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Vascular Flashcards

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1
Q

Most common congenital hypercoagulable disorder

A

Leiden factor- resistance to activated protein C

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2
Q

Most common acquired hypercoagulable disorder

A

Smoking

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3
Q

Most important risk factor for stroke and cerebrovascular disease

A

HTN

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4
Q

Most common site of stenosis in carotids

A

carotid bifurcation

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5
Q

Normal flow in internal carotid artery

A

continuous forward flow

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6
Q

Normal flow in external carotid artery

A

Triphasic flow (antegrade, retrograde, antegrade)

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7
Q

1st branch of external carotid artery

A

Superior thyroid artery

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8
Q

Communication between ICA and ECA occurs via which arteries?

A

Ophthalmic artery (off ICA) and internal maxillary artery (off ECA)

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9
Q

Most commonly diseased intracranial artery

A

Middle cerebral artery

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10
Q

S&S of ACA events

A

mental status change, release, slowing

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11
Q

S&S of MCA events

A

contralateral motor and speech, contralateral facial droop

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12
Q

S&S of PCA events

A

vertigo, tinnitus, drop attacks, incoordination

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13
Q

occlusion of ophthalmic branch of ICA causes

A

Amaurosis fugax (visual changes; shade coming down over eye)

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14
Q

Indications for CEA

A

symptomatic > 50% stenosis

asymptomatic > 70% stenosis

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15
Q

Indications for emergent CEA

A

fluctuating neurologic symptoms

crescendo/evolving TIAs

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16
Q

If bilateral carotid stenosis, which side should be repaired first?

A

Repair tightest side first if patient has bilateral stenosis
Repair dominant side first if patient has equal stenosis

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17
Q

When to use a shunt in CEA?

A

if back pressure is <50 mm Hg or if contralateral side is tight or occluded

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18
Q

When should you repair an occluded ICA?

A

You shouldn’t. NO benefit

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19
Q

What is the most common cranial nerve injury with CEA?

A

Vagus nerve injury secondary to vascular clamping. Patients get hoarseness because recurrent laryngeal nerve comes off of vagus.

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20
Q

What other cranial nerve is at risk during CEA?

A

Hypoglossal nerve; tongue deviates TOWARDS side of injury (speech and mastication difficult).

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21
Q

Pseudoaneurysm after CEA

A

pulsatile, bleeding mass

Drape and prep before intubation, intubate, repair

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22
Q

Restenosis rate after CEA

A

15%

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23
Q

Symptoms of ascending aortic aneurysms

A

back pain (compression of vertebra)
voice changes (RLN)
dyspnea/PNA (bronchi)
dysphagia (esophagus)

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24
Q

Indications for repair of Ascending aortic aneurysms

A

acutely symptomatic
> 5.5 cm
> 5 cm w/ Marfans
rapid increase in size (> 0.5 cm year)

