Ch. 9 Vascular Flashcards
Traditional carotid endarterectomy (CEA) surgical procedure
open operation / arteriotomy made ICA / material is removed / opening is closed / place patch
Common problems associated with CEA
narrowing of vessel / plaque that wasn’t removed / NEOINTIMAL HYPERPLASIA as surgical site
Restenosis is
neointimal hyperplasia at surgical site
Surgical patches are used to enlarge surgical site and
reduce the potential for a stenosis by widening the lumen
With surgical patches, why are veins often everted
allows double wall thickness and vein intima to face lumen of artery
Why is eversion different from a CEA
ICA is transected at bifur and evertesd to peel plaque from wall / does not require a patch / less obvious on US
In eversion, sutures will appear
circumferentially around the ICA
What is the primary concern of these surgeries
restenosis / residual plaque / suture narrowing / thrombosis or occlusion
Dacron patch has
woven appearance
PTFE patch has
two bright echogenic lines
Vein patch resmbles
native wall
After surgery with synthetic patch, neck swelling may be caused by
hematoma, infection or pseudoaneurysm
After surgery with vein patch, neck swelling may be caused by
patch rupture
Post CEA infection is associated with
encap masses / perivascular fluid / neck swelling / extravasated blood
Pitfalls in US post surgery
complicated exam during postoperatively period
Why is it hard to examine post surgery for patches
air entrapped in patch / wound hematoma / synthetic patch
Complications with diagnosis and patches include
suture disruption / suture hole bleeding / pseudoaneurysm
Non-stenotic pathology includes
oversized/irregular patch / loose strands of suture / intimal flap / embolization/occlusion
Stenotic problems within 1 month post surgery
narrowing of closure / shelf lesion / thrombus
Remnant plaque is also called
shelf lesion
Restenosis problems include
narrowing in the first 24 months considered neointimal hyperplasia / possible occlusion
After 2 years, stenosis considered
atherosclerotic
Catheter access for carotid artery stenting is usually through the
common femoral artery
Complications from stents that occur in carotid system and pathway of catheter are
dissection / thrombosis / perforations
What is commonly used prior to stent placement
embolic protection device (EPD)
Stenting procedure
pre-dilation with angioplasty balloon / self expanding stent placement followed by balloon
Stent must cover ____ lesion and extend ____ beyond proximal and distal margins of lesion
full, 5mm
What is most common post stent placement issue and what %
stent border stenosis, 40%
What is a pitfall in stent placement
atherosclerotic plaque is not removed
What happens when the atherosclerotic plaque is not removed
dense calcification and shadowing
Dense plaquing may result in
problems placing stent / restricts balloon / increase hyperplasia
Stent fracture and migration is strongly associated with
calcifications
Restenosis rates after CAS may be
40% higher than CEA
In stent restenosis ______ may be an ongoing response to implanted foreign object
hyperplasia
Hyperplasia can occur across
middle of stent, proximal attachment sire or distal attachment site
What is seen with diabetes with stent placement
aggressive initial hyperplasia and in stent restenosis
Changes in velocity after placement
elevated velocity and reduces arterial compliance
Primary discriminator for significant stenosis is the
peak systolic velocity
What is the PSV threshold for 50% stenosis
175-240 cm/s
