Arterial Disorder Flashcards
Keywords which indicates acute arterial occlusion
Atrial Fibrillation and Irregularly irregular heartbeat
6Ps of acute arterial occlusions are
Pain
Pallor
Paresis
Paraesthesia ; complete loss of sensation
Poikilothermia
Pulselessness (late sign)
IOC for acute arterial occlusion is
Duplex Scan
What is embolectomy
Is the emergency surgical removal of emboli which are blocking blood circulation. It involves removal of thrombi , and is then referred to as thrombectomy
Embolectomy in acute arterial obstruction is done by
Fogarty’s ballons
What is compartment syndrome?
A painful and dangerous condition caused by pressure buildup from internal bleeding or swelling of tissues. It occurs when pressure rises in and around muscles. It can limit the flow of blood, oxygen and nutrients to muscle and nerves.
What are the clinical features of compartment syndrome?
Excessive pain
pain on passive stretching
Pulsations can be present
What are the clinical features of chronic arterial occlusion?
Intermittent claudication pain,
rest pain(it is worse at night)
Which classification is used in chronic arterial occlusion?
Boyd classification
In boyd class one classification there is pain on walking but pain reduces as patient continues to walk. why so?
Due to dilution of substance P
What is neurogenic claudication?
Varies with posture, (lumbar canal stenosis. )Pain is relieved when patients bends forward.
Where does pain is felt in chronic arterial occlusion
Pain felt in the muscle group distal to the block due to collateral Formed
In case of a lower limb occlusion, where does most commonly pain is felt
Calf
What is leriche syndrome?
Aortoiliac obstruction, claudication in buttocks thighs and calves.
impotence in males
What is the earliest sign of leriche syndrome?
Gluteal claudication
What is the formula of ABPI ?
Maximum systolic BP in ankle/Maxximum systolic BP in arm
Readings of a ABPI Are
0.9 to 1.3 normal
< 0.9 intermittent claudication starts
< 0.5 rest pain.
< 0.3 critical limb ischemia, (iminent necrosis)
> 1.3 calcified vessels (usually seen in DM/CKD )
Normal patient after exercise ABPI
Increases
patient with rate limiting arterial disease after exercise ABPI
DECREASES
For every 0.1 decreases in a ABPI below 0.9. , risk of cardiac mortality, increases by…%
10%
In obese patient which investigation is done to visualize the illiac block
MR angio and digital subtraction angiography
Why, Bergers disease is known as thromboangiitis obliterans
Because it involves all three vessels artery vein, and nerve while in atherosclerosis only artery is involved
Describe the spread of Bergers disease
Spread is distal to proximal ; small to medium vessels, vice versa for atherosclerosis 
On angiography, what can we see in burgess disease?
Corkscrew collaterals can be seen 
Management of Bergers disease
Stop smoking
Pentoxifylline, : reduce viscosity increase micro perfusion
conservative amputation
no bypass grafting
lumbar sympathectomy - lumber sympathectomy is contraindicated in intermittent claudication
Most common structure, which can be mistaken for sympathetic chain during lumbar sympathectomy, is
genitofemoral nerve
What caution should be taken during bilateral lumbar, sympathectomy
L1 ganglion needs to be saved on one side otherwise it will lead to importance
Omental plasty has no role
What is the first line management for atherosclerosis involves bigger vessel?
Angioplasty and stenting
What to do if angiography is not successful
Do bypass grafting
Management in leriche syndrome (aorto- iliac block)
Aorto bifemoral graft needs to be done Decron graft craft for above the inguinal ligament
Which graft is used for illiac blocks
Aorto femoral/iliofemoral graft —> Dacron
For femoral artery block, which grat is used?
Ilio-popliteal graft(below inguinal ligament)
Best graft for infra inguinal graft.
Reversed saphenous vein graft
Best synthetic graft: PTFE
Reversed saphenous vein graft> PTFE
What is line of demarcation?
Junction between dead and living tissues,
lined by granulation tissues, hyperesthesia present
Indication of amputation are
Dead : gangrene
Deadly : gas gangrene , sarcoma ,cancer
Damn nuisance : contractures, sinus/fistula , deformity
In DM ….. amputation of digits is done
Local
If metatarsophalangeal joint is involved, …..incision is made
Ray
Below knee amputation amputation stump is placed at
Not < 8 cm below knee(10-12cm)
Which flap are used in knee amputation
Long posterior flap : more popular anterior mark 10 cm below tibial tuberosity
Skew flap
length above knee amputation is
Length not < 20 cm for prosthesis to fit in
What is phantom limb?
