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Advanced Principles III > Vascular Anesthesia > Flashcards

Flashcards in Vascular Anesthesia Deck (5)
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1
Q

Why are vascular surgeries so high-risk?

A
  • Often have overt or occult CAD
    • <10% of vascular surgery pts have normal coronary arteries
  • CAD is leading cause of perioperative and long-term mortality after vascular surgery
    • nearly 10% have significant mycardial injury in perioperative period
    • 2% with MACE (major adverse cardiac events)
2
Q

What are the definitions of MACE?

A
  • Narrowly: nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death
  • Broader: CVD events, admission for HF, ischemic cardiovascular events, cardiac death
3
Q

Review of the anatomy off the aortic arch

A
4
Q

How is plaque formed?

A
  • Stage 1:
    • Endothelium is damaged d/t hemodynamic shear stress, oxidized LDL desctuction, chronic inflammatory response, infection….
    • Lipoproteins enter the arterial intimal layer via endothelium and become trapped.
      • this promotes inflammation
      • macrophages become lipid laden and turn to foam cells
  • Stage 2:
    • Fibrous plaque forms from lipid accumulation, inflammatory cells, proliferated smooth muscle, and calcium deposits
    • blood flow reduced, thrombus risk
  • Stage 3: Advanced lesion
    • Plaque with lipid rich necrotic core is at high risk of rupturing and releasing thrombus
    • complete occlusion possible
5
Q
A