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Vascular Disease Flashcards

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1
Q

Aortic Aneurysm needs surgery when it is over ____

A

5.5 cm

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2
Q

saccular aneurysm is a ___ shape

A

berry

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3
Q

Fusiform is a ___ dilation of the vessel

A

circumferential

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4
Q

Diagnosis of a dissection of an aneurysm by ___ is the fastest

A

doppler echo

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5
Q

Tx of aneurysm

A

Treatment: ​

Medical management to ↓expansion rate​

Manage BP, Cholesterol, stop smoking​

Avoid strenuous exercise, stimulants, stress​

Regular monitoring for progression​

Surgery indicated if >5.5 cm, growth >10mm/yr, family h/o dissection​

Endovascular stent repair has become a mainstay over open surgery w/graft​

AAA stent repair, CV surgeon on standby

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6
Q

3 Main Arterial Pathologies: ___ ____ _____

A

aneurysms, dissections, occlusions​

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7
Q

______ & its branches more likely to be affected by aneurysms & dissections​

______ arteries are more likely to be affected by occlusions​

A

aorta; peripheral

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8
Q

Aortic aneurysm: Dilation of all _____ layers of artery, leading to a >50% increase in diameter

A

3

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9
Q

AAA stent repair is done under _____

A

fluoroscopy

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10
Q

Dissection is not a _____

A

rupture
Dissection: Tear in intimal layer of the vessel, causing blood to enter the medial layer​

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11
Q

Describe Ascending dissection

A

Ascending dissection: Catastrophic, requires emergent surgical intervention​

Stanford A, Debakey 1 & 2​

Mortality increases by 1-2% per hr ​

Overall mortality 27-58%​

Sx: Severe sharp pain in posterior chest or back​

Diagnosis:​

Stable= CXR, CT, MRI, Angiogram​

Unstable=Echocardiogram​

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12
Q

Stanford A, Debakey 1 & 2​ describes what

A

aortic dissection

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13
Q
A

Stanford Class A, B​

A: Ascending and descending​

B: just descending​

DeBakey Class 1,2,3​

1: both ascending and propagates the arch​

2: ascending​

3: Descending​

​

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14
Q

Stanford A is always an ____ while stanford B is not

A

emergency

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15
Q

Stanford A treatment

A

Ascending aorta involved​

Should be considered candidates for surgery​

The most commonly performed procedures:​

ascending aorta & aortic valve replacement w/a composite graft ​

ascending aorta replacement with resuspension of the aortic valve​

​

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16
Q

How hypothermic do you keep a pt for stanford A surgery

A

Circulatory arrest at a body temp 15-18°C for 30-40 minutes can be tolerated by most pts​

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17
Q

Stanford B treatment

A

Descending thoracic Aorta: An uncomplicated type B dissection with normal hemodynamics, no hematoma, and no branch vessel involvement can be treated medically​

Medical therapy consists of:​

 1) intraarterial monitoring of SBP and UOP​

If their kidneys arent being perfused they may be a candidate for surgery​

 2) drugs to control BP and the force of LV contraction (BBs, Cardene, SNP)​

in-hospital mortality rate of 10%​

long-term survival rate with medical tx is 60-80% at 5 yrs and 40-50% at 10 yrs​

​

Surgery is indicated for type B dissection with signs of impending rupture (persistent pain, hypotension, left-sided hemothorax) or compromised perfusion to the lower body​

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18
Q

What are the symptoms of impending rupture for a stanford B AA

A

persistent pain, hypotension, left-sided hemothorax

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19
Q

Risk factors for aortic dissection

A

Risk Factors: HTN, atherosclerosis, aneurysms, fam hx, cocaine use, & inflammatory diseases​