It is a late complication of amputation
It occurs when neuroma is formed when the nerves are not sharply cut, leading to the perception of the limb, still being there.
What is the most common form of aneurysm ?
Fusiform aneurysm (uniform dilation of vessel)
What is the most common vessels involved in aneurysm is
Circle of Willis
What is the most common extracranial vessel involved in aneurysm?
Infrarenal abdominal aorta
What is the most common peripheral vessel involved in Aneurysm
Popliteal vessels
What is the most common visceral vessel involved in?
Splenic artery
Most common vessel involved in mycotic aneurysm is
Aorta
The term mycotic is misnomer. It is actually a bacterial aneurysm organism involved is staph aureus
Pseudoaneurysm formation is commonly seen in the
Femoral artery, and this is secondary to cannulation or any trauma
What is AAA
Abdominal, aortic aneurysm
Who is the most important RF for aneurysm formation is
Atherosclerosis
Critical diameter of aneurysm is
5.5 cm even if the patient are asymptomatic, they should be surgically managed.
What is the critical diameter in female?
5 cm chances of rupture higher in females
Value of critical diameter in descending thoracic, aortic aneurysm is
6 cm
if there is more than 1 cm increase in size, it is a significant finding
Value of critical diameter in ascending thoracic, aortic aneurysm is
5.5 cm
if there is more than 0.5 cm increase in size, it is a significant finding
Critical diameter for a patient with Marfan syndrome
4.5 to 5 cm
What is Blue toe syndrome? Gangrene.
Aneurysm can also act as a source of embolus
IOC for aneurysm
CT
Screening modality is USG abdomen
What are the contraindications of EVAR?
Difficult iliac access
increase angulation
Improper seal type of endoleak is seen in
Thoracic, aortic aneurysm
Retrograde leak from the lumbar vessels is seen in
Abdominal aorta
What is Mattox procedure?
Aorta lies on the left side
It is a left medial visceral rotation
Here the descending colon is mobilized immediately it will expose the aorta behind
What is kettle brash manoeuvre?
It is right medial visceral, rotation
here, ascending colon is mobilized medially exposing the IVC
What is kocherization?
It is the mobilization of the duodenum
Complication of AAA
CVS cause
Renal failure 
Aorto duodenal fistula
Colonic ischemia (left side and involves inferior mesenteric artery)
Paraparesis (due to involvement of artery of Adamkiwiez supplies, the anterior spinal artery )
Artery of Adamkiwiez
typically arises from the left side of the aorta between T8 and L2
The artery of Adamkiewicz is significant in that it is the only major arterial supply supplying the anterior spinal artery along the lower thoracic, lumbar, and sacral segments of the spinal cord
Mortality ratio in emergency repair of AAA
More than 50%
 If there is a rupture of AAA NO which GRAFT REPAIR IS MUST DONE
Dacron
Which classification is used for thoracal abdominal aortic aneurysm
Crawford classification
Which is the most extensive type in Crawford classification for TAAA?
Type II
Causes of TAAA
They can be secondary to atherosclerosis Marfan syndrome,
Ehlers danlos syndrome
what is Ortner’s syndrome?
Presence of hoarseness due to pressure from descending thoracic aneurysm in left recurrent laryngeal nerve
IOC for TAAA
CT angiography
Blood normally flow from which layer of the vessel
Intima
What is the common site of dissection?
Lateral wall of ascending thoracic aorta
Where does chest pain radiate , in AD?
To the back in the interscapular region
More common in males
IOC for AD
If stable : CT angiography
If Unstable : transesophageal, echo
What are the two types of classification for AD?
DeBakey classification ( Type 1,2,3(3a 3b)
Stanford classification (Type A & Type B)
Tell me about some interesting topic in AD
Although hypertension triggers the tear, but once the tear is occur, there is hypotension due to the formation of a parallel lumen
First line treatment for AD
Esmolol administered immediately and it is a short acting beta blocker
Management of AD
Type type 1&2 DeBucky- graft repair is done
Type type 3 DeBucky- patient are monitor if progressive symptoms. Are there surgery done
How does popliteal aneurysms patient present?
