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VASCULAR Flashcards

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1
Q

Best options for SMA bypass for chronic mesenteric ischemia

A
  • suprarenal aorta (infrarenal typically has high degree atherosclerotic burden)
  • right iliac artery
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2
Q

Sxs of chronic mesenteric ischemia

A

postprandial abdominal pain, fear of food, unintentional weight loss (not typically N/V)

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3
Q

To remember for traumatic isolated LE vascular injuries…

A
  • death MC injuries to CFA/SFA than to pop/tib arteries
  • death MC penetrating injuries than blunt
  • amputation MC injuries to pop/tib than CFA/SFA
  • amputation MC blunt injuries than penetrating
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4
Q

Mgmt for penetrating wound close to major vascular structure, but wo hard signs of vascular injury…?

A

arterial pressure index (API) - doppler arterial pressure distal to site of injury/doppler pressure in uninvolved contralateral extremity

  • if <0.9 -> need angiography
  • if >0.9 -> unlikely to have vascular injury
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5
Q

Surgical approach for repair of popliteal artery? Exposure gives view of what structures?

A

medial incision of popliteal space w/ division of medial head gastrocnemius and semimembranosus and semitendinosus muscles - exposure gives complete view of poplliteal artery/vein and tibial nerve

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6
Q

Mgmt ileofemoral DVT

A

cath-directed pharmacologic thrombolysis or pharmacomechanical thrombectomy

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7
Q

Criteria for early thrombus removal of first episode acute iliofemoral DVT

A
  1. symptom duration <14d
  2. low risk bleeding
  3. ambulatory
  4. good functional capacity
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8
Q

Why iliofemoral DVT worse prognosis than femoropopliteal DVT?

A
  • associated with long-term postthrombotic syndrome, which is related to residual venous obstruction and valvular reflux
  • associated with higher risk recurrent VTE
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9
Q

What is “nonocclusive” mesenteric ischemia due to?

A

typically low-flow states - dehydration, sepsis, cardiac failure, vasopressor use

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10
Q

Presentation of nonocclusive ischemic colitis

A

acute onset abdominal pain, cramping, bloody diarrhea (2/2 mucosal injury)

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11
Q

Mgmt ischemic colitis

A

bowel rest + IV fluids

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12
Q

Tx DVT (including iliofemoral, unless life-threatening) during pregnancy

A

SQH for duration of pregnancy + 6-wk post-partum

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13
Q

Can repair of thoracic aorta be done endovascularly in pediatrics?

A

NO - bc growing.

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14
Q

Blockage of left subclavian artery during TEVAR may result in…

A
  • paraplegia: blood supply to upper spinal cord through vertebral artery connection to anterior spinal artery
  • left arm ischemia
  • vertebrobasilar ischemia: covering flow to left vertebral artery results in reversal of blood flow in left vertebral, stealing flow from posterior circulation
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15
Q

Sxs of vertebrobasiliar ischemia

A

syncope, diplopia, vertigo

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16
Q

Is angiography good way to dx colonic ischemia?

A

NO - bc colonic ischemia (unlike midgut mesenteric ischemia) is usually associated with small vessels

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17
Q

Mesenteric venous thrombosis typically associated with…?

A

hypercoagulable state

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18
Q

Presentation of mesenteric venous thrombosis

A

slow onset abdominal pain, made worse by meals, +/- abdominal distention - hx hypercoag state

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19
Q

Postthrombotic syndrome (PTS)

A

occurs after DVT destroys compentency of deep venous valvular system -> reflux and HTN of venous system -> swollen, heavy, and painful leg that is worse with standing/walking

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20
Q

Mgmt postthrombotic syndrome

A

anticoag 6-mo + compression stockings for at least 24-mo

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21
Q

Surgical approach to access origin/proximal/distal subclavian artery

A

@origin - partial or complete sternotomy
@prox left - anterolateral
@distal or right side - supraclavicular

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22
Q

Can pts receiving thrombolytic therapy also receive heparin?

A

YES.

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23
Q

Association of thrombolytic therapy and stroke?

A

Thrombolytic therapy associated with 3x increase risk of periprocedural stroke

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24
Q

Anatomical relationship between right vs. left external iliac vein and artery

A

Right: vein posterior and lateral to artery
Left: vein posterior and medial to artery

