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Vascular Surgery by Emi > Venous > Flashcards

Venous Flashcards

1
Q

normal PPG refil time

A

> 20 seconds

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2
Q

reflux PPG refill time

A

<20 seconds

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3
Q

what indicates superficial vein reflux ONLY

A

PPG <20 seconds without a tourniquet but >20 seconds with a tourniquet

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4
Q

normal venous flow on duplex

A

less than or equal to 0.5 seconds

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5
Q

reflux venous flow on duplex

A

More than 0.5 seconds

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6
Q

C in CEAP classification

A
  1. teleangiectasia <3mm
  2. reticular veins >3mm
  3. edema
  4. skin changes - discoloration
  5. healed ulcer
  6. active ulcer
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7
Q

E in CEAP

A

etiology
c - congenital
p - primary
s - secondary

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8
Q

A in CEAP

A

anatomy
s - superficial
d - depp
p - perforator

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9
Q

P in CEAP

A

patophysiology
r - reflux
o - obstruction
r,o - both

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10
Q

direction of venous flow in upper extremity

A

UP with INSPIRATION
down with expiration
(augmented with negative pressure in the chest)

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11
Q

direction of venous flow in lower extremity

A

down with INSPIRATION

UP with expiration

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12
Q

indication for suprarenal IVC filter

A
  1. duplicated IVC
  2. malposition of the IVC filter
  3. pregnancy
  4. ovarian vein thrombosis
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13
Q

common femoral vein size

A

10mm

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14
Q

saphenous vein size

A

5mm`

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15
Q

what is the point of origin for lower extremity venosu thrombus

A

soleal sinus

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16
Q

how do you perform venous PPG

A

patient does dorsiflexio / plantarflexion while sitting wihich activates the calf muscle pump. Upon cessation, time required to refill the calf compartments is measured.

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17
Q

what are characteristics of deep venous reflux?

A

on PPG <20 seconds regardless of turniquet

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18
Q

how do you perform venous insufficiency study (doppler)

A

inflate pressure cuff around calf to 80-100mHg reduces calf muscle blood volume. With rapid deflation in normal person valve closure limits pop venous flow reversal to less than 0.5sec

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19
Q

What does it mean if Valsalva generates reflux in a vein

A

there are no competent valves between that vein and diaphragm

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20
Q

ACCP recommendations for treatment of acute DVT in lower extremity

A

LMWH or fundaparineux rather than unfractionated heparin
daily LMWH is preferred
may be treated at home
may walk

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21
Q

what is the association of brachial, axillary and subclavian DVT with complications

A

5% PE
20% post thrombotic syndrome
8% recurrence

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22
Q

ACCP recommendations for treatment of upper extremity DVT

A
  1. central line association - if line is needed, leave and anticoagulate for the time line is in and 3 months
  2. axillary and proximal - full anticoagulation with LMWH or fundaparineux; selective thrombolysis
  3. isolated brachial vein - full anticoagulation if symptomatic, + cancer and + TLC (for 3 months)
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23
Q

Anatomical anomalies of IVC

A
  1. retroaortic or circumaortic left renal vein 5-7%
  2. IVC transposition 0.2-0.5%
  3. IVC duplication 0.2-0.3%
  4. IVC agenesis
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24
Q

Greater saphenous vein tributaries

A
  1. inferior epigastric vein
  2. superficial circumflex iliac vein
  3. lateral accessory saphenous vein
  4. medial accessory saphenous vein
  5. deep external pudendal vein
  6. superficial external pudendal vein
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25
Q

size of teleangiectasia

A

0.1 - 1 mm

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26
Q

methods of femoral vein valve reconstruction

A
  1. internal valvuloplasty
  2. external valvuloplasty
  3. external banding
  4. valve transposition
  5. valve transplantation
27
Q

Indications for iliac vein stenting

A

C0-2 limbs with severe diffuse venous limb pain not relieved by compression
C3-6 limbs failing compression

28
Q

Treatment algorithm for postthrombotic venous insufficiency

A

Treat saphenous reflux first, provided gsv is at least 5mm in size
Treat perforator reflux underneath the ulcer if larger than 3.5 mm and reflux in >500ms
Correct obstruction next
Correct reflux if all of the above fails

29
Q

How do you size stents for veins

A

CIV normal size is 16 mm, oversize 2mm —> 18 mm stet
EIV normal size 14mm, —> 16 stent
CFV normal size 12mm, —> 12 stent

30
Q

Stent patency in nonthrombotic venous obstruction

A

79% primary
100% primary assistant
Thrombosis extremely rare

31
Q

Patency if venous stent for recanalization thrombotic occlusion

A

54% for primary,
68% for primary assisted
74% secondary

32
Q

What does lack of femoral venous respiratory variation mean

A

Iliofemora occlusion

33
Q

Phasicity

A

Cyclic vartiation with respiration

34
Q

Augmentation

A

Produced by distal compression or release of proximal compression

35
Q

Valvular competence in venous duplex

A

Presence or absence of reverse flow in response to proximal compression or Valsalva maneuver

Flow reversal >0.5sec abnormal

36
Q

Characteristics of acute DVT on duplex

A

Echolucent, spongy / incompressible, dilated vein, homogenous vein, smooth luminal surface, absent collateral, confluent flow channel, +/- present free floating rail

