Chap 122 Raynauds Flashcards Preview

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Flashcards in Chap 122 Raynauds Deck (24):
1

What is the cause of primary raynauds?

idiopathic

2

What are connective tissue causes of secondary raynauds?

systemic sclerosis
inflammaroty muscle disease
Lupus
Sjogren's syndrome
Vasculitis

3

What drugs can cause secondary raynauds?

BB
clonidine
ergotamine
vinyl chloride

4

What occupational cause can cause raynauds?

HAVS
TOS

5

What illness that impair digital perfusion can cause secondary raynauds?

paraproteinemia
cryoglobulinemia
malignancy

6

What are some large vessel disease that can cause secondary raynauds?

athero
thromboangitis obliterans

7

What are proposed pathogenic cases of raynauds?

vascular
impaired vasod (impaired NO and prostacyclin)
increased vasoconstriction (overproduction of ATII, ET-1)
structural vascular abnormalities

Neural
impaired vasod (calcitonin gene related peptide)
increased vasoc (abnormal adrenergic function)
central (stress induced)

Intravascular factos (plt WBC activation, increased thrombin generation)

Genetic

8

What are important questions on hx?

tissue loss
CTD (difficulty swallowing, photosensitivity, mouth ulcers)
asymmetry
what drugs
occupational hx
fam hx
RF for athero
bruits, pulses

9

What investigations to do for raynauds?

nailfold cappilaroscopy (abnormalities)
angio/NIV for large vessel
Thermography (normal thermal gradients at room temp for PRP but not for sclerosis)

10

What is medical therapy for raynauds?

remove triggers
CCB
ACEi
phosphodiesterase inhibitors
topical NO, nitrate

11

When to do sx? what sx options for raynauds?

when medical treatment fails
ulcer debridement
cervical sympathectomy (symptoms may return)
periarterial symapthectomy
Balloon angio
arterial reconstruction
excision of calcific deposits
amputation
botox injections

12

What is the angio anatomic classification of raynauds?

type I: occlusion of R or U artery, decreased flow in level 2-3 arteries
type II: as I but with stenosis of R or U artery
type IIIa: main disorder in common digital or digital arteries
type IIIb: rare, occlusion of the digital arteries to index finger caused by vibration
type IV: all level stenotic
Type V: global ischemia, paucity of vessels, scant flow on angio

13

What is the technique for digital sympathectomy?

bruner Z-shaped incision
stripp adventitia of common digital artery

14

How many neurone are in the motor sympathetic route?

3

15

Where is the thoracic sympathetic trunk located?

in the middle of the intercostal space either bottom edge of top rib or top edge of bottom rib

16

Name indications for cervicothoracic sympathectomy

essential hyperhidrosis
ischemia of the hand
CRPS
Long QT syndrome
Raynauds

17

What are surgical approaches to sympathectomy?

paravertebral
transthoracic
supraclavicular
VATS (gold standard)

18

What is the target for CRPS vascular disease and raynauds?

stellate, G2 and G3

19

What are results of sympathectomy for raynauds?

50% dissatifaction
60% compensatory hyperhidrosis
may no longer be recommended

20

What are results of sympathectomy for CRPS?

Success 85% needs to be done early

21

What are common complications to sympathectomy?

Compensatory sweating
Segmental atelectasis
Penumo
Subcut emphysema

22

What are rare complications of sympathectomy?

Horners
Hemo
Effusion
Injry to vagus, phrenic, scla, sclv

23

What are causes of failure of sympathectomy?

Incomplete denervation
Regeneration
Functional reorganization

23

What arête appears to be preferentially affected in secondary raynauds?

Ulnar