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25
MC acute thoracic aortic pathology
aortic dissection
26
If have flank/abdominal pain with known aortic dissection, think...?
progression of intimal tear -> occlusion renal or mesenteric vessels -> ischemia
27
MC occurring visceral aneurysm (#1, #2)
splenic (#1), hepatic artery (#2)
28
MC location of aneurysm along splenic artery
75% occur in distal third
29
"Saturday night palsy"
compressive brachial plexopathy and ischemia of UE -> may need compartment release
30
Pts with popliteal artery entrapment syndrome will usually c/o...?
calf pain with walking
31
Dx imaging for popliteal artery entrapment syndrome
angiography or MRI w/ pt's feet in both dorsiflexion and plantar flexion (provocative studies)
32
Sxs chronic exertional compartment syndrome
pain or tightness, cramping, burning, or aching over affected compartment with exercise; may also have weakness
33
Dx chronic exertional compartment syndrome
measuring pre- and post-exercise compartment syndrome
34
Risk factors with immediate score of 5 on Caprini model = highest risk
- stroke within past month - elective major LE arthroplasty - hip, pelvis or leg fx within past month - acute spinal cord injury (paralysis) within past month - multiple trauma within past month
35
Effected bowel in acute embolic vs. thrombotic mesenteric ischemia
Embolic (occludes SMA distal to middle colic): sparing of proximal jejunum + transverse colon Thrombotic (occludes at proximal SMA): all SMA effected
36
Prevention of post-thrombotic syndrome after acute DVT involves...?
wearing 30-40mmHg compression stockings from time of dx for up to 2 years
37
What is post-thrombotic syndrome?
development of chronic pain, swelling, ulceration, and discoloration after DVT - may develop ulceration 2/2 venous stasis
38
RF post-thrombotic syndrome
- older age - proximal DVT - recurrent DVT in same limb - morbid obesity - persistent sxs despite AC
39
Mgmt: penetrating injury w/o hard signs vascular injury
ABI - if <0.9, need to further evaluate with CT angio
40
Fistula stenosis physical exam finding (what type of flow?)
pulsatile flow compared to palpable thrill
41
May-Thurner syndrome
(Iliac vein compression syndrome) | 2/2 compression of common venous outflow tract of LLE that may cause swelling and DVT in iliofemoral veins
42
MC nerve damaged during LE fasciotomy
Superficial peroneal nerve
43
Location of artery of Adamkiewics
Between T7 and L1
44
MC location which cardiac emboli lodge in LE
Common femoral artery
45
What does monophonic signal suggest about flow?
Proximal occlusion with patent distal vessels
46
Most significant RF for stroke
HTN
47
MCC ischemic stroke
Cardioembolic disease
48
Which PSA not likely to spontaneously thrombose (aka. Need intervention) after angio puncture?
- >3cm size | - presence of anticoagulation
49
Steps of thrombin injection for Tx of PSA
- Duplex US: characteristic “swirling” flow within cavity - US-guided needle injection of thrombin - 1000U/cc thrombin injected SLOWLY over 15s - once thrombosis achieved, must stop injection to avoid thrombin reaching circulation - bed rest for 1hr - repeat duplex US in 24hrs to confirm thrombosis
50
Patho of arterial wall thickening (HTN) 2/2 atherosclerosis
Artery wall thickens due to invasion and accumulation of WBC and proliferation of intimacy smooth muscle cells
51
Patho fibromuscular dysplasia (on micro vasculature level)
Multi-focal fibroplasia -> thickening of media and collagen formation
52
Visceral aneurysms listed from descending order of incidence
spleen > hepatic
53
Pt w/ recent exposure to heparin, who presents with acute thrombosis... suspect?
HIT
54
Approach for LE open embolectomy
- CFA preferred site of cutdown - once exposed, vessel loops to gain control of artery - transverse arteriotomy preferred incision to avoid narrowing of vessel upon closure - embolectomy cath passed both prox and distal until back bleeding achieved - completion angiogram
55
Appropriate diameter of vein and artery for HD access
Vein >3mm without evidence signif stenosis | Artery >2mm
56
MCC (#1 and #2) of peripheral arterial embolic occlusion
``` #1 = atrial fibrillation #2 = proximal atherosclerosis ```
57
Which mesenteric artery cannot be ligated even in trauma? (Bc incompatible with life if ligated)
SMA
58
Renal artery stenosis causing HTN in young females typically caused by...?
fibromuscular dysplasia
59
Pathophys: fibromuscular dysplasia
thickening of media and collagen formation
60
s/p TEVAR, with bloody diarrhea that improves with fluids and IV Abx... next step to evaluate?
sigmoidoscopy - black mucosa signifies transmural necrosis and needs OR (NOT CT angio A/P bc cannot evaluate severity)
61
MC organism non-aneurysmal aortic infection
salmonella
62
MC organism aortic infections (both aneurysmal and non)
S.aureus - associated with aneurysmal degeneration
63
on US, acute DVT vs. chronic DVT appears how?
``` acute = echolucent (black) chronic = echogenic (white) ```
64
Tx septic thrombophlebitis superficial vs. deep veins?
Abx and excision of superficial vein (entire lenght) - if deep/central veins, then only IV Abx + hep gtt for 2-3wk (cannot excise)
65
Paget-Schroetter syndrome
venous thoracic outlet syndrome; exercise-induced thrombosis of subclavian and axillary veins
66
Sxs and Tx Paget-Schroetter syndrome
Sxs: short hx pain/swelling arm Tx: cath-directed thrombolysis
67
Vessel lumen is not compromised until >?% stenosis occurs
>40%
68
Nerves that may be damaged during CEA and their deficits
- vagus nerve (long recurrent laryngeal): hoarseness - superior laryngeal (br off vagus): loss high-pitches - marginal mandibular: drooping of ipsilateral lip - hypoglossal: ipsilateral deviation of tongue
69
Which LE artery has longest patency after angioplasty?
iliac arteries - proximal has better patency
70
Dx compartment syndrome via pressure transducer
pt's compartment pressure - pt's DBP <30mmHg, then Dx supported
71
Presentation of porto-mesenteric vein thrombosis (PMVT)
abrupt onset abdominal pain >10d after discharge (s/p bypass)
72
Thickness of vein wall for acute vs. chronic DVT
``` Acute = thin, smooth Chronic = thick, contracted (2/2 inflammation) ```
73
Rule of 6s criteria for cannulation of dialysis access
- vein diameter 6mm - access depth of 6mm - access flow of 600 cc/min
74
30d mortality for endovascular vs. open repair of infrarenal AAA
endo: 1.6% open: 4.8% * no long-term benefit shown with EVAR vs. open
75
90d mortality for open thoracoabdominal aneurysm repair
8-10%
76
% mortality endo vs. open repair of ruptured AAA
endo: 25% open: 50%

QUESTION NOTES (28 decks)

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