Podcast
Questions and Answers
Which classification is based on the site of tear and extent of aortic dissection?
Which classification is based on the site of tear and extent of aortic dissection?
- Type II DeBakey classification
- Type I DeBakey classification (correct)
- Stanford classification
- Type III DeBakey classification
What is the major concern with repair of aortic dissection?
What is the major concern with repair of aortic dissection?
- Risk of renal failure
- Risk of myocardial infarction
- Risk of paraplegia (correct)
- Risk of aortic insufficiency
What is the prevention method for reducing spinal pressure during repair?
What is the prevention method for reducing spinal pressure during repair?
- Placing graft to eliminate flow to the false lumen
- Placing lumbar drain to remove CSF fluid (correct)
- Administering IV beta-blockers
- Increasing systemic BP with Neo-Synephrine
Which symptom can aortic dissection mimic?
Which symptom can aortic dissection mimic?
What percentage of patients with aortic dissection have severe HTN at presentation?
What percentage of patients with aortic dissection have severe HTN at presentation?
What is the cause of aortic insufficiency in aortic dissection?
What is the cause of aortic insufficiency in aortic dissection?
What is the primary cause of death with ascending aortic dissections?
What is the primary cause of death with ascending aortic dissections?
What is the initial medical treatment for controlling blood pressure in aortic dissection?
What is the initial medical treatment for controlling blood pressure in aortic dissection?
When should surgery be considered for descending aortic dissections?
When should surgery be considered for descending aortic dissections?
What are the postoperative complications for thoracic aortic surgery?
What are the postoperative complications for thoracic aortic surgery?
What is the most common source of cerebral emboli?
What is the most common source of cerebral emboli?
Which artery is the most commonly diseased intracranial artery?
Which artery is the most commonly diseased intracranial artery?
What are the distinct symptoms associated with middle cerebral artery (MCA) events?
What are the distinct symptoms associated with middle cerebral artery (MCA) events?
What causes amaurosis fugax?
What causes amaurosis fugax?
When should a carotid traumatic injury with major fixed deficit not be repaired?
When should a carotid traumatic injury with major fixed deficit not be repaired?
What are the repair indications for carotid endarterectomy (CEA)?
What are the repair indications for carotid endarterectomy (CEA)?
What is the most common congenital hypercoagulable disorder?
What is the most common congenital hypercoagulable disorder?
What is the most important risk factor for stroke and cerebrovascular disease?
What is the most important risk factor for stroke and cerebrovascular disease?
What is the first branch of the internal carotid artery?
What is the first branch of the internal carotid artery?
What is the normal flow pattern in the external carotid artery (ECA)?
What is the normal flow pattern in the external carotid artery (ECA)?
What are the stages of atherosclerosis in order?
What are the stages of atherosclerosis in order?
What is contained within the carotid sheath?
What is contained within the carotid sheath?
What percentage of blood flow to the brain do the carotids supply?
What percentage of blood flow to the brain do the carotids supply?
What is the most common acquired hypercoagulable disorder?
What is the most common acquired hypercoagulable disorder?
What is the normal flow pattern in the internal carotid artery (ICA)?
What is the normal flow pattern in the internal carotid artery (ICA)?
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Study Notes
Vascular Surgery: Carotid and Vertebral Artery Disease
- Communication between internal carotid artery (ICA) and external carotid artery (ECA) occurs through ophthalmic artery and internal maxillary artery
- Most commonly diseased intracranial artery is the middle cerebral artery
- Cerebral ischemic events mostly result from arterial embolization from the ICA, not thrombosis
- Heart is the second most common source of cerebral emboli
- Different cerebral artery events have distinct symptoms: ACA - mental status changes, MCA - contralateral motor and speech, PCA - vertigo and tinnitus
- Amaurosis fugax is caused by occlusion of the ophthalmic branch of the ICA and results in transient visual changes
- Carotid traumatic injury with major fixed deficit should not be repaired if occluded
- Repair indications for carotid endarterectomy (CEA) include symptomatic > 50% stenosis and asymptomatic > 70% stenosis
- Timing of operation after stroke varies based on stroke type
- Most important technical concern in CEA is getting a good distal end point
- Complications from CEA include vagus nerve injury, hypoglossal nerve injury, and pseudoaneurysm
- Carotid stenting is suitable for high-risk patients, and TCAR has a lower stroke rate by using a distal carotid to femoral artery shunt
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