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A Cut Above the Rest (ABSITE) > Arterial Disease > Flashcards

Arterial Disease Flashcards

1
Q

An ankle brachial index that suggests increased risk of myocardial infarction

A

<0.9

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2
Q

Abdominal aortic aneurysm

A
  • 10TH LEADING CAUSE OF DEATH FOR MEN
  • Risk of rupture is low when below 5.5 cm
  • Overall moratlity rate of AAA rupture is 71 to 77%
  • Women appear to be at thigher risk of ruptures
    • 4.5 cm to 5 cm
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3
Q

The compartment most commonly affected in a lower leg compartment syndrome

A

Anterior

  • Numbness in the web space between the forst and second toes is diagnostic
    • compression of the deep peroneal nerve
  • Pressures greater than 20 mmHg are an indication for fasciotomy
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4
Q

Contraindications of MRA

A
  • Pacemakres
  • defibrillators
  • spinal cord stimulators
  • intracerebral shunts
  • cochlear implants
  • cranial clips

MRA has the advantage of not requiring iodinated contrast. Gadolinium is not nephroptoxic

Nitimol stents produce minimal artifacts

Metallic stents causes artifacts and signal drop out, howeverm these can be dealth with using alternations in image acquisition and processing

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5
Q

The preferred procedure for treatment of typical occlusive disease of the aorta and both ilicac arteries

A

Aortobifemoral bypass

  • performed becasue patients usually have disease in both iliac systmes
  • long term patency (70-80% at 10 years)
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6
Q

The most common cause of ischemic stroke is

A

Cardiogenic emboli

  • Cardiogenic emboli (35%)
  • Carotid artery disease (30%)
  • lacunar (10%)
  • Misc (10%)
  • idiopathic (15%)
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7
Q

The treatment of acute embolic mesenteric ischemia

A

Operative embolectomy

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8
Q

The correct classification for the degree of stenosis in the internal carotid artery of a patient with a luminal diameter of 69%

A

Moderate

Mild (<50%) Moderate (50-69%) severe (70-99%)

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9
Q

The treatment of nonocclusive mesenteric ischemia is

A

Catheter infusion of papaverine

  • intraarterial papaverine is given at adose of 30 to 60 mg/h this must ne coupled woth the cessayion of other vasoconstricting agents
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10
Q

Hollenhorst plawur is founf within the

A

Retinal vessels

  • cholesterol embolization from the carotid bifurcation
  • Amaurosis fugax
    • transient monocular blindness,
    • lasts for a few minutes and then resolves
    • due to embolic occlusion of the maina rtery or the upper or lower divisions
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11
Q

The msot accurate diagnostic test with the lower motor morbidity in the diagnosis of renal artery stenosis is

A

MRA

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12
Q

The risk of a recurrent ipsilateral steoke in patients with severe carotid stenosis

A

40%

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13
Q

Carotid body tumors

A
  • Usually benign
  • Carotid body originates from the third branchial arch and from neuroectodermal derived neural crest lineage.
  • The normal carotid body is located in the adventitia or periadventitial tissue at the bifurcation of the common carotid artery
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14
Q

Major risk factors associated with carotid stenosis disease progression

A
  • cigarette smoking
  • Diabetes melliutus
  • age
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15
Q

Rest pain seen with occlusive peripheral vascular disease in the lower lextremity most commonly occurs in

A

The metatarsophalangeal joint

  • requires placing the foot in a dependent position to improve symproms
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16
Q

Fibromuscular dysplasia is _____

A
  • Commonly present bilaterally in the carotid artery
  • the vertebral artery is also involved
  • an intracranial saccular aneurysm of the carotid siphon or middle cerebral artery can be identified in 50% of the patients
  • medium sized arteries that long andhave few branches
  • Women in the 4th or 5th decade are more common
  • Most common type is medial fibroplasia
    • focal stenosis or mutliple lesions with intervening aneurysmal outpouchings
    • mural dilatations and microaneursms
  • Antiplatelet medication is the generally accepted therapy
  • Endovascular treatment is recommended for patients with documented lateralizing symptoms
17
Q

The best initial treatment for a groin pseudoaneurysm after angiography?

A

Ultrasound guided injection of thrombin

  • Percutaneous catheter aspiration
    • calf vessel embolziation
    • for larger (profunda femoris or common femoral)
      • surgical embolectomy may be required
18
Q

The primary cause of renal artery occlusive lesions is

A

Atherosclerosis

  • 2/3 ialteral
  • men are affected twiche as frequently as women
  • 6th decade of life
  • the second most common = FMD
    • young, often multiparous
    • affects distal 2/3 of the main renal artery
    • R>L
19
Q

Carotid coiling

A

Associated with loss of elasticity inadults and an abrupt angulation of vessel

  • Excessive elongation og the internal carotid artery producing tortousity of the vessel
  • Carotid artery is derived from the 3rd aortic arch and dorsal aortic root uncoiled
  • Kinking is more common in women
20
Q

Complications of endovascular treatment for mesenteric ischemia

A

Access site thombosis, hematomas, and infection

  • Dissection can occur during PTA and is managed with placement of a stent
  • Balloon mounted stents are preferred over the self expanding ones because of higher radial force and the more precise placement
21
Q

