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Vascular > All Things Vascular > Flashcards

All Things Vascular Flashcards

1
Q

Rutherford stage of ischemia: not immediately threatened; intact motor and sensory function with audible arterial and venous signals

A

rutherford stage 1

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2
Q

Rutherford stage of ischemia: marginally threatened and salvageable limb (intact motor function and sensory deficit in the toes with inaudible arterial signal)

A

rutherford stage 2a

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3
Q

Rutherford stage of ischemia: immediately threatened and salvageable only with emergent revascularization (mild to moderate neurodeficit)

A

rutherford stage 2b

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4
Q

Rutherford stage of ischemia: irreversibly damaged limb with major tissue loss or nerve damage (paralysis)

A

rutherford stage 3

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5
Q

what major nerve is transected during an AKA?

A

sciatic nerve

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6
Q

Most commonly implicated muscle in popliteal entrapment syndrome:

A

gastrocnemius

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7
Q

waterhammer pulse is indicative of ischemia from what: example, bounding femoral pulses with absent distal pulses

A

indicative of acute embolism at a bifurcation (femoral bifurcation)

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8
Q

True or false. Angioplasty alone is generally sufficient in treating fibromuscular dysplasia

A

true

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9
Q

most common etiology of SMA aneurysm

A

infectious etiology; risk factors are IV drug use, bacteremia, and infective endocarditis

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10
Q

which type of bypass has the highest patency rate?

A

aortobifemoral bypass

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11
Q

threshold for compartment syndrome

A

intracompartmental pressure >30mm Hg; difference of less than 40mm Hg between MAP and intracompartmental pressure; difference of <10mm Hg between DBP and intracompartmental pressure

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12
Q

management of pseudoaneurysms <2cm in diameter without complications:

A

observation

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13
Q

contraindications to nonoperative management of pseudoaneurysms:

A

peripheral or cutaneous ischemia, infection, prosthetic graft, large suprainguinal, rapid enlargement, skin necrosis, distal embolization, rupture

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14
Q

True or False. Calcaneous osteomyelitis is simple to heal and flaps usually do well

A

false

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15
Q

true or false. cause of graft failure depends on the time since surgery at which it occurs

A

true

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16
Q

most common cause of early graft failure:

A

(within 30 days) technical error or inadequate inflow/outflow

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17
Q

most common cause of intermediate graft failure:

A

(30-2 years) intimal hyperplasia

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18
Q

most common cause of late graft failure:

A

(>2years) progression or recurrence of atherosclerotic disease

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19
Q

effects of nitric oxide on vascular tissue:

A

inhibits proliferation of vascular smooth muscle by downregulating endothelin 1 and platelet derived growth factor b; inhibits adhesion and aggregation of platelets to the endothelium

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20
Q

symptoms of vertebrobasilar insufficiency:

A

ataxia, bilateral or alternating weakness, dizziness, vertigo

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21
Q

True or false. A TIA by definition lasts 48 hours.

A

false (less than 24 hrs)

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22
Q

treatment of asymptomatic moderate carotid disease in setting of CAD:

A

manage medically until coronary artery disease is addressed (CABG before CEA)

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23
Q

True or false. Skin of lipodermatosclerosis is highly suggestive of venous insufficiency/stasis

A

True

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24
Q

disorder characterized by nonpitting edema, thickening of the skin, woody edema, and hyperkeratotic papillomatous plaques

A

lymphedema

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25
Q

True or false. Observation is appropriate for aneurysms <2cm

A

true

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26
Q

complex coagulation process that involves activation of teh coagulation system with deposition of fibrin in the microvasculature

A

DIC

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27
Q

treatment of DIC

A

treat the underlying cause

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28
Q

characterized by thickening of the vessel media and collagen formation

A

fibromuscular dysplasia

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29
Q

vascular disease characterized by artery wall thickening as a result of invasion and accumulation of white blood cells and proliferation of intimal smooth muscle cells

A

atherosclerosis

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30
Q

causes arterial thrombosis as a result of rupture of fat rich deposit in the blood vessel wall

A

atheroma

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31
Q

small tear that forms in the innermost lining of the arterial wall called the tunica intima

A

arterial dissection

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32
Q

what is the initial treatment for intermittent claudication?

