Chap 43-46 Anastomotic aneurysm, AEF, Graft Thrombosis and Endovascular Flashcards Preview

Vascular Surgery > Chap 43-46 Anastomotic aneurysm, AEF, Graft Thrombosis and Endovascular > Flashcards

Flashcards in Chap 43-46 Anastomotic aneurysm, AEF, Graft Thrombosis and Endovascular Deck (45):
1

List local factors associated with development of anastomotic aneurysm.

Arterial wall degen
Suture line disruption
Prosthetic graft failure
Infection/inflammation
Technical factors
Mechanical stress

2

List systemic factors associated with anastomotic aneurysm.

Smoking
DLP
HTN
Anticoagulation
Vasculitides
Generalized arterial weakness

3

What are indications for treatment for anastomotic aneurysm?

>2.5cm
symptomatic

4

Is endovascular better then open repair for anastomotic aneurysms?

endo can offer lower mortality and morbidity rates with high success rates in certain patients

5

What are the causes of primary AEF?

aneurismal aorta (most common)
foreign body
tumor
radiation
infection
GI dz

6

What portion of the duodenum is involved in AEF?

3rd or 4th

7

Where do secondary AEF and AEE occurs?

AEF suture line
AEE on graft

8

What are the causes of secondary AEF?

infection
pulsatile pressure (graft non compliant)
technical error (injury to bowel)

9

what is the classic triad for secondary AEF?

GI bleeding
abdo pain
pulsatile mass
11%

10

What is the classic feature of a secondary AEF?

herald bleed

11

What are findings on CT scan that indicate AEF?

Effacement of fat planes around aorta
Perigraft fluid and soft tissue thickening,
ectopic gas,
tethering of adjacent thickened bowel loops toward aortic graft, rarely extrav

12

What are signs of AEF on endoscopy?

need to see 3-4th portions
visualization of graft
ulcer
erosion with adherent clot
extrinsic pulsatile mass

13

What are the most common bacteria for primary AEF?

salmonella
klebsiella

14

What are the most common bacteria for secondary AEF?

s.aureus

15

What are repair options?

graft excision without replacement if enough ollaterals

insitu graft replacement

neo-aortoiliac procedure

extra-anatomic revasc

endovascular (as bridge)

16

What grafts can be used for replacement?

allograft
synthetic graft
silver coated dacron
antibiotic impregnated grafts

17

What are the result of operative repair for AEF?

mortality 30%
amputation 10%
3 yr survival 50%

18

What are most common complications after PCI?

bleeding/hematoma
PSA
AVF
dissection
thrombosis

19

What are RF for complications after endo procedure?

larger sheath
interventional procedures
previous cath
small BMI
female
uncontrolled HTN
GIIbIIIa
increased age

20

What are indications for intervention for femoral hematoma?

hemo instability
persistent anemia
skin necrosis
nerve compression
severe pain

21

What nerves can be affected in the retroperitoneal space (4)?

lateral cutaneous nerve of the thigh
genitofemoral nerve
femoral nerve
nerve to cremaster muscle

22

What does the lateral cutaneous nerve of the thigh innervate?

innervates skin on lateral thigh

23

What does the genitofermoral nerve innervate?

sensation upper anterior thigh
sensation anterior scrotum/mons

24

What does the femoral nerve innervate?

sensation ant/medial thigh/medial chin/arch of foot
extends knee

25

What does the nerve of the cremaster muscle innervate?

cremasteric reflex

26

What are signs/symptoms of RPB?

non-specific groin/back pain
oliguria
numbness weakness LE
ecchymosis flank (grey turner)
ecchymosis umbilicus (cullens)

27

What is natural hx of AVF from endovascular procedure?

30-80% resolve spontaneously within 1 year (most within 1 month)

28

What are treatment strategies for PSA?

US compression

US guided thrombin

observation

surgical

Endovascular

29

what is success of thrombin injection for PSA? describe procedure.

95-100%

Anesthetize skin
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
Recurrence 3%

30

What are indications for surgical intervention on PSA?

Infected
Hemo instability
Skin necrosis
Distal limb ischemia
Neurologic defecit
Failure of US treatment
Large aneurysm >5cm with wide necks

31

What causes thrombosis after endovasclar procedure?

large sheath
aggressive compression
closure device failure

32

What are methods of nerve injury in brachial access?

hematoma
direct damage
schema from arterial thrombosis

33

What are different types of closure devices and give an e.g.?

collagen based (angioseal)
suture based (per close)
metal/disk based (star close)

34

What is the evidence for closure devices?

MA
no difference in complication rate then with compression alone

35

What are active and passive closure devices?

active
suture/clip
extravascular prothrombotic matrix

passive (faciliatate compression)
external patches with prothrombotic coating
assisted compression

36

What were the rates of life threatening hemorrhage in TOPAS and STILE trial?

13%
6%

37

At what fibrinogen levels do you alter thrombolysis management?

<100 stop

38

List ways to assess graft latency intra-operatively.

inspection
palpation
arteriography
doppler
duplex
angioscopy
IVUS

39

What b/w to send off before initiating heparin in thromboses grafts?

Plt
Functional activated protein C resistance
Anticardiolipin antibodies
ATIII
Protein S
HITT assay

40

What are RF for graft thrombosis?

Single vessel runoff high rate of graft failure
Below knee target
DM
Preop tissue loss
BMI >35
Early revision
African American
smoking
failure to go to surveillance

41

What are the critical elements for sustained flow in bypass graft?

Inflow
Outflow
Conduit
Operative technique
Coagulation profile

42

What are 30 day causes of graft thrombosis?

technical error
graft thrombogenicity
poor runoff
obstructive venous disease

43

What are 18 month causes of graft failure?

neointimal hyperplasia
vein graft structural abnormalities

44

What are 5 year causes of graft failure?

vein or prosthetic graft structural abnormalities
progressive athero

44

What are indications for angioplasty for intimal hyperplasia?

Post CTD to bridge to OR
High risk for OR
Difficult to approach surgically