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Vascular Surgery > Ischemia And Injury > Flashcards

Ischemia And Injury Flashcards

1
Q

Falsely high ABI is found in……

A

Calcified vessels (DM, renal failure)

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2
Q

MC site of acute uschemia dt embolism is…..

A

Superficial femoral art, aorta

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3
Q

MC cause of of embolism is…..while that of thrombosis is…..

A

AF
Atherosclerosis

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4
Q

Differentiate clinically between acute embolism & thrombosis

A

Differentiation based on:
-Onset (throm is acute but less dramatic)
-Trophic changes
-Presence of collaterals
-History of claudications

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5
Q

List 5 most common sites of arterial embolism in descending order of frequency

A

Bifurcation of:
1. Superficial femoral artery
2. Aorta
3. Politeal a
4. Brachial a
5. CCA

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6
Q

Describe heparin therapy in acute limb ischemia

A

I.V. heparin. Start with 5000 IU bolus followed by 1300 IU / hour by continuous drip. The dose is controlled by checking activated partial thromboplastin time (APTT) every 12 hours, which should be maintained at 2 - 3 times the baseline level.

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7
Q

Definitive ttt of emoblism is…..

A

Urgent embolectomy using Fogarty catheter

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8
Q

Best thrombolytic is….

A

TPA

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9
Q

Systemic manifestations of reperfusion injury is….

A

Rhabdomyolysis, renal failure, ARDS, myocardial dysfunction & clotting disorders

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10
Q

List hard signs of peripheral arterial injury

A
  1. Pulsatile hge
  2. Shock with ongoing bleeding
  3. Expanding or pulsatile hematoma
  4. Papable thrill or bruit at or distal to injury
  5. No distal pulse
  6. Signs of acute limb ischemia
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11
Q

Mention indications of fasciotomy in ac limb ischemia

A
  1. Late cases
  2. Muscle edema
  3. Development of swelling/paralysis after revascularization
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12
Q

List causes of compartment $

A

Fractures, crush injuries, revascularization following ac ischemia, intramuscular bleeding, severe burns & shock

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13
Q

Systolic bruit indicates…..while continuous indicates….

A

Aneurysm
AV fisula

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14
Q

Mention special tests for claudication

A
  1. Capillary refilling time
  2. Disappearing pulse test
    Buerger’s angle: the angle at which blanching of limb occur
    Harvey’s venous refilling time: detect delayed venous refilling
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15
Q

Describe claudication ttt

A
  1. Best is medical: risk factor modification, antiplatelets, vaso-active drugs, care of feet, exercise
  2. If not improved angiography
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16
Q

Site of rest pain is…..because of….
Edge of ulcer in critical limb ischemia is….

A

Never above ankle, ischemic neuritis
Punched out

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17
Q

The ttt for long segment stenosis in critical limb ischemia is…..
Above inguinal ligament….is used but below….is used

A

Arterial bypass
Synthetic graft
Saphenous graft

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18
Q

List indications for surgery in critical limb ischemia

A

Starting & pre-gangrene, severe claudication pain, ulcer resistant for healing, long segment occluded >12 cm

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19
Q

Mention indications for amputation

A
  1. Severe spreading gangrene
  2. Spreading infection
  3. Severe uncontrollable pain
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20
Q

Mention indications for endovascular & open revascularization

A
  1. Critical limb ischemia: rest pain, ischemic ulcers, gangrene
  2. Incapacitating claudication
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21
Q

Mention the triad of Leriche

A

Buttock claudicaytion, impotence, absent femoral pulses

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22
Q

Portwine hemangioma may be part of….., ttt is…..

A

Sturge Weber $
Laser: pulsed dye in children under GA, YAG in adults

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23
Q

Surface of capillary malformation is….., while that of venous is……

A

Flat
Elevated, lobulated

24
Q

Mention ttt of cavernous malformation

A

Compression, percutaneous sclerosis, laser (YAG, argon), excusion after embolization

25
Q

Describe etiology of cystic hygroma

A

Failure of lymphatics to communicate w/ venous system

26
Q

Mention comp of cystic hygroma

A

Obstructed labor, recurrent infection, RD dt compression of fibrosis

27
Q

Describe ttt of cystic hygroma

A

Complete surgical excision, intracystic injection of Borylate leads subsequent shrinkage
If discovered prenatal, delivery should be in 3ry center to deal with postnatal dyspnea & airway should be secured before cord clamping in huge lesions.

28
Q

Cercoid aneurysm is…….most common site is…..

A

Congenital AV fistula
Temporal (forehead) in relation superficial temporal artery

29
Q

In neuropathic DF, pulse is…., veins are….

