterectomy
Thrombectomies
Multiple bypass procedures

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9
Q

Postoperative considerations for PERIPHERAL VASCULAR DISEASE

A

Administration of narcotics
Epidural opioids and local anesthetics
Postoperative monitoring

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10
Q

Diagnosis of PVD;

A

Intermittent claudication
Rest at pain
Decreased/absent pulses
Bruits in the abdomen, pelvis, and inguinal area
Subq atrophy, hair loss

ultrasound no flow

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11
Q

Ankle-brachial index and associated levels

A

bp in ankle and brachial (non invasice)

< 0.9 claudication
< 0.4 rest pain
< 0.25 impending gangrene

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12
Q

Treatment for pvd

A

Exercise programs
Stop smoking
Treat HTN, CAD, DM
Lipid lowering
Revascularization vs amputation

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13
Q

Common places for revasularization

A

Iliac vs femoral/popliteal

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14
Q

advantages or regional over general

A

Increased blood flow
Anticoagulation
Dementia
Spine surgery
Upper extremity harvesting

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15
Q

Carotid Artery Disease rate of death and types

A

Stroke 3rd leading cause of death

Hemorrhagic
Ischemic

87% are ischemic

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16
Q

Most common carotid occlusion site

A

internal cartoid artery
thecarotidbifurcation, where thecommon carotiddivides into the internal and externalcarotid

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17
Q

Risk Factors for Carotid artery disease

A

Age
History/family history
Black race
Male
Sickle cell disease
HTN/smoking/diabetes
Atrial fibrillation
Hypercholesterolemia
Obesity

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18
Q

Procedure on aorta are complicated by

A

Need to cross-clamp the aorta
Potential for large intraoperative blood loss

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19
Q

Aortic cross-clamping

A

Acutely increases LV afterload; severe HTN, myocardial ischemia, LV failure, or aortic valve regurgitation

Comprises organ perfusion distal to point of occlusion; interruption of blood flow to the spinal cord and kidneys can produce paraplegia and renal failure

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20
Q

hardest aneurysm to treat

A

ascending

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21
Q

Indications for aortic surgery include

A

Aortic dissection
Aneurysms
Occlusive disease
Trauma
Coarctation

22
Q

most common factor contributing to the progression of the lesion/ aneurysm

A

htn

23
Q

AORTIC DISSECTION is what?

A

Characterized by a spontaneous tear of the vessel wall intima, permitting the passage of blood along a false lumen

24
Q

Treatment of dissecting aortic lesions:

A

Proximal dissections are nearly always treated surgically

Distal dissections may be managed medically initially

25
Q

Most common cause of abdominal aortic aneurysm

A

medial cystic necrosis

can also have RA, athero, spondyloarthropathies, and trauma

26
Q

What aneurysms require cardiopulmonary bypass

A

Ascending and transverse

27
Q

Vessel walls

A

tunica externa- fibrous connective tissue

tunica media- smooth muscle/elastic tissue

tunica interna - epithelial layer, squamous cells

28
Q

Classic symptoms for aortic rupture

A

Hypotension
Back pain
Pulsatile mass
Only present 50% experience hemorrhage and tamponade into retroperitoneum

29
Q

Most common site for thoracic aneurysm

A

Just above aortic valve
Just distal to left subclavian takeoff
Ligamentum arteriosum

30
Q

Classic deficit is that of an anterior spinal artery syndrome:

A

Loss of motor function and pinprick sensation but preservation of vibration and proprioception

31
Q

Artery of Adamkiewicz arises

A

Arises from
T5-T8 in 15% of the pop.
T9-12 in 60%. - most common
L1-L2 in 25%.
Nearly always arises on the left side.

32
Q

Increased incidence of renal failure following aortic surgery associated with:

A

Emergency procedures
Prolonged cross-clamp periods
Prolonged hypotension

33
Q

Spinal cord perfusion pressure

A

Spinal cord perfusion pressure = MAP- SCP

34
Q

Dx for carotid artery dz

A

Carotid bruit

Carotid stenosis

Sudden neurological deficits

Angiography

35
Q

What is considered and aneurysm

A

Dilation with 50% increase in diameter

36
Q

What is a dissection

A

Blood enters media layer from tear in intima

37
Q

Debakey 1 and Debakey 2

A

Both are Standford A (proximal)

38
Q

Debakey 3

A

Standford B (distal)

39
Q

dividing line for Stanford A and B

A

Innominate artery

40
Q

normal aorta width

A

2-3 cm

elctive resections generally with aneurysms greater than 4 cm

41
Q

things Found on exam
Related to compression of adjacent structure

A

Hoarseness
Stridor
Dyspnea
Dysphagia
Dilation of aortic valve annulus

42
Q

DX for thoracic aneurysm

A

CXR

TEE

Arteriogram

43
Q

tx for thoracic aneurysm

A

Elective procedure >/= 5-6 cm

44
Q

Which aneurysm has a genetic link

A

abdominal aneuysms

45
Q

Abd aneurysm diagnosis

A

Abdominal ultrasound

Helical CT; 3D for endovascular feasibility

MRI; Lack of radiation/contrast medium

46
Q

threshold for rupture (mortality as high as 75%- abd aneurysm

A

6-7 cm

47
Q

abd aneurysm need repair at what size

A

5-6 cm

48
Q

size of abd aneurysm for elective repair w/low operative risk and good life expectancy.

A

4-5cm

49
Q

Characteristics of anterior spinal artery syndrome

A

loss of bowel and bladder function

50
Q

Activation of which reflex may cause bradycardia in carotid surgery

A

baroreceptor

51
Q

Which anesthesia technique is preferred for carotid surgery

A

regional

52
Q

The risk of pneumonia is how many times higher in smokers than non smokers

A

twice as high

HA (15 decks)

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