37
Q

Chronic DVT duplex characteristics

A 
Echogenic
Firm vein
Contracted vein
Heterogenous inside of vein
Irregular luminal surface
Present collaterals
Multiple flow channels
Absent free floating tail
38
Q

What increases VTE risk 10 fold

A

Antithrombin deficiency

Protein C and S deficiency

39
Q

How much does factor V Laiden increase VTE risk

A

5 fold for heterozygotws

50 fold for honozygotes

40
Q

Classification of the antiphospholipid syndrome

A

Clinical criteria:

  1. Vascular thrombosis (one or more episodes of arterial, venous or small Vassell thrombosis within any tissue or organ)
  2. Unexplained death of a normal fetus >10 week gestation
  3. Premature birth or normal neonates less than 34 weeks gestation due to eclampsia, preeclampsia, placenta insufficiency
  4. 3 or more spontaneous abortions less than 10 week gestation

Laboratory criteria

  1. Lupus anticoagulant two or more occasions more than 12 weeks apart
  2. Anticardiolipin igg or igm on two or more occasions more than 12 weeks apart
  3. Anti beta 2 GP1 IGG or IGM on two or more occasions more than 12 weeks apart
41
Q

Secondary theomboprophylwxis with antiphospholipid syndrome

A

1 venous event - indifinite with INR 2-3
Arterial event - indefinite with INR 3-4 and ASA
Recurrent events - indefinite with INR 3-4 or lovenox

42
Q

Malignancy associated with arterial thrombosis

A 
Leukemia
Myeloproliferarive disorder (JAK2 mutation)
Multiple myeloma
Neurofibromatosia
Lung
Transitional cell
Breast
Ovarian
Colorectal
Unknown primary
43
Q

Vascular complications associated with l- asparinginase

A

CVA

44
Q

Vascular complications associated with cis platinum

A

CVA, peripheral arterial events, aortic thrombosis

45
Q

Vascular complications associated with fluorouracil

A

Coronary vasospasm mediated ischemia

46
Q

Vascular complications associated with bevacizumab

A

Coronary thrombosis mediated ischemia, CVA

47
Q

Vascular complications associated with gembotabine

A

Digital ischemia, thrombotic microangiopathy

48
Q

Vascular complications associated with thalidomide

A

Arterial thrombosis

49
Q

Vascular complications associated with sorafenib, sunitinib

A

Myocardial infarction, CVA

50
Q

Clinics criteria for HIT

A

Unexplained thrombocytopenia (less than 100)
Or decrease in platelet count more than 30-50%
Positive assays for HAABs (platelet aggregation teat, 2point platelet aggregation assay, C14-serotonin release assay)
Positive ELISA (40% discordance vs platelet aggregation, IGG, IGM)
Arterial and o venous thrombus

51
Q

Purpose of tumescent infiltration in endogenous ablation

A

Helps uniformly compression vein around heating element
Creates fluid cushion to exanguinatr treatment vein
Create depth between skin surface and anterior vein wall
Acts as heat sink to protect perivenous tissue from thermal injury

52
Q

EHIT levels

A
  1. Before the branches to GSV around the SFJ
  2. Past inferior epigastric vein branch but still in GSV
  3. At the GSV deep vein junction, not extending into CFV
  4. Extending into CFV <50%
  5. Extending into CFV >50%
  6. Occluding CFV
53
Q

EHIT treatment

A

Level 1-2 no treatment
Level 3 surgeons choice
Level 4-5 lovenox until the clot retracts to level 3
Level 6 lovenox abd warfarin for 3 months

54
Q

What is May - Husni procedure

A

Popliteo - femoral venous bypass using GSV

55
Q

Palma procedure

A

Femoral femoral venous bypass with GSV

56
Q

PEIHO trial

A

Randomized double blinded
Patients with intermediate risk PE
TEnecteplase vs heparin
Endpoint: death, hemodynamic collapse
Statistically lower primary outcome and hemodynamic collaps in lysis group but higher (much) stroke rate and major bleeding
Patients received therapeutic heparin during lysis

57
Q

Recommended treatment for superficial thrombophlebitis

A

In those with SVT >5cm use prophylactic dose fundapsrinha or LMWH for 45 days

58
Q

Contraindication to endovascular venous ablation

A

Absolute: active superficial vein thrombosis
GSV close to the skin
Relative: pacemaker, arterial insufficiency, GSV less than 5mm (or 2?) and over than 15mm and tortuous GSV

59
Q

Cyaniacrylate vein closure

A

VeClose shows noninferioriry with EVLA
Closure rates are comparable

CAE does not require anesthesia
Decrease post op ecchymosis
No other difference

60
Q

What’s a superficial accessory great saphenous vein

A

Any venous segment ascending parallel to the GSV and located more superficially above saphenous faascia both in the leg and in the thigh

61
Q

What is anterior accessory great saphenous vein

A

Any venous segment ascending parallel to GSV and located anteriorly both in the leg and in the thigh

62
Q

What is vein of Giacomini

A

Cranial extension of the SSV that communicates with the GSV via posterior thigh circumflex vein

63
Q

whats the energy delivery in EVLA over length

A

withdraw the catheter to deliver 30-50 joules/cm

64
Q

Speed of withdrawal for EVLA

A

1-2mm/sec for first 10 seconds, followed by 2-3mm for the remainder

Vascular Surgery by Emi (15 decks)

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