Vascular Flashcards
(15 cards)
Vascular air embolus management
Durant manoeuvre
- left lateral decubitus + head down (AKA right side up / left side down / Trendelenburg)
- 100% oxygen
Diagnostic angiography pre-procedure INR
<=1.5
Diagnostic angiography pre-procedure antibiotics
angioplasty / thrombolysis are considered “clean procedures” and don’t require antibiotics
Diagnostic angiography pre-procedure anticoagulation witholding
Stop ASA (aspirin) / Plavix (clopidogrel) 5 days prior
Diagnostic angiography post procedure compression
15 mins compression post procedure
Diagnostic angiography ACT to pull sheath
ACT of < 150-180
Activated clotting time (ACT) is a lab test used to monitor heparin before, during, and shortly after procedures. A normal ACT indicates that tested blood contains no heparin or that all heparin is inhibited by protamine (reversal agent). < 150, or < 150-180 depending on who you ask.
Fallopian tube recanalisation absolute contraindications
- pregnancy and active pelvic infection
- performed in the follicular phase
- oral doxycycline is typically given as peri-procedural prophylaxis
bullimic patient with gastrointestinal bleed is most likely bleeding from the…
left gastric artery
- 85% of upper GI bleeds are from the left gastric artery
- Mallory-Weiss tears are sometimes (depends on the institution) treated with embolisation of the left gastric if endoscopic therapy fails
Which types of endoleak need acute treatment?
Type 1 endoleak (unapposed proximal or distally)
Type 3 endoleak (fabric tear or gaps between components)
Type 2 endoleaks, retrograde filling from collateral unoccluded vessels, are the most common type representing ~50% of leaks but can often self resolve
FMD treatment
angioplasty alone is usually sufficient
management of bradycardia + hypotension during sheath insertion
- IV fluids
- oxygen
- atropine 0.6-1.0 mg
What needle size will allow a 0.035 guidewire ?
19G
Post vascular access; management?
- direct pressure to pseudoaneurysm neck with transducer
- needle into the apex of the cavity
- 0.5 – 1.0 ml of 500-1000 units thrombin under US
- do NOT aspirate blood into the syringe (clots)
- Contraindications: local infection, distal limb ischemia, large neck, rapid enlargement
Complications of vascular access
- bleeding
- arterial thrombosis
- distal embolization
- arteriovenous fistula
- pseudoaneurysm, risk of embolisation and catastrophic rupture
- persistent pain
- compression neuropathy
ABPI ischemia threshold
[Highest ankle pressure, DP or PT] / [Highest arm pressure, either arm]
- abnormal < 1
- rest pain < 0.5
- ischemia < 0.2
- often non-diagnostic with dense vascular calcifications (ratio > 1)
