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Vascular Surgery > Chap 43-46 Anastomotic aneurysm, AEF, Graft Thrombosis and Endovascular > Flashcards

Chap 43-46 Anastomotic aneurysm, AEF, Graft Thrombosis and Endovascular Flashcards

1
Q

List local factors associated with development of anastomotic aneurysm.

A 
Arterial wall degen
Suture line disruption
Prosthetic graft failure
Infection/inflammation
Technical factors
Mechanical stress
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2
Q

List systemic factors associated with anastomotic aneurysm.

A 
Smoking
DLP
HTN
Anticoagulation
Vasculitides
Generalized arterial weakness
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3
Q

What are indications for treatment for anastomotic aneurysm?

A

> 2.5cm

symptomatic

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4
Q

Is endovascular better then open repair for anastomotic aneurysms?

A

endo can offer lower mortality and morbidity rates with high success rates in certain patients

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5
Q

What are the causes of primary AEF?

A 
aneurismal aorta (most common)
foreign body
tumor
radiation
infection
GI dz
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6
Q

What portion of the duodenum is involved in AEF?

A

3rd or 4th

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7
Q

Where do secondary AEF and AEE occurs?

A

AEF suture line

AEE on graft

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8
Q

What are the causes of secondary AEF?

A 
infection
pulsatile pressure (graft non compliant)
technical error (injury to bowel)
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9
Q

what is the classic triad for secondary AEF?

A

GI bleeding
abdo pain
pulsatile mass
11%

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10
Q

What is the classic feature of a secondary AEF?

A

herald bleed

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11
Q

What are findings on CT scan that indicate AEF?

A

Effacement of fat planes around aorta
Perigraft fluid and soft tissue thickening,
ectopic gas,
tethering of adjacent thickened bowel loops toward aortic graft, rarely extrav

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12
Q

What are signs of AEF on endoscopy?

A 
need to see 3-4th portions
visualization of graft
ulcer
erosion with adherent clot
extrinsic pulsatile mass
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13
Q

What are the most common bacteria for primary AEF?

A

salmonella

klebsiella

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14
Q

What are the most common bacteria for secondary AEF?

A

s.aureus

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15
Q

What are repair options?

A

graft excision without replacement if enough ollaterals

insitu graft replacement

neo-aortoiliac procedure

extra-anatomic revasc

endovascular (as bridge)

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16
Q

What grafts can be used for replacement?

A

allograft
synthetic graft
silver coated dacron
antibiotic impregnated grafts

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17
Q

What are the result of operative repair for AEF?

A

mortality 30%
amputation 10%
3 yr survival 50%

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18
Q

What are most common complications after PCI?

A 
bleeding/hematoma
PSA
AVF
dissection
thrombosis
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19
Q

What are RF for complications after endo procedure?

A 
larger sheath
interventional procedures
previous cath
small BMI
female
uncontrolled HTN
GIIbIIIa
increased age
20
Q

What are indications for intervention for femoral hematoma?

A 
hemo instability
persistent anemia
skin necrosis
nerve compression 
severe pain
21
Q

What nerves can be affected in the retroperitoneal space (4)?

A

lateral cutaneous nerve of the thigh
genitofemoral nerve
femoral nerve
nerve to cremaster muscle

22
Q

What does the lateral cutaneous nerve of the thigh innervate?

A

innervates skin on lateral thigh

23
Q

What does the genitofermoral nerve innervate?

A

sensation upper anterior thigh

sensation anterior scrotum/mons

24
Q

What does the femoral nerve innervate?

A

sensation ant/medial thigh/medial chin/arch of foot

extends knee

25
Q

What does the nerve of the cremaster muscle innervate?

A

cremasteric reflex

26
Q

What are signs/symptoms of RPB?

A 
non-specific groin/back pain
oliguria
numbness weakness LE
ecchymosis flank (grey turner)
ecchymosis umbilicus (cullens)
27
Q

What is natural hx of AVF from endovascular procedure?

A

30-80% resolve spontaneously within 1 year (most within 1 month)

28
Q

What are treatment strategies for PSA?

A

US compression

US guided thrombin

observation

surgical

Endovascular

29
Q

what is success of thrombin injection for PSA? describe procedure.

A

95-100%

Anesthetize skin
Fill sac with 0.1-0.2ml of thrombine
Direct needle away from inflow of the PSA
If perist then another dose
Check distal pulses and repeat US in 24-48 hours
Recurrence 3%

30
Q

What are indications for surgical intervention on PSA?

A 
Infected
Hemo instability
Skin necrosis
Distal limb ischemia
Neurologic defecit
Failure of US treatment
Large aneurysm >5cm with wide necks
31
Q

What causes thrombosis after endovasclar procedure?

A

large sheath
aggressive compression
closure device failure

32
Q

What are methods of nerve injury in brachial access?

A

hematoma
direct damage
schema from arterial thrombosis

33
Q

What are different types of closure devices and give an e.g.?

A 
collagen based (angioseal)
suture based (per close)
metal/disk based (star close)
34
Q

What is the evidence for closure devices?

A

MA

no difference in complication rate then with compression alone

35
Q

What are active and passive closure devices?

A

active
suture/clip
extravascular prothrombotic matrix

passive (faciliatate compression)
external patches with prothrombotic coating
assisted compression

36
Q

What were the rates of life threatening hemorrhage in TOPAS and STILE trial?

A

13%

6%

37
Q

At what fibrinogen levels do you alter thrombolysis management?

A

<100 stop

38
Q

List ways to assess graft latency intra-operatively.

A 
inspection
palpation
arteriography
doppler
duplex
angioscopy
IVUS
39
Q

What b/w to send off before initiating heparin in thromboses grafts?

A 
Plt
Functional activated protein C resistance
Anticardiolipin antibodies
ATIII
Protein S
HITT assay
40
Q

What are RF for graft thrombosis?

A 
Single vessel runoff high rate of graft failure
Below knee target
DM
Preop tissue loss
BMI >35
Early revision
African American
smoking
failure to go to surveillance
41
Q

What are the critical elements for sustained flow in bypass graft?

A 
Inflow
Outflow
Conduit
Operative technique
Coagulation profile
42
Q

What are 30 day causes of graft thrombosis?

A

technical error
graft thrombogenicity
poor runoff
obstructive venous disease

43
Q

What are 18 month causes of graft failure?

A

neointimal hyperplasia

vein graft structural abnormalities

44
Q

What are 5 year causes of graft failure?

A

vein or prosthetic graft structural abnormalities

progressive athero

44
Q

What are indications for angioplasty for intimal hyperplasia?

A

Post CTD to bridge to OR
High risk for OR
Difficult to approach surgically

Vascular Surgery (53 decks)

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