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*Surgery > Vascular > Flashcards

Vascular Flashcards

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1
Q

Most common cause of arterial stenosis and occlusion

A

atherosclerosis

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2
Q

biggest risk factor for atherosclerosis

A

smoking

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3
Q

cholesterol profile that increases risk for atherosclerosis

A

elevated LDL

low HDL

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4
Q

Treatment for atherosclerosis

A 
stope smoking
exercise, nutrition
antiplatelet
Beta blockers
statins
anithypertensives
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5
Q

Occlusion or stenosis of the arteries in the lower extremities

A

Peripheral Arterial Dz

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6
Q

PAD above the inguinal ligament

A

aortoilliac dz

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7
Q

PAD below the inguinal ligament

A

femoropopliteal dz

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8
Q

PAD below the popiteal trifurcation

A

tibial occlusive disease

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9
Q

presentations of PAD

A 
Asymptomatic 
Intermittent claudication
Ischemic rest pain
Skin ulceration
Gangrene
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10
Q

Sxs of aortoiliac dz

A

buttock pain

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11
Q

sx of femoropopliteal dz

A

thigh pain

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12
Q

sx of tibial occlusive dz

A

calf claudication

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13
Q

Described as an achiness or heaviness in the extremity with exercise and relieved by rest

A

claudication

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14
Q

syndrome caused by aortoiliac disease. have buttock claudication, absence of femoral pulses and erectile dysfunction

A

leriche syndrome

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15
Q

Burning or boring pain in the distal extremity (toes and feet) while supine and may be relieved by dangling foot off side of bed

A

Ischemic rest pain

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16
Q

Mummification without infection

A

dry gangrene

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17
Q

infection w/ cellulitis and purulent discharge

A

wet gangrene

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18
Q

what are the 5 Ps associated w/ PAD

A

pain, pallor, paresthesias, poikilothermia, and pulselessness (6 Ps – add paralysis)

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19
Q

what is a normal ABI?

A

> 0.9

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20
Q

how to calculate ABI

A

BP at brachial and ankles

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21
Q

when is there claudciation w/ ABI

A

<0.8

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22
Q

where is there rest pain or tissue loss with ABI

A

<0.4

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23
Q

what can an ABI>1 indicate

A

calcification

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24
Q

for claudicaton you may have to repeat ABIs after what?

