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Arterial Disorder Flashcards

1
Q

Keywords which indicates acute arterial occlusion

A

Atrial Fibrillation and Irregularly irregular heartbeat

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2
Q

6Ps of acute arterial occlusions are

A

Pain
Pallor
Paresis
Paraesthesia ; complete loss of sensation
Poikilothermia
Pulselessness (late sign)

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3
Q

IOC for acute arterial occlusion is

A

Duplex Scan

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4
Q

What is embolectomy

A

Is the emergency surgical removal of emboli which are blocking blood circulation. It involves removal of thrombi , and is then referred to as thrombectomy

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5
Q

Embolectomy in acute arterial obstruction is done by

A

Fogarty’s ballons

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6
Q

What is compartment syndrome?

A

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.

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7
Q

What are the clinical features of compartment syndrome?

A

Excessive pain
pain on passive stretching
Pulsations can be present

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8
Q

What are the clinical features of chronic arterial occlusion?

A

Intermittent claudication pain,
rest pain(it is worse at night)

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9
Q

Which classification is used in chronic arterial occlusion?

A

Boyd classification

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10
Q

In boyd class one classification there is pain on walking but pain reduces as patient continues to walk. why so?

A

Due to dilution of substance P

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11
Q

What is neurogenic claudication?

A

Varies with posture, (lumbar canal stenosis. )Pain is relieved when patients bends forward.

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12
Q

Where does pain is felt in chronic arterial occlusion

A

Pain felt in the muscle group distal to the block due to collateral Formed

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13
Q

In case of a lower limb occlusion, where does most commonly pain is felt

A

Calf

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14
Q

What is leriche syndrome?

A

Aortoiliac obstruction, claudication in buttocks thighs and calves.
impotence in males

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15
Q

What is the earliest sign of leriche syndrome?

A

Gluteal claudication

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16
Q

What is the formula of ABPI ?

A

Maximum systolic BP in ankle/Maxximum systolic BP in arm

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17
Q

Readings of a ABPI Are

A

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 )

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18
Q

Normal patient after exercise ABPI

A

Increases

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19
Q

patient with rate limiting arterial disease after exercise ABPI

A

DECREASES

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20
Q

For every 0.1 decreases in a ABPI below 0.9. , risk of cardiac mortality, increases by…%

A

10%

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21
Q

In obese patient which investigation is done to visualize the illiac block

A

MR angio and digital subtraction angiography

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22
Q

Why, Bergers disease is known as thromboangiitis obliterans

A

Because it involves all three vessels artery vein, and nerve while in atherosclerosis only artery is involved

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23
Q

Describe the spread of Bergers disease

A

Spread is distal to proximal ; small to medium vessels, vice versa for atherosclerosis 

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24
Q

On angiography, what can we see in burgess disease?