A

medical management; smoking cessation, antiplatelet therapy, statin therapy, exercise

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33
Q

True or false. revascularization is only recommended in severe cases of claudication that have failed medical therapy

A

true

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34
Q

treatment of asymptomatic FMD of the carotid artery

A

antiplatelet therapy

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35
Q

treatment of symptomatic FMD of the carotid artery

A

open arteriotomy with serial dilation or balloon dilation (angioplasty)

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36
Q

True or false. superficial venous thrombosis (SVT) in teh trunks of the GSV or SSV have highest risk of extension into the deep venous system

A

true

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37
Q

treatment of SVT within 3 cm of the saphenofemoral junction:

A

fondaparinux for 45 days; patients with risk for DVT should be considered for chemoprophylaxis

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38
Q

surgical patients are at increased risk of DVT due to transient release of large amounts of ____

A

tissue factor (a potent procoagulant)

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39
Q

true or false. patients with chronic renal disease and nephrotic syndrome are at decreased risk of DVT

A

false

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40
Q

how long should clopidogrel be held for elective surgery reversal?

A

5-7 days

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41
Q

amaurosis fugax: caused by isolated embolism where?

A

retinal or ophthalmic artery

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42
Q

most common complication of untreated jugular vein suppurative thrombophlebitis:

A

septic emboli to the lungs that can infiltrate, cavitate and form empyemas

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43
Q

therapeutic anticoagulation regimen for acute limb ischemia:

A

heparin bolus of 80 units/kg and then heparin drip at 18units/kg with goal aPTT of 60-90 seconds

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44
Q

types of thoracic outlet syndromes (TOS)

A

neurogenic, arterial, venous

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45
Q

most common type of TOS

A

neurogenic

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46
Q

initial treatment of neurogenic TOS

A

physical therapy; if this fails treat with rib resection, scalenectomy, and dissection of brachial plexus

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47
Q

presentation of neurogenic TOS:

A

pain over posterior and lateral neck that radiates down the upper extremity to the medial aspect of the hand and arm with associated paresthesia

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48
Q

venous TO treatment:

A

catheter directed thrombolysis of subclavian vein; if stenosis is present on venogram afterwards, need surgical decompression as in neurogenic type

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49
Q

cause of arterial TOS

A

subclavian artery thrombosis or aneurysm; occurs exclusively in patients with a cervical rib or elongated TP of C7 vertebrae

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50
Q

treatment of arterial TOS

A

resection of C7 bone abnormality, the first rib, and subclavian artery with graft reconstruction

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51
Q

branches of external iliac artery

A

deep circumflex iliac (provides collateral circulation to lower leg in patients with femoral occlusions); inferior epigastric

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52
Q

hypervascular tumor derived from neural crest cells located at carotid bifurcation

A

carotid body tumor

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53
Q

treatment and presentation of carotid body tumors:

A

asymptomatic in many; also may present with neck pain, dysphonia, hoarseness, stridor, dysphagia, sore throat; treat with resection

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54
Q

failure of AV access is mainly due to ____

A

outflow stenosis from intimal hyperplasia; occurs anywhere in vein of AVF and at the anastomosis of the AVF graft

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55
Q

where do peripheral arterial emboli typically lodge?

A

bifurcations

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56
Q

most common site of embolic lodgement

A

common femoral bifurcation

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57
Q

What is a DRIL (distal revascularization and interval ligation)?

A

procedure of choice for steal; artery is ligated distal to the origin of the fistula and a bypass is done between proximal and distal portions of the artery

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58
Q

physiologic effect of unilateral renal artery stenosis:

A

compensatory response by unaffected kidney to maintain euvolemia by creating a renin dependent euvolemic HTN (high serum renin)

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59
Q

physiologic effect of bilateral renal artery stenosis:

A

no compensation to maintain euvolemia, creating a volume-dependent or hypervolemic hypertensive state through negative feedback resulting in normal/low serum renin

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60
Q

treatment of an iliofemoral DVT

A

chemical and mechanical thrombolysis (superior to anticoagulation)

61
Q

True or False. Late access thrombosis of a fistula or graft usually occurs 1-2 years after placement, most commonly from intimal hyperplasia.

