Chapter 14: Miscellaneous Conditions/ Tests (2%) Flashcards Preview

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Flashcards in Chapter 14: Miscellaneous Conditions/ Tests (2%) Deck (39):
1

What is an AV fistula

abnormal connection between high pressure arterial system and low pressure venous system

2

AV fistulas can be

congenital or traumatic

3

If a fistula is close to the heart what increases

potential for cardiac failure

4

a fistula located peripherally is more likely to cause

ischemia

5

AVF may involve

prx and dst arteries/veins as well as collaterals

6

Proximal arterial flow (prox to AV fistula)

increase diastolic flow because fistula reduces resistance

7

Depending on size of fistula, arterial flow distal to AV fistula may

resume its normal triphasic pattern or be somewhat reduced

8

Flow throughout the AV fistula

higher velocities
low resistance

9

Venous outflow of AV fistula

takes on flow quality of fistulas low resistant pulsatile flow

10

Compartment syndrome

compression of tibial arteries due to swelling
leads to necrosis of muscle

11

compartment syndrome can be caused by

repair of tibial artery (from trauma or occlusion)
compartment is bound by bone, fascia and interosseous membrane that does not allow for expansion

12

pts with compartment syndrome present with

severe pain
tenderness
foot drop

13

treatment for anterior compartment syndrome

fasciotomy (cutting of fascia to relieve pressure)

14

Treatment for Pseudoaneurysms

US guided compression
US guided thrombin injection

15

US guided compression for pseudos technique

compression of 10-15 min with short rest period performed with MD present
monitoring of distal perfusion necessary
length of time varies

16

US guided compression for pseudo contraindications

inability to uniformly compress neck
pt anticoagulated
multiple communicating channels

17

key to success of compression of pseudo

neck between native artery and PSA must be uniformly and completely compressed

18

US guided thrombin injection of PSA contraindications

allergy to thrombin or bovine
infection in groin
ischemia of overlying skin
short/wide neck

19

Popliteal artery entrapment syndrome is when

pop artery is compressed by medial head of gastrocnemius muscle or fibrous band

20

pop artery entrapment syndrome is found commonly

in young men

21

patients with pop artery entrapment syndrome present with

symptomatic arterial occlusion or intermittent claudication

22

Epigastric artery is

terminal branch of internal mammary artery

23

epigastic arteries and perforators

take blood to rectus abdominis muscle

24

TRAM flap

rectus abdominis muscle, sub q fat, arteries, perforators, overlying skin

25

reason for mapping epigastric artery

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

26

Internal mammary artery (internal thoracic artery) arises

off arch of subclavian artery
descending posterior side of upper 6 ribs
1cm from sternum

27

reason for mapping internal mammary artery

free flaps for breast reconstruction
graft left anterior descending coronary artery

28

radial artery mapping is used to

determine suitability for use as graft for coronary artery bypass

29

radial artery mapping technique

assess patency of palmar arch (allen test)
pt does not make a fist, use PPG with radial compression instead
PPG pulsations should continue with rad art compression, if they do not do not proceed because removal of artery will compromise hand
measure diameter of rad artery

30

Vein mapping is used to determine

use for coronary bypass
use for dialysis access/graft

31

vein mapping technique lower extremity

GSV used (sometimes lesser saf) mapped prx to distal
measurements obtained along extemity
high mid distal thigh
knee
behind knee
prx mid dist calf and ankle

32

upper extremity vein mapping

cephalic or basillic are used
measurements prx bicep, above elbow, elbow, forearm prx mid dist and wrist

33

vein mapping general techniques

tourniquet used to expand vessel
compressibility assessed
outer to outer edge diameter measurement along extremity
vein length cm obtained

34

vein dimension for vein mapping

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

35

thoracic outlet syndrome is

neurovascular bundle compression by should structures
occurs in certain arm positions

36

most common compression of thoracic outlet syndrome

compression of brachial plexus (97%)
small percentage due to subclavian artery or vein

37

symptoms of thoracic outlet syndrome

numbness/tingling of arm
pain/aching of shoulder or forearm
upward position increase pain/symptoms
25-30% of people are asymptomatic

38

ruling out thoracic outlet syndrome

PPG and doppler
arm resting and placed in various positions

39

thoracic outlet test normal and abnormal results

normal: resting waveforms maintained
abnormal: flattening of waveforms in one or more positions