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RVT Review > Chapter 14 > Flashcards

Chapter 14 Flashcards

1
Q

what is a arteriovenous fistulae?

A

abnormal connection between high pressure arterial system and low pressure venous system. marked anatomic and hemodynamic changes

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2
Q

T/F AVF is congenital or traumatic

A

true

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3
Q

what can happen if a fistula is close to the heart?

A

potential for cardiac failure increases

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4
Q

fistulas located peripherally more likely to cause?

A

ischemia

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5
Q

what may avfs involve?

A

proximal and distal arteries/ veins as well as collateral arteries/veins. diameter and length predicts resistance it offers

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6
Q

what will the arterial waveform look like proximal to an AVF?

A

increased diastolic flow b/c fistula reduces resistance

low resistance

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7
Q

what will arterial waveform be distal to an AVF?

A

resumes its normal triphasic pattern or may be somewhat reduced

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8
Q

what is the flow at the AVF?

A

high velocities. lower resistant flow

turbulent flow

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9
Q

what will venous outflow waveform look like at an AVF?

A

takes on the flow quality of the fistulas low resistant more pulsatile flow

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10
Q

how should the neck of a pseudoansym be compressed?

A

b/w native artery and pseudoane can be uniformly and completely compressed
compressions can last 10-15min
distal monitoring of the great toe

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11
Q

what is pop a entrapment syndrome?

A

pop a possibly compressed by medial head of gastrocnemius muscle (anomalous origin) or fibrous bands

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12
Q

who is more likely to get pop a entrapment syndrome?

A

found in young men,

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13
Q

repeated trauma to the pop cause?

A

aneurysm, thrombosis, emboli

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14
Q

what are patients symptoms with pop a entrapment?

A

symptomatic arterial occlusion or intermittent claudication

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15
Q

what is the testing for pop a entrapment?

A

flow to great toe is monitored with an end point detector such as PPG
diminished pulsations considered abnormal

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16
Q

what will confirm pop a entrapment?

A

with knee extended and active plantar flexion of the foot (or with passive dorsiflexion of the foot) against resistance, PPG pulsations may diminish or obliterate, which could be suggestive of pop a entrapement

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17
Q

which vessels can they look at for preoperative arterial mapping?

A

epigastric EA

internal mammary artery/ internal thoracic artery

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18
Q

what is a terminal branch of the internal mammary artery?

A

deep superior EA

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19
Q

what does the EA fed?

A

both arteries and perforators take blood to the rectus abdominis muscle, long strap muscle vertically ordiented, each side of midline

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20
Q

what is part of the transverse recuts abdominus myocuaneous flap (TRAM)

A

rectus abdominis muscle, subq fat, arteries, perforators, overlying skin

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21
Q

what is the reason for mapping the EA?

A

surgeon wants to use the best arterially supplied muscle section for TRAM flap for autogenous breast reconstruction

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22
Q

where is another name for internal mammary artery?

A

internal thoracic artery

23
Q

where does the internal thoracic artery arise from?

A

subclavian artery

24
Q

where does the internal mammary artery descendes from?

A

posterior side of cartilage of upper 6 ribs, about 1 cm from sternum

25
Q

reasons for mapping the internal thoracic artery?

A

utilzed as a recipient side for free flaps in breast reconstruction
second important use for this artery is as a graft to the left anterior descending (LAD) coronary artery

26
Q

reasons for mapping the radial artery

A

determine suitability for use as graft for coronary artery bypass

27
Q

what is the technique for assessing the radial artery?

A

assess patency of palmar arch with modified Allen test

28
Q

what will a positive allen test for radial artery do?

A

do not proceed.

removal of radial artery will compromise the hand

29
Q

what freq transducer will you use on radial artery?

A

7.5 or 5MHz

30
Q

what abnormalities should you be on the look out for with radial artery mapping?

A

focal elevated PSV, abnormal doppler quality,

intimal thickening, aneurysm, calcification

31
Q

what should you measure of the radial artery?

A

diameter prox, mid, distal

32
Q

what are some limitations of radial artery study?

A

wall calcification

33
Q

what are indications for preoperative vein mapping?

A

determine suitability for use as extremity or coronary bypass
determine suitability of veins for use in dialysis access. graft

34
Q

what is the technique for vein mapping LE?

A

7.5 MHz or higher
GSV sometimes LSV mapped (prox-dist)
high, mid, dist thigh, knee, BK, prox, mid, distal calf, ankle

35
Q

what is the technique for vein mapping UE?

A

cephalic and basilic veins are mapped

measure at prox, biceps, above elbow, forearm. (prox mid distal,) wrist

36
Q

what will proximal tourniquet do?

A

assists with expansion of the vein size

37
Q

what is evaluated with vein mapping?

A

vein wall coaptation (compressibility)

38
Q

how is the criteria for measuring vessels for vein mapping?

A 
outer edge to outer edge diameter measurements (mm)
vein length (cm) obtained
39
Q

what are normal findings with vein mappings?

A

compressilbilty of veins without evidence of thrombosis

40
Q

what is the acceptable diameter measurement for vein mapping?

A

at least 2-3mm. basilic vein is often larger than cephalic

41
Q

what findings may prevent use of vein for bypass graft?

A

presence of vein wall thickening or mural calcifications

42
Q

what is thoracic outlet syndrome?

A

occurs with neurovascular bundle compression by should structures (cervical rib, clavicle, scalene muscle) occurs in certain arm positions

43
Q

why do most symptoms occur with TOS?

A

due to neurogenic compression of the brachial plexus and a small percentage due to subclavian vein or artery compression

44
Q

what are symptoms of TOS?

A

numbness/ tingling of arm
pain/aching of shoulder/forearm
exercise/upward positions increase discomfort/symptoms
25-30% have asymptomic compression

45
Q

what is used to diagnosis TOS?

A

PPG and or doppler waveform

46
Q

what is the technique for PPG / doppler for TOS?

A

PPG attached to index finger. or CW doppler on radial artery
resting waveform obtained
patients arm placed in various positions while arterial pulsations monitored

47
Q

what is normal for TOS PPG/ Doppler?

A

resting waveforms maintained

48
Q

what is abnormal for TOS PPG / doppler?

A

attenuation or flattening of the waveforms in one or more of the positions

49
Q

what are some arm positions for TOS?

A 
resting position- hand in lap
arm at 90 degrees
arm at 180 degress
exaggerated military stance 
adson maneuver 
causative position/ hand where symptoms arise
50
Q

what is Adson maneuver?

A

arm extended 180 degress with head turned sharply right and then left

51
Q

what kind of surgery can help with TOS?

A

rib resection with or without scalene splitting

52
Q

where can arterial injuries result from?

A

blunt trauma e.g long bone fractures which injure vessels or penetrating trauma (e.g stabbing wounds)

53
Q

what is a clinical presentation of a trauma?

A

open wound, hemorrage, hematoma

may or may not have distal pulses

RVT Review (30 decks)

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