Ch. 9 Vascular

Question 1

Traditional carotid endarterectomy (CEA) surgical procedure

Answer 1

open operation / arteriotomy made ICA / material is removed / opening is closed / place patch

Question 2

Common problems associated with CEA

Answer 2

narrowing of vessel / plaque that wasn’t removed / NEOINTIMAL HYPERPLASIA as surgical site

Question 3

Restenosis is

Answer 3

neointimal hyperplasia at surgical site

Question 4

Surgical patches are used to enlarge surgical site and

Answer 4

reduce the potential for a stenosis by widening the lumen

Question 5

With surgical patches, why are veins often everted

Answer 5

allows double wall thickness and vein intima to face lumen of artery

Question 6

Why is eversion different from a CEA

Answer 6

ICA is transected at bifur and evertesd to peel plaque from wall / does not require a patch / less obvious on US

Question 7

In eversion, sutures will appear

Answer 7

circumferentially around the ICA

Question 8

What is the primary concern of these surgeries

Answer 8

restenosis / residual plaque / suture narrowing / thrombosis or occlusion

Question 9

Dacron patch has

Answer 9

woven appearance

Question 10

PTFE patch has

Answer 10

two bright echogenic lines

Question 11

Vein patch resmbles

Answer 11

native wall

Question 12

After surgery with synthetic patch, neck swelling may be caused by

Answer 12

hematoma, infection or pseudoaneurysm

Question 13

After surgery with vein patch, neck swelling may be caused by

Answer 13

patch rupture

Question 14

Post CEA infection is associated with

Answer 14

encap masses / perivascular fluid / neck swelling / extravasated blood

Question 15

Pitfalls in US post surgery

Answer 15

complicated exam during postoperatively period

Question 16

Why is it hard to examine post surgery for patches

Answer 16

air entrapped in patch / wound hematoma / synthetic patch

Question 17

Complications with diagnosis and patches include

Answer 17

suture disruption / suture hole bleeding / pseudoaneurysm

Question 18

Non-stenotic pathology includes

Answer 18

oversized/irregular patch / loose strands of suture / intimal flap / embolization/occlusion

Question 19

Stenotic problems within 1 month post surgery

Answer 19

narrowing of closure / shelf lesion / thrombus

Question 20

Remnant plaque is also called

Answer 20

shelf lesion

Question 21

Restenosis problems include

Answer 21

narrowing in the first 24 months considered neointimal hyperplasia / possible occlusion

Question 22

After 2 years, stenosis considered

Answer 22

atherosclerotic

Question 23

Catheter access for carotid artery stenting is usually through the

Answer 23

common femoral artery

Question 24

Complications from stents that occur in carotid system and pathway of catheter are

Answer 24

dissection / thrombosis / perforations

Question 25

What is commonly used prior to stent placement

Answer 25

embolic protection device (EPD)

Question 26

Stenting procedure

Answer 26

pre-dilation with angioplasty balloon / self expanding stent placement followed by balloon

Question 27

Stent must cover ____ lesion and extend ____ beyond proximal and distal margins of lesion

Answer 27

full, 5mm

Question 28

What is most common post stent placement issue and what %

Answer 28

stent border stenosis, 40%

Question 29

What is a pitfall in stent placement

Answer 29

atherosclerotic plaque is not removed

Question 30

What happens when the atherosclerotic plaque is not removed

Answer 30

dense calcification and shadowing

Question 31

Dense plaquing may result in

Answer 31

problems placing stent / restricts balloon / increase hyperplasia

Question 32

Stent fracture and migration is strongly associated with

Answer 32

calcifications

Question 33

Restenosis rates after CAS may be

Answer 33

40% higher than CEA

Question 34

In stent restenosis ______ may be an ongoing response to implanted foreign object

Answer 34

hyperplasia

Question 35

Hyperplasia can occur across

Answer 35

middle of stent, proximal attachment sire or distal attachment site

Question 36

What is seen with diabetes with stent placement

Answer 36

aggressive initial hyperplasia and in stent restenosis

Question 37

Changes in velocity after placement

Answer 37

elevated velocity and reduces arterial compliance

Question 38

Primary discriminator for significant stenosis is the

Answer 38

peak systolic velocity

Question 39

What is the PSV threshold for 50% stenosis

Answer 39

175-240 cm/s