AVF Flashcards
what is an AVF
ABNORMAL connection between high pressure arterial and low pressure venous system
describe the waveform prox to the AVF
increased diastolic flow
fistula reduces resistance
describe arterial flow distal to AVF
resumes normal triphasic pattern
or
may be slightly reduced
describe arterial and venous connection in AVF
high velocities low resistant flow
describe venous outflow of AVF
low resistant pulsatile flow
what is compartment syndrome
trauma or occlusion causes swelling in tightly bound compartment
what complication may come from compartment syndrome
extrinsic compression on nerves and tibial arteries causes
sever pain, tenderness, foot drop and neurological changes
what is the protocol for r/i a pseudoaneurysm
determine size and location
image neck (measure)
(doppler bidirectional flow pattern)how is pseudoaneurysm treated
what is the key to determining the success of this technique
compression
finding the neck between the artery and the pseudoaneurysm and making sure tat it can be uniformly and compleatly compressed
what are contraindication to treating psudoaneurysm
inability to unifromly compress neck
anticoagulation therapy
multiple communicating channels *
what is another type of treatment for pseudo aneurysm
what are contraindications
thrombin injection
alergic rx bc it is bovine material
infection
ischemia of overlying skin
distal limb ischemia (if too much thrombin is injected!!!:0)
this size of the neck should always be measured as it is what determines what method of treatment is used
what is treatment for compartment syndrome
faciotomy
what is Popliteal artery entrapment syndrome
pop a compressed by the head of the gatronemius muscle or fibrous bands
how do patients present with popliteal entrapment syndrome
symptomatic arterial occlusion or intermittent claudication
young men— intermitent occlusion with dorsiflection
monitor flow distal from area of entrapment have pt contract gastroc and if flow goes away it is positive
what is the deep superior epigastric artery a terminal branch of
internal mammary artery
what is TRAM flap and what is it used for
transverse rectus abdominis myocutaneous
removed from rectus abdominal muscle with vasculature ect to use in autogionus breast reconstruction
internal mamary artery is also called
internal thoracic artery
the internal mammary artery comes off of
subclavian artery
why is the internal thoracic artery significant in vein mapping
in autogeneous breast reconstruction it is used as connection for deep superior epigastric artery from rectus sheath of TRAM flap
used as graft to the left anterior descending coronary artery
Radial artery mapping is used for
coronary artery graft
allen test is used to see if it can be removed
what is the value that the radial artery should measure greater than if it is suitable for graft use
> 2mm
what are indications for preop vein mapping
coronary bypass graft
dialysis access graft
which veins are commonly used for grafts and what size do they need to be
GSV (sometimes SSV)
measurements are made at various segments through the entire vessel
Basilic and Cephalic vessels in the UE
what are the teq of vein mapping
measure diameter (outter to outter edge)
compressability
length of segment that can be used for graft
> 2-3mm
mentioning thickening of wall , note high bifurcation , duplicate venous system , thin walls ect
what is thoracic outlet syndrome
ompression of neurovascular bundle by cervical rib clavicle.scalene m. which occurs with certain arm positions
what is the cause of thoracic outlet syndrome
neurogenic 97%
subclavian compression
what method is used in thoracic outlet test
doppler with ppg
normal signal is negative
if no signal / abnormal dampened signal during arm positions =positive
arm positions for thoracic outlet test
6
:(
resting arms in lap arm 90* 's arm 180*'s adduction exaggerated military stance Addison's maneuver : military stance with head turned sharp rigt and then left causative position as per pt
what is treatment for thoracic outlet syndrome
shoulder exercises / surgery
how can vascular trauma occur and what may not be present because of them
blunt trauma bone fracture hematoma penetrating trauma GSW
there may or may not be distal trauma
