Exam 3 vascular

Question 1

3 Main Arterial Pathologies

Answer 1

aneurysms, dissections, occlusions

Question 2

2 types of Aortic aneurysm?

Answer 2

fusiform and saccular

Question 3

In a suspected dissection, what is the fastest/safest measure of obtaining adiagnosis ofaneurysm

Answer 3

doppler echocardiogram

Question 4

What is needed if ther is >5.5 cm, growth >10mm/yr, family h/o dissection?

Answer 4

synthetic graft surgery, and possible aortic valve replacement as well

Question 5

Noninvasive treatment option? pretty broad list.

Answer 5

Medical management to ↓expansion rate
Manage BP, Cholesterol, stop smoking
Avoid strenuous exercise, stimulants, stress
Regular monitoring for progression

Question 6

Aortic dissection classifications?

Answer 6

Debakey 1, 2, or 3
Stanford A or B

Question 7

I cause severe sharp posterior chest and back pain, my hemodynamics are in free fall if unstable, and I can be confirmed via ECHO?

Answer 7

I am an Aortic dissection

Question 8

Who needs surgery, Stanford A or Stanford B

Answer 8

Stanford A, this is a dissection contained to or originating from ascending arch.

Question 9

Stanford A dissections need what during surgery?

Answer 9

Cardio bypass, cardiac rest, and hypothermia. Most patients tolerate this, but it does not come issue free.

Neuro deficits are not uncommon.

Question 10

When would a type B patient need surgery?

Answer 10

Signs of impending rupture.

Question 11

What is the typical management for Stanford B dissections?

Answer 11

patient whom have normal hemodynamics, no periaortic hematoma, and no branch vessel involvement can be treated with medical therapy

drugs to control BP and the force of LV contraction

Question 12

What is the triad of aortic aneurysm rupture?

Answer 12

Hypotension, pulsating abdominal mass, back pain

Question 13

Why would permissive hypotension be a good idea with a ruptured aneurysm?

Answer 13

Potential to blow the clot out or ruin any of potential tamponade occurring. Take them to surgery, this is their only chance for survival.

Question 14

What are the for primary causes of mortality from aortic surgeries?

Answer 14

MI, CVA, Renal failure, respiratory failure.

Question 15

Preop eval is important for the aortic surgeries, why?

Answer 15

preop renal failure, likely precipitates worsening renal failure.
TIA & CVA, check your carotids!!!!!

Question 16

What artery supplies the lower anterior spinal cord, sometimes a bypass is created if aortic cross clamping is needed?

Answer 16

Artery of adamkiewicz

great anterior radiculomedullary artery.

Question 17

We have all had plenty of experience with this diagnosis, it can either be hemorrhagic or ischemic?

Answer 17

CVA!!!

Question 18

Angiography or ultrasound can diagnose this at the external/internal bifurcation.

CTA is also an option.

Answer 18

carotid stenosis, make sure to work up for other potential areas of clot formation.

Think heart failure, PFO, or A-fib.

Question 19

They say time is brain, how quickly should we administer TPA or TNK ?

Answer 19

< 4.5 hours at onset of symptoms. Thrombectomy within 8 hours also has improved outcomes.

Question 20

Common therapies post CVA?

Answer 20

Antiplatelet tx
Smoking cessation
BP control
Cholesterol control
Diet & Physical activity

Question 21

What is the more important priority, CEA or CAD repair? what if they need both?

Answer 21

The more compromised area needs surgery first. Maintain BP, watch out for compression of collateral or contralateral flow.

Maintain your CPP. Apparently your brain needs blood, who knew?

Question 22

Your patient has a bp of 98/55 and a ICP of 12, what is your CPP?

Answer 22

57

Question 23

What is the ABI?

Answer 23

SBP Ankle: SBP Brachial

anything <.9, this person has some sort of occlusion.

Question 24

Acute artery occlusion, cause, symptom, and treatment?

Answer 24

Emboli of left sided origin.

limb ischemia, pain/paresthesia, weakness, ↓peripheral pulses, cool skin, color changes distal to occlusion

Surgical embolectomy, anticoagulation, amputation

Question 25

This requires ipsilateral retrograde flow to perfuse affected side?

Answer 25

subclavian steal syndrome.

Revision of stenosis or blockage resolves symptoms.

Question 26

Subclavian steal can have motor symptoms that resemble stroke, why?

Answer 26

Lack of blood flow to effected limb. BP is typically less on that side.as well. Lack of blood supply means lack of supply to the nerves that innervate.

Question 27

This is seen in women, thromboangiitis obliterans, and scelorderma?

Answer 27

Raynaud’s phenomena.

Keep them or warm, or keep them from constricting.

Question 28

virchow’s triad is a collection of signs that predicate your chance of DVT formation, what are they?

Answer 28

Venous stasis
Hypercoagulability
Disrupted vascular endothelium

Question 29

If i can’t compress your saphenous vein, what is most likely occurring?

Answer 29

You have a deep vein clot. can be confirmed with an ultrasound or CT. compression is an excellent predictor of clot.

Question 30

Besides obvious pain and swelling in the effected limb, why are DVTs such an issue?

Answer 30

Pulmonary embolism. Many a patient need an IVC and anticoagulation to prevent this.

Question 31

Heparin vs LWMH, pro and cons?

Answer 31

Heparin is cheap, coag test available, reversible.

HIT is a possibility. protamine can kill or cause an allergic reaction.

LWMH- longer HL & more predictable dose response
doesn’t require serial assessment of activated partial thromboplastin time
Less risk of bleeding

-Higher cost
-Lack of reversal agent
-not the greatest for those with renal failure.

Question 32

Throw back time, what factors does warfarin prevent the reduction, therefore activation of ?

Answer 32

II, VII, IX, X

protein C & S

Question 33

The three types of vasculitis?

Answer 33

Small to medium, medium, and large artery

Question 34

What disease primarily effects medium sized arteries?

Answer 34

Kawasaki’s disease. effects the coronaries

Question 35

This type of vasculitis is typically ipsilateral and why do they need steroids pronto?

Answer 35

Temporal aka Giant cell arteritis
they need steroids to prevent blindness if they are having vision complications.

Question 36

Buerger disease can be resolved with one very simple solution?

Answer 36

Smoking cessation.

Question 37

This small vessel vasculitis can effect many of our primary organs?

Answer 37

polyarteritis nodosa.

Many renal complications, the common cause of mortality.

associated with leukemia and hepatitis.

Question 38

Anesthesia implications for polyarteritis nodosa?

Answer 38

preop renal and cardiac evaluation. they respond well to steroids.

Question 39

this disease process is associated with high estrogen, obesity, pregnancy, prolonged standing, and age

Answer 39

Varicose veins aka chronic venous insufficiency .

compression stockings, venous drainage, and pressure relief all help with prevention.

Laser therapy is a surgical option