A

Corkscrew collaterals can be seen 

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25
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
26
Most common structure, which can be mistaken for sympathetic chain during lumbar sympathectomy, is
genitofemoral nerve
27
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
28
What is the first line management for atherosclerosis involves bigger vessel?
Angioplasty and stenting
29
What to do if angiography is not successful
Do bypass grafting
30
Management in leriche syndrome (aorto- iliac block)
Aorto bifemoral graft needs to be done Decron graft craft for above the inguinal ligament
31
Which graft is used for illiac blocks
Aorto femoral/iliofemoral graft —> Dacron
32
For femoral artery block, which grat is used?
Ilio-popliteal graft(below inguinal ligament)
33
Best graft for infra inguinal graft.
Reversed saphenous vein graft Best synthetic graft: PTFE Reversed saphenous vein graft> PTFE
34
What is line of demarcation?
Junction between dead and living tissues, lined by granulation tissues, hyperesthesia present
35
Indication of amputation are
Dead : gangrene Deadly : gas gangrene , sarcoma ,cancer Damn nuisance : contractures, sinus/fistula , deformity
36
In DM ….. amputation of digits is done
Local
37
If metatarsophalangeal joint is involved, …..incision is made
Ray
38
Below knee amputation amputation stump is placed at
Not < 8 cm below knee(10-12cm)
39
Which flap are used in knee amputation
Long posterior flap : more popular anterior mark 10 cm below tibial tuberosity Skew flap
40
length above knee amputation is
Length not < 20 cm for prosthesis to fit in
41
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.
42
What is the most common form of aneurysm ?
Fusiform aneurysm (uniform dilation of vessel)
43
What is the most common vessels involved in aneurysm is
Circle of Willis
44
What is the most common extracranial vessel involved in aneurysm?
Infrarenal abdominal aorta
45
What is the most common peripheral vessel involved in Aneurysm
Popliteal vessels
46
What is the most common visceral vessel involved in?
Splenic artery
47
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
48
Pseudoaneurysm formation is commonly seen in the
Femoral artery, and this is secondary to cannulation or any trauma
49
What is AAA
Abdominal, aortic aneurysm
50
Who is the most important RF for aneurysm formation is
Atherosclerosis
51
Critical diameter of aneurysm is
5.5 cm even if the patient are asymptomatic, they should be surgically managed.
52
What is the critical diameter in female?
5 cm chances of rupture higher in females
53
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
54
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
55
Critical diameter for a patient with Marfan syndrome
4.5 to 5 cm
56
What is Blue toe syndrome? Gangrene.
Aneurysm can also act as a source of embolus
57
IOC for aneurysm
CT Screening modality is USG abdomen
58
What are the contraindications of EVAR?
Difficult iliac access increase angulation
59
Improper seal type of endoleak is seen in
Thoracic, aortic aneurysm
60
Retrograde leak from the lumbar vessels is seen in
Abdominal aorta
61
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
62
What is kettle brash manoeuvre?
It is right medial visceral, rotation here, ascending colon is mobilized medially exposing the IVC
63
What is kocherization?
It is the mobilization of the duodenum
64
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 )
65
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
66
Mortality ratio in emergency repair of AAA
More than 50%
67
 If there is a rupture of AAA NO which GRAFT REPAIR IS MUST DONE
Dacron
68
Which classification is used for thoracal abdominal aortic aneurysm
Crawford classification
69
Which is the most extensive type in Crawford classification for TAAA?
Type II
70
Causes of TAAA
They can be secondary to atherosclerosis Marfan syndrome, Ehlers danlos syndrome
71
what is Ortner’s syndrome?
Presence of hoarseness due to pressure from descending thoracic aneurysm in left recurrent laryngeal nerve
72
IOC for TAAA
CT angiography
73
Blood normally flow from which layer of the vessel
Intima
74
What is the common site of dissection?
Lateral wall of ascending thoracic aorta
75
Where does chest pain radiate , in AD?
To the back in the interscapular region More common in males
76
IOC for AD
If stable : CT angiography If Unstable : transesophageal, echo
77
What are the two types of classification for AD?
DeBakey classification ( Type 1,2,3(3a 3b) Stanford classification (Type A & Type B)
78
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
79
First line treatment for AD
Esmolol administered immediately and it is a short acting beta blocker
80
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
81
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.
82
IOC for popliteal aneurysms
CT angiogram
83
What is the indication of intervention in a patient with popliteal aneurysms?
Asymptomatic but diameter >2 cm all symptomatic patient
84
What is the critical diameter for femoral artery?
3 cm
85
Treatment for FAA
<3 cm Thrombin injection against USC guidance >3 cm surgical repair
86
What is the etiology of Raynaud’s phenomena
Vasospasm
87
In which phase of Raynaud’s phenomenon the hand becomes blue and extent painful
Phase 2
88
Raynaud’s phenomena is commonly seen in
Workers constantly using vibrating tools
89
What is the DOC of Raynaud’s phenomenon?
CCB
90
What is the DD of Raynaud’s phenomenon
Acrocyanosis but unlike the disease, acrocyanosis painless, and non-episodic
91
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
92
Management of subclavian steal syndrome
Angioplasty
93
What is the most common site for carotid artery stenosis?
Bifurcation
94
MCC of carotid artery stenosis
Secondary to atherosclerosis
95
What are the symptoms of carotid artery stenosis?
Transient ischemic attacks Amaurosis fugax : episodic blindness Dysphagia
96
IOC for carotid artery stenosis
Duplex scan
97
What does thoracic outlet includes
Subclavian vessels and brachial plexus
98
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
99
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 
100
AV fistulas are
Cimino fistula which is a radio cephalic fistula between the radial artery and the cephalic vein
101
Name some of the congenital AV fistula
Parker webber syndrome back with Weidman syndrome, Sturge-Weber syndrome
102
Which clinical signs seen in congenital AV fistulae
Nicolasoni/branham sign : on pressing the feeding vessel of AV fistula
103
IOC for congenital AV fistulae
MRI and angiography
104
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
105
On doppler USG a normal artery has a …. Flow
Triphasic flow
106
Critical limb ischemia is characterized by
Ulceration, gangrene, rest pain
107
Which nerve is involved in TOS
Ulnar nerve
108
Pancoast thmor arise from
Upper lobe of the lung
109
Patient with TOS comes with a complaint of
Been in paresthesias along the medial aspect of the arm and medial two finger
110
Value of critical diameter in a patient with popliteal artery aneurysm
>2-3 cm
111
What is the criteria for rapidly growing aneurysms?
> 0.5 cm/year for ascending aortic aneurysm >1 cm/year for descending aortic aneurysm
112
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.
113
Which test is used to perform the severity of peripheral vascular disease?
Burgers test
114
Most common symptom of POVD
Intermittent claudication
115
In POVD, muscle group affected by claudication is …..the level of arterial disease
One anatomical level below
116
Which is the best graft for femoroilliac bypass
Great saphenous vein
117
Ischemia beyond how many hours is usually irreversible and result in limb loss
6 hours
118
Atheroembolism is AKA
Cholesterol embolism or blue toe syndrome
119
In paget-schroetter syndrome….. is affected
Subclavian vein
120
Burgers disease AKA
Thrombophlebitis oblitetans
121
Triad of Burgers disease
Claudication of affected extremities Raynaud’s phenomenon Migratory superficial vein thrombophlebitis
122
Mgt of leriche syndrome
Aortobifemoral grafting
123
What is the most common location of aortic aneurysm?
Infrarenal aorta
124
80% AAA ruptures into
Retroperitoneal space
125
20% AAA ruptures into
Peritoneal cavity
126
Most common site of a traumatic aneurysm is
Descending thoracic aorta
127
Which structure is most commonly involved in crisoid aneurysm
Superficial temporal artery

Surgery (30 decks)

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