A

walking on the treadmill

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25
normal flow in the artery
triphasic | w/ disease- biphasic then monophasic
26
tx for claudication
cessation of smoking graded exercise (condition muscles) walk until pain starts and continue until moderate antiplatelets
27
how do you describe the claudication
onset of pain to a particular walking distance
28
who requires operative management with PAD
moderate to severe claudication that interferes w/ normal activity rest pain tissue loss
29
most minimally invasive tx for PAD
angioplasty w/wo stenting
30
procedure where you take a plaque out of an artery
endarterectomy
31
Characterized by sudden onset of pain | More commonly associated with acute thrombosis in a chronically stenosed vessel in a patient with chronic ischemia
acute arterial occlusion
32
tx for acute arterial occlusion
immediate thrombectomy or embolectomy is limb threatening ischemia
33
PE findings w/ acute arterial occlusion
6 Ps (6th ones is paresthesia)
34
if no limb threatening ischemica present how do you tx a acute areterial occlusions
thrombolytic therapy
35
when can reperfusion injury occur w/ acute arterial occlusions
is leg ischemia is >6 hours
36
what occurs w/ reperfusion injury
limb swelling due to increased cpaillary | leakage from dmaged cells can cause acidosis, hyperkalemia, myoglobinemia leading to ATN
37
carotid artery stenosis presentation
asymptomatic TIA CVA amaurosis fugax
38
caused by hollandhorse plaque, will have blindness like a curtain closing over eye
amaurosis fugax
39
does carotid artery stenosis mean there is a bruit
No, but they can | there can be a bruit w/o stenosis
40
diagnosis for carotid artery stenosis
carotid US and MRA
41
Tx for mild and moderate carotid artery sternosis
antiplatelet or anticoagulation | routine surveillance and tx of risk factor
42
tx for severe or symptomatic dz w/ carotid artery stenosis
carotid endarectomy (CEA) or stenting
43
C/I to CEA
Patients with a severe neurologic deficit following a cerebral infarction Patients with an occluded carotid artery Concurrent medical illness that would significantly limit the patient's life expectancy
44
Seen mostly in younger (<40) smokers who smoke more than 25 to 30 cigarettes a day A progressive inflammatory disease of small vessels caused by smoking causing obliteration of the vessels
Buerger's Dz | Thromboangiitis Obliterans
45
what is Buerger's dz often associated w/
Raynaud's phenomenon | superficial thrombophlebitis of the hands and feet
46
only tx for Buerger's Dz
stop smoking
47
Characterized by hypertension that is difficult to control, of acute onset or sudden progression despite having been stable
Renal Artery Stenosis
48
cause of renal artery stenosis
Caused by stenosis of one or both renal arteries most commonly by atherosclerosis (older patients) and less commonly by fibromuscular dysplasia (young women)
49
Diagnosis of renal artery stenosis
renal artery US
50
Tx of renal artery stenosis
angioplasty w/ stenting of the affected vessel or endarterectomy
51
Focal dilation > 1.5 times it’s regular size
aneurysms
52
what are most true aneurysms associated w/?
atherosclerosis
53
what are false aneurysms associated w/?
injury or infection
54
what type of aneurysms rupture?
AAA and iliac
55
what type or aneurysms rarely rupture but thrombus can dislodge and embolize arteries of the calf and foot
popliteal and femoral
56
if elective surgery for an aneurysms is planned what do you need before
CTA or arteriogram
57
most non-ruptures AAAs are what?
asymptomatic
58
AAA rupture causes what
acute back pain HPOTN hemodynamic collapse
59
classic triad of a AAA
back pain HPOTN pulsatile abdominal mass
60
tx for non-ruptured AAA
>5 cm to 5.5 cm in men and >4.5 cm in women (transverse diameter) OR rapidly enlarging OR symptomatic
61
Tx for ruptured AAA
NO CT scan | call vascular surgeon- need immediate surgery
62
traditional repair for AAA
Abdominal incision Aorta clamped Prosthetic graft sewn in place
63
endovascular repair w/ AAA
Placing prosthetic grafts with wire supports through femoral or iliac arteries
64
immediate risks of AAA reapir
MI, renal failure, colonic ischemia, distal emboli, hemorrhage
65
long term risks of AAA repair
– graft infection, aortic-enteric fistula, graft thrombosis, pseudoaneurysm
66
endovascular risk w/ AAA remair
endoleak
67
Usually with AAA Most asymptomatic May be felt on PE but most found incidentally Risk is rupture
iliac aneurysm (true)
68
when do you repair an iliac aneurysm
>4 cm
69
Usually asymptomatic Don’t rupture Thrombose and embolize (blue toe syndrome) Acute ischemia
