Vascular Flashcards by Joshua Rosen

What is the most common site of stenosis in the carotids?

At the bifurcation

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What is the flow pattern in the external vs internal carotid?

Internal -> continuous flow

External -> triphasic flow

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What two arteries allow for communication of the ECA and ICA?

Ophthalmic and internal maxillary artery

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What is the tx for a carotid traumatic injury with fixed deficit?

Occluded -> do not repair due to bleeding risk

Not Occluded -> Repair

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What are indications for CEA?

Symptomatic > 70%, asymptomatic > 80% stenosis

If recent stroke wait 4-6 weeks

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What side should be repaired first in bilateral carotid disease?

Tightest side first, if equal then repair dominant side first

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What is the most common complications from CEA?

Vagus injury > hypoglossal > glossopharyngeal

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What is the treatment for pseudoaneurysm after CEA?

Drape and prep prior to intubation, then intubate and repair

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What causes hypertension post-CEA?

Damage to carotid body

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What are indications for repair of ascending aortic aneurysms?

Acutely symptomatic
> 5.5 cm (5.0 with Marfan’s)
>0.5 cm/yr size increase

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What are indications for repair of thoracic descending aortic aneurysms?

> 5.5 cm for endovascular

>6.5 cm for open repair

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What are indications for operative management of thoracic descending dissections?

Ischemia or contained rupture

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What is the most likely site of rupture for a AAA?

Left posterolateral wall, 2-4 cm below renal arteries

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What are significant risk factors for rupture?

Diastolic HTN

COPD

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What are indications for AAA repair?

Symptomatic
> 5.5 cm
Growth > 0.5 cm/yr

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What are indications for IMA re-implantation?

Backpressure < 40 mmHg (poor back-bleeding)
Previous colonic surgery
Stenosis at SMA
Inadequate flow to left colon

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Why should you ensure flow to at least one internal iliac when performing aorto-bifemoral repair?

To avoid vasculogenic impotence

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What is the most common vein injury with aortic crossclamp in AAA repair?

Retro-aortic left renal vein

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What are causes of death after AAA repair?

Acute -> MI

Late -> Renal Failure

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What are risk factors for mortality in AAA repair?

Cr > 1.8, CHF, ischemia on EKG, COPD, increased age, female sex

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What are the types of endoleaks?

I: Graft attachment sites (Tx extension cuffs)
II: Collaterals (Observe or embolize)
III: Overlap sites (secondary endograft)
IV: Wall porosity or suture holes (observe)
V: Expansion of aneurysm without evidence of leak (re-do EVAR or open repair)

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Where are adhesions found in inflammatory aneurysms?

3rd/4th portions of duodenum
Ureteral entrapment (25%)

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What is the most common causes of mycotic aneurysms?

Salmonella > Staphylococcus

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What are sx/signs of mycotic aneurysm?

Pain, fevers

Periaortic fluid, gas, RP soft tissue edema, LAD

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What is the tx for mycotic aneurysm?

Extra-anatomic bypass and resection of aorta to clear infection

What is the most common cause of aortic graft infection?

Staph > E. Coli | Blood cultures often negative

What is the treatment of infected aortic graft?

Bypass through non-contaminated field and resection of graft

What are the signs of an aortoenteric fistula?

Herald bleed with hematemesis Then blood per rectum Usually erode into the duodenum

Where do claudication symptoms occur relative to the lesion?

Symptoms occur one level below lesion

What is Leriche syndrome?

Occlusion at the aortic bifurcation: - No femoral pulses - Buttock or thigh claudication - Impotence

What is the most common location for lower extremity PAD?

Hunter's Canal (distal SFA exit)

What are the ABIs for symptoms?

< 0.9 - Claudication < 0.5 - Rest Pain < 0.4 - Ulcers < 0.3 - Gangrene

Where should synthetic grafts not be used?

Below the knee

What must you check for when doing an aorto-bifemoral repair?

Flow to at least 1 internal iliac artery (want good back bleeding from at least one artery, or else need to bypass to internal iliac as well)

Why are distal lesions more limb threatening?

Lack of collaterals

What is the 5-year patency for LE bypasses?

Fem-pop: 75% | Femoral-Distal: 50%

What is a complication of femoral-femoral crossover graft?

