Exam 3 vascular Flashcards
Vascular
3 Main Arterial Pathologies
aneurysms, dissections, occlusions
2 types of Aortic aneurysm?
fusiform and saccular
In a suspected dissection, what is the fastest/safest measure of obtaining adiagnosis ofaneurysm
doppler echocardiogram
What is needed if ther is >5.5 cm, growth >10mm/yr, family h/o dissection?
synthetic graft surgery, and possible aortic valve replacement as well
Noninvasive treatment option? pretty broad list.
Medical management to ↓expansion rate
Manage BP, Cholesterol, stop smoking
Avoid strenuous exercise, stimulants, stress
Regular monitoring for progression
Aortic dissection classifications?
Debakey 1, 2, or 3
Stanford A or B
I cause severe sharp posterior chest and back pain, my hemodynamics are in free fall if unstable, and I can be confirmed via ECHO?
I am an Aortic dissection
Who needs surgery, Stanford A or Stanford B
Stanford A, this is a dissection contained to or originating from ascending arch.
Stanford A dissections need what during surgery?
Cardio bypass, cardiac rest, and hypothermia. Most patients tolerate this, but it does not come issue free.
Neuro deficits are not uncommon.
When would a type B patient need surgery?
Signs of impending rupture.
What is the typical management for Stanford B dissections?
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
What is the triad of aortic aneurysm rupture?
Hypotension, pulsating abdominal mass, back pain
Why would permissive hypotension be a good idea with a ruptured aneurysm?
Potential to blow the clot out or ruin any of potential tamponade occurring. Take them to surgery, this is their only chance for survival.
What are the for primary causes of mortality from aortic surgeries?
MI, CVA, Renal failure, respiratory failure.
Preop eval is important for the aortic surgeries, why?
preop renal failure, likely precipitates worsening renal failure.
TIA & CVA, check your carotids!!!!!
What artery supplies the lower anterior spinal cord, sometimes a bypass is created if aortic cross clamping is needed?
Artery of adamkiewicz
great anterior radiculomedullary artery.
We have all had plenty of experience with this diagnosis, it can either be hemorrhagic or ischemic?
CVA!!!
Angiography or ultrasound can diagnose this at the external/internal bifurcation.
CTA is also an option.
carotid stenosis, make sure to work up for other potential areas of clot formation.
Think heart failure, PFO, or A-fib.
They say time is brain, how quickly should we administer TPA or TNK ?
< 4.5 hours at onset of symptoms. Thrombectomy within 8 hours also has improved outcomes.
Common therapies post CVA?
Antiplatelet tx
Smoking cessation
BP control
Cholesterol control
Diet & Physical activity
What is the more important priority, CEA or CAD repair? what if they need both?
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?
Your patient has a bp of 98/55 and a ICP of 12, what is your CPP?
57
What is the ABI?
SBP Ankle: SBP Brachial
anything <.9, this person has some sort of occlusion.
Acute artery occlusion, cause, symptom, and treatment?
Emboli of left sided origin.
limb ischemia, pain/paresthesia, weakness, ↓peripheral pulses, cool skin, color changes distal to occlusion
Surgical embolectomy, anticoagulation, amputation
