Vascular Flashcards by Marialaina Tomolonis

What are the common sites for plaque formation in arteries

Branch points (carotid bifurcation) Tethered sites (SFA)

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What are the three layers of artery?

Intima 2. Media 3. Adventitia

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What is a true aneurysm?

Dilation (>2xnL diam) of all three layers of vessel

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1 Aorta

2 Internal iliac (hypogastric)

External iliac
common femoral
Profundi femoral artery
Superficial femoral artery (SFA)
Popliteal
Trifurcation

9 Anterior tibial artery

10 Peroneal artery

Posterior tibial artery
Dorsalis pedis artery

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How can you remember the orientation of the lower exterior arteries below the knee on A-gram?

LAMP

Lateral Anterior tibial

Medial Posterior tibial

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What is the most common site of arterial atherosclerotic occlusion in the lower extremities?

SFA in hunters canal

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What are the sx of PVD?

Intermittent claudication, rest pain, erectile dysfunction, sensorimotor impairment, tissue loss

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What is Intermittent claudication

Pain and cramping (usually in calf) after walking a specific distance, resolves when stop walking for a certain amount of time.

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What is rest pain

pain in LE (usually top of foot) arising at rest, usually when sleeping

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SIGNS of PVD

absent pulses, bruit, muscular atrophy, decreased ahair growth, thick toenails tissue necrosis/ulcers/infusions

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ABI’s associated with normals, claudicators and rest pain

Normal ABI->/= 1.0

Claudicator-<0.6

Rest pain - <0.4

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Why would a pt get a false ABI reading

Completely calcified arteries (esp. pt’s with DM)

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Indications for surgical tx of PVD

STIR

Severed claudication refractory to tx

Tissue necrosis

Infection

Rest pain

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What is risk of limb loss w/ claudication

5% in 5 years

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What is the risk of limb loss w/ rest pain

>50% of these pts will lose a limb at some point

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in pt with PVD what is the main post op concern?

CARDIAC!!! - Most pt’s with PVD have coronary artery dz as well.

MI is most common cause of post op death after a PVD operation

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What are the classic signs/symptoms of acute arterial occlusion?

the 6 p’s

Pain

paresthesias

paralysis

pallor

Poikilothermia

Pulselessness

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What is the immediate preoperative management of acute arterial occlusion

Anticoagulate wit hIV heparin (bolus w/ cont infusion)
A-gram

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What is the most common cause of embolus from the heart?

afib

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What is the most common site of arterial occlusion by an embolus

carotid artery

(SFA mc site of arterial occlusion from atherosclerosis)

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What is the tx for acute arterial occlusion?

surgical embolectomy with cutdown

fogarty balloon

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What is the most common site for AAA

Infrarenal

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What are sx of AAA?

Most commonly asymptomatic

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Signs of ruptured AAA?

1 abd pain

pulsatile mass

3 hypotension

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Laplace's Law

Wall tension = pressure x diameter

What are indications for AAA surgery?

AAA \>5.5cm diameter rupture of AAA Any size AAA with rapid growth symptoms/embolization of plaque

What is the mortality rate for elective rx of AAA

What is the mortality rate for AAA that is ruptured?

~50% operative mortality

What is the leadign cause of post op death in pt undergoing elective AAA tx

What is mean normal aortic diameter

2cm

Why is colonic ischemia a concern with AAA rx?

often the IMA is sacrificed during surgery. if collaterals are not adequate pt will have colonic ischemia

Operative complications of AAA rx?

MI Atheroembolism declamping hypotension acute renal failure uretal injury hemorrhage

sx of colonic ischemia

Heme positive stool Bright red blood per rectum diarrhea abdominal pain

What is the possible long term complication that oftn presents with both upper and lower GI bleeding?

Aortoenteric fistula

What are sx of anterior cord syndrome (complication of AAA repair)

1. Paraplegia 2. Loss of bladder/bowel control 3. Loss of pain/temp sensation below level of involvement 4. SPARING OF PROPRIOCEPTION

How is a graft infection with an aortoenteric fistula tx?

xtra-anatomic bypass (ax-bifem)

Which vein crosses the neck of athe AAA proximally?

L renal vein

What part of the small bowel crosses in front of the AAA

Duodenum

Which artery comes off the middle of the AAA and runs to the left?

