Chap 84 86 Acquired AVF and Spine exposure Flashcards
What incision best for T3-T6?
T7-12
right thoracotomy
left thoracotomy
What are different approaches to the lumbosacral spine?
Transperitoneal exposure
Transperitoneal laparoscopic
Retroperitoneal
What are different methods of acquiring an AVF?
traumatic
iatrogenic
spontaneously
What is the natural hx of an iatrogenic AVF?
shunt volumes <500
50% close spon
usually benign
List disease associated with spontaneous AVF.
aneurysm
syphillis
HIV
CTD
What are the aAVF connection for carotid and vert?
to internal jugular
What are RF for femoral aAVF?
Older age Female Htn Anticoagulation Higher dose heparin Warfarin Left sided puncture Multiple puncture Low puncture Large sheath High BMI
What anatomical parameters determine flow in the distal artery?
CSA of fistula =/< then 1.5 d of inflow artery then distal flow in artery maintained
flow diminished or reversed if opening threefold size of artery
prox flow increase by x5 if 3
What are changes to vessels in chronic aAVF?
Proximally artery elongates
Artery thins ultimately leading to aneurismal degen
Proximal vein enlarges and becomes tortuous
Distal artery flow often reversed
Venous collateral
Reversible if repaired within 2 years
What are cath findings with large aAVF?
increased CO
elevated RA, RV, wedge P
decease in PVR
What are findings on duplex for aAVF?
Fistilous connection
Clor mosaic at level of fistula
Color pixels in adjacent soft tissue
Loss of triphasic wave forms in prox artery
Decreased flow in distal artery
Continuous high velocity flow in vein cephalad
What are findings of aAVF on angio?
Early venous filling
Failure of distal vessels to opacify
What are treatment strategies?
conservative for 1 year, indefinitely if really small and no sequallae
US guided compression –poor success rate
endovascular
embolization
covered stent
aortic endografts
surgery
