AVF

Question 1

what is an AVF

Answer 1

ABNORMAL connection between high pressure arterial and low pressure venous system

Question 2

describe the waveform prox to the AVF

Answer 2

increased diastolic flow

fistula reduces resistance

Question 3

describe arterial flow distal to AVF

Answer 3

resumes normal triphasic pattern
or
may be slightly reduced

Question 4

describe arterial and venous connection in AVF

Answer 4

high velocities low resistant flow

Question 5

describe venous outflow of AVF

Answer 5

low resistant pulsatile flow

Question 6

what is compartment syndrome

Answer 6

trauma or occlusion causes swelling in tightly bound compartment

Question 7

what complication may come from compartment syndrome

Answer 7

extrinsic compression on nerves and tibial arteries causes

sever pain, tenderness, foot drop and neurological changes

Question 8

what is the protocol for r/i a pseudoaneurysm

Answer 8

determine size and location
image neck (measure)
                    (doppler bidirectional flow pattern)

Question 9

how is pseudoaneurysm treated

what is the key to determining the success of this technique

Answer 9

compression

finding the neck between the artery and the pseudoaneurysm and making sure tat it can be uniformly and compleatly compressed

Question 10

what are contraindication to treating psudoaneurysm

Answer 10

inability to unifromly compress neck
anticoagulation therapy
multiple communicating channels *

Question 11

what is another type of treatment for pseudo aneurysm

what are contraindications

Answer 11

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

Question 12

what is treatment for compartment syndrome

Answer 12

faciotomy

Question 13

what is Popliteal artery entrapment syndrome

Answer 13

pop a compressed by the head of the gatronemius muscle or fibrous bands

Question 14

how do patients present with popliteal entrapment syndrome

Answer 14

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

Question 15

what is the deep superior epigastric artery a terminal branch of

Answer 15

internal mammary artery

Question 16

what is TRAM flap and what is it used for

Answer 16

transverse rectus abdominis myocutaneous

removed from rectus abdominal muscle with vasculature ect to use in autogionus breast reconstruction

Question 17

internal mamary artery is also called

Answer 17

internal thoracic artery

Question 18

the internal mammary artery comes off of

Answer 18

subclavian artery

Question 19

why is the internal thoracic artery significant in vein mapping

Answer 19

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

Question 20

Radial artery mapping is used for

Answer 20

coronary artery graft

allen test is used to see if it can be removed

Question 21

what is the value that the radial artery should measure greater than if it is suitable for graft use

Answer 21

> 2mm

Question 22

what are indications for preop vein mapping

Answer 22

coronary bypass graft

dialysis access graft

Question 23

which veins are commonly used for grafts and what size do they need to be

Answer 23

GSV (sometimes SSV)
measurements are made at various segments through the entire vessel
Basilic and Cephalic vessels in the UE

Question 24

what are the teq of vein mapping

Answer 24

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

Question 25

what is thoracic outlet syndrome

Answer 25

ompression of neurovascular bundle by cervical rib clavicle.scalene m. which occurs with certain arm positions

Question 26

what is the cause of thoracic outlet syndrome

Answer 26

neurogenic 97%

subclavian compression

Question 27

what method is used in thoracic outlet test

Answer 27

doppler with ppg

normal signal is negative
if no signal / abnormal dampened signal during arm positions =positive

Question 28

arm positions for thoracic outlet test
6
:(

Answer 28

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

Question 29

what is treatment for thoracic outlet syndrome

Answer 29

shoulder exercises / surgery

Question 30

how can vascular trauma occur and what may not be present because of them

Answer 30

blunt trauma
bone fracture
hematoma 
penetrating trauma 
GSW

there may or may not be distal trauma