popliteal aneurysms (true)
70
when is repair w/ a popliteal aneursyms done?
at 2 cm of any size if lined w/ thrombus or emboli
71
Uncommon | Most are psuedo-aneurysms (False) – after arteriogram
femoral aneursyms
72
Tx for a true femoral aneurysm
>2 cm or throwing emboli
73
risk factors for DVTs
``` older age obesity cancer surgery trauma immobilization HRT< OCP preggo neurologic dz varicose veins chemo history/ FH of DVT ```
74
genetic hypercoagulable states
Deficiencies of antithrombin III, protein C or S Factor V Leiden Elevated homocysteine levels Elevated factor VIII
75
present w/ Dull ache in calf or leg with mild edema to severe pain and massive swelling
DVT
76
massive swelling, cyanosis, may have low grade fever and tachycardia
proximal DVT
77
severe form of DVT with leg pulseless, pale and cool
Phlegmasia alba dolens
78
DVT w/ cyanosis and gangrene
Phlegmasia cerulea dolens
79
Do if positive D-dimer and in all patients with a moderate-to-high risk of DVT
Duplex US
80
what is the prediction criterion for DVT
Wells Clinical Prediction Rule
81
if DVT was unprovoked or recurrent what should you do
Evaluate for hypercoagulability
82
pharm tx for DVT prophylaxis
SQ heparin, LMWH or warfarin
83
Tx for DVT
LMWH (at home) IV heparin (hospital) transition to warfarin
84
if high suspicion of a DVT when should you treat ?
initiate tx before results of diagnostics
85
if you have an intermediate suspicion of a DVT when should you start tx
treat before results if not available for >4 hours
86
what type DVT have low risk of PE
calf DVTs
87
Obstructions of large pulmonary arteries results in increase PA pressure and acute right ventricular failure
Pulmonary Embolism
88
presentation of PE (triad)
Dyspnea pleuritic chest pain hemoptysis
89
standard for dx of PE
pulmonary angiography | but CTA initial imaging of choice
90
TX for PE
anticoagultion to prevent further emboli thrombolytic therapy- if stable but compromised IVC filter embelectomy- really high mortality
91
See in patients with VV, pregnancy or postpartum, or from trauma, like an IV Erythema, induration and tenderness along a superficial vein Palpable cord
Superficial thrombophlebitis
92
tx for superficial thrombophlebitis
``` NSAIDs heat elevation compression and walking excision if persistence or spread of process ```
93
if superficial thrombophlebitis is in the greater saphenous and progressing to the SFJ what needs to be done?
full anticoagulation
94
tx for septic thrombophlebitis
broad spectrum abx and excision
95
The superficial, perforating and deep veins connect Blood flows from superficial to deep Dilated, tortuous superficial veins in the LE
varicose veins
96
Symptoms of varicose veins
Sxs-heaviness and fatigue with standing, swelling, night cramps, itching, venous stasis ulcers, superficial thrombophlebitis and bleeding
97
what is primary varicose veins
incompetent valves at the SFJ
98
tx for varicose veins
elastic stockings periodic elevation regular exercise
99
indications for surgery for varicose veins
Persistent or disabling pain despite non-operative measures Recurrent superficial thrombophlebitis Erosion of overlying skin with bleeding Ulceration
100
surgery tx for varicose veins
stripping- remove saphenous veins saphenous ligation- high recurrence endovenous laser tx or RF ablation branch vein excision
101
what causes chronic venous insufficiency
venous HTN
102
presentation of CVI
swollen legs hyperpigmentation at the ankles venous stasis ulceration- medial/ lateral malleoli
103
Tx of CVI
compression and wound care leg elevation and exercise surgery in rare cases
104
diagnosis of CVI
US
105
painless edema of mostly LE- including feet and toes
lymphedema
106
diagnostics for lymphedema
venous duplex (r/o venous insufficiency) or DVT
107
tx for lymphedema
compression massage sequential pneumatic compression devices good skin care w/ lotion
108
Vasospastic disorder of the hands and feet most commonly seen in young women Classic history is cold stimulus followed by tricolor changes of the digits White(pallor)  blue(cyanosis)  red(hyperemia)
Raynaud Syndrome
109
Due to spasm Common and benign Characterized by hyperresponsiveness of normal vasospasm to cold or emotional stimuli
Raynaud Disease (primary)
110
Older women Associated with connective tissue disorders Scleroderma, SLE Generally more severe with occasional tissue loss or gangrene ↑ sed rate and ANA
Raynaud phenomenon (secondary)
111
Tx of Raynaud syndrome
avoid triggers no smoking, OCP or meds that decrease CO or cause vasospasm CCB or angiotensin receptor blockers

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