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Fiser's ABSITE Ryan > Chapter 27 - Vascular III > Flashcards

Chapter 27 - Vascular III Flashcards

1
Q

What is Paget-von-Schrotter disease?

A

effort induced thrombosis of subclabian vein
Venography gold standard for evaluation
men, pain swelling with activity
80% have thoracic outlet problem
thrombolytics, heparin, warfarin. Repair.

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2
Q

What is mortality from mesenteric ischemia?

A

50-70%

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3
Q

What are fintings of mesenteric ischemia on CT?

A

bowel thickening, intrabural gas, portal venous gas, vascular occlusion

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4
Q

Wat are causes of visceral ischemia?

A

Acute embolic occlusion 50%
Thrombotic occlusion 25%
low-flow state 15%
Venous thrombosis 5%

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5
Q

Superior mesenteric embolism occurs in what area of SMA?

A 
origin of SMA
pain out of proportion
sudden onset
hematochezia
peritoneal signs late finding
Tx: volume resusc. antibiotics, embolectomy, resect infarcted bowe, heparin
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6
Q

What are signs of mesenteric artery thrombosis?

A

food fear
wt loss
Thrombectomy, SMA bypass, resect infarcted bowe

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7
Q

What are signs of mesenteric vein thrombosis?

A

short segments of intestine involved
bloody diarrhea, crampy abdominal pain
Heparin, thrombolytics, can try mesenteric vein thrombectomy if dx early, resect bowel

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8
Q

Non-occlusive mesenteric ischemia happens when?

A 
Spasm
low flow states
hypovolemia
hemoconcentration
Digoxin
Water shed areas most common
Tx volume resuscitation, glucagon, papaverine, nitrates, increase CO, resect bowel
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9
Q

What is Median arcuate ligament syndrome?

A 
celiac compression
bruit near epigastrium
chronic pain
weight loss
diarrhea
Tx: transect median arcuate ligament, may need arterial reconstruction
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10
Q

Chronic mesenteric angina?

A

food fear
30 minutes after meals
may need PTA, bypass, endarterectomy

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11
Q

What is the collateral between SMA and celiac?

A

arc of riolan

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12
Q

What is the most common complication of aneurysms above inguinal ligament?

A

Rupture

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13
Q

What is the most common complication of aneurysms below inguinal ligament?

A

thrombosis and emboli

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14
Q

What do you do with splanchnic aneurysms?

A

repair, 50% rupture rate

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15
Q

What do you do with splenic artery aneurysms?

A

most common visceral aneurysm.
more common in women
Repair if symptomatic, pregnant, women of childbearing age

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16
Q

What dilatation of visceral arteries is considered aneurysmal?

A

> 2cm

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17
Q

What can you do with splenic and common hepatic aneurysms?

A

can exclude- have good collaterals

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18
Q

What are the surgical indications for iliac a aneurysms?

A

symptomatic- thrombosis, emboli, compression, >3.0cm, mycotic
bypass with exclusion

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19
Q

What are surgical indications for femoral a aneurysm?

A

symptomatic, >2.5cm

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20
Q

What are the surgical indications for popliteal aneurysms?

A

exclusion and bypass of >2cm, mycotic, symptomatic
1/2 bilateral, 1/2 have another aneurysm elsewhere
thrombosis and emboli with limb ischemia most common with these

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21
Q

What do you do with a femoral pseudoaneurysm?

A

if acter percutaneous intervention need US guided compression with thrombin injection. May need surgical repair if this fails
-collection of blood in continuity with the arterial system but unenclosed by all 3 layers of the wall

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22
Q

What are the surgical indications for renal A aneurysms?

A

symptomatic, expansion, >1.5 com, women who want to get knocked up.
reconstruction with vein patch; nephrectomy with rupture

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23
Q

Fibromuscular dysplasia?

A

young women, HTN if involves renals
renal most commonly involved vessel (right), carotid next, iliac next
string of (anal) beads
medial fibrodysplasia most common variant
PTA or bypass

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24
Q

What is Buerger’s disease?

A

you men, smokers, corkscrew collateral on angiogram and severe distal disease
severe rest pain
gangrene of digits
normal arterial tree proximal to popliteal and brachial
stop smoking or amputate

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25
Q

What diseases cause cystic medial necrosis?

A

marfan’s- type I collagen
Ehlers-danlos - tendency for arterial rupture
Can’t do angiogram- risk of laceration of vessel

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26
Q

What is temporal arteritis?

A

giant cell arteritis- granulomatous disease
inflammation of large vessels
long segments of smooth stenosis alternating with segments of larger diameter
fever, arthralgia, myalgia, anorexia
Steroids, bypass, no endarterectomy

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27
Q

What is takayasu’s?

A

same path, syx, and treatment of temporal artheritis

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28
Q

What is polyarteritis Nodos?

A

Get aneurysms that thrombose or rupture
renals most common
steroids

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29
Q

What is Kawasaki’s disease?

A

affects douchebags in affliction T’s on lime green motorcycles
children- get dilated coronaries and brachiocephalic vessels
die from arrhythmias
steroids, possible CABG

30
Q

What is hypersensitivity angiitis?

