Vascular Disease

  1. Peripheral Vascular Disease (General)
    • Results in compromised blood flow to the extremities. Ankle-Brachial index of less than 0.90. 
    • Higher risk of cardiovascular ischemic events
    • Chronic: atherosclerosis
    • Acute: arterial embolism
  2. Peripheral Vascular Disease (Risk Factors)
    • Similar to those causing ischemic heart disease: Diabetes mellitus, HTN, tobacco use, dyslipidemia, hyperhomocysteinemia, and a family Hx
    • Prognosis with PAD is related to increased risk of CV ischemic events and cerebrovascular disease
  3. Peripheral Vascular Disease (Signs/Symptoms)
    • Intermittent claudication (requirements of exercise exceeds oxygen delivery) and rest pain
    • Decreased or absent arterial pulses (most reliable)
    • Normal transcutaneous oxygen tension is 60 mm Hg in the foot and may be less than 40mm Hg w/ skin ischemia
  4. Peripheral Vascular Disease (Treatment)
    • Smoking cessation
    • Lipid-lowering therapy
    • Anti-HTN (except B-blockers)
    • Ravascularization (rapid and completeness)
    • Operative risk related to the presence of atherosclerotic vascular disease (ischemic heart disease and cerebrovascular disease)
  5. Peripheral Vascular Disease (Anesthesia)
    • Principal risk if ischemic heart disease
    • Beta-blockers indicated for surgery
    • Heparin is common before vascular cross-clamp to reduce the risk of thromboembolic complication
  6. Peripheral Vascular Disease (Postoperative)
    Dexmedetomidine can attenuate the increase in HR and catecholamine release during emergence from anesthesia (produces analgesia and sedation w/o cardiac/respiratory depression)
  7. Subclavian Steal Syndrome
    • Occlusion of subclavian artery proximal to the vertebral artery reverses blood flow from the brain to supply the arm
    • Symptoms of CNS ischemia
  8. Acute Arterial Occlusion
    • S/S: limb ischemia (pain, paresthesia, motor weakness)
    • Tx: heparin and thrombolysis
    • Anesthesia: similar to Peripheral Vascular Disease
  9. Coronary Artery Disease
    • Cerebrovascular accident (stroke): sudden neurologic deficits due to ischemic, hemorrhagic, or thrombotic events. 
    • Brain receives 20% of CO via internal carotid and vertebral arteries to form major intracranial vessels and circle of willis. 
    • Acute ischemic stroke: Small vessel occlusion due to DM or systemic HTN, HTN is the most significant risk factor for acute ischemic stroke.
  10. Carotid Endarterectomy
    • Preop: Examine for CV and renal disease. Ischemic hear disease is a major cause of morbidity and mortality. Check the effect of a change in head position on cerebral function. 
    • GA Anesthetic: BP lability may be large but decrease in CMRO2 may provide protection.
    • Monitoring: Intraarterial catheter, cerebral function
    • Postop: Hypertension and hypotension (cerebral edema and ischemia) should be avoided. NTG for HTN + hydrazine or labetolol.
  11. Peripheral Venous Disease
    Deep vein thrombosis and subsequent pulmonary embolism are leading cause of posts morbidity and mortality. Tx with anticoagulation to an INR of 2-3
Card Set
Vascular Disease
Vascular Disease