Lower extremity Flashcards
(99 cards)
1
Q
Highest bypass risk on duplex
A
PSV>300 or VR >3.5 or EDV >100
graft flow <45cm/sec
ABI reduction >0.15
2
Q
high bypass risk on duplex
A
PSV >300 or Vr >3.5
graft flow >45 cm/sec
ABI reduction <0.15
3
Q
Intermediate bypass risk on duplex
A
PSV 180-300 or Vr>2
graft flow >45 cm/sec
ABI reduction <0.15
4
Q
low bypass risk on duplex
A
PSV <180
graft flow >45 cm/sec
ABI <0.15
5
Q
definition of VR
A
PSV within lesion / PSV in proximal normal graft
6
Q
acute lim ischemia class I
A
viable limb
no sensory or motor deficit
audible arterial and venous signal
7
Q
acute limb ischemia class IIa
A
marginally threatened minimal sensory loss no motor loss inaudible arterial signal audible venous signal
8
Q
acute limb ischemia class IIb
A
immediatelly threatened sensory loss more than toes + rest pain mild to moderate motor loss inaudible arterial signl audible venous signal
9
Q
acute limb ischemia class III
A
irreversible
profound sensory loss
paralysis and rigor
inaudible arterial and venous signal
10
Q
anterior lower leg compartment
A
tibialis anterior extensors peroneus tertium anterior tibial artery deep peroneal nerve
11
Q
lateral lower leg compartment
A
peroneus longus and brevis
superficial peroneal nerve
12
Q
superficial posterior lower leg compartment
A
gastrocnemius
soleus
plantaris
tibial nerve
13
Q
deep posterior lower leg compartment
A
tibialis posterior
flexor popliteus muscle
14
Q
anterior compartment of thigh
A
sartorius
quadriceps (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius)
femoral nerve
15
Q
posterior compartment of thigh
A
biceps
semimembranosus
semitendinosus
sciatic nerve
16
Q
medial compartment of thigh
A
pectineus gracilis obturator externus adductor obturator nerve
17
Q
L3 function
A
hip flexion
18
Q
L4 function
A
knee extention
19
Q
L5 function
A
foot dorsiflexion
2nd web space sensation
(injury causes foot drop)
20
Q
S1 function
A
plantar flexion
Achilles reflex
lateral foot sensation
21
Q
C5 function
A
deltoid and biceps
22
Q
C6 function
A
biceps, weak wrist extention
23
Q
C7 function
A
triceps
24
Q
C8 function
A
intrinsic muscle of the hand
wrist flexion
25
arterial lysis Rochester trial
57 patients in urikinase and 57 patients in OR group
| @ 1 year amp free: 75% vs 52%
26
arterial lysis STILE trial
393 patients -> surgery vs lysis with tPA and urokinase
If symptoms longer than 14 days --> amputation lower in OR (3vs 12%)
if symptoms shorter than 14 days --> amputation lower in lysis (11 vs 30%)
27
arterial lysis TOPAZ trial
better clinical outcomes in lysis group
28
what is 5 year patency of aorto - bifemoral bypass?
90%
29
what is 5 year patency of femorl - femoral bypass?
70%
30
what is 5 year patency of fem - BK pop bypass with vein?
70%
31
what is 5 year patency of iliac angioplasty?
70%
32
what is 5 year patency of axillary - bifemoral bypass?
70%
33
what is 5 year patency of ax-unifemoral bypass?
50-55%
34
what is 5 year patency of SFA patency for stenosis?
50-55%
35
what is 5 year patency of SFA angioplasty for occlusion?
40%
36
what is 5 year patency of fem - distal bypass?
40%
37
what is 5 year patency of of fem - BK pop with PTFE?
30%
38
what is a TASC A (Aorto - iliac)?
unilateral or bilateral stenosis of CIA
| unilateral or bilateral single <= 3cm EIA stenosis
39
what is a TASC B (Aorto - iliac)?