Inferior mescenteric artery

Which vein runs behind the R common iliac artery?

L common iliac vein

which renal vein is longer?

sx and sg of carotid vascular dz

Amaurosis fugax TIA Reversible ischemic neurologic deficit CVA

Indications for CEA in Asymptomatic patient?

Carotid Stenosis \>60% (greates tbenefit is probably in pt's with \>80%)

Indications for CEA in SYMPTOMATIC patient

Carotid stenosis \>50%

Post operative complications for CEA

CVA MI hematoma wound infection hemorrhage hypiotension/hypertension thrombosis vagus nerve injury (change in voice) Hypoglossal injury (ipselateral tongue deviation)

Mortality rate of CEA

~1%

Most common cause of death during early postop period for vascular surgery

What thin muscle is cutright under the skin in the neck?

Platysma

What are the branches of the ICA?

NONE

Which vein crosses the carotid bifurcation?

facial vein

What is the first branch of the external carotid

Superior thyroid

What muscle crosses the common carotid proximally

Omohyoid

Which muscle crosses the carotid artery distally?

Posterior belly of the digastric (D=Distal, D=digastric)

Which nerve crosses approximately 1cm distal to the carotid bifurcation

Hypoglossal

Which nerve crosses the interal carotid near the ear

facial nerve

What is in the carotid sheath

1. Carotid artery 2. internal Jugular vein 3. vagus nerve 4. Deep cervical lymph nodes

what should be examined in a pt with politeal artery aneurysm

contralateral side - 50% of pt's with pop artery aneurysm have one on contralateral side rest of arterial tree (especially aorta) - 75% of all patients with popliteal aneurysm have additional aneurysms elsewhere (50% are located in aorta/iliac)

What are indications for elective surgical rx of a pop aneurysm?

1. \>/= 2cm in diameter 2. Intraluminal thrombus 3. artery deformation

Indications for surgical rx of following aneurysm? Thoracic aorta

\>6.5%

Indications for surgical rx of following aneurysm? Abdominal aorta

\>5.5cm

Indications for surgical rx of following aneurysm? Iliac artery?

\>4cm

Indications for surgical rx of following aneurysm? Femoral artery

\>2.5cm

Indications for surgical rx of following aneurysm? Popliteal artery

\>2cm

what are the branches of the ECA

Superior thyroid Ascending pharyngeal Lingual Facial occipital posterior auricular maxillary superficial temporal

What order are the clamps put on in CEA

I C E Internal Common External

What order are the vessels unclamped in CEA?

E C I External Common Internal

What is median arcuate ligament syndrome

mesenteric ischemia from narrowing of the celiac axis vessels by extrinsic compression by the median arcuate ligament

What is the median arcuate ligament comprised of?

Diaphragm hiatus fibers

What are symptoms of median arcuate ligament syndrome?

Postprandial pain, weight loss

What are SIGNS of median arcuate ligament syndrome?

Abd bruit in almost all pateints

Tx: of median arcuate ligament syndrome?

Release arcuate ligament surgically

What are associated risks/clues of renal artery stenosis

Fam hx early onset HTN HTN refractory to medical tx.

sx/sg of renal artery stenosis

Most are asx but may have HA DIASTOLIC HTN Flank bruit Dec renal fxn

What are dx tests of renal artery stenosis

Agram (GOLD STANDARD) IVP Renal vein renin ratio

What is surgical tx for renal artery stenosis? Invasive but non-surgical tx for renal artery stenosis?

Surgical - Resection, bypass, vein/graft interposition, or endarterectomy Non-surgical - PRTA/stenting

What anti-hypertensive med is CONTRAINDICATED in pt w/ hypertension from renovascular stenosis

ACE - I

Define "Milk leg"

AKA plegmasia alba dolens; Often seen in pregnant women w/ occlusion of iliac vein resulting from xt. compression by uterus

Phlegmasia cerulea dolens

2nd to severe venous outflow obstruction and results in cyanotic leg: extensive venous thrombosis results in arterial inflow impairment

Takayasu's arteritis

arteritis of the aorta and aortic branches, resulting in stenosis/occlusion/aneurysms

Buerger's disease

thromboangitis obliterans; seen in young men who smoke Digital gangrene --\> amputations

Tx for beurger's disease

smoking cessation +/- sympathectomy

Vascular Flashcards

(82 cards)