Major Vascular II Flashcards
(41 cards)
what factors contrubute to the development of an aneurysm
- adventitial elestin layer degradation
- chronic inflammation
- concomittant aortoiliac occlusie disease
dissection is a tear in the
intimal layer
risk factors for abdominal aneurysm
- smoking
- family history
- atherosclerotic disease
risk factors for thoracic aneurysm
- congenital syndromes
- trauma
- Ao cannulation
- bicuspid Ao valve
what is the risk for an aneurysm rupture for 4-5.9cm
0.5 - 15%
What size aneurysm will likely result in a patient needing elective surgery
> 6cm
which aneurysm type is likely to result in respiratory failure and paraplegia?
Thoracic
Between saccular and fusiform aneurysm which type is more common?
fusiform
a patient with stridor, dysphagia, and upper body edema is likely to have what type of aneurysm
thoracic
what will you see on xray for a thoracic aneurysm?
widened mediastinum
describe a debakey I aortic dissection
proximal aorta, Ao arch, and descending aorta. A large percentage of aorta has dissected. 60%.
Debakey II is what percentage of dissection? Proximal or distal?
10-15%
Proximal
What are the general abdominal aneurysm symptoms
- hypotension
- back pain
- pulsatile mass
where do abdominal aneurysms rupture into? is it good or bad?
left retroperitoneum
Good -> helps tamponade the bleeding and helps proximally control bleeding
(keep patient hypotensive to reduce bleeding, dont transfuse)
Many abdominal aneurysms are diagnosed ___
incidentally
Pre op considerations for patients with aneurysms
- Previous MI/ Vasculopath: EKG, CHF, CEA, valve dysfunction, echo?
- Hx of COPD/Smoking: PFTs, ABGs
- Renal: hydration, avoid low CO, avoid nephrotoxic drugs
Induction for aneurysm patients
- minimize hypotenion and hypertension
- DLT for surgical exposure
- CVL, flow trac, vigeleo
- A-line
- Hot line/ 2 PIVs
- blood
- warming / underbody fluid blanket
- heparin, ACTs, protamine
- Consider renal clearance of NMBDs (cisatricurium, Rocuronium has minimal renal clearance)
What considerations are important with a trans-peritoneal approach for AAA repair
fluid shifts, ileus, pulmonary complications, longer ICU stay
A retroperitoneal approach is indicated for what patients?
obesity, COPD, previous abdominal surgeries
benefits of retroperitoneal approach
less fluid shift/ pulm/ abd issues
drawbacks of retroperitoneal approach
more hernias, chronic wound pain, less visualization
Concerns with Ao clamping
significant increase in SVR
increase in catecholamine release
significant decrease in CO
Renal vascular resistance increased by 70%
active venoconstriction (increase preload)
What complication can increase mortality by 4-5x
Acute renal failure r/t Ao cross clamp
After cross clamp we can give small boluses of _______
Vasodilator
reduce afterload, promote blood flow to renal/spinal, etc