A

true

62
Q

first line operative therapy for FMD of the carotid artery

A

balloon angioplasty

63
Q

what nerve is at highest risk of injury during 4 compartment fasciotomy

A

superficial peroneal nerve, courses around the neck of the fibula in the lateral compartment

64
Q

Mickey Mouse sign on duplex US:

A

Mickey’s ears are the GSV (more superficial ear) and CFA; common femoral vein is the head (middle)

65
Q

What is May Thurner Syndrome:

A

compression of the left common iliac vein by the right common iliac artery, resulting in mechanical obstruction of the venous outflow tract from the LLE

66
Q

where do individuals who smoke tend to develop arterial disease?

A

SFA disease

67
Q

where do diabetics and renal disease patients tend to develop arterial disease?

A

infrapopliteal disease

68
Q

US findings of significant reflux in the saphenous, tibial, & deep femoral veins:

A

> 0.5 seconds of reflux

69
Q

US findings of significant reflux in femoral and popliteal veins:

A

> 1 second of reflux

70
Q

signs of superficial venous disease

A

pain and swelling that is least apparent in the morning before standing and ambulation; swelling limited to leg and ankle (spares foot); pain is nonspecific

71
Q

pancreaticoduodenal artery provides a vital collateral pathway between ___ and ____

A

celiac and SMA

72
Q

NASCET and ECST trial findings:

A

there is significant risk reduction in stroke for patients with symptomatic high grade stenosis (70-90%) undergoing CEA when compared to medical therapy alone; for patients with moderate stenosis (50-69%) the benefit is less but still favorable when compared to medical therapy alone

73
Q

bypass options for SMA occlusion:

A

supraceliac aorto to SMA; common iliac to SMA

74
Q

transperitoneal approach to aortic repairs advantage:

A

provides better access to the right side of the aorta (renal and iliac arteries)

75
Q

retroperitoneal approach to aortic repairs advantages:

A

less blood loss, less ileus, less pain, less infeciton, more proximal exposure of aorta

76
Q

earliest sign of compartment syndrome

A

pain

77
Q

minimum size of cephalic vein used for AVF

A

2.5-3mm

78
Q

what energy increase is required for a below knee amputation to ambulate

A

10-40%

79
Q

first line tx for mesenteric venous thrombosis

A

anticoagulation

80
Q

what accounts for most cases of renovascular HTN

A

renal artery occlusive disease due to atherosclerosis

81
Q

treatment of fibromuscular dysplasia

A

percutaneous transluminal angioplasty

82
Q

first step in management of suspected acute limb ischemia

A

IV anticoagulation

83
Q

most common microorganism in suppurative thrombophlebitis

A

Staph aureus

84
Q

treatment of suppurative thrombophlebitis

A

catheter removal, blood culture, expression of pus, antibiotics

85
Q

when is surgery required for a pseudoaneursysm?

A

acutely expanding, compressing adjacent nerves, or compromising overlying skin

86
Q

True or false. renal artery angioplasty with stent placement has been shown to be more effective in the treatment of atherosclerotic renal artery stenosis when compared with angioplasty alone

A

true

87
Q

mechanism and presentation of heparin induced thrombocytopenia:

A

heparin antibody complex binds to platelets to cause their activation and thrombocytopenia

presents 3-14 days after initial heparin exposure with arterial or venous thrombosis, platelet drop below 100,000 or by half

88
Q

testing and treatment of HIT

A

test for with ELISA test initially, confirm dx with serotonin release assay for confirmation; treat by stopping all heparin products (including lovenox) and starting direct thrombin inhibitor

