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Ch. 11: Venous Disease > Venous Disease > Flashcards

Venous Disease Flashcards

(90 cards)

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1
Q

Aortomesenteric angle NCS

A

usually < 20 degrees

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2
Q

Most common symptoms of NCS

A

hematuria

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3
Q

Work of for NCS

A

1st: UA - if negative hematuria; unlikely diagnosis.
2nd: renal vein venography for pressure measurements

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4
Q

Renal vein venography for NCS pressure gradient

A

> 3-5 mmHg

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5
Q

Duplex diagnosis of NCS

A

PSV ratio > 5

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6
Q

Classic CT/MRV finding for NCS

A

“bird beak” of renal vein

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7
Q

Management of NCS based on age

A

< 18 years: observation & weight gain –> may self resolve.

> 18 years: RVT (gold standard)

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8
Q

Primary concern for renal vein stenting

A

Migration of stent and/or stent fracture.

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9
Q

Which side is more common to develop PCS

A

LEFT reflux much more common

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10
Q

1st line diagnosis of PCS

A

1st: Transabdominal ultrasound: Dx if ovarian vein dilates to > 6 mm with valsalva. does NOT rely on reflux times.
2nd: transvaginal ultrasound

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11
Q

Best axial imaging for PCS

A

MRV

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12
Q

Diagnosis of PCS by venography

A

Ovarian vein dilated > 5-6 mm

Retention of contrast in vein > 20 seconds

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13
Q

1st line treatment for PCS

A

coil embolization of refluxing segments

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14
Q

What is considered “hemodynamically” significant lesion on venography

A

> 5 mmHg

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15
Q

Women are at much higher risk compared to men for development of which complication secondary to MTS

A

PE (9x more likely)

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16
Q

1 year primary patency of iliocaval reconstruction`

A

~60%

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17
Q

Preferred conduit for surgical venous bypass

A

contralateral GSV

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18
Q

When should AVF creation be considered as adjunct for surgical vein bypass

A

PTFE conduit or conduit size > 10 mm

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19
Q

When does majority of venous recanalization occur following acute DVT

A

first 3 months (~50% thrombus burden reduction)

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20
Q

C1-C6 disease

A

1: telang/reticular veins
2: varicose veins (> 3 mm)
3: edema
4A: hyperpigmentation or eczema
4B: lipodermatosclerosis / atrophic blanche
5: healed venous ulcer
6: active venous ulcer

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21
Q

Pathologic reflux times

A

Superficial / Profunda / Perforator: > 0.5 seconds

Femoral vein / popliteal vein: > 1 second

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22
Q

“Pathologic perforator vein”

A

> 3.5 mm diameter
reflux > 0.5 seconds
adjacent to ulcer (C5 or C6)

–> warrants intervention

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23
Q

Duplicate GSV

A

~25% population.

If present, duplicate GSV will course in superficial dermis (not deep in parallel)

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24
Q

Most common configuration of popliteal fossa (deep –> superficial)

