Chap 87-91 Open Endovascular Technique Flashcards
List occlusive clamps.
Debakey aortic aneurysm clamp
Fogarty aortic clamp
Lambert-kay aortic clamp
Wylie hypogastric clamp
List partially occluding clamps.
Lemole-strong aortic clamp
Statinsky
Cooley anastomosis
List self compressing clamps.
Potts bulldog
Debakey bulldog
Dietrich bulldog
List different needle types.
Calcific CC Small BV Medium C1 Large RB-1 Large aorta v7 Large MH
List when to use what size fogarty.
2F small vessel pedal/hand 3F tibial 4F pop/SFA 5F external iliac 6-7 graft saddle aortic
List adjunct to localizeing th eCFA for puncture.
palpation/landmarks
fluoro
US
What is the gauge of a puncture needle? micro puncture?
18 gauge (0.035) 21 gauge (0.018)
What is the pressure limit for flow through a multi holed and end hole catheter?
900 PSI
300-500 PSI
List different flush catheters.
pigtail
omni
straight
List different single curved.
kumpe
Bernstein
MPA
MPB
List different double curved.
C1 C2 C3 head hunter Rim mammary judkins
List diffferent reverse curve
SOS
VS1-3
simmons
Name different crossing catheters.
quick cross
trailblazer
crosscath
minnie
What is nominal pressure?
Pressure required to expand the balloon to stated diameter
What is rated burst pressure?
Pressure at which 99.9% of balloons tested will not burst
What is compliance?
Amount a balloon will expand beyond its diameter as inflation pressure is increased
Do lower compliance balloon have higher or lower burst P?
lower
What is trackability?
Ability to follow course of guide wire
What is push ability?
Columnar force transmitted to shaft of balloon catheter to tip of balloon
What size balloon for CIA? EIA? SFA? pop? tibial?
6-10 6-8 5-7 4-6 2-3
List three devices used for crossing CTO?
corsser device (vibrate) truepath (rotational) frontrunner (articulating)
What are pros for BE?
high radial force/ongitudinal force
precise placement
further expansion with larger balloons
radioopaque
What are cons for BE?
short lengths, prone to crushing
What are pros for SE?
flexible, longer length
continued radial force ir oversize
crush resistant
ability to clamp stent
What are cons for SE?
low radial force
less precise
limited radioopacity
What are indications for secondary stenting?
Dissection Residual stenosis Pressure gradient Occlusion Recurrence
What are indication for primary stenting?
Heavily calcified ostial lesions
Renal, mesenteric
Brachiocephalic
Aortic bifurcation
What are relative indications for aorta-uni?
Very small terminal aorta <15mm
Severe unilateral iliac occlusive disease
Secondary treatment of a short-body endograft migration
What are some anatomical considerations for EVAR?
neck 10-15mm neck diameter accomodate 10-20% oversize angulation <20mm iliac coverage 2cm careful thrombus, conical, calcified, posterior bulges in neck
what are relative CI for perch closure?
severly scarred groins high fem bifurcation frequen introducer changes significant prox iliac occlusive disease small ilio fem anterior calcific femoral
What are adjunct to facilitate contra limb cannulation?
don’t loose wire access on contra side/may be difficult to regain if tortuose choose steerable angled wire oblique fluoro view antegrade access from brachial convert to aorto-uni
What to look for on completion angio?
confirm patency of renal hypo
assess precision of LZ
eval for iliac dz
endoleaks
How to manage Type Ia?
compliant balloon if 5mm then consider aortic cuff
palmaz (5cm at 10mm expansion
33mm at 28 mm)
How to manage type Ib?
angioplasty
extension
How to manage III?
angio
bridging stent
How to manage renal artery coverage?
Pull caudally (wire over flow divider)
Snorkerl (best from brachial)
Bypass
Open conversion
How to manage CIA aneurysm?
Can extend into EIA
Occlude the hypo
Branched graft
Bypass
When to treat type II endoleaks?
evidence of type II with growth of 5mm
what are treatment options for type II?
coil or glue embo
transarterial (branch vessel, behind limb)
translumbar
transcaval
laparascopic IMA clipping
open surgical
ligation
conversion
What are the landing zones of the arch?
0 up to distal in nom 1up to distal LCA 2 up to distal scla 3 prox DTA 4 mid-distal DTA
What are indications for spinal cord drainage?
prior AAA extensive coverage thoracic aorta coverage T8-L2 LSCLA without revasc dissection with malperfusion
List indications for LSCA revasc.
patent LIMA bypass dominant l vert left vert with terminate PICA aortic arch origin of left vert hypo or stenotic right vert artery AVF in dialysis patient
What are techniques for management of branches?
debranching
parallel stents
BEVAR, FEVAR
Z-fen