89
Q

presentation of acute aortic occlusion from saddle embolus

A

acute bilateral leg ischemia and sudden paraplegia from spinal cord ischemia/cauda equina syndrome (loss of bowel and bladder control)

90
Q

treatment of saddle embolus aortic occlusion

A

immediate operative thrombectomy/embolectomy, preferably through bilateral femoral exposures of the aorta and both legs

91
Q

presentation of popliteal entrapment

A

claudication with active ankle plantar flexion and passive ankle dorsiflexion; seen in young runners

92
Q

most specific test for the presence of a DVT

A

venous duplex ultrasound

93
Q

management of acutely thrombosed popliteal artery aneurysm with acute ischemia:

A

anticoagulate with heparin
perform leg angiography to identify runoff vessel
if runoff vessel identified, perform a bypass
if no runoff, perform thrombolysis to identify a potential distal target for bypass

94
Q

classic appearance of FMD on imaging

A

string of beads appearance

95
Q

because of its location deep in the compartment of the lower leg, the _____ artery is the most likely artery to remain patent in diabetic patients with vascular disease

A

peroneal

96
Q

True or false. Thrombolysis for acute limb ischemia leads to fewer number of subsequent open surgical procedures, equivalent amputation free survival, and higher major hemorrhage rates than upfront open surgery

A

true

97
Q

True or false. accessing the supraceliac aorta requires mobilizing the left lobe of the liver and dividing the triangular ligament

A

true

98
Q

Where should the final location of the catheter tip be for a tunneled dialysis catheter

A

right atrium - because they require higher flow rates than a standard CVC

99
Q

medially located venous ulcers are connected to an incompetent ____

A

GSV

100
Q

laterally located venous ulcers are connected to an incompetent ____

A

small saphenous vein (SSV)

101
Q

At what ABI does rest pain begin?

A

0.5

102
Q

constellation of symptoms of aortoiliac occlusive disease (Leriche syndrome):

A

diminished or absent femoral pulse, buttock claudication; impotence

103
Q

presentation and treatment of venous TOS (Paget Schroetter Syndrome)

A

young, healthy people with hx of repetitive exercise (e.g. swimming, pitching); present with arm fatigue and heaviness that progresses to swelling; treat with thrombolysis (anticoagulation alone is associated with high morbidity)

104
Q

first line therapy for renovascular HTN

A

ACE inhibitor and beta blocker

105
Q

True or False. There is significant benefit in stenting over only medical therapy for patients with renovascular HTN

A

false (ASTRAL trial)

106
Q

what is post thrombotic syndrome?

A

development of chronic venous stasis symptoms after a LE DVT

107
Q

treatment of a severely symptomatic iliofemoral DVT:

A

catheter directed thrombolysis to improve morbidity and long term function (reduce posthrombotic sydrome)

108
Q

True or false. Short term complications are higher for open AAA repair but long term complications are higher with EVAR

A

true

109
Q

what is a type 1 endoleak?

A

incomplete seal between stent-graft device and native vessel; occurs typically in early postprocedure period and has a continued risk of rupture

110
Q

treatment of type 1 endoleak:

A

treat with balloon angioplasty +/- placemetn of additional component

111
Q

what is a type 2 endoleak?

A

persistent retrograde flow into the aneurysm from branch vessels/collaterals of infrarenal aorta

112
Q

treatment of type 2 endoleak:

A

controversial; may resolve spontaneously; persistent ones treated with embolization or open ligation of involved vessel

113
Q

what is a type 3 endoleak?

A

tear or rupture of fabric of graft; requires intervention

114
Q

treatment of a type 3 endoleak:

A

place a cuff or reline with a new stent within the stent graft to cover the tear

115
Q

what is a type 4 endoleak?

A

passage of blood through graft due to graft porosity; very rare with modern grafts

116
Q

treatment of type 4 endoleak?

A

anticoagulation

117
Q

what is a type 5 endoleak/endotension?

A

persistently elevated intraaneurysmal sac pressure in absence of obvious endoleak on CT

118
Q

treatment of type 5 endoleak?