A

Bounding
Distended

30
Q

Describe ttt of diabetic vasculopathy

A
  1. Macro: short segment: PTA, long segment:bypass
  2. Micro: debridemnet, Abx, daily dressing, flap when wound is untidy
31
Q

List consequences of DF

A
  1. Persistent ulcer
  2. Osteomyelitis
  3. Spread of infection & gangrene if foot
  4. Infection spread ro leg & thigh
  5. Septicemia & septic shock
32
Q

List causes of inc susceptibility to inf in DM

A

Peripheral neuropathy, vascular affection, immunocompromised, glycosylation of tissues

33
Q

New deck

A
34
Q

Mention drugs used in TTT of 1ry Raynaud

A

VDs, baby aspirin, CCB

35
Q

CP of 2ry Raynaud

A

May affect LL, unilateral asymmetrical, +ve trophic changes, no peripheral pulsations, progressive

36
Q

Describe TTT of 2ry Raynaud

A

TTT of cause, VDs, BBs
Sympathectomy has limited benefit due to vascultitis & cryo-Abs

37
Q

Describe PDFs & etiology of Buerger’s disease

A

Unknown, males 20-40 yrs, SMOKERS: may becallergic reaction to nicotine, associated w/ interdigital fungal infection

38
Q

Describe TTT of Buerger’s

A

Stop smoking, conservative med therapy w/ addition of steroids during episodes of activity.
Sympathectomy in non-healing ischemic ulcer, persistent rest pain, acrocyanosis

39
Q

List causes of thoracic outlet $

A

Cervical rib, scalene $, hyperabduction $, malunion of clavicle, pancoast tumor, tumor or inflammation of 1st rib, post-fixation of brachial plexus, costoclvicular $

40
Q

Mention most common presentation of thoracic outlet $

A

Neural: compression of lower trunk of brachial plexus
Sensory on ulnar side, motor small muscles of hand atrophy & weakness

41
Q

Buerger’s disease affects….., diagnosis is based on…….

A

Distal vessels usually to popliteal artery
Clinical exam & duplex scan

42
Q

What is Addison’s test?

A

In thoracic outlet $, radial pulse becomes weak or disappears when asking pt to brace his shoulders backwards turns head upward & toward side of affected limb & takes a deep breath

43
Q

List INV for thoracic outlet $

A
  1. Angiography in abduction, compression of subclavian a on arm elevation, there’s post-stenotic dilatation
  2. Plain X ray: cervical rib or prominent C7 transverse process
  3. Nerve conduction veolcity & EMG
  4. Venous duplex or contrast venography
44
Q

TTT of severe thoracic oulet

A

Affecting artery
1. Resection of cervical rib or 1st rib
2. Scalenotomy of ant scalene
3. Osteotomy & internal fixation of clavicle
4. Radio & chemo for pancoast

45
Q

Describe etiology of 1ry VV

A

Idiopathic, congenital mesenchymal weakness (Marfan, Ehler Danlos, Askar $)
Congenital valvular incompetence, agg factors (female, high parity, obese, prolonged standing, OCP, +FH)

46
Q

Describe INV for VV

A

1ry: doppler, venous duplex (gold standard, reversal of bloodflow w/ vaksalva or muscle squeeze OR thrombosis OR dilated veins w/incompetent valves), venography, X-ray: periostitis, biopsy for malignancy
2ry as before + arteriography

47
Q

Describe etiology of 2ry VV

A

DVT (MC), AVF (Klipple trenaury $, butcher’s thigh), aneurysm, buerger disease, pelvic tumors, pregnancy

48
Q

Mention differentiating symptoms bet 1ry & 2ry VV

A

1ry: mild pain, relieved by walking, mild swelling
2ry: marked pain relieved by elevation, persistent diffuse swelling

49
Q

Mention signs of 2ry VV

A

As 1ry +
Arranged haphazardly, veins crossing inguinal ligament, massive edema, MC of skin CCC: pigmentation, dermatitis, eczema, ulcer, LDS

50
Q

Stripping of superficial veins is CI in…

A

DVT

51
Q

List indications of injection in VV

A

Small superficial telangiectasia, useful for small localized VV, recurrent VV after surgery

52
Q

List comp of VV

A
  1. Venous comp; LL edema, post-traumatic hge, superficial thrombophelbitis
  2. Skim CCC: pigmentation, dermatitis, eczema, ulcer, LDS.
  3. Others: marjolin ulcer, talipus equniavorus
53
Q

Mention CI to sclerotherapy

A

Septic thrombophlebitis, 2ry VV, injection of long saphenous v, avoid injection of all veins at same time

54
Q

Mention indications of surgical intervention in VV

A

Patients w/ clear evidence of long or short saphenous incompetence or a combination of the two shoukd be treated by saphenofemoral or -popliteal disconnection combined w/ stripping of the vein

55
Q

Mention etiology of venous ulcer

A

MC DVT, AVF, 1RY VV (rarely)

56
Q

Describe conservative management

A

Rest & elevation of limb, compression by graduated elastic stockings or crepe bandage, compression stockings, dressing w/saline, NOT anti-septic, debidement. Medications (pentoxyphilline, PGE1, Diosmin)

Vascular Surgery (3 decks)

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