[16] Surgery for PVD Flashcards Preview

[OS 213] CVS Module > [16] Surgery for PVD > Flashcards

Flashcards in [16] Surgery for PVD Deck (30):
1

Most Common Location of an Aneurysm

Abdominal Aorta

2

Growth Rate of an AAA

3.3-4mm/year

3

Good Cheap Diagnostic Test for Aneurysms

Ultrasound

4

Do you operate on all aneurysms?

Risk of rupture is 1%
Risk of major surgery 1-2%

Up to you DJ Villeza

5

Gold Standard for Diagnosing Carotid Artery Stenosis

Contrast Angiography

6

Define: Claudication

Pain experienced in a functional muscle unit, usually when blood flow is insufficient during activity

7

How to Relieve Claudication

Rest

8

Formula: Ankle-Brachial Index

ABI = Ankle Systolic Pressure / Brachial Artery Systolic Pressure

9

[Example: Ankle-Brachial Index]
Right Arm: 150 mmHg
Right Ant Tib: 68
Right Post Tib: 75

Left Arm: 143
Left Ant Tib: 120
Left Post Tib: 100

ABI = 75/150 = 0.50

ABI = 120/150 = 0.80

10

ABI is important for diagnosing?

What is its diagnostic value?

How sensitive is it? How specific is it?

Peripheral Arterial Diseases

ABI <= 90

95% Sensitivity and 99% Specificity

11

Indications for Intervention with Chronic Limb Ischemia

Rest Pain
Tissue Loss
Severe, life-limiting Claudication

12

Cause of Sudden Onset of Limb Ischemia

Embolism

13

Embolus vs. Thrombus in an Angiogram

Embolus blockage would cause no collateral circulation to flow either

14

[T/F] Soft plaques are more prone to embolization

T

Higher chance of chipping off if plaques are soft

15

Important clinical clue in diagnosing renovascular hypertension

Onset before 30y/o without any risk factors (hypertension in the young)

16

Which of the following is not a risk factor for AAA?
A. Family history
B. Diabetes
C. Smoking
D. Hypercholesterolemia

(c/o Salem, Salliman, Sambo)

B

17

75% of atherosclerotic aneurysms occurs in the?

(c/o Salem, Salliman, Sambo)

Distal Abdominal Aorta (infrarenal artery)

18

Usual presentation of AAA in PE

(c/o Salem, Salliman, Sambo)

Pulsatile mass on abdomen (do not confuse with transmitted pulse)

19

Which is the current standard for quick diagnosis and screening for patients with suspected AAA?

(A) Abdominal X-ray
(B) Ultrasound Duplex
(C) CT Aortogram

(c/o Salem, Salliman, Sambo)

B. Ultrasound duplex is also the most practical diagnostic test in our local setting.

CT Aortogram is still the gold standard, more accurate than Ultrasound duplex but more EXPENSIVE.

Abdominal X-ray doesn't give much for diagnosis

20

Approach and management of AAA with a diameter >5.5 cm

(c/o Salem, Salliman, Sambo)

Evaluate for repair

AAA <5.5 cm: do only ultrasound surveillance

21

Most commonly used method for open surgery of AAA

(c/o Salem, Salliman, Sambo)

Midline Laparotomy

22

Common finding/s in the history and PE of patient with Carotid Artery Disease EXCEPT:
(A) Bruit
(B) Murmur
(C) Absence of carotid pulse
(D) Hollenhorst plaque

(c/o Salem, Salliman, Sambo)

B

23

What is the syndrome of increased arterial pressure due to decreased kidney perfusion

(c/o Salem, Salliman, Sambo)

Renovascular Hypertension

24

What physical examination finding will be definitive for an abdominal aneurysm?

(A) Pulsatile abdominal mass
(B) Transmitted pulses from a pulsatile mass in the abdomen (C) Presence of a palpable abdominal expansile tumor

(c/o Salem, Salliman, Sambo)

C

25

[T/F] Diabetes is NOT associated with Abdominal Aortic Aneurysm development.

(c/o Salem, Salliman, Sambo)

T

26

The following are definitive indicators for surgical repair of an aneurysm, except:
(A) Rapidly growing aneurysm (>0.5 cm/yr
(B) Healthy patients with small saccular AAA (5 cm AAA
(D) None of the above

(c/o Salem, Salliman, Sambo)

D

27

The ff. are advantages of Endovascular Repair for AAA over open surgery. EXCEPT:

(A) Less blood loss
(B) Decreased rate of need for blood transfusions
(C) Longer recovery time
(D) Reduction in early major adverse events

(c/o Salem, Salliman, Sambo)

C

Faster, not longer, recovery time

28

In terms of diagnostic procedures, what is the gold standard for evaluating for the presence of Carotid Artery Disease (CAD)?

(A) Carotid Duplex
(B) MRI
(C) CT scan
(D) Contrast Angiography

(c/o Salem, Salliman, Sambo)

D

Examiner is able to visualize degree of stenosis using anatomic data

29

Definitive Indicators for AAA Repair

1. Lower size threshold for women
2. Rapidly growing aneurysm (>0.5cm/year)
3. Healthy patients with risk factors known to correlate with rupture

30

What is Amaurosis fugax

Cholesterol emboli causing occlusion of blood flow to retinal artery causing fleeting blindness