Inherited disorders: Marfans, Ehlers Danlos, Bicuspid Aortic Valve

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20
Q

What are iatrogenic causes of AD

A

heart cath, aortic manipulation, cross clamping, arterial incision

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21
Q

What patients are the most common to have aortic dissection

A

men and preg women in third trimester

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22
Q
A

know that stuff

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23
Q

What is the symptom triad for aortic aneurysm rupture

A

A triad of sx seen in about ½ of cases:​

Hypotension​

Back pain​

A pulsatile abdominal mass​

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24
Q

Most abdominal aortic aneurysms rupture into the __ ______

A

left retroperitoneum​

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25
4 Primary causes of mortality r/t surgeries of thoracic aorta:​
MI​ Respiratory failure​ Renal failure​ Stroke
26
If __ ____ is occurring then volume resuscitation may be delayed to preserve the clot
If retroperitoneal tamponade occurs, volume resuscitation may be delayed until the rupture is surgically controlled, to maintain a lower BP and reduce risk of further bleeding, hypotension, and death​
27
Preop Eval for AA
Assess for presence of CAD, valve dysfunction, heart failure​ Ischemic heart dz may require intervention prior to surgery​ Cardiac evaluation tests: stress test, echocardiogram​ Low FEV1 or renal failure may preclude a pt from aortic resection​ ---> probably will not tolerate Smoking/COPD = predictors of post aortic surgery respiratory failure​ PFTs & ABGs help define risk​ Consider bronchodilators, abx, chest physiotherapy​ Preop renal dysfunction is the most significant indicator of post-aortic surgery renal failure​ Preop hydration​: Avoid hypovolemia, HoTN & low cardiac output​ Avoid nephrotoxic drugs ​ h/o stroke or TIA​ Carotid ultrasound​ Angiogram of brachiocephalic & intracranial arteries​ Severe carotid stenosis→ workup for CEA before elective surgery​ ​
28
What is Anterior Spinal Artery Syndrome​
ASA syndrome is caused by lack of blood flow to the anterior spinal artery​
29
The anterior spinal artery perfuses the anterior ____ of the spinal cord​
2/3
30
Ischemia of ASAS leads to:​
loss motor function below the infarct​ diminished pain and temperature sensation below the infarct​ antonomic dysfunction, leading to hypotension and bowel & bladder dysfunction​
31
ASA is the most common form of spinal. cord ____
ischemia bc lack of collateral circulation
32
Posterior is perfused by ___ arteries
2
33
Common causes of ASA syndrome are....
: Aortic aneurysms, aortic dissection, atherosclerosis, trauma​
34
Carotid disease is a prominent predictor of ____
stroke
35
How do you diagnosis carotid disease
Angiography- can dx vascular occlusion​ CT & MRI- less invasive, may also identify aneurysms & AVMs​ Transcranial doppler US- may give evidence of vascular ​ occlusions with real-time monitoring ​ Carotid auscultation- can identify bruits​ Carotid US- can quantify degree of carotid stenosis​
36
Carotid stenosis commonly occurs at the ___ _____, due to turbulent blood flow at the branch-point
carotid bifurcation
37
American Heart Assoc recommends TPA within ______ of onset​
4.5hr
38
Describe the treatment of CVA - IR - CEA - Carotid stenting - Ongoing medical tx
Interventional radiology​ - intra-arterial thrombolysis​ - Intravascular thrombectomy *benefits seen up to 8h after onset of CVA​ Carotid Endarterectomy (CEA)​ - Surgical treatment for severe carotid stenosis (lumen diameter 1.5mm or >70% blockage)​ Carotid stenting​ - Alternative to CEA​ - Major risk of microembolization→CVA​ - Embolic protection devices developed to reduce risk; so far CVA risk still unchanged​ Ongoing medical therapy​ - Antiplatelet tx​ -Smoking cessation​ -BP control ​ -Cholesterol control​ -Diet & Physical activity​ ​
39
Surgical treatment for severe carotid stenosis is at a lumen diameter _____ mm or ____% blockage)
1.5mm or >70%
40
CEA preop eval
- neuro eval and baseline - heart disease, probably have CAD - HTN - CPP = MAP - ICP (so we want the MAP a little higher) - maintain flow through cross clamping - Extreme head rotation will compress blood flow, so dont do that - use cerebral oximetry
41
Cerebral Oxygenation affected by:​ (5 things) Cerebral 02 consumption affected by:​ (2 things)
Cerebral Oxygenation affected by:​ MAP​ COP​ Sa02​ HGB​ PaC02​ Cerebral 02 consumption affected by:​ Temperature​ Depth Anesthesia​
42
Defined by an ankle-brachial index (ABI) <____ Acute occlusions are typically due to embolism​ Atherosclerosis is systemic​ Pt w/PAD have 3-5x increased risk of MI & CVA​ ​
0.9 ABI= ratio of SBP @ ankle : SBP @ brachial artery​
43
Chronic hypo-perfusion is typically due to ______
atherosclerosis​ sometimes May also be due to vasculitis​ Acute occlusions are typically due to embolism​ Atherosclerosis is systemic​ Pt w/PAD have 3-5x increased risk of MI & CVA​
44
Rx for PAD
45
diagnosis of PAD
Doppler U/S: provides a pulse volume waveform identifies arterial stenosis​ Duplex U/S: can identify areas of plaque formation & calcification​ Transcutaneous oximetry: can assess the severity of tissue ischemia​ MRI w/contrast angiography: used to guide endovascular intervention or surgical bypass​
46
What is the medical tx for PAD
Medical Tx: exercise, controlling BP, cholesterol, and glucose​ Intervention: revascularization indicated w/disabling claudication or ischemia​ Surgical reconstruction- arterial bypass procedure​ Endovascular repair- angioplasty or stent placement​
47
What are common causes of peripheral arterial occlusion
Common causes:​ cardiac Left atrial thrombus d/t Afib​ Left ventricular thrombus d/t cardiomyopathy after MI​
48
For peripheral arterial occlusion what are the.... SX DX TX
Sx: limb ischemia, pain/paresthesia, weakness, ↓peripheral pulses, cool skin, color changes distal to occlusion​ Dx: Arteriogram​ Tx: anticoagulation, surgical embolectomy, amputation (last resort)​
49
Subclavian Steal Syndrome​
SC steal: occluded SCA, proximal to vertebral artery​ vertebral artery flow diverts away from brainstem​
50
Subclavian Steal Syndrome​ sx
Sx: Syncope, vertigo, ataxia, hemiplegia, ipsilateral arm ischemia​ Effected arm SBP may be ̴20mmhg lower​ Bruit over SCA
51
Subclavian Steal Syndrome​ rx
Risk Factors: atherosclerosis, h/o aortic surgery, Takayasu Arteritis
52
Subclavian Steal Syndrome​ tx
Tx: SC endarterectomy​
53
Virchows Triad: 3 factors that predispose to venous thrombosis​ ​
Virchows Triad: 3 factors that predispose to venous thrombosis​ Venous stasis​ Disrupted vascular endothelium​ Hypercoagulability​ ​
54
Risk factors for DVT
risk factors: >age 40, surgery >1h, cancer, ortho surgeries on pelvis & LEs, abdominal surgery
55
Half of all hip replacements will result in ____ that will resolve on their own
50%
56
How do you treat a DVT
Anticoagulation: Warfarin + Heparin or LMWH​ - LMWH advantages over unfractionated heparin - ​longer HL & more predictable dose response ​ - doesn’t require serial assessment of aPTT​ - Less risk of bleeding​ LMWH disadvantages​ -Higher cost​ L-ack of reversal agent​ Warfarin (vit K antagonist) is initiated during heparin treatment and adjusted to achieve INR btw 2-3​ Heparin discontinued when Warfarin achieves therapeutic effect​ PO anticoagulants continued 6 months or longer​ IVC filter may be indicated w/ recurrent PE, or contraindication to anticoagulants​
57
what is systemic vasculitis
Group of vascular inflammatory diseases catagorized by the size of the vessels at the primary site of the abnormality​
58
Large-artery vasculitis includes:​ 2 Medium-artery vasculitis includes:​ 1 Medium to small-artery vasculitis includes:​ 3
Large-artery vasculitis includes:​ Takayasu arteritis ​ Temporal (or giant cell) arteritis​ Medium-artery vasculitis includes:​ Kawasaki disease, which usually affects the coronary arteries​ Medium to small-artery vasculitis includes:​ Thromboangiitis obliterans​ Wegener granulomatosis​ Polyarteritis nodosa​
59
Temporal (or giant cell) arteritis​ sx,dx,tx
60
buergers disease is .....
Inflammatory vasculitis leading to small & medium vessel occlusions in the extremities​
61
buergers disease is mainly triggered by _____ and in ____ under 45
smoking; men
62
the main vessel with issues in buergers disease is .....
infrapopliteal arterial occlusive dz​
63
Polyarteritis Nodosa​ is....
Vasculitis of the small and medium vessels​
64
Polyarteritis Nodosa​ leads to what 4 things
Leads to glomerulonephritis, myocardial ischemia, peripheral neuropathy and seizures​
65
Lower Extremity Chronic Venous Disease​ risk factors
Risk factors: ​ advanced age​ family hx​ pregnancy ​ ligamentous laicity​ previous venous thrombosis​ LE injuries​ prolonged standing​ obesity​ smoking​ sedentary lifestyle​ high estrogen levels​
66
Lower Extremity Chronic Venous Disease diagnostic criteria
Diagnostic criteria: Sx of leg pain, heaviness, fatigue​ Confirmed by ultrasound showing venous reflux​ Retrograde blood flow > 0.5 seconds​
67

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