A

secondary to drug/tumor antigens
rash, fever, end-organ dysfunction
Ca+ channel blockers, pentoxifylline

31
Q

What happens with radiation arteritis?

A

sloughing and thrmobosis early
fibrosis, scar, stenosis 1-10 years
Advanced atherosclerosis 3-30 years

32
Q

Raynaud’s disease?

A

young women, pallor, cyanosis, rubor

Ca2+ blockers, warmth

33
Q

Where is the great saphenous vein?

A

joins femoral vein near groin- runs medially

34
Q

Where is the lesser saphenous vein?

A

joins popliteal in lower leg- runs lateral at first

35
Q

Can you clamp the IVC?

A

No- will tear

36
Q

Can you ligate left renal vein?

A

yes- gonadal/adrenal vein collaterals

37
Q

What is the most common cause of failure of AV grafts?

A

venous obstruction secondary to intimal hyperplasia

38
Q

What is a Cimino graft?

A

radial artery to cephalic vein- wait 6 weeks

39
Q

How long before an interposition graft can be used?

A

6 weeks to allow fibrous scar to form

40
Q

How do you get an acquired AV fistula

A

Trauma
can get peripheral insufficiency, CHF, aneurysm, limb length problems
-repair with lateral venous suture, may need bypass of arterial side

41
Q

Varicose veins

A

smoking, obesity, low activity

tx with stockings, elevation, exercise, sclerotherapy

42
Q

Venous ulcers

A

secondary to venous valve incompitence

-unna boot cures 90%

43
Q

Venous insufficiency symptoms?

A

aching, swelling, night cramps, brawny edema
ulceration above and posterior to malleoli
edema secondary to incompetent perforators

44
Q

How do you perform a trendelenburg test?

A

elevate leg, occlude greater saphenofemoral vein junction, lower leg, rapid filling of greater saphenous vein suggests incompetent perforators
2 if first part did not fill, release pressure on saphenofemoral jxn- rapid filling suggests incompetent valves in greater saphenous

45
Q

What is superficial thrombophlebitis?

A

nonbacterial inflammation

NSAIDS, warm packs, ambulation

46
Q

What is suppurtive thrombophlebitis?

A

fever, increased WBC, erythema, fluctuance- resect vein

47
Q

What is migrating thrombophlebitis a sign of?

A

pancreatic CA

48
Q

what is Mondor’s Disease?

A

self limiting thrombophlebitis of the breast

49
Q

How do SCD’s work?

A

help prevent blood clots by decreasing venous stasis, increasing AT-III, tPA, increased fibrinolysis

50
Q

Where is DVT most common?

A

calf

51
Q

what is Virchow’s triad?

A

stasis, hypercoagulability, vessel wall injury

52
Q

what do you get with calf DVT?

A

minimal swelling

53
Q

What do you get with femoral DVT?

A

ankle and calf swelling

54
Q

what do you get with iliofemoral DVT?

A

severe leg swelling

55
Q

What is phlegmasia alba dolens?

A

tenderness, pallor, edema with DVT

56
Q

What is phelgmasia cerulea dolens

A

tenderness, cyanosis, massive edema

57
Q

Treatment for long term DVT?

A

1st- coumadin for 6 months
2nd- coumadin for 1 year
3rd or PE- coumadin for life

58
Q

when do you put in a greenfield filter?

A

contraindication for anticoagulation
PE on coumadin
free floating ileofemoral thrombi
after pulmonary embolectomy

59
Q

what can you get a PE with filter in place?

A

ovarian veins, inferior vena cava, upper extremity

60
Q

what do you do with venous thrombosis with a central line?

A

pull out if not needed, try to tx with heparin or TPA down line

61
Q

what do you see with PE?

A

decreased paO2, decreased PaCO2, increased RR, alkalosis
most arise from above knee
if in shock- OR for pulmonary artery thrombectomy

62
Q

do lymphatics have a basement membrane?

A

no

63
Q

Where are lymphatics not found?

A

bone, muscle, tendon, cartilage, brain, cornea

64
Q

When does lymphedema occur?

A

obstruction, too few in number, nonfunctional
woody edema secondary to fibrous tissue in subcutaneous tissue
cellulitis aand lymphantitis secondary to minor trauma
-strep most common infection

65
Q

What side is congenital lymphedema most common?

A

Left

66
Q

What do you see with lymphangiosarcoma?

A

raised blue/red coloring

early mets to lung

67
Q

What is stewart treves syndrome?

A

lymphangiosarcoma associated with breast axillary dissection

68
Q

what is lymphangiectasia?

A

dilation of preexisting lymphatic channels
dx with lymphangiography
tx with resection

69
Q

When do you get lymphocele?

A

after surgery- usually groun

rule out infectious source first

70
Q

How do you identify lymphatic channels going to a lymphocele?

A

inject isosulfan blue into foot to id channels

resect lymphocele and ligate supplying channel

Fiser's ABSITE Ryan (50 decks)

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