A

artery -> vein -> tibial nerve

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25
Most common cause of therapy failure: endo vs. open (CVI)
open: neovascularization endo: recanalization
26
Which artery classically crosses between GSV & femoral vein --> AVF after RFA
external pudendal artery
27
Contraindications to ablation therapies for CVI
Tortuous proximal segment (unable to pass wire/device) Chronic/acute thrombophlebitis Vein diameter > 2.5 cm vein to skin surface < 1 cm
28
ESCHAR trial
Compared compression vs. compression + GSV Ablation for C5or 6 disease: Rates of ulcer recurrence were LOWER with combo therapy, but healing rates were similar. Follow up EVRA trial showed both recurrence and healing time was lower with combo therapy
29
Deep venous valve transposition
transposing a competent venous valve segment that is DISTAL to an incompetent segment onto a competent segment
30
IVC develops from which primitive veins? (3)
Supracardinal vein (right) Subcardinal vein Posterior cardinal vein
31
Cuase of duplicate IVC system
persistence of both right & left supracardinal veins (left should normally regress)
32
Course of IVC relative to aorta with LEFT sided IVC
courses ANTERIOR crossing aorta at level of renal veins
33
Most common complication of venous ablation therapies
Ecchymosis
34
FDA approved sclerosing agents
Sotradecol (sodium tetradecol sulfate) | Asclera (pilodocinol)
35
Patients should avoid _____ ~48 hrs post procedure to avoid reversal
NSAIDS | Warm compress
36
Most common complication of sclerotherapy
Hyperpigmentation (self resolves)
37
Telengiectatic matting
Formation of new telangiectasias following sclero therapy --> resolves.
38
Neurologic symptoms following sclerotherapy treatment
Treat with 100% oxygen
39
Primary benefit of MOCA compared to ablation therapy
does NOT require tumescent anesthesia
40
CariVein
Mechanical rotation + sotradecol
41
VenaSeal
Cyanoacrylate glue
42
Common complication of VenaSeal
Delayed Type IV HS RXN Tx: Antihistamines & steroids
43
DVT PPx in patient with HITT
Fondaparinux
44
Which patients SHOULD receive DVT PPx throughout pregnancy? How long is this continued?
F5L Homozygous ATIII deficiency Prothrombin Homozygous Continue 6 weeks post partum This is IRREGARDLESS of DVT history F5 hetero, Prothrombin hetero & Protein C/S def does NOT require PPx.
45
Etiology of venous gangrene tissue loss
venous hypertension --> microvessel thrombosis. Is NOT due to primary arterial hypoperfusion
46
PT & PTT levels with DIC
both elevated
47
Most common symptom of LE DVT
pain
48
T/F. Wells score has proven to be accurate in both outpatient & inpatient setting.
FALSE. Grossly underestimates DVT in IN-patient setting.
49
Preferred anticoagulation during pregnancy
Lovenox
50
Classic EKG for PE | Most common EKG for PE
S1Q3T3 Sinus tachycardia
51
RV:LV end-diastolic ratio to suggest severe PE on TTE
> 1.0: RV-strain > 1.5: "severe PE"
52
McConnell Sign
TTE shows RV basal hypokenesis with sparing of apex --> suggests PE
53
When is V/Q scan considered
Dx of PE COnsidered during pregnancy and/or poor renal function V/Q: 0.8 = normal V/Q: > 0.8 --> mismatch --> consistent with PE
54
Regular Submassive Massive PE
Regular; stable & no RV strain Submassive: stable, + RV strain Massive: unstable, + RV strain
55
When is systemic tPA and/or CDT therapy indicated for PE
Massive PE
56
FDA approved CDT catheters for PE
``` Ekos catheter (ultrasound lysis) FlowTreiver ```
57
Most common cause of death with PE
acute RV failure
58
When is risk of PE highest during pregnancy?
Immediate post-partum period
59
Most common location for primary SVT
GSV
60
Trousseaue Syndrome
Migratory primary SVT; likely undiagnosed malignancy (pancreatic most common)
61
SVT saltans vs. migrans
Saltans: SVT in several Separate veins Migrans: SVT in several segments of the Same vein
62
CALISTO Trial
SVT in GSV: >5 cm length AND < 5 cm from SFJ: treat with PPx dosing Fondo (2.5 mg BID) or LMWH for 45 days
63
Management of purulent thrombophlebitis
Remove offending IV/line IV antibiotics +/- excision of infected vein if refractory to medical management and/or gross purulence tracking
64
ATTRACT trial
Acute LE DVT: CDT + AC vs. AC alone. For iliofemoral DVT: CDT therapy reduced SEVERITY of PTS at 2 years follow up, but did NOT reduce incidence of PTS or recurrent DVT NO benefit of CDT for fem/pop DVT without iliac vein involvement.
65
Technique for distal femoral/pop open venous thrombectomy
Attempt ESMARC exsanguination FIRST (balloon can damage valves); but if fails then proceed with balloon embolectomy.
66
Most common cause of SVC syndrome
Malignant etiology (NSCL) Malignant etiology ~60% Benign etiology ~40%
67
Type I-IV SVC syndrome
I: antegrade flow maintained through SVC (< 90% stenosis) II: antegrade flow lost through SVC (> 90% stenosis), antegrade flow maintained through Azygous III: retrograde flow through azygous & IVC IV: no flow through azygous system, all flow retrograde through IVC
68
SVC syndrome management
All managed conservatively at first. If malignant etiology: focus should be on tumor burden reduction (chemo/radiation) Endovascular first line invasive therapy
69
Open surgical management of SVC syndrome
Typically only considered in those planned for open tumor resection and/or young patients Spiral saphenous vein graft preferred (rPTFE if not available) --> IJ/innominate --> atrial appendage.
70
CVC with highest associated thrombotic & infection compications
Femoral vein (both)
71
3 subtypes of primary aortic tumors
Intimal (most common) - branch occlusion Polypoid - embolic potential Adventitial - grows OUTWARDS, invades adjacent organs
72
Most common Primary & Secondary IVC tumor
Leiomyosarcoma & RP Leiomyosarcoma
73
Most common secondary IVC tumor to cause tumor thrombus
RCC
74
Neves & Zencke classification (RCC)
Tumor thrombus extent I: < 2 cm from renal vein ostium (out into IVC) II: > 2 cm out from renal ostium (into IVC) III: retrohepatic IV: Supra diaphragm / right atrium
75
When to perform IVC primary repair vs. patch/interposition
< 50% residual stenosis: primary repair OK | > 50% residual stenosis: patch or interposition
76
Patch diameter estimate for IVC reconstruction
patch diameter = 3.14 x IVC diameter x % resection
77
Conduit for IVC reconstruction
rPTFE (1st line) | Spiral vein graft if concern for infection
78
Largest IVC filter
Birds Nest: < 40 mm IVC diameter. Majority of filters treat up to 30 mm IVC
79
PREPIC-1 & PREPIC-2 Trial
1: IVC filter increases risk of recurrent LE DVT at 2 years follow up. 2: filter + AC vs. AC alone is NOT superior for prevention of PE
80
Variable most associated with failure of IVC filter removal
Duration of placement.
81
Most common peripheral venous aneurysm
Popliteal Treat > 2 asymptomatic and/or Symptomatic any size. lateral venorraphy with aneurysmectomy
82
Primary concern with venous aneurysms
thromboembolic >>>> rupture
83
Type I-IV IVC aneurysm
I: suprahepatic NO obstruction II: OBSTRUCTION III: infrarenal NO obstruction IV: anything else
84
Most common visceral venous aneurysm
Portal vein (> 1.5-2 cm) All visceral venous aneurysm treat when > 3 cm. Splenic vein: any size child-bearing age.
85
Race & blood type PROTECTIVE of VTE
Japanese | Blood type O
86
Malignancy most associated with VTE complications
Pancreatic
87
T/F. chemotherapy increases risk of VTE
True.
88
Most common heritable hypercoag condition
F5L deficiency (F5 is resistant to protein C degredation)
89
Blood type with increased VTE risk
A
90
Most common location for acute DVT
calf vein > femoral > popliteal

Ch. 11: Venous Disease (1 decks)

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