A

observation

119
Q

Treatment of thrombus after EVLA at the saphenofemoral or saphenopopliteal junction:

A

aspirin

120
Q

Treatment of thrombus after EVLA with extension into the common femoral or popliteal veins with <50% surface area involvement:

A

aspirin

121
Q

Treatment of thrombus after EVLA with extension into the common femoral or popliteal veins with >50% surface area involvement or total occlusion:

A

anticoagulation

122
Q

Most common site of aortoenteric fistulas

A

duodenum

123
Q

What is nutcracker syndrome?

A

compression of left renal vein between SMA and aorta

124
Q

Symptoms of nutcracker syndrome:

A

left flank and abdominal pain
associated with varicocele in men
gross or microscopic hematuria

125
Q

What is May Thurner syndrome:

A

compression of left common iliac vein between right common iliac artery and sacral promontory/5th lumbar vertebra causing acute ileofemoral dvt and left leg swelling

126
Q

Treatment of nutcracker syndrome:

A

left adrenal vein transposition and stenting

127
Q

Treatment of May Thurner syndrome:

A

anticoagulation and compression stockings

may improve with catheter directed thrombolysis with placement of self-expanding stent

128
Q

Symptoms of popliteal vein compression:

A

varicose veins below knee or DVT

129
Q

True or false. Thrombolysis is equivalent to anticoagulation in treatment of iliofemoral DVT.

A

False. Thrombolysis is superior

130
Q

Atherosclerotic plaques often form on the _____ aspect of sclerotic vessels.

A

posterior

131
Q

Classic Ehler Danlos syndrome is due to a defect in production of ____

A

type V collagen

132
Q

Vascular Ehler Danlos syndrome is due to a defect in production of ____

A

type III collagen

133
Q

Common complication of suppurative thrombophlebitis of the jugular vein

A

septic emboli to the lungs causing empyema

134
Q

Management of uncomplicated pseudoaneursym <3cm

A

observation

135
Q

management of uncomplicated pseudoaneursym >3cm

A

US guided thrombin injection or compression

136
Q

Most common operation for SMA syndrome

A

duodenojejunostomy: bypasses compression caused by the abdominal aorta and SMA

137
Q

Treatment of spontaneous/primary superficial venous thrombosis within 3 cm of the saphenofemoral junction

A

fondaparinux for 45 days

138
Q

Peak systolic velocity for the ICA in normal anatomy

A

<125 cm/sec

139
Q

Peak systolic velocity for the ICA in 50% stenosis

A

125 cm/sec

140
Q

Peak systolic velocity for 50-69% stenosis

A

125-230 cm/sec

141
Q

Peak systolic velocity of ICA for >70% stenosis

A

> 230 cm/sec

142
Q

Management of uncomplicated femoral pseudoaneurysm <3cm

A

observation; if still not resolved after 6 weeks, US-guided thrombin injection

143
Q

Management of uncomplicated femoral pseudoaneurysm >3cm

A

US guided thrombin injection

144
Q

Features of complicated pseudoaneursym that requires surgical repair

A 
infected pseudoaneurysm
hemodynamic instability
active bleeding
skin necrosis or cellulitis
distal limb ischemia
neurologic deficit
failure of US guided treatment
large aneurysm with wide neck
145
Q

The diagnostic test of choice to confirm lymphedema

A

lymphoscintigraphy

146
Q

What is Paget-von Schroetter syndrome

A

venous thoracic outlet syndrome; severe narrowing or thrombosis of the subclavian-axillary vein secondary to chronic extrinsic mechanical compression

147
Q

Initial treatment of venous TOS

A

catheter directed thrombolytics (no longer anticoagulation alone); perform first rib resection after reestablishing venous patency

148
Q

Strongest risk factor for abdominal aortic aneursym:

A

smoking

149
Q

Basic pathophysiologic process of AAA:

A

degradation of the tunica media by proteolytic processes such as matrix metalloproteinases that least to decreased elastic and smooth muscle fibers

Vascular (1 decks)

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