<= 3cm stenosis of infrarenal aorta
unilateral CIA occlusion
stenosis 3-10cm involving EIA but not CFA
unilateral EIA occlusion (not CFA)
40
what is a TASC C (Aorto - iliac)?
bilateral CIA occlusion
bilateral EIA stenosis 3-10cm extending to CFA
unilateral EIA occlusion including IIA or CFA
heavily calcified unilateral EIA occlusion involving IIA or CFA
41
what is a TASC D (Aorto - iliac)?
infrarenal aortic occlusion
diffuse disease of aorta and both iliacs
diffuse multiple stenosis of CIA, EIA, CFA
unilateral occlusion of CIA + EIA
bilateral EIA occlusion
iliac stenosis + AAA not amenable for endovascular repair
42
Plantar arch
PT bifurcation : medial and lateral plantar arteries + DP --> plantar metatarsal artery
43
toe - brachial index claudication
0.2-0.5
44
toe - brachial index rest pain
<0.2
45
toe - brachial index normal
>=0.8
46
most common risk factor for popliteal artery aneurysm
HTN
47
popliteal aneurysm growth rate
1.5mm/year for PAA <20mm
3mm/year for PAA 20-30mm
3.7mm/year for PAA >30mm
48
incidence of popliteal aneurysms
7.4/100000 for men
| 1/100000 for women
49
other aneurysms association with popliteal aneurysms
50% will have bilateral popliteal aneurysms
30-50% with popliteal aneurys will have AAA
10% of AAA will have popliteal aneurysms
50
criteria for endovascular treatment of popliteal aneurysms
1. 2 cm landing zones
2. no large discrepancy in size between zones
3. lack of turtuosity
51
exclusion for endovascular repair of popliteal aneurysm
1. people who frequently bent their knees >90*
| 2. inability to use antiplatelets
52
sizing of stent for popliteal aneurysms
oversize 10-15% more than internal diameter of popliteal vessel below and above the aneurysm
53
major SFA and popliteal branches
1. supreme geniculate artery
2. Medial and lateral superior geniculate branches
3. sural artery
4. medial and lateral inferior geniculate branches
5. division: At and TP trunk
54
profunda femoris branches
1. medial circumflex
2. lateral circumflex
3. descending branches
4. perforating branches
55
PT branches
1. circumflex fibular artery
| 2. common plantar artery: medial and lateral plantarartery
56
AT branches
1. recurrent tibial artery
2. anterior lateral and medial malleolar (tarsal) artery
3. dorsalis pedis: 1st dorsal metatarsal, arquate artery, depp palmar artery
57
How many claudicants will deteriorate significantly
2-3% per year
58
what is infrainguinal TASC A?
1. signle SFA stenosis <=10cm in length
| 2. single SFA occlusion <= 5cm in length
59
what is infrainguinal TASC B?
1. multiple lesions each <= 5cm
2. single stenosis or occlusion <=15 not involving the infrageniculate popliteal artery
3. single or multiple lesions in the absence of continuous tibial vessel to improve inflow for a distal bypass
4. heavily calcified occlusion <=5cm in length
5. single popliteal stenosis
60
what is infrainguinal TASC C?
1. multiple stenosis or occlusions totaling >15 cm with or without heavy calcifications
2. recurrent stenosis or occlusions that need treatment after 2 endovascular procedures
61
what is infrainguinal TASC D?
1. chronic total occlusion of popliteal artery and proximal trifurcation vessels
2. chronic total occlusion of CFA and SFA (>20 cm involving popliteal artery)
62
What does BASIL trial say
450 patients randomized into bypass or PTA in severe limb ischemia.
Amputation free survival the same after 6 months.
After 2 years AFS and overall survival was better in surgical group
63
Obturator bypass
tunnel anteromedially - vessels are posterolateral then tunnel in potential space between adductor longus and brevis anteriorly and adductor magnus posteriorly
64
normal CFA size
0.8-1cm
65
Division of internal iliac artery
anterior and posterior
66
Anterior division of IIA branches
1. umbilical (only in fetus)
2. superior vesical artery (branch of umbilical)
3. obturator artery (in 25% will branch of inferior epigastric artery)
4. vaginal artery
5. inferior vesical / vaginal artery
6. uterine artery
7. middle rectal artery
8. internal pudendal artery
9. inferior gluteal artery
67
posterior division of IIA braches
1. iliolumbar
2. lateral sacral superior and inferior
3. superior gluteal
68
how many intermittent claudicants will deteriorate?
2-3% per year
69
How many popliteal aneurysms are bilateral?
40-50%
70
How many people with popliteal aneurysms have AAA?
50-60%
71
I how many AAA have a peripheral aneurysm?
