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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?

A

CTA

24
Q

Preferred repair of aortic transection

A

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

25
Q

MC catastrophic event involving the aorta?

A

Aortic dissection

Brittle aortic wall, destruction of arterial media, loss of elastic fibers, intima tear

26
Q

Stanford:

A

Any proximal involvement - “A”

Distal involvement “B”

27
Q

Presentation of dissection

A 
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
Q

W/U for aortic dissection

A

R/O MI/PE first

Imaging - CXR c widened mediastinum, pulm. edema, pleural effusion

CT

TEE

29
Q

96% of aortic dissections had which three findings?

A

Abrupt onset tearing/ripping pain
Pulse deficit or BP difference > 20
Widened mediastinum on CXR

30
Q

Management of aortic dissection

A

BB’s THEN vasodilators

Ascending - surgical
Descending - medical

31
Q

3 causes of carotid-related CVA:

A
  1. Embolization (MC)
  2. Thrombosis from a-fib
  3. Flow-related brain ischemia
32
Q

Sxs of carotid artery dz

A

Many asymptomatic

TIA (hemiparesis, slurred speech, amarurosis fugax)

33
Q

Diagnosis of carotid artery dz

A

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
Q

Medical management of carotid artery dz

A

Stop smoking
ASA 81mg PO QD
Serial duplex scans

35
Q

Surgical management of carotid artery dz

A

Carotid endarterectomy

Carotid stent

36
Q

Subclavian steal syndrome

A

Narrow subclavian artery

Use of arm causes early fatigue

Subclavian “steals” blood from the vertebral artery

Causes brain ischemia (light-headedness)

37
Q

Acute Mesenteric ischemia will look like:

A

Pain out of proportion

Severe/diffuse ABD pain

Can lead to peritonitis if bowel becomes necrotic

38
Q

Chronic mesenteric ischemia will look like

A

Food fear - post-prandial ABD pain

Weight loss

N/V/D

39
Q

Risk factors for atherosclerotic peripheral vascular dz

A 
Smoking
HTN
DM
Dyslipidemia
Known vascular dz
40
Q

Sxs of PVD

A

Intermittent claudication

41
Q

PE for PVD

A 
Femoral bruit
Decreased ABI
Decreased pedal pulses
Decreased hair 
Shiny / brittle skin
Muscle atrophy
Impaired wound healing
Pallor in elevation 
Ischemic ulceration
42
Q

Dx of PVD

A

H and P
Measure ABI
US with doppler
CTA

43
Q

Management of PVD

A 
Stop smoking
Eat better
Exercise
Be nicer to the homeless
Take your statins and ASA
44
Q

Late management of PVD

A

Stents
Bypass / grafting

Goals - prevent limb loss and avoid disability

45
Q

Popliteal artery entrapment

A

Abnormal insertion of gastroc

Medial deviation of artery

Ischemia with exercise

Intermittent claudication

Asymptomatic at rest

46
Q

Thromboangitiis obliterans

A

AKA Buerger’s Dz

Young smokers

AI component

Foot claudication
Excruciating ischemic pain
Goes away if you stop smoking

47
Q

Causes of acute arterial occlusion

A

Emboli
Chronic PVD
Trauma (long-bone fx)

48
Q

5 P’s

A 
Pain out of proportion
Pallor
Paresthesia
Pulseless
Paralysis
49
Q

Hard signs of arterial injury

A 
Pulsatile bleed
Expanding hematoma 
Bruit / thrill
Pulseless / cool extremity 
Sensory deficit
50
Q

Txt for arterial occlusion

A

Anticoagulate c heparin
Arteriogram
Trauma - repair

51
Q

Transected artery

A

Penetrating wounds
Deep lacs
Partial amputations

Arterial stump can retract with clot

Absent distal pulses

Distal ischemia

52
Q

Problem c lacerated pseudoaneurysm?

A

Can’t retract / spasm / constrict

53
Q

AV fistula

A

Communication between artery and vein

Thrill over the anastomose site

Repair c vascular surgery

Used in dialysis

54
Q

Arterial stress injuries

A

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
Q

Penetrating injuries management

A

Can observe if:
No hard signs
No fx
ABI > 0.9

If above criteria not met, must get imaging - CTA, arteriogram, US

56
Q

Every girl is a squirter

A

If you hit an artery

Senior - Surgery 2 (9 decks)

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