Vascular Flashcards
(42 cards)
Describe ASCVD
Atherosclerotic Vascular Disease
-inflammatory disorder of the arterial tree
-most common mechanism underlying cardiovascular disease
First phase of ASCVD
Fatty streak: macrophages and T lymphocytes stick to vessel wall
Second stage of ASCVD
“Vulnerable plaque”
-inflammation and mediators weaken the fibrous cap that develops on chronically inflamed wall
Percentage of coronary artery occlusive events caused by plaque rupture
60-70%
What is CIMT and what are its impact on MI risk?
Carotid intima-media thickness
For each 0.1mm increase in CIMT, MI risk is increased by 10-15%
For a 0.1mm decrease, risk is decreased by 20%
Beta-blocker admin in the perioperative setting
Continue day of surgery
-starting new B-blocker therapy day of is associated with risk of major adverse events following vascular surgery
Bradycardia/hypotension/stroke
BE careful-not benign
Statins in ASCVD
Inhibit inflammatory response
Reduce ischemia-reperfusion injury
Reduce thrombosis
Decrease platelet reactivity
Restore endothelial function
-reduce cardiac morbidity and mortality following cardiac and vascular surgery
Risk factors for PAD
Non-white
Male
Age
Smoking***I
DM
HTN
Dyslipidemia
Renal insufficiency
3 indications for Surgery in PAD
Intermittent claudication
Ischemic rest pain
Ulcerations or gangrene
**usually MAC procedures to monitor for stroke
Most common cause of renal insufficiency that requires dialysis
Diabetes
Cause of silent ischemia in diabetic patients
Autonomic neuropathy
-diminished ventilatory response to hypoxia+cardiac dysfunction
Most common cause of perioperative morbidity/mortality for diabetic patients
Ischemic cardiac disease
Signs and symptoms of cardiac dysfunction in Diabetes/autonomic neuropathy (name 3)
Resting tachycardia
Orthostatic hypotension
Decreased beat to beat variability with deep breathing
Incidence of CAD in vascular surgery patients
40-80%
Major cause of M/M
Renal considerations in setting of Vascular surgery
Many factory lead to inadequate perfusion and injury
May be volume depleted
At risk for contrast induced. ATN
Cardiac risk percentages in vascular surgery
10% will have myocardial injury
2% of that 10% will have a significant MI
Mucomyst/n-acetylcysteine in vascular
Given to attenuate renal injury in the setting of high contrast administration-literature has mixed results on this
-give fluid!!
Anesthetic considerations axillofemoral bypass grafting…
Restores blood flow to lower extremities
-have discussion with surgeon about field avoidance
-place artline in opposite arm- they may graft from upper extremities and clamp above your line :(
Femoral-popliteal bypass considerations
Grafting takes a long time, EBL minimal
GA typically
If giving alpha adrenergic (phenyl) communicate!! May impact their field
ETT vs LMA in vascular setting
These can be long procedures
LMA causes soft tissue injury after 3-4 hours so mostly go with ETT
3 categories of AAA
Abdominal**
Infra
Renal
Supra
85% happen below (infra)
Size of AAA for elective resection
> 5cm
Leads to best prognosis <2% mortality
Emergency repair 70-80% mortality
Crawford classification of descending Aortic Aneurysms (4 types)
Type I: descending thoracic aorta, ends above visceral vessels
Type II: subclavian to distal abdominal aorta
Type III: mid thoracic to distal abdominal aorta
Type IV: diaphram to distal aorta
Most common thoracic aorta issue
Atherosclerotic aneurysms
(20% of all aortic aneurysms)
