Vascular 1

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Questions and Answers

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?

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?

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?

Myocardial infarction Signup and view all the answers

What percentage of patients with aortic dissection have severe HTN at presentation?

95.3 Signup and view all the answers

What is the cause of aortic insufficiency in aortic dissection?

Shearing off of aortic valve cusp Signup and view all the answers

What is the primary cause of death with ascending aortic dissections?

Cardiac failure from aortic insufficiency Signup and view all the answers

What is the initial medical treatment for controlling blood pressure in aortic dissection?

IV beta-blockers Signup and view all the answers

When should surgery be considered for descending aortic dissections?

If contained rupture occurs Signup and view all the answers

What are the postoperative complications for thoracic aortic surgery?

Renal failure and paraplegia Signup and view all the answers

What is the most common source of cerebral emboli?

Heart Signup and view all the answers

Which artery is the most commonly diseased intracranial artery?

Middle cerebral artery Signup and view all the answers

What are the distinct symptoms associated with middle cerebral artery (MCA) events?

Contralateral motor and speech symptoms Signup and view all the answers

What causes amaurosis fugax?

Occlusion of the ophthalmic branch of the internal carotid artery Signup and view all the answers

When should a carotid traumatic injury with major fixed deficit not be repaired?

If occluded Signup and view all the answers

What are the repair indications for carotid endarterectomy (CEA)?

> 50% stenosis for symptomatic and > 70% stenosis for asymptomatic patients Signup and view all the answers

What is the most common congenital hypercoagulable disorder?

Resistance to activated protein C (Leiden factor) Signup and view all the answers

What is the most important risk factor for stroke and cerebrovascular disease?

Hypertension (HTN) Signup and view all the answers

What is the first branch of the internal carotid artery?

Ophthalmic artery Signup and view all the answers

What is the normal flow pattern in the external carotid artery (ECA)?

Triphasic flow (antegrade, retrograde, then antegrade again) Signup and view all the answers

What are the stages of atherosclerosis in order?

Foam cells, smooth muscle cell proliferation, intimal disruption Signup and view all the answers

What is contained within the carotid sheath?

Carotid artery, internal jugular vein, and vagus nerve. Signup and view all the answers

What percentage of blood flow to the brain do the carotids supply?

85% Signup and view all the answers

What is the most common acquired hypercoagulable disorder?

Smoking Signup and view all the answers

What is the normal flow pattern in the internal carotid artery (ICA)?

Continuous forward flow (biphasic signal, fast antegrade, then slower diastolic antegrade signal) Signup and view all the answers

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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Description

Test your knowledge of hypercoagulable disorders such as resistance to activated protein C and acquired hypercoagulable disorders like smoking, as well as the stages of atherosclerosis from foam cells to intimal disruption.