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Senior - Surgery 2 > 4 - Vascular > Flashcards

4 - Vascular Flashcards

1
Q

Anatomy review: artery

A

Intima - endothelium that lines the lumen of all vessels

Media - smooth muscle, elastic fibers

Adventitia - collagen fibers

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2
Q

What is an aneurysm?

A

Local dilation of an artery

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3
Q

MC cause of arterial aneurysm?

A

Atherosclerosis (95%)

HTN

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4
Q

Describe AAA

A 
The guys you call when your car breaks down
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Also, a pulsatile mass on the anterior abdomen, often asymptomatic and found on routine exam
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5
Q

What do you wanna avoid with AAA?

A

Manipulation - you could cause shower emboli

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6
Q

If the abdominal aorta is TTP:

A

Refer immediately

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7
Q

Plain films of an aneurysm may show:

A

Calcification

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8
Q

Best study for following the size of a AAA?

A

US

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9
Q

Study fro dx’ing aneurysmal rupture?

A

CT

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10
Q

When is aortogram usually done?

A

Prior to a scheduled procedure

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11
Q

3 subtypes of pseudo-aneurysm?

A
  1. Saccular - discrete outpouching
  2. Fusiform - diffuse
  3. Mycotic-associated with infection
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12
Q

MCC of pseudo-aneurysm?

A

Trauma

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13
Q

MCC of mycotic aneurysm?

A

Syphilis

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14
Q

Factors that increase risk of rupture of AAA:

A 
>6cm
Rapid expansion (>0.6cm/yr)
Female>male
Saccular>fusiform
Smoking
HTN
COPD
Steroid use
Family Hx
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15
Q

When to do surgical repair of AAA?

A
  1. If symptomatic - emergent
  2. Rapid expansion

If asymptomatic but >5.5cm, elective surgical repair

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16
Q

Sxs of rupture:

A

Flank, back or abd pain

Tenderness to palpation

Flank ecchymosis (Gray-Turner)

HOTN

Decreased femoral pulse

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17
Q

Types of AAA repairs:

A

Open - really risky, but if rupture, gotta do it

Endovascular stent - safer

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18
Q

Complications of AAA

A

Infection -> mycotic aneurysm

Fistula:
IVC -> CHF
GI tract -> aorto-enteric fistula (GI bleed)

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19
Q

Blue Toe Syndrome?

A

Distal embolization

Mural emboli and plaques -> small clots

Impaired blood supply to toes

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20
Q

Causes of thoracic aneurysm?

A 
Aortic dissection
Marfan’s 
Infx
Trauma
Associated with but not caused by atherosclerosis
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21
Q

MCC of aortic transection

A

MVA’s

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22
Q

Prognosis for aortic transection?

A

80% die at the scene

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23
Q

Most reliable test for aortic transection?

24
Q

Preferred repair of aortic transection

A

Delayed repair preferred to allow for BP control (make pt hemodynamically stable)

25
MC catastrophic event involving the aorta?
Aortic dissection Brittle aortic wall, destruction of arterial media, loss of elastic fibers, intima tear
26
Stanford:
Any proximal involvement - “A” Distal involvement “B”
27
Presentation of dissection
``` Older men Sharp, sudden, tearing chest/back pain Hx of HTN FHx Pulse difference between arms Diastolic murmur Pulmonary edema Signs of CVA if carotid involved ```
28
W/U for aortic dissection
R/O MI/PE first Imaging - CXR c widened mediastinum, pulm. edema, pleural effusion CT TEE
29
96% of aortic dissections had which three findings?
Abrupt onset tearing/ripping pain Pulse deficit or BP difference > 20 Widened mediastinum on CXR
30
Management of aortic dissection
BB’s THEN vasodilators Ascending - surgical Descending - medical
31
3 causes of carotid-related CVA:
1. Embolization (MC) 2. Thrombosis from a-fib 3. Flow-related brain ischemia
32
Sxs of carotid artery dz
Many asymptomatic TIA (hemiparesis, slurred speech, amarurosis fugax)
33
Diagnosis of carotid artery dz
Duplex US - luminal diameter and blood flow CT head MRI/MRA - better for ischemic CVA Echo - rule out cardiac source Carotid angiogram - GOLD STANDARD
34
Medical management of carotid artery dz
Stop smoking ASA 81mg PO QD Serial duplex scans
35
Surgical management of carotid artery dz
Carotid endarterectomy | Carotid stent
36
Subclavian steal syndrome
Narrow subclavian artery Use of arm causes early fatigue Subclavian “steals” blood from the vertebral artery Causes brain ischemia (light-headedness)
37
Acute Mesenteric ischemia will look like:
Pain out of proportion Severe/diffuse ABD pain Can lead to peritonitis if bowel becomes necrotic
38
Chronic mesenteric ischemia will look like
Food fear - post-prandial ABD pain Weight loss N/V/D
39
Risk factors for atherosclerotic peripheral vascular dz
``` Smoking HTN DM Dyslipidemia Known vascular dz ```
40
Sxs of PVD
Intermittent claudication
41
PE for PVD
``` Femoral bruit Decreased ABI Decreased pedal pulses Decreased hair Shiny / brittle skin Muscle atrophy Impaired wound healing Pallor in elevation Ischemic ulceration ```
42
Dx of PVD
H and P Measure ABI US with doppler CTA
43
Management of PVD
``` Stop smoking Eat better Exercise Be nicer to the homeless Take your statins and ASA ```
44
Late management of PVD
Stents Bypass / grafting Goals - prevent limb loss and avoid disability
45
Popliteal artery entrapment
Abnormal insertion of gastroc Medial deviation of artery Ischemia with exercise Intermittent claudication Asymptomatic at rest
46
Thromboangitiis obliterans
AKA Buerger’s Dz Young smokers AI component Foot claudication Excruciating ischemic pain Goes away if you stop smoking
47
Causes of acute arterial occlusion
Emboli Chronic PVD Trauma (long-bone fx)
48
5 P’s
``` Pain out of proportion Pallor Paresthesia Pulseless Paralysis ```
49
Hard signs of arterial injury
``` Pulsatile bleed Expanding hematoma Bruit / thrill Pulseless / cool extremity Sensory deficit ```
50
Txt for arterial occlusion
Anticoagulate c heparin Arteriogram Trauma - repair
51
Transected artery
Penetrating wounds Deep lacs Partial amputations Arterial stump can retract with clot Absent distal pulses Distal ischemia
52
Problem c lacerated pseudoaneurysm?
Can’t retract / spasm / constrict
53
AV fistula
Communication between artery and vein Thrill over the anastomose site Repair c vascular surgery Used in dialysis
54
Arterial stress injuries
Anterior dislocation of knee Sonic injury from bullet Internal disruption of intima with thrombosis Contained injury, no bleeding May still have distal perfusion from collateral vessel Urgent managemment
55
Penetrating injuries management
Can observe if: No hard signs No fx ABI > 0.9 If above criteria not met, must get imaging - CTA, arteriogram, US
56
Every girl is a squirter
If you hit an artery

Senior - Surgery 2 (9 decks)

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