Flashcards in Chap 43-46 Anastomotic aneurysm, AEF, Graft Thrombosis and Endovascular Deck (45):
List local factors associated with development of anastomotic aneurysm.
Arterial wall degen
Suture line disruption
Prosthetic graft failure
List systemic factors associated with anastomotic aneurysm.
Generalized arterial weakness
What are indications for treatment for anastomotic aneurysm?
Is endovascular better then open repair for anastomotic aneurysms?
endo can offer lower mortality and morbidity rates with high success rates in certain patients
What are the causes of primary AEF?
aneurismal aorta (most common)
What portion of the duodenum is involved in AEF?
3rd or 4th
Where do secondary AEF and AEE occurs?
AEF suture line
AEE on graft
What are the causes of secondary AEF?
pulsatile pressure (graft non compliant)
technical error (injury to bowel)
what is the classic triad for secondary AEF?
What is the classic feature of a secondary AEF?
What are findings on CT scan that indicate AEF?
Effacement of fat planes around aorta
Perigraft fluid and soft tissue thickening,
tethering of adjacent thickened bowel loops toward aortic graft, rarely extrav
What are signs of AEF on endoscopy?
need to see 3-4th portions
visualization of graft
erosion with adherent clot
extrinsic pulsatile mass
What are the most common bacteria for primary AEF?
What are the most common bacteria for secondary AEF?
What are repair options?
graft excision without replacement if enough ollaterals
insitu graft replacement
endovascular (as bridge)
What grafts can be used for replacement?
silver coated dacron
antibiotic impregnated grafts
What are the result of operative repair for AEF?
3 yr survival 50%
What are most common complications after PCI?
What are RF for complications after endo procedure?
What are indications for intervention for femoral hematoma?
What nerves can be affected in the retroperitoneal space (4)?
lateral cutaneous nerve of the thigh
nerve to cremaster muscle
What does the lateral cutaneous nerve of the thigh innervate?
innervates skin on lateral thigh
What does the genitofermoral nerve innervate?
sensation upper anterior thigh
sensation anterior scrotum/mons
What does the femoral nerve innervate?
sensation ant/medial thigh/medial chin/arch of foot
What does the nerve of the cremaster muscle innervate?
What are signs/symptoms of RPB?
non-specific groin/back pain
numbness weakness LE
ecchymosis flank (grey turner)
ecchymosis umbilicus (cullens)
What is natural hx of AVF from endovascular procedure?
30-80% resolve spontaneously within 1 year (most within 1 month)
What are treatment strategies for PSA?
US guided thrombin
what is success of thrombin injection for PSA? describe procedure.
Fill sac with 0.1-0.2ml of thrombine
Direct needle away from inflow of the PSA
If perist then another dose
Check distal pulses and repeat US in 24-48 hours
What are indications for surgical intervention on PSA?
Distal limb ischemia
Failure of US treatment
Large aneurysm >5cm with wide necks
What causes thrombosis after endovasclar procedure?
closure device failure
What are methods of nerve injury in brachial access?
schema from arterial thrombosis
What are different types of closure devices and give an e.g.?
collagen based (angioseal)
suture based (per close)
metal/disk based (star close)
What is the evidence for closure devices?
no difference in complication rate then with compression alone
What are active and passive closure devices?
extravascular prothrombotic matrix
passive (faciliatate compression)
external patches with prothrombotic coating
What were the rates of life threatening hemorrhage in TOPAS and STILE trial?
At what fibrinogen levels do you alter thrombolysis management?
List ways to assess graft latency intra-operatively.
What b/w to send off before initiating heparin in thromboses grafts?
Functional activated protein C resistance
What are RF for graft thrombosis?
Single vessel runoff high rate of graft failure
Below knee target
Preop tissue loss
failure to go to surveillance
What are the critical elements for sustained flow in bypass graft?
What are 30 day causes of graft thrombosis?
obstructive venous disease
What are 18 month causes of graft failure?
vein graft structural abnormalities
What are 5 year causes of graft failure?
vein or prosthetic graft structural abnormalities