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25
Indications for repair of descending aortic repair
Endovascular repair >5.5 cm | Open repair > 6.5 cm
26
Stanford classification of aortic dissections
Class A- any ascending aortic involvement | Class B- descending aortic involvement ONLY
27
DeBakey Classification of aortic dissections
Type I- ascending and descending Type II- ascending only Type III- descending only
28
Most dissections start _____.
in ascending aorta
29
Symptoms of aortic dissection:
tearing-like chest pain | unequal pulses in upper extremities
30
RF for aortic dissection
sever HTN, Marfan's, previous aneurysm, atherosclerosis
31
Dx of aortic dissection
chest CT w contrast
32
Dissection occurs in ______ layer of blood vessel wall.
medial
33
Aortic insufficiency occurs in ___% of cases and is caused by ______.
70% | annular dilation or when aortic valve cusp is sheared off
34
Medical Tx of aortic dissection
control BP with IV beta-blockers (esmolol) and nipride
35
When to operate on ascending aortic dissections?
operate on all ascending aortic dissections; need open repair, graft is placed to eliminate flow to false lumen
36
When to operate on descending aortic dissections?
visceral or extremity ischemia or if contained rupture endograft vs open repair (left thoracotomy); can also place fenestrations in dissection flap to restore blood flow to viscera or extremity if ischemia is the problem
37
Post Op complications of thoracic aortic surgery
MI renal failure paraplegia (descending thoracic aortic surgery)
38
What causes paraplegia in dissections?
spinal cord ischemia due to occlusion of intercostal arteries and artery of Adamkiewicz that occurs with descending thoracic aortic surgery
39
Measurement of normal aorta
2-3 cm
40
MCC AAA
atherosclerosis (results in degeneration of medial layer)
41
Indications for repair of AAA
``` > 5.5 cm in men >5 cm in women or those with high rupture risk (severe COPD, numerous relatives with rupture, poorly controlled HTN, eccentric shape) Growth > 1.0 cm/ year Symptomatic Infected ```
42
``` Ideal Criteria for AAA Endovascular repair: Neck length ____ Neck diameter _____ Neck angulation _____ Common iliac artery length _____ Common iliac artery diameter ____ Other ______ ```
``` Neck length > 15 mm Neck diameter < 30 mm Neck angulation < 60 degrees Common iliac artery length > 10 mm Common iliac artery diameter 8-18 mm Other: non-tortuous, non-calcified iliac arteries, lack of neck thrombus ```
43
Type I Endoleak
proximal or distal graft attachment sites
44
Type I Endoleak treatment
extension cuffs
45
Type II Endoleak
collaterals (patent lumbar, IMA, intercostals, accessori renal)
46
Type II Endoleak Tx
observe most; percutaneous coil embolization if pressuring aneurysm
47
Type III Endoleak
overlap sites when using multiple grafts or fabric tear
48
Type III Endoleak Tx
Secondary endograft to cover overlap site or tear
49
Type IV Endoleak
Graft wall porosity or suture holes
50
Type IV Endoleak Tx
Observe, can place nonporous stent if that fails
51
Type V Endoleak
expansion of aneurysm without evidence of leak
52
Type V Endoleak treatment
repeat EVAR or open repair
53
When does aortoenteric fistula usually occur?
> 6 months after abdominal aortic surgery
54
S&S of aortoenteric fistula
herald bleed with hematemesis, then blood per rectum then exsanguination
55
Cause of aortoenteric fistula
graft erodes into 3rd or 4th portion of duodenum near proximal suture line
56
Tx of aortoenteric fistula
bypass through non-contaminated field (axillary-femoral bypass with femoral to femoral cross over), resect graft, close hole in duodenum
57
Leg compartment- anterior
Anterior- deep perineal nerve (dorsiflexion and sensation between 1st and 2nd toes), anterior tibial artery
58
Leg compartment- lateral
Lateral- superficial peroneal nerve (eversion, lateral foot sensation)
59
Leg compartment- deep posterior
Deep posterior- tibial nerve (plantar flexion), posterior tibial artery, peroneal artery
60
Leg compartment- superficial posterior
sural nerve
61
Where is PAD? 1) buttock claudication 2) mid-thigh claudication 3) calf claudication 4) foot claudication
1) aortoiliac disease 2) external iliac 3) common femoral artery or proximal superficial femoral artery disease 4) distal superficial femoral artery or popliteal disease
62
Leriche syndrome
no femoral pulses, buttock/thigh claudication, impotence, lesion at aortic bifurcation or above
63
Leriche syndrome Tx
aorto-bifemoral bypass graft
64
Most common atherosclerotic occlusion in lower extremity?
Hunters canal (distal superficial femoral artery exits here) the sartorious muscle covers Hunter's canal
65
Surgical indications for PAD
rest pain ulceration or gangrene lifestyle limitations atheromatous embolization
66
When to use PTFE (gore-tex) for PAD
ONLY for bypasses above the knee; have reduced patency below knee; need to use SVG for below knee bypasses
67
Best predictor of long-term latency in PAD bypasses?
vein quality
68
Best technique for graft surveillance?
Duplex U/S
69
Best treatment for patency and reducing cardiovascular events after lower extremity bypass
ASA

SURG (6 decks)

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