Vascular Flashcards
(79 cards)
1
Q
What are the three main arterial pathologies?
A
Aneurysms, dissections, occlusions
2
Q
Which part of the vascular system is more likely to be affected by aneurysms and dissections?
A
Aorta and its branches
3
Q
What part of the vascular system is affected by occlusions?
A
Peripheral arteries
4
Q
What is an aortic aneurysm?
A
Dilation of all 3 layers of artery, leading to a >50% increase in diameter
5
Q
What is the initial treatment for an aortic aneurysm?
A
Medical management
6
Q
What causes symptoms due to aortic aneurysms?
A
Compression of surrounding structures
7
Q
At what diameter is surgery indicated for an aortic aneurysm?
A
> 5.5 cm diameter
- Surgery is also indicated with growth >10 mm/yr or family history of dissection
8
Q
What is the mortality rate associated with aortic aneurysm rupture?
A
75%
9
Q
What are the two types of aortic aneurysms?
A
- Saccular
- Fusiform
10
Q
What is the difference between saccular and fusiform?
A
- Saccular: outpouching bulge to one side
- Fusiform: Uniform circumferential dilation
11
Q
What are the symptoms of aortic aneurysms?
A
Asymptomatic or pain due to surrounding compression
12
Q
What diagnostic tools are used for aortic aneurysms?
A
- CT
- MRI
- CXR
- Angiogram
- Echocardiogram
13
Q
What is the fastest/safest measure to diagnose a suspected dissection?
A
Doppler echocardiogram
14
Q
What is the main goal of medical management for aortic aneurysms?
A
To decrease expansion rate
15
Q
What procedure is done for aortic aneurysms?
A
Endovascular stent repair
16
Q
What are common symptoms of an aortic dissection?
A
Severe, sharp pain in posterior chest or back
17
Q
What is the classification system for aortic dissections?
A
Stanford Class A, B and DeBakey Class 1, 2, 3
18
Q
What is a dissection?
A
Tear in the intimal layer of the vessel, causing blood to enter the medial layer
19
Q
What type of dissection is classified as Stanford A?
A
Ascending aorta involved
20
Q
What is indicated for Stanford A dissection if the aortic arch is involved?
A
Surgical resection
21
Q
Stanford B?
A
Descending aorta involved
22
Q
DeBakey 1?
A
Ascending and descending aorta
23
Q
DeBakey 2?
A
Ascending aorta
24
Q
DeBakey 3?
A
Descending aorta
25
Is Stanford A or B a medical emergency?
Stanford A
26
What is required after aortic arch surgical resection?
- Cardiopulmonary bypass
- Hypothermia
27
What is a major complication of aortic arch replacement?
Neurologic deficit
28
What is the in-hospital mortality rate for type B aortic dissections treated medically?
10%
29
What are the risk factors for aortic dissections?
* HTN
* Atherosclerosis
* Aneurysms
* Family history
* Cocaine use
* Inflammatory diseases
30
What is a common triad of symptoms seen in aortic aneurysm rupture?
* Hypotension
* Back pain
* Pulsatile abdominal mass
31
What is the most significant indicator of post-aortic surgery renal failure?
Preoperative renal dysfunction
32
What syndrome is caused by lack of blood flow to the anterior spinal artery?
Anterior Spinal Artery Syndrome
33
What are the consequences of ischemia in the anterior spinal artery?
* Loss of motor function below the infarct
* Diminished pain and temperature sensation below the infarct
* Autonomic dysfunction
34
What percentage of CVAs are ischemic?
87%
35
What is a TIA?
Temporary, self-limited ischemia with symptoms resolving within 24 hours
36
What is the first leading cause of disability in the US?
CVA
37
What is the preferred surgical treatment for severe carotid stenosis?
Carotid Endarterectomy (CEA)
38
What is Virchow's Triad?
* Venous stasis
* Disrupted vascular endothelium
* Hypercoagulability
39
What are common symptoms of Peripheral Artery Disease (PAD)?
* Intermittent claudication
* Resting extremity pain
* Weak pulses
* Subcutaneous atrophy
* Hair loss
* Coolness
* Cyanosis
40
What is the ankle-brachial index (ABI) threshold for defining PAD?
<0.9
41
What are common causes of acute peripheral artery occlusion?
* Cardiogenic embolism
* Left atrial thrombus due to A-fib
* Left ventricular thrombus due to cardiomyopathy after MI
42
What is Subclavian Steal Syndrome?
Occlusion of the subclavian artery proximal to the vertebral artery causing diversion of flow
43
What is Raynaud's Phenomenon?
Episodic vasospastic ischemia of the digits
44
What are the signs of Deep Vein Thrombosis (DVT)?
* Extremity pain
* Swelling
45
What is the treatment for DVT?
* Anticoagulation
* Warfarin + Heparin or LMWH
46
What is the purpose of prophylactic measures for DVT?
To prevent venous thromboembolism
47
What is the common diagnostic tool for assessing arterial stenosis in PAD?