The most common location for the development of atherosclerotic disease

A

Renal artery

22
Q

Angiograph indication for renal artery revascularization

A
  • Angiography criteria
    • Documented renal artery stenosis (?70%)
    • FMD
    • Pressure gradient >20 mmHg
    • Affected/unaffected kidney renin ration >1.5 to 1
  • Clinical Cirteria
    • Refractory or rapidly progressive hypertension
    • HTN associated with flash pulmonary edema without coronary disease
    • Rapidly progressive deterioration in renal function
    • Intolerance to anti HTN medications
    • Chronic renal insufficiency related to bialteral renal artery occlusive disease or stenosis to a solitary functioning kidney
    • Dialysis depended renal failure without another definite cause
    • Recurrent congestive heart failure or flash pulmonary edema not attributable to active coronary ischemia
23
Q

Aortoiliac disease represented by diffuse aortoiliac disease above the iliac artery is classified as

A

Type II

  • Type I : focal disease affecting the distal aorta and proximal common iliac artery
  • Type II: diffuse aortoiliac disease above the inguinal ligament
  • Type III: multisegment occlusive disease involving aortoiliac and infra-inguinal arterial cessels
24
Q

The treatment of choice for type B iliac lesion is

A

Endovascular therapy

  • TASC (transAtlantic Intersociety consensus)
  • TYPE A and B - endovascular
  • TYPE C and D - surgery
25
Q

Carotid bifurcation occlusive disease resultling in stroke is usually caused by

A

Atheroemboli

  • the carotid bifurcation is an area of low flow velocity and low shear stress
  • there is separation of flow into the low resistance internal carotid artery and the high resistance external carotid artery
26
Q

Crescendo TIAs refers to a syndrome comprising repeated TIAs within

A

A short period of time that is characterized by complete neurologic recovery in between

  • TIA = focal loss of neurologic function, lasting for less than 24 hours
  • Hemodynamic TIA = represents focal cerebral events that are aggravated by exercise or hemodynamic stress and typically occur after short burst of physical activity
  • Reversible ischemic = more than 24 hours but resolving within 3 weeks
  • Completed stroke = longer thant 3 weeks
27
Q

Postoperative complications of oartobitemporal bypass grafting

A
28
Q

The best diagnotic imaging modality for identifying lower extreminity occlusive disease

A

Contrast angiography

29
Q

Fontaine classification of lower extremity occlusive disease

A
  • Fontaine I - asymptomatic
  • Fontaine II
    • IIa - mild claudication
    • IIb - severe claudication
  • Fontaine III - ischemic rest pain
  • Fontaine IV - soft tissue loss, ulceration or gangrene
30
Q

The most common source of distal emboli is

A

Heart (90%)

Atrial fibrillation

  • Emboli that arise from aventricular aneurysm or from a dilated cardiomyopathy can be very large and can lodge at the aortic bigurcation
31
Q

Absolute contraindication to thrombolytic therapy

A
  • Establsuhes cardiovascular events (including TIA within the last 2 months)
  • Active bleedinf diathesis
  • Recent (<10 days) GI bleeding
  • Neurosurgery (intracranial or spinal) within the lsat 3 months
  • Intracranial trauma within the last 3 months
  • Intracranial malignancy or metastasis
32
Q

The term chronic limb ischemia is reserved for patients with objectively proven arterial occlusive disease and symtpoms lasting for more than _____

A

2 weeks

  • symptoms include, rest pain, and tissue loss
  • The diagnosis should be corroborated with noninvasive diagnostic tests
  • Ischemic rest pain most commonly occurs below an ankle pressure of 50 mmHg or a toe pressure less than 30 mmHg
33
Q

Neuropathic vs Ischemic Ulcer

A
34
Q

The percentage of patients with vein grafts that will develop intrinsic stenosis within the first 18 months

A

15%

  • Stenosis >50%, especially if associated with changes in ABI should be repaired to prevent graft thrombosis
    • patch angioplasty or short segent venous interposition
    • PTA/stenting is an option for short, focal lesions
35
Q

Cryopreserved grafts

A
  • Prone to early thrombosis
  • More expensive
  • More prone to failure than prosthetic grafts
  • Ptone to aneurysmal degeneration

usually cadaveric arteries or veins that have been subjected to rate controlled freezing with dimethyl sulfoxide (DMSO) and other cryopreservants

36
Q

When lower extremity occlusive disease extends to involve the popliteal artery or tibial vessels, the appropriate outflow vessels for performing bypass in order of descending preference are

A
  • above knee popliteal artery, belo knee popliteal artery, popliteal tibial artery, anterior tibial artery, and peroneal artery

Suitable outflow vessels are defined as uninterrupted flow channels beyond anastomosis into the foot

In patients with diabetesm it is frequently the perneal artery that is spared.

  • collaterilization to the posterior tibial and anterior tibial arteries makes it an appropriate outflow vessel
37
Q

Giant cell arteritis

A

diagnosed by temporal artery biopsy

  • also known as temporal arteritis
  • systemic chronic inflammatory vascular disease
  • typically involves the aorta and its extracranial branches of which the superficial temporal artery is specifically affected
  • ISchemic optic neuritis (40%)
  • multinucleated giant cells with a dense perivascular inflammatory infiltrate
  • Treatment: corticosteroids
38
Q

The disorder most likely involved in systemic small vessel vasculitis would be

A

Hypersensitivity angitis

39
Q

Polyarteritis nodosa

A
  • Predominantly treated with steroid and cytotoxic agent therapy
  • Men over women. 2:1
  • Presenting symptoms include low grade fever, malaise, and myalgias
  • May be sufficiently diagnosed with skin biopsy
  • Neuritis from nerve infarction occurs in 60%
  • Gi complications (50%)
  • renal involvement (40%)

A Cut Above the Rest (ABSITE) (48 decks)

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