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Endovascular Repair Flashcards

(51 cards)

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1
Q

5 types of stenting procedures.

A
  • aortic
  • renal
  • distal vessels
  • carotids
  • cerebral
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2
Q

What is EVAR, TEVAR, EVAAR?

A
  • endovascular aortic repair
  • Thoracic endovascular repair
  • Endovascualr abdominal aortic repair
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3
Q

Prior to stent deployment, what is needed in the aorta?

A

-Landing zone of at least 1cm on both sides of graft.

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4
Q

What 2 things can happen with aortic branches?

A
  • Excluded by graft

- Aortic debranching (anatomic bypass)

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5
Q

Why did tube grafts have a high failure rate?

A

-Underestimation of atheromatous disease in the illiac or distal aorta

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6
Q

what problem arose with Aorto-uni-iliac stent grafts, and what did it necessitate?

A
  • Occlusion of the contralateral iliac

- fem-fem bypass

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7
Q

What does a modular bifurcated stent graft allow you to preserve?

A

Normal aorta-iliac anatomy

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8
Q

What is the benefit of a fenestrated stent?

A

-Accommodates visceral arteries

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9
Q

What does a branched stent graft allow for?

A

-Preservation vital arteries

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10
Q

When would a retroperitoneal approach be used?

A

-femoral vessels are small or heavily calcified

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11
Q

During a Retroperitoneal approach a conduit is sewn into what to introduce the graft?

A
  • Distal aorta

- Proximal iliac

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12
Q

What two things does a hybrid procedure combine? and when is it used?

A
  • Open surgical and endovascular stenting

- when major vessels would be occluded

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13
Q

Up 40% of TEVARS have lesions covering what? What does this require?

A
  • Ostium of the left subclavian

- Pre-TEVAR carotid-subclavian bypass

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14
Q

Describe stage 1 of a elephant trunk repair.

A
  • Open ascending aortc arch repair

- Leaving descending aneurysm alone

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15
Q

What is deep hypothermic circulatory arrest?

A

Find in reading

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16
Q

Describe stage 2 of an elephant repair.

A
  • Endovascular repair of the descending aorta

- Connecting to previously done open ascending repair

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17
Q

what is Aortic Visceral Debranching ?

A

Clarify

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18
Q

When is elective repair appropriate for AAA?

A

-AAA > 5.0 cm or growing more the 1 cm per year

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19
Q

When is elective repair appropriate for TAA?

A

-TAA > 5.5 cm or growing more than 3 mm per year

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20
Q

Repair is indicated for any ________ aneurysm.

A

Symptomatic

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21
Q

Indications for EVAR over open?

Study These Flashcards
A
  • Significant co-morbidities

- Type B dissection

22
Q

Name the 2 types of aortic dissection classifications?

Study These Flashcards
A
  • Debakey

- Standford

23
Q

Name the 2 types of stanford dissections?

Study These Flashcards
A
  • A = Ascending or Ascending and descending

- B = Descending only

24
Q

Name the 3 Debakey types?

Study These Flashcards
A
  • I = Ascending and Descending
  • II = Ascending
  • III = Descending
25
EVAR MAC considerations?
- Supine for 1-2 hours - Deep sedation not possible for need to hold breath - Favorable anatomy - Favorable aneurysm (no fenestrations or branch grafts)
26
Central neuraxial blockade for EVAR?
- No TEE, MEP or SSEP needed | - Be careful of heparin causing hematomas
27
General anesthesia EVAR considerations.
-Used for: Illiac access, TEE, hemodynamic manipulations, SSEP/MEP, Difficult airway history
28
What are the goals for anesthesia in EVAR?
- Hemodynamic stability - Avoid HTN and tachycardia - Volume - Bleeding management
29
Why avoid HTN and Tachycardia in EVAR?
- Decrease coronary ischemia | - Reduce wall pressure in aorta
30
EVAR renal considerations?
- Hypoperfusion - graft occludes renal arteries - Emboli of renal arteries - Contrast induced neuropathy
31
How to prevent renal injuries.
- Adequate volume - Maintain BP and CO - Limit dye
32
Pharmacologic strategies for baseline kidney disease.
- Use Iso-osmolar or Non-ionic dyes - N-Acetylcysteine - Sodium Bicarb - Statins
33
Causes of hypotension in EVAR
- Iliac artery rupture - Accidental withdrawl leads to femoral bleed - Rupture of aortic aneurysm - Retroperitioneal bleed
34
What can build up in lower extremities? And what can it lead to?
- Lactic acid | - Lactic acidosis
35
________ ________ can follow EVAR of acute aortic type _____ dissection.
- Reperfusion syndrome | - B
36
Guide wire manipulation can what? by stimulating what?
- Arrhythmias | - Aortic baroreceptors
37
Over advancement of guidewire can result in what?
- Hemopericardium | - Cardiac tamponade
38
What 3 maneuvers are used to create a motionless field?
- Adenosine - Rapid ventricular pacing - Right atrial inflow occlusion
39
How would you treat vasospasms
Nitroglycerin into major aortic branches
40
Neurogenic hypotension can cause what? Leading to What?
- Acute spinal artery syndrome | - Paraplegia and neurogenic shock
41
Abdominal compartment syndrome may follow TEVAR for what?
-type B dissection
42
Why would a CSF drain be used?
-To increase spinal cord perfusion pressure and prevent spinal cord ischemia
43
what 2 ways can be used to increase spinal cord perfusion pressure?
- Increase MAP | - Decrease CSF pressure
44
What is the largest artery supplying the spine, and where does it originate?
- Artery of adamkiewicz | - from aorta @ T9-T12
45
Why would SSEP and MEP be utilized in EVAR?
- Ensure spinal cord perfusion | - Identify ischemic changes
46
When would TEE be used?
- Elephant repair - Avoid contrast dye - Detect endo leaks - Aortic pathology - ID guidewire, sheath, endograft
47
Occlusion of what 2 arteries can cause spinal cord ischemia?
- Artery of adamkiewicz | - Critical intercostal
48
What 4 things place one at a greater risk of spinal chord ischemia?
- Previous AAA repair - External iliac injury - Hypotension r/t retroperitional bleed - Athersclerosis of thoracic aorta
49
How do you treat parapelgia?
- Increase MAP - CSF drainage - Repeated neuro exams - Avoid abrupt cessation of CSF drain
50
What is the goal during graft deployment? What should be used?
- Reduce blood flow through aorta. | - Esmolol, nipride, clevidpine
51
Why is a motionless field so important after graft deployment?
- Landing zones close to vessels | - Windsock effect

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