10%
72
Femoral artery aneurysm classification (Cutler and Darling) type 1
Involve only the CFA and end proximal to the femoral bifurcation
73
Femoral artery aneurysm classification (Cutler and Darling) type 2
Aneurysms extend into the origin of the deep femoral artery
74
Indications for intervention with popliteal artery aneurysm
```
Size 2-2.5 cm
Presence of mural thrombus
Evidence of distal embolization
Rupture
Acute thrombosis
Chronic thrombosis with critical limb ischemia
```
75
How do you reconstruct type 2femoral aneurysms
Interposition graft between CFA to either SFA or profound a, with rimplantation of the other branch on top of the graft
76
Treatment of acutely thrombosis popliteal aneurysm
If Rutherford 1 and 2a - thrombolysis first to open distal target
77
Graft patency in interposition graft for popliteal aneurysm repair
>90% at 2 years
78
What approach is better for primary patency in popliteal aneurysm repair
Posterior
79
Patency of endovascular repair of popliteal artery aneurysm
83% at 1 year
80
Comparison of endo and open popliteal aneurysm repair
Longe length of stay in open (7vs 3)
Higher 30 day graft occlusion in endo (9% vs 2%)
Higher reintervention rates in endo (9% vs 4%)
No significant difference in survival, limb loss and primary patency
4 year PP: 54-86% in endo and 63-88%in open
81
Most important factor influencing success of endo repair in popliteal artery aneurysms
Number of runoff vessels
82
Best predictor of primary healing of a toe wound
Toe pressure >30 Maggie
83
Critical limb ischemia outcomes
At 1 year:
Alive with two legs 50%
Amputation 25%
CV mortality 25%
84
Outcomes from claudicants
```
5 years:
Mortality 15-30% (out of that 75% from CV causes)
CLI: 1-2%
Worsening claudixstion 10-20%
Stable claudicstion 70-70%
```
85
Characteristics of balloon expendable stent
```
High radial force,
Low flexibility,
Requires sheath delivery
High radiopacity
No oversized recommended
No to treatment of lesions with variable diameter
No resistance to ezxternal compression and bending
High precision of deployment
```
86
Self expending stents characteristics
```
Low radial force
High flexibility
Does not require sheath delivery
Variable radiopacity
Oversized is recommended
Can treat lesions with variable diameter
Lower precision in deployment
```
87
What’s infrapoplieal TASC A
Single stenosis <1cm in the tibial or peroneal vessel
88
What’s infrapoplieal TASC B
1. Multiple focal stenosis of the tibial or peroneal vessel, each less than or equal to 1 cm in length
2. One or two focal stenosis, each less than 1 cm long, at the tibial trifurcation
3. Short tibial or peroneal stenosis in conjunction with femoropopliteal PTA
89
What’s infrapoplieal TASC C
Stenosis 1-4 cm in length
Occlusion 1-2 cm in length of the tibial or peroneal vessels
Extensive stenosis of the tibial trifurcation
90
What’s infrapoplieal TASC D
Tibia or peroneal occlusion slinger than 2 cm
| Diffusely disease tibial or peroneal vessels
91
Infrapopliteal stentinf trials results
DES showed improved primary patency in 2-3 cm lesions comparing to PTA and to BMS
92
Mechanism of action of paclitaxel
Microtubule inhibitor
93
What did ZilverPTX trial show
Improvement in event free survival and improved primary patency in the drug eluding stent cohort when compared to bare metal stent cohort
94
Popliteal entrapment Type 1
Popliteal artery completes its development before migration of the medial head of the gastrocnemius muscle which then pushes the artery medically during migration. Popliteal artery lies medically to normal location
95
Popliteal entrapment Type II
Artery is discplace medically but the gastrocnemius muscle has a variable attachment on the lateral aspect of the medial femoral condyle or intercondyllar area.
The artery forms prematurely and partially arrests the migration of the gastrocnemius muscle, resulting in the artery being positioned medical to abnormally attached muscle
96
Popliteal entrapment Type III
Abnormal muscle slip or band that arises from either media or lateral femora condyle.
Embryologic remnants of the gastrocnemius muscle remain posterior to the popliteal artery or the artery develops within this muscle mass
97
Popliteal entrapment Type IV
Persistence of the axial artery as the nature distal popliteal artery. This remnant remains in the embryologic position deep to the popliteal muscle and fibrous band
98
Popliteal entrapment Type V
Both artery and vein are involved or entrapped via any of the previously described mechanisms
99
Popliteal entrapment Type VI
Functional entrapment
| Compression of artery with stress maneuvers in the absence of an explanatory anatomical abnormality
