Abdominal Aortic Reconstruction Flashcards
(31 cards)
Greatest risk in abdominal aortic reconstruction surgery
Post operative myocardial infarction
6 Major Clinical Risk Factors
high-risk surgery ischemic heart disease high creatinine (>2.0) hx TIA, CVA Type 1 Diabetes hx CHF
Evaluating Risk Tests
Exercise EKG
Dipyridamole-Thallium Stress Test
Dobutamine Stress Echo
3 Factors of Surgical Cardiac Assessment
Clinical Predictor, Functional Capacity, Surgical Risk
High Risk Surgery
Emergent surgery; aortic and major vascular surg; periph vascular; prolonged surgery with large fluid shifts/blood loss
Intermediate Risk Surgery
Carotid endart; head/neck; intraperitoneal/intrathoracic; orthopedic; prostate
Low Risk Surgery
Endoscopic procedures, superficial procedure, cataract, breast, ambulatory surgery
Breaking point for METs
4
3 Risk Assessment Methods Used to Determine is Surgery Will Happen
METs, Number of risk factors, Risk of surgery
CABG indicated
Stable angina and L main stenosis
Stable angina and 3-vessel CAD
Stable angina and 2-vessel CAD with LAD stenosis and EF< 0.5 or positive stress test
Unstable angina or acute MI
Drug Eluting Stents (DES)
Metal is infused with drug that prevents the growth of tissue around the stent
Stent risks
Platelets can be activated and cause thrombosis - patients must be on anti-platelet drugs
DES is at risk for this for longer than BMS
Aortic aneurism size - surgery
> 5-6 cm
What happens when you cross-clamp the aorta?
Increased after load
Increase preload
Increased contractility of the heart
Increased after load causes release of
catecholamines and vasoconstrictors so that blood flows elsewhere
What causes increased preload in cross clamping?
Distal to the clamp the vessels collapse and push the blood to the heart
Clamp above the renal
Kidneys don’t get bloodflow
Clamp above the celiac
Liver doesn’t get bloodflow
Increased blood in other areas
Significant hemodynamic changes
Must monitor urine output during all clamping because
Decreased blood flow to the kidneys concerns you about kidney damage
Unclamping
Vascular bed distal to the clamp is empty and dilated
Unclamping leads to hypotension
Fluid overload before unclamping, treat with vasoconstrictor
Endostent Graft
To repair aortic aneurisms less invasively with less hemodynamic changes
Risk of high (thoracic) aortic surgery is paraplegia because
The anterior spinal artery gets significantly reduced blood flow and the increased ICP further decreases blood flow in the spinal cord
Spinal Drain
Used to help relieve the issues of decreased blood flow in the spinal cord
Carotid Endarterectomy
Removes plaques of the carotid to reduce the risk of stroke
