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Surgery.(General 2).Vascular > Arterial.10.AV fistula > Flashcards

Arterial.10.AV fistula Flashcards

(42 cards)

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1
Q

Definition of AV fistula

A

Communication between an artery and vein

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2
Q

PATHOLOGICAL TYPES of AV fistula

A
  1. Aneurysmal varix

2. Varicose aneurysm

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3
Q

Aneurysmal varix in PATHOLOGICAL TYPES of AV fistula

A

Direct communication between an artery & vein.

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4
Q

Varicose aneurysm in PATHOLOGICAL TYPES of AV fistula

A

The artery & vein communicate through a false sac.

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5
Q

Etiology of AV fistula

A

A. Congenital

B. Acquired

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6
Q

Congenital Etiology of AV fistula

A
  1. Robertson’s Giant Limb

2. Cirsoid aneurysm of the scalp “Arterial hemangioma”

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7
Q

Robertson’s Giant Limb in Congenital Etiology of AV fistula

A
  • Alternative name

* Pathogenesis

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8
Q

Alternative name of Robertson’s Giant Limb in Congenital Etiology of AV fistula

A

Klippel-Trenaunay syndrome

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9
Q

Pathogenesis of Robertson’s Giant Limb in Congenital Etiology of AV fistula

A
  • Affecting mainly the lower limb with multiple A.V fistula mainly in the bones
  • Causing local gigantism
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10
Q

Cirsoid aneurysm of the scalp in Congenital Etiology of AV fistula

A
  • Alternative name
  • Common sites
  • Associations
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11
Q

Alternative name of Cirsoid aneurysm of the scalp in Congenital Etiology of AV fistula

A

Arterial hemangioma

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12
Q

Common sites of Cirsoid aneurysm of the scalp in Congenital Etiology of AV fistula

A
  • Temporal region : in relation to the superficial temporal artery
  • Occipital regions of the scalp.
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13
Q

Associations of Cirsoid aneurysm of the scalp in Congenital Etiology of AV fistula

A

Sometimes it has intracranial connections

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14
Q

Clinical picture of AV fistula

A

A) Local characters

B) Effects on the Limb

C) Effects on the circulation

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15
Q

Local characters in Clinical picture of AV fistula

A
  • Similarities to true aneurysm If there is a swelling

* Differences between Varicose aneurysm and true aneurysm

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16
Q

Similarities to true aneurysm If there is a swelling in Local characters in Clinical picture of AV fistula

A
  • Smooth, rounded, cystic & compressible with expansile pulsation
  • In the line of an artery.
  • Movable across, but not along that artery
  • Compressing the proximal artery reduces its size and stops its pulsation, thrill and bruit.
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17
Q

Differences between Varicose aneurysm and true aneurysm in Local characters in Clinical picture of AV fistula

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A
  • Timing of thrill and bruit

* Propagation of thrill and bruit

18
Q

Timing of thrill and bruit in Varicose aneurysm

Study These Flashcards
A

Overlying systolic & diastolic

19
Q

Timing of thrill and bruit in true aneurysm

Study These Flashcards
A

Overlying only systolic

20
Q

Propagation of thrill and bruit in Varicose aneurysm

Study These Flashcards
A

propagated distally and proximally.

21
Q

Propagation of thrill and bruit in true aneurysm

Study These Flashcards
A

propagated distally only.

22
Q

Effects on the Iimb in Clinical picture of AV fistula

Study These Flashcards
A
  1. Local overgrowth (gigantism)
  2. Chronic ischemia
  3. Pulsatile varicose veins
23
Q

Local overgrowth (gigantism) in Effects on the Iimb in Clinical picture of AV fistula

Study These Flashcards
A
  • Affected type of AV fistula

* Pathogenesis

24
Q

Affected type of AV fistula in Local overgrowth (gigantism) in Effects on the Iimb in Clinical picture of AV fistula

Study These Flashcards
A

only in congenital type especially if widespread.

25
Pathogenesis of Local overgrowth (gigantism) in Effects on the Iimb in Clinical picture of AV fistula
It is due to increase oxygenation and nutrition through the leg.
26
Pathogenesis of Chronic ischemia in Effects on the Iimb in Clinical picture of AV fistula
due to decrease arterial blood flow.
27
Pathogenesis of Pulsatile varicose veins in Effects on the Iimb in Clinical picture of AV fistula
due to increase venous flow.
28
Effects of AV fistula on the circulation in Clinical picture of AV fistula
1. Hyperdynamic circulation 2. The Branham's bradycardic reaction : 3. Later ventricular hypertrophy & high cardiac output failure occur.
29
Pathogenesis of Hyperdynamic circulation in Effects of AV fistula on the circulation in Clinical picture of AV fistula
A-V fistula produces : * Increased venous return. * Increased cardiac output. * Tachycardia & high pulse pressure.
30
The Branham's bradycardic reaction in Effects of AV fistula on the circulation in Clinical picture of AV fistula
Compressing the artery proximal to the fistula causes bradycardia (Branham's sign). due to Dec venous return to the heart
31
INVESTIGATIONS OF AV fistula
* ACQUIRED FISTULA | * CIRSOID ANEURYSM OF THE SCALP
32
ACQUIRED FISTULA investigation in INVESTIGATIONS OF AV fistula
1. Doppler study or duplex scan | 2. Arteriography.
33
Doppler study or duplex in ACQUIRED FISTULA INVESTIGATIONS OF AV fistula
can localize the site of the fistula.
34
CIRSOID ANEURYSM OF THE SCALP investigations in INVESTIGATIONS OF AV fistula
1. Plain X-Ray skull | 2. External carotid angiography
35
Plain X-Ray skull in CIRSOID ANEURYSM OF THE SCALP investigations in INVESTIGATIONS OF AV fistula
Rarified bone.
36
External carotid angiography in CIRSOID ANEURYSM OF THE SCALP investigations in INVESTIGATIONS OF AV fistula
To detect any intracranial connections
37
Treatment of AV fistula
* Congenital AV fistula | * Acquired AV fistula
38
Congenital AV fistula Treatment in Treatment of AV fistula
1. Robertson's Giant Limb | 2. Cirsoid aneurysm
39
Treatment of Robertson's Giant Limb in Congenital AV fistula Treatment in Treatment of AV fistula
Usually stationary & needs no operative interference.
40
Treatment of Cirsoid aneurysm in Congenital AV fistula Treatment in Treatment of AV fistula
* Surgical excision under general hypotensive anesthesia | * Preliminary therapeutic embolization by gelfoam of the feeding vessels may be tried.
41
Acquired AV fistula Treatment in Treatment of AV fistula
1. Excision and vascular repair of both artery & vein. | 2. Quadruple ligation
42
Quadruple ligation in Acquired AV fistula Treatment in Treatment of AV fistula
The artery & vein are ligated above & below the fistula Done if the above operation is difficult due to extensive adhesions in a peripheral unimportant artery.

Surgery.(General 2).Vascular (16 decks)

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