Doppler U/S
48
What are the advantages of LMWH over unfractionated heparin?
* Longer half-life
* More predictable dose response
* Doesn't require serial assessment of aPTT
49
What are the advantages of LMWH over unfractionated heparin?
Longer half-life, more predictable dose response, doesn’t require serial assessment of aPTT, less risk of bleeding
## Footnote
LMWH stands for Low Molecular Weight Heparin.
50
What are the disadvantages of LMWH?
Higher cost, lack of reversal agent
## Footnote
LMWH stands for Low Molecular Weight Heparin.
51
What is the therapeutic INR range for Warfarin?
2-3
## Footnote
Warfarin is a vitamin K antagonist.
52
When is Heparin discontinued in the treatment of Warfarin?
When Warfarin achieves therapeutic effect
## Footnote
Warfarin is typically initiated during heparin treatment.
53
What is an IVC filter indicated for?
Recurrent PE or contraindication to anticoagulants
54
What is systemic vasculitis?
Group of vascular inflammatory diseases categorized by the size of the vessels at the primary site of the abnormality
55
Name two examples of large-artery vasculitis.
* Takayasu arteritis
* Temporal (giant cell) arteritis
56
Which disease usually affects the coronary arteries and is classified as medium-artery vasculitis?
Kawasaki disease
57
What are some examples of medium to small-artery vasculitis?
* Thromboangiitis obliterans
* Wegener granulomatosis
* Polyarteritis nodosa
58
What are the symptoms of Temporal (Giant Cell) Arteritis?
* Unilateral headache
* Scalp tenderness
* Jaw claudication
59
What can ophthalmic arterial branches lead to in Temporal Arteritis?
Ischemic optic neuritis and unilateral blindness
60
What is the diagnosis for Temporal Arteritis?
Biopsy of temporal artery shows arteritis in 90% of patients
61
What is the treatment for Temporal Arteritis when visual symptoms are present?
Corticosteroids indicated to prevent blindness
62
What is Thromboangiitis Obliterans also known as?
Buerger Disease
63
What is a major trigger for Thromboangiitis Obliterans?
Autoimmune response triggered by nicotine
64
What are the five diagnostic criteria for Thromboangiitis Obliterans?
* History of smoking
* Onset before 50
* Infrapopliteal arterial occlusive disease
* Upper limb involvement
* Absence of risk factors for atherosclerosis (outside of tobacco)
65
What symptoms are associated with Thromboangiitis Obliterans?
* Forearm, calf, foot claudication
* Ischemia of hands & feet
* Ulceration and skin necrosis
* Raynaud's is commonly seen
66
What is the most effective treatment for Thromboangiitis Obliterans?
Smoking cessation
67
What are the anesthesia implications for patients with Thromboangiitis Obliterans?
* Meticulous positioning/padding
* Avoid cold; warm the room and use warming devices
* Prefer non-invasive BP and conservative line placement
68
What conditions can Polyarteritis Nodosa lead to?
* Glomerulonephritis
* Myocardial ischemia
* Peripheral neuropathy
* Seizures
69
What is the primary cause of death in Polyarteritis Nodosa?
Renal failure
70
What are the treatment options for Polyarteritis Nodosa?
* Steroids
* Cyclophosphamide
* Treating underlying cause (e.g., cancer)
71
What are the implications for anesthesia in patients with Polyarteritis Nodosa?
* Consider coexisting renal disease
* Cardiac disease
* Hypertension
* Steroids likely beneficial
72
What percentage of the population is affected by Lower Extremity Chronic Venous Disease?
50%
73
What are mild symptoms of Lower Extremity Chronic Venous Disease?
* Telangiectasias
* Varicose veins
74
What are severe symptoms of Lower Extremity Chronic Venous Disease?
* Edema
* Skin changes
* Ulceration
75
What are some risk factors for Lower Extremity Chronic Venous Disease?
* Advanced age
* Family history
* Pregnancy
* Ligamentous laxity
* Previous venous thrombosis
* LE injuries
* Prolonged standing
* Obesity
* Smoking
* Sedentary lifestyle
* High estrogen levels
76
What are the diagnostic criteria for Lower Extremity Chronic Venous Insufficiency?
Symptoms of leg pain, heaviness, fatigue confirmed by ultrasound showing venous reflux
77
What is the initial treatment for Lower Extremity Chronic Venous Insufficiency?
* Leg elevation
* Exercise
* Weight loss
* Compression therapy
* Skin barriers/emollients
* Steroids
* Wound management
78
What are the conservative medical management options for Lower Extremity Chronic Venous Disease?
* Diuretics
* Aspirin
* Antibiotics
* Prostacyclin analogues
* Zinc sulphate
79
What surgical interventions may be performed for Lower Extremity Chronic Venous Disease?
* Saphenous vein inversion
* High saphenous ligation
* Ambulatory phlebectomy
* Transilluminated-powered phlebectomy
* Venous ligation
* Perforator ligation
