Fiser Ch 27: Vascular

Question 1

most common acquired hypcoagulable disorder

Answer 1

smoking

Question 2

1st branch off internal carotid artery?

Answer 2

ophthalmic aa

Question 3

1st brach off external carotid artery?

Answer 3

superior thyroid aa

Question 4

indications for CEA?

Answer 4

1. Asymptomatic with >70% stenosis

2. Symptomatic with >50% stenosis

Question 5

what part of vessel do you remove in CEA?

Answer 5

intima and part of media

Question 6

why do 20% of ppl get hypertensive after CEA?

Answer 6

injury to carotid body, tx w nipride

Question 7

what are the three aortic arch vessels?

Answer 7

1. innominate aa (branches to right subclavian and right common carotid)
2. left common carotid
3. left subclavian

Question 8

whats DeBakey Classification for AAAs?

Answer 8

Type I: ascending and descending
Type II: Ascending only
Type III: Descending only

Question 9

where do dissections normally occur? (layer)

Answer 9

medial layer of blood vessel wall

Question 10

how do you get paraplegia after a thoracic AAA repair? how can you prevent it?

Answer 10

• spinal cord ischemia due to occlusion of intercostal arteries and artery of Adamkiewicz
• reimplant intercostal arteries afte T8

Question 11

most likely location of rupture of abdominal AAA?

Answer 11

left lateral wall 2-4cm below renals

Question 12

when do you reimplant the IMA? indications (4)

Answer 12

1. If backpressure <40mmHg
2. Previous colonic surgery
3. Stenosis at the SMA
4. Flow to colon appears inadquate

Question 13

1 causes of acute and late death after AAA repair?

Answer 13

acute: MI
late: renal failure

Question 14

5 types of endoleaks

Answer 14

Type I: Proximal or distal attachment sits
Type II: Collaterals (observe)
Type III: Overlap sites of multiple grafts (secondary endograft to cover)
Type IV: Graft wall porosity or suture holes (observe)
Type V: expansion of aneurysm without evidence of leak (back to OR)

Question 15

top 2 organisms that cause mycotic aneurysms and tx

Answer 15

1. Staph
2. Salmonella
   extra-anatomic bypass (ax fem) and resection of infected aorta

Question 16

top 2 organisms that cause aortic graft infections

Answer 16

1. staph

2. E. Coli

Question 17

whats leriche syndrome? tx?

Answer 17

• aortoiliac occlusive disease causing:
  1. no femoral pulses
  2. Buttock o thigh claudication
  3. impotence
  tx: aorto-bifem bypass

Question 18

ABI: claudication

Answer 18

0.7-0.9

Question 19

ABI: rest pain

Answer 19

0.5

Question 20

ABI: ulcers

Answer 20

0.4

Question 21

ABI gangrene

Answer 21

<0.3

Question 22

when to use gortex (PTFE) vs saphenous v.

Answer 22

PTFE above the knee

saphenous below the knee bypasses

Question 23

when do you use dacron graft?

Answer 23

aorta or large vessels

Question 24

when do you use PTA?

Answer 24

percutaneous transluminal angioplasty, use:

• common iliac artery stenosis
• short stenoses

Question 25

diagnosis of compartment syndrome

Answer 25

pressures >20-30mmHg

Question 26

diagnosis of popliteal entrapment syndrome? tx?

Answer 26

loss of pulses with plantarflexion | tx: resection of head of gastroc

Question 27

what arteries are used in CABG?

Answer 27

arterial autografts: radial aa IMA

Question 28

most common site of peripheral obstruction from emboli

Answer 28

common femoral artery

Question 29

management of acute arterial embolus

Answer 29

embolectomy

Question 30

most common site of atheroma embolism

Answer 30

renals

Question 31

management of acute arterial thrombus

Answer 31

threatened limb: give heparin and OR thrombectomy | nonthreatened limb: angiography for thrombolytics

Question 32

renal artery stenosis, management if due to atherosclerosis or FMD

Answer 32

athero: PTA w stent | Fibromuscular dysplasia: PTA without stent

Question 33

difference in presentation of renal artery stenosis between atherosclerosis and FMD

Answer 33

athero: left, proximal 1/3, men FMD: right, distal 1/3, women

Question 34

indications for nephrectomy w renal HTN

Answer 34

atrophic kidney <6cm with persistently high renin levels

Question 35

most common site of upper extremity stenosis

Answer 35

subclavian artery

Question 36

describe anatomy of thoracic outlet

Answer 36

subclavian v. and phenic n. lay anterior to anterior scalene, then subclavian a. and brachial plexus lie between ant and middle scalene muscles

Question 37

what is Paget-von Schrotter disease

Answer 37

effort induced thrombosis of subclavian vein, acutely painful, swollen, blue limb

Question 38

whats adsons test?

Answer 38

absent radial pulse with head turned to ipsilateral side of subclavian artery compression 2/2 ant. scalene hypertrophy

Question 39

what is the arc of riolan?

Answer 39

collateral between SMA and IMA

Question 40

most common visceral aneurysm

Answer 40

splenic artery aneurysm

Question 41

when do you repair a splenic artery aneurysm? (3)

Answer 41

1. if symptomatic 2. If pt is pregnant or in childbearing age 3. >3-4cm

Question 42

treatment of splenic artery aneurysm?

Answer 42

covered stent

Question 43

treatment of popliteal artery aneurysm

Answer 43

exclusion and bypass

Question 44

difference in collateral system between right and left renal vein

Answer 44

RIGHT has NO collaterals, thus you can ligate LEFT renal vein

Question 45

migrating thrombophlebitis indicates what pathology?

Answer 45

pancreatic cancer

Question 46

AEIOU of dialysis

Answer 46

``` A: acidosis E: electrolyte imbalances I: intoxication O: overload U: uremia ```

Question 47

which artery has the highest patentcy after angioplasty?

Answer 47

iliac aa (decreases as you mov distally)

Question 48

MC organism causing: early graft infection v late graft infection

Answer 48

early: staph aureus late: staph epidemidis