Vascular steal in the donor leg

What are the #1 causes of saphenous vein graft failures?

Early - Technical problem | Late - Atherosclerosis

What is a Mal Perforans ulcer?

Ulcer at metatarsal heads (2nd MTP most common)

When is re-perfusion/compratment syndrome more likely to occur?

With ischemia times > 4-6 hours

What is the most common site in the leg for compartment syndrome?

Anterior compartment (results in foot drop)

What are the symptoms of popliteal entrapment syndrome?

Loss of pulses with plantar flexion. | Cause is medial aviation of artery around medial head of gastroc

What is adventitial cystic disease?

Men in 40s. Bilateral ganglia originate from joint capsule causing compression in popliteal fossa (most common). Symptoms change with knee flexion/extension

What is the most common site of peripheral obstruction from emboli?

Common femoral artery

What is atheroma embolism?

Cholesterol clefts that lodge in small arteries. Renals most common site

What is the most common source of Blue Toe Syndrome?

Aortoiliac disease that keeps embolizing

What is the treatment of acute arterial thrombosis?

Threatened limb -> heparin and OR | Non-threatened -> angiography and thrombolytics

What is the most common site of renal atherosclerosis?

Proximal left artery

What are indications for nephrectomy with renal HTN?

Atrophic kidney < 6 cm with persistently elevated renin levels

What is the most common site of upper extremity occlusive disease?

Subclavian artery

What is the most common symptom of TOS?

Neurologic involvement with ulnar nerve involvement (triceps weakness and intrinsic hand muscles)

What is the common cause of subclavian artery TOS?

Anterior scalene hypertrophy (weight lifters) causing hand pain from ischemia

What is Adson's test?

Absent radial pulse with head turn to ipsilateral side

Why can you have motor function in digits after prolonged hand ischemia?

Motor groups for digits are in proximal forearm

What history elements might distinguish SMA embolism from thrombosis?

Thrombosis has more chronic history of food fear, weight loss

What are the symptoms of mesenteric venous thrombosis?

Bloody diarrhea, cramps pain | Hx of: vasculitis, hyper coagulable, portal HTN

What are Griffith's and Sudan's areas?

Watershed areas in colon, splenic flexure and upper rectum respectively

What is median arcuate ligament syndrome?

Celiac artery compression causing bruit near epigastrum

What is the arc of Riolan?

important collateral between SMA and IMA

What are the common complications of aneurysms above and below the inguinal ligament?

Above -> Rupture | Below -> Thrombosis

When should splanchnic artery aneurysms be repaired?

> 2 cm EXCEPT splenic

When should splenic artery aneurysms be repaired?

Symptomatic Pregnant Childbearing Age >3-4 cm

What is the treatment for splanchnic artery aneurysms?

``` Covered Stent (bypass if fails) Splenic -> Ligate aneurysm ```

When should renal artery aneurysms be treated?

> 1.5 cm -> covered stent

When should iliac and femoral artery aneurysms be treated?

Iliac > 3 cm | Femoral > 2.5 cm

What are surgical indications for a popliteal aneurysm?

> 2 cm Mycotic Symptomatic

What is the treatment of choice for popliteal aneurysms?

Exclusion and bypass NOT covered stent

What is implied by a pseudyaneurysm at a suture line months to years after surgery?

Graft infection

What is the classic imaging finding of Breuger's disease?

Corkscrew collaterals

What are the timelines of radiation arteritis?

Early -> Sloughing/thrombosis Late (1-10 years) -> scar, fibrosis, stenosis Very late (3-30 years) -> atherosclerosis

What is the most common cause of dialysis graft failure?

Venous obstruction due to intimal hyperplasia

What is Phlegmasia Alba Dolens?

Tenderness + Pallor + edema | Tx: Heparin

What is Phlegmasia Cerulia Dolens?

Tenderness + cyanosis + massive edema | Tx: Heparin (rarely surgery)

What is the source of a PE with an IVC filter in place?

Ovarian veins, IVC superior to filter, SVC/upper extremities

What is the most common organism causing cellulitis and lymphangitis?

Strep

What is Stewart-Treves syndrome?

Lymphangiosarcoma from chronic lymphedema 2/2 breast axillary dissection

Vascular Flashcards

(76 cards)