Patient comes with a pulse it and swelling of the knees. There’s a loss of contour in the knee behind . there can be pain and distal emboli.
IOC for popliteal aneurysms
CT angiogram
What is the indication of intervention in a patient with popliteal aneurysms?
Asymptomatic but diameter >2 cm
all symptomatic patient
What is the critical diameter for femoral artery?
3 cm
Treatment for FAA
<3 cm Thrombin injection against USC guidance
>3 cm surgical repair
What is the etiology of Raynaud’s phenomena
Vasospasm
In which phase of Raynaud’s phenomenon the hand becomes blue and extent painful
Phase 2
Raynaud’s phenomena is commonly seen in
Workers constantly using vibrating tools
What is the DOC of Raynaud’s phenomenon?
CCB
What is the DD of Raynaud’s phenomenon
Acrocyanosis but unlike the disease, acrocyanosis painless, and non-episodic
What is subclavian steal syndrome?
This occurs when stenosis in the first part of the block occurs when the flow to the arm is impaired
Management of subclavian steal syndrome
Angioplasty
What is the most common site for carotid artery stenosis?
Bifurcation
MCC of carotid artery stenosis
Secondary to atherosclerosis
What are the symptoms of carotid artery stenosis?
Transient ischemic attacks
Amaurosis fugax : episodic blindness
Dysphagia
IOC for carotid artery stenosis
Duplex scan
What does thoracic outlet includes
Subclavian vessels and brachial plexus
What clinical tests are done in a patient with thoracic outlet syndrome
Adson test
Halstead maneuver(reverse Adson’s test)
Wright’s hyper abduction test
EAST or Roos test
ULTT or ELVEY
What is cirsoid aneurysm
It is an AV malformation . it is seen in the region of the scalp, and associated with superficial temporal vessels of vascular pulsatile swelling, which can be partially compressible 
AV fistulas are
Cimino fistula which is a radio cephalic fistula between the radial artery and the cephalic vein
Name some of the congenital AV fistula
Parker webber syndrome
back with Weidman syndrome,
Sturge-Weber syndrome
Which clinical signs seen in congenital AV fistulae
Nicolasoni/branham sign : on pressing the feeding vessel of AV fistula
IOC for congenital AV fistulae
MRI and angiography
What is carotid endarterectomy?
Carotid endarterectomy is a surgical procedure used to reduce the risk of stroke from carotid artery stenosis. In endarterectomy, the surgeon opens the artery and removes the plaque
On doppler USG a normal artery has a …. Flow
Triphasic flow
Critical limb ischemia is characterized by
Ulceration,
gangrene,
rest pain
Which nerve is involved in TOS
Ulnar nerve
Pancoast thmor arise from
Upper lobe of the lung
Patient with TOS comes with a complaint of
Been in paresthesias along the medial aspect of the arm and medial two finger
Value of critical diameter in a patient with popliteal artery aneurysm
> 2-3 cm
What is the criteria for rapidly growing aneurysms?
> 0.5 cm/year for ascending aortic aneurysm
1 cm/year for descending aortic aneurysm
What is sunset foot sign?
A swollen and erythematous limb is seen in critical limb ischemia when the limb is in the dependent position there is pooling of blood, which causes the limb to appear red and swollen.
Which test is used to perform the severity of peripheral vascular disease?
Burgers test
Most common symptom of POVD
Intermittent claudication
In POVD, muscle group affected by claudication is …..the level of arterial disease
One anatomical level below
Which is the best graft for femoroilliac bypass
Great saphenous vein
Ischemia beyond how many hours is usually irreversible and result in limb loss
6 hours
Atheroembolism is AKA
Cholesterol embolism or blue toe syndrome
In paget-schroetter syndrome….. is affected
Subclavian vein
Burgers disease AKA
Thrombophlebitis oblitetans
Triad of Burgers disease
Claudication of affected extremities
Raynaud’s phenomenon
Migratory superficial vein thrombophlebitis
Mgt of leriche syndrome
Aortobifemoral grafting
What is the most common location of aortic aneurysm?
Infrarenal aorta
80% AAA ruptures into
Retroperitoneal space
20% AAA ruptures into
Peritoneal cavity
Most common site of a traumatic aneurysm is
Descending thoracic aorta
Which structure is most commonly involved in crisoid aneurysm
Superficial temporal artery
