What is the most common cause of occlusive disease in the lower extremity?
Peripheral Vascular Disease
What is the degenerative pathophysiologic process of peripheral vascular disease?
- Formation of plaque/stenosis
- Thrombosis/Ischemia
- Embolism
- Aneurysm formation of weak vessel wall
What are the listed risk factors of peripheral vascular disease?
- Hypercholesterolemia
- elevated triglycerides
- Cigarette smoking
- Hypertension
- Diabetes mellitus
- Obesity
- Genetic predisposition
- Gender (Males>Female)
- Impaired long term glucse regulation
- Homocysteine
- C-reactive protien
What are the symptom of peripheral vascular disease?
- Mottling
- IMPOTENCE
- Cold extremites
- Claudication
- Ulceration
What is the mortality rate of patient diagnosed with peripheral vascular disease?
- 5 years/30%death
- 10 years/70%death
What is the treatment of peripheral vascular disease?
- Pharmacologic therapy
- Surgical
What is the greatest risk to vascular surgery?
-Myocardial infarction (MI)
T/F: Beta blockers and statins have a cardiovascular protective feature when used during anesthesia?
TRUE
What monitors or preoperative testing should be anticipated for a vascular surgery?
- A Line
- Swan (PAC)
- TEE
- EKG
What are risk factors for an abdominal aortic aneurysm?
- Atheroscherosis
- Proteolysis of elastin and collagen within a vessel wall
- HTN
- Cigarette Smoking
- Genetic predisposition
- Obesity
T/F: Obesity may mask the signs and symptoms of AAA.
-TRUE
T/F: Minimal blood factor is associated with a endovascular AAA repair.
FALSE
What is the systemic anticoagulation of heparin when performing a endovascular precedural?
50-100 units/kg
What are some advantages of Endograph vascular procedure?
- hemodynamic stability
- decrease in embolic events
- decrease blood loss
- reduced surgical stress response
- Decrease in renal dysfunction
- decrease in post op pain
What are the complication of an endograph vascular procedure?
- Endograph thrombosis
- endograft migration
- Endograft rupture
- Graft infection
- Iliac artery rupture
- Lower extremity ischemia
- Ischemic gut
What are contraindication for a surgical repair of a AAA?
- Intractable angina
- Recent MI
- Sever pulmonary dysfunction
- Chronic renal insufficiency
What law is in used in the aneurysmal dimensions?
-Law of Laplace
List the monitors that would be used during a AAA repair?
- EKG
- Pulse oximetry
- Capnography
- Temperature
- Urinary catheter
- Nerve Stimulator
- A line
- PAC
What are the SITE for cross clamping during a AAA?
- Suprarenal
- Justarenal
- Infrarenal
T/F: The Suprarenal is the most commonly clamped site for a AAA.
FALSE (Infrarenal)
T/F: Increase in afterload will cause an increase in myocardial wall tension.
TRUE
What is a Neuroendocrine response?
Mediated by cytokines and tumor necrosis factor, as well as plasma catecholamines and cortisol
What will occur if there is a interruption of blood flow to the artery of adamkiewicz and collateral blood flow?
Post Op Parapegia
T/F: The incidence of neurologic complications DECREASE as the clamp is positioned higher on the aorta.
FALSE
What artery supplies the